The Pap test (also called Pap smear) is a routine test that is performed annually during the annual pelvic exam starting from when a woman becomes sexually active and, in exceptional cases, girls or women who have yet to become sexually active.
It involves taking a swab of cells from the vagina and cervix. This technique is primarily used to diagnose precursor lesions of cervical cancer or cervical cancer itself, but can also help in the diagnosis of infections and in some cases can be used for hormonal diagnosis.
It is a simple, painless procedure that takes only minutes.
Ultrasound is a technique that uses ultrasound (high frequency sound waves) that are bounced back differently by different tissues to produce an image of what is going on inside the body.
Also, as the result of the so-called “Doppler effect“, ultrasound also provides information on the speed and movement of blood (since the sound of blood moving towards the object is more acute and the sound of blood flowing away is deeper).
Today, a pelvic ultrasound is a routine diagnostic test that plays a key role in the early detection of a range of gynaecologic disorders.
There are different types of pelvic ultrasounds, the most common of which are vaginal and abdominal.
Most vaginal ultrasounds are performed by introducing a small transducer into the vagina; this probe is closer to the pelvic organs, making it possible to get a clearer and larger image of the ovaries and uterus. No preparation is required for vaginal ultrasounds.
The abdominal approach is recommend for women who have not had sex or in special cases in which a pelvic ultrasound cannot be performed transvaginally. Patients are required to drink a litre of water an hour before the test, because having a full bladder makes it easier to obtain the images.
In general, ultrasounds can be performed at any time, although it depends on the purpose.
A breast ultrasound does not use ionizing radiation but rather non-linear, high-frequency sound waves (equal to or higher than 7 MHz) to examine the breasts.
The ultrasound serves to trace the entire breast and axillary region to diagnose cysts, solid lumps, destructured areas and some types of breast cancers; as well as diagnose any possible issues with the armpit.
Since this is a dynamic technique it depends largely on the experience of the physician. It allows us to diagnose mastitis/abscesses, monitor breast implants, monitor scars and secretions and to guide invasive techniques such as FNA (fine-needle aspiration, an easy and reliable technique that allows us to obtain cells for cytology. It does not require anaesthesia and is well tolerated) and CNB (core needle biopsy, which allows us to obtain small tissue samples for further pathological examination with 100% reliability. It requires local anaesthesia and causes some discomfort that lasts for a few days).
Technique developed by Hinselmann in 1925, in order to localise lesions after abnormal results on a Pap test, evaluate them and if necessary perform a directed biopsy. Colposcopy is a non-invasive technique for determining whether a cytological lesion has an impact on cervical tissue.
This technique is performed with two dyes:
- The first is an acid acetic wash that colours lesions white, making it easier to see the disruption of cervical epithelium.
- The second is Lugol’s iodine (Schiller Test) based on iodine staining normal epithelium (by the presence of glycogen in their intermediate strata); immature and dysplastic epithelium will not stain.
A coloscope is used to examine all abnormalities and makes it possible to perform directed cervical biopsies.
A mammogram is the main and most important breast exam procedure in women 40 and older.
It is based on the use of ionizing radiation to take two images or projections of each breast (mediolateral-oblique and cranio-caudal views), which are obtained by compressing the breast.
This compression can cause discomfort and even pain in some women, especially in the days leading up to menstruation (we try to perform this procedure after menstruation).
Mammograms are the basis for diagnosing breast cancer, but is not infallible technique and fails to diagnose the disease in 10% of cases.
At our centre we recommend the first mammogram at age 35, then every two years from ages 40 to 50 and annually after age 50. But patients with a family history of breast cancer or other factors may start before and have more frequent mammograms.
Men can also get mammograms and is indicated as an initial imaging for the diagnosis of breast cancer and aomastia.
Mammograms are classified according to the BI-RADS categories, which range from 0 to 5 depending on the images taken and the risk of breast cancer.
Currently, most radiology centres use digital mammography for shorter compression times and image processing.
Diagnostic hysteroscopy is a useful procedure in gynaecology. It involves inserting a small optical lens with a camera on the end into the vagina to evaluate the cavity of the uterus and cervix. The 3 mm diagnostic hysteroscope uses a gaseous (carbon dioxide) or liquid (serum) medium to separate the walls of the uterus. It is usually an outpatient test and can be performed without anaesthesia (pain is similar to that associated with a heavy period) or local anaesthesia.
The most common indications are:
- Abnormal uterine bleeding, especially in menopause
- Location and removal of foreign bodies (IUDs)
- Examination of the uterine cavity because of ultrasound results: polyps, myomas, synechiae
Spotting can occur for a couple of days after the procedure and patients may experience mild discomfort in the lower abdomen for a few hours that can be treated with a mild analgesic.
Urodynamic testing is the most reliable method for the accurate diagnosis of urinary incontinence and for determining the appropriate treatment. This test can rule out other associated disorders like overactive bladder syndrome. They should always be performed before any surgery for incontinence.
Urodynamic testing consists of the following texts:
- Urethral pressure profile
- EMG of striated-muscle urethral sphincter.
It is a test that does not require anaesthesia although the need to perform several tests and inserting a probe may be uncomfortable.