Evaluation of Abnormal Pap Smears
A pap smear is an efficient method of screening for cervical disorders, by obtaining cells from the surface of the cervix during a pelvic exam. It is interpreted by a trained cytologist and/or pathologist in the laboratory. If it is reported as abnormal, further investigation is needed to determine if cervical cancer or a pre-cancerous condition may be present. This testing may involve screening for HPV (Human Papilloma Virus), which is known to be a cause of cervical disorders, and colposcopy. This is a non-painful simple procedure in which the cervix is viewed under magnification and biopsies of any abnormally appearing areas, which the physician has been trained to recognize, will be taken. Once the results of the biopsies are received from the lab, the physician will discuss the diagnosis in detail and offer treatment options to the patient. On occasion, a patient may require a larger biopsy called a LEEP (Loop Electrosurgical Excision Procedure) for additional tissue sampling and diagnosis. In many cases, this larger biopsy may be not only diagnostic, but therapeutic as well. LEEP is easily performed on most patients as an office procedure under very light oral sedation and local anesthesia.
Evaluation of Urinary Incontinence
Urinary incontinence simply means uncontrollable loss of urine that may result in social embarrassment and isolation. It is a very common problem in women and the incidence increases with increasing age. Although many patients with this problem are hesitant to discuss it, we want them to know that most patients with incontinence can be helped. It is important to let the doctor know about the symptoms so a thorough evaluation can be initiated. Not all urinary incontinence problems are caused by the same reason, and treatment options will vary greatly, depending on each patients clinical presentation and needs. The evaluation will often require a comprehensive history, keeping tract of urinary habits with a voiding diary, laboratory testing, and diagnostic evaluations. One procedure done in the office is called urodynamic testing. This is performed to evaluate functional (voiding) disorders of the bladder and urethra. In some cases an additional procedure called cystoscopy will be performed. This involves insertion of a small telescope through the urethra into the bladder to visualize its internal lining. Frequently conditions which lead to bladder symptoms such as frequency, urgency, pain, and incontinence can be diagnosed this way. The results of these tests will help the physician determine what may be causing a patients incontinence and decide what treatment options would be reasonable, whether they be surgical, medical, or a combination of both. Following interpretation of the bladder tests, the physician will review the results in detail with the patient.
Permanent Birth Control
For patients who have completed their families and are seeking a form of permanent birth control, our physicians are pleased to offer the option of Essure, an FDA-approved procedure which creates a non-reversible barrier in the fallopian tubes. Clinical trials have shown that Essure is 99.8% effective in prevention of pregnancy and should only be considered to those women who are absolutely certain that they do not want future pregnancies.
Performed in the office under oral pain medication and/or light sedation, the procedure involves placement of soft micro-inserts into the fallopian tubes. No incision is necessary, as the inserts are passed through the vagina, cervix, and uterus using a hysteroscope for visualization. Most patients tolerate this short procedure quite well and are back to their usual activities within one day.
Over a period of three months, a natural barrier is formed in the tubes, which prevents pregnancy by blocking sperm from reaching the patient’s eggs. During this time another form of contraception must be used. Patients should not rely on Essure alone until a test to confirm tubal blockage is performed. Three months after the Essure placement, the physician will order an x-ray (hysterosalpingogram or HSG) which will verify that the inserts are in place. Only then should patients rely on Essure for permanent birth control.
Certified to perform Essure insertions, our physicians are happy to discuss this option in detail with patients, as well as present other birth control methods that are available. We realize that patients have different needs and will do our best to assist each patient in the selection of the best choice for her and her family.
Pelvic ultrasound is an office procedure that gives the physician valuable information during the evaluation of gynecological problems such as abnormal uterine bleeding, pelvic pain, or abnormalities detected on physical exam. Also know as sonography, it uses high-frequency sound waves to make pictures of the organs in the pelvis, such as the uterus, ovaries, and bladder. No radiation (x-ray) is involved. No significant preparation on the patient's part is necessary, with the exception that she need to have a full bladder for the initial trans-abdominal portion of the scan. Additional pictures may be taken, using a trans-vaginal probe. Only a minor amount of discomfort is occasionally noted by some patients during this part of the procedure. No anesthesia is required.
In certain cases, an additional office procedure called SIS, or saline infusion sonography, may be recommended by the physician to further evaluate abnormal uterine bleeding or abnormalities detected in the uterine cavity on the initial ultrasound. With SIS, warm sterile saline is slowly passed into the uterine cavity using a small plastic tube. The infused fluid separates the walls of the uterus and improves the chances that abnormalities within the cavity will be seen. This helps the physician determine if any further testing or surgical procedures are needed. In many cases, the results of the test can help prevent the patient from having to undergo unnecessary surgeries under anesthesia.
Once the evaluation of a patient with abnormal bleeding has been completed, treatment options will be discussed in detail. An office procedure called endometrial ablation may be an appropriate choice for some women, depending on the diagnosis. The treatment ablates, or destroys, a significant part of the lining of the uterus, called the endometrium. This, in turn, keeps the lining from growing back, therefore creating very light periods, or in a few cases, no more bleeding at all. The success of this treatment is highest in those patients in whom no physical abnormality in the uterus is found. In cases where the problem is a result of a uterine abnormality such as fibroids, polyps, endometriosis, cancer, or some pre-cancerous conditions, other treatments will be a better choice. The physician will be able to discuss the treatment options and help each patient make an educated decision about what is best for her own case.