Diagnostic procedures in gynecology

Last updated: October 4, 2022

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A complete gynecological examination includes inspection of the vagina with the aid of a speculum and, if needed, colposcopy and bimanual palpation. Speculum examination is also used to facilitate obtaining smears for cytological and microbiological studies. Depending on the clinical presentation, other laboratory diagnostics and imaging procedures may be indicated. MRI scans and/or ultrasounds of the breast, for example, may supplement standard screening tests such as mammography. Unexplained pelvic symptoms may require transvaginal ultrasonography or more invasive diagnostic procedures such as endometrial sampling and hysteroscopic or laparoscopic examination.

Speculum examination is virtually never indicated in preadolescent patients! If absolutely necessary (e.g., vaginal bleeding, trauma, abuse), it is usually performed under general anesthesia!

References:[1]

Vaginal swab

Types [4][5]

Tests

Finding Diagnosis
Motile flagellated protozoa Trichomoniasis
Pseudomycelia and/or yeast cells on a KOH preparation Vaginal candidiasis
Clue cells and a positive whiff test (adding KOH to vaginal smear elicits a fishy odor) Bacterial vaginosis

Endocervical swab

  • Colposcope: a type of microscope used to acquire a magnified view of the ectocervix or vaginal wall
  • Allows for assessment of the ectocervix under magnification (6–40 x)
  • Application of acetic acid or iodine facilitates the colposcopic detection of precancerous and cancerous lesions
  • Colposcopy-directed cervical smears and biopsies
  • Surgical procedures under colposcopic guidance

Benign lesions

Abnormal findings

References:[9][10][11][12]

Depending on the clinical presentation, other laboratory tests may be indicated:

Always perform a pregnancy test if a woman of child-bearing age presents with lower abdominal pain!References:[13][14]

Transabdominal ultrasound

Transvaginal ultrasound

Breast ultrasound

Breast ultrasound can be used to assess breast lesions which were detected by palpation, mammography, and/or breast MRI scans. Ultrasound can also be used to assess the axilla for lymph node involvement if there is suspicion for breast cancer.

References:[15]

References:[16]

  1. Carusi DA, Barbieri RL, Falk SJ. The Gynecologic History and Pelvic Examination. In: Post TW, ed. UpToDate. Waltham, MA: UpToDate. https://www.uptodate.com/contents/the-gynecologic-history-and-pelvic-examination.Last updated: March 27, 2017. Accessed: July 3, 2017.
  2. Feltmate CM, Feldman S, Goff B, Falk SJ. Colposcopy. In: Post TW, ed. UpToDate. Waltham, MA: UpToDate. https://www.uptodate.com/contents/colposcopy.Last updated: September 26, 2016. Accessed: July 3, 2017.
  3. Cervical Polyps. https://www.msdmanuals.com/professional/gynecology-and-obstetrics/benign-gynecologic-lesions/cervical-polyps. Updated: March 1, 2017. Accessed: April 17, 2018.
  4. Nabothian Cyst. https://radiopaedia.org/articles/nabothian-cyst. Updated: January 1, 2018. Accessed: April 17, 2018.
  5. Kleppa E, Holmen SD, Lillebø K, et al. Cervical ectopy: associations with sexually transmitted infections and HIV. A cross-sectional study of high school students in rural South Africa. Sex Transm Infect. 2014; 91 (2): p.124-129. doi: 10.1136/sextrans-2014-051674 . | Open in Read by QxMD
  6. Bradley LD. Overview of Hysteroscopy. In: Post TW, ed. UpToDate. Waltham, MA: UpToDate. https://www.uptodate.com/contents/overview-of-hysteroscopy.Last updated: November 6, 2017. Accessed: April 17, 2018.
  7. Smith-Bindman R, Weiss E, Feldstein V. How thick is too thick? When endometrial thickness should prompt biopsy in postmenopausal women without vaginal bleeding. Ultrasound Obstet Gynecol. 2004; 24 (5): p.558-565. doi: 10.1002/uog.1704 . | Open in Read by QxMD
  8. Miller JM, Binnicker MJ, Campbell S, et al. A Guide to Utilization of the Microbiology Laboratory for Diagnosis of Infectious Diseases: 2018 Update by the Infectious Diseases Society of America and the American Society for Microbiology. Clin Infect Dis. 2018; 67 (6): p.e1-e94. doi: 10.1093/cid/ciy381 . | Open in Read by QxMD
  9. Workowski KA, Bachmann LH, Chan PA, et al. Sexually Transmitted Infections Treatment Guidelines, 2021. MMWR. Recommendations and Reports. 2021; 70 (4): p.1-187. doi: 10.15585/mmwr.rr7004a1 . | Open in Read by QxMD
  10. Smith K, Harrington K, Wingood G, Oh MK, Hook III EW, DiClemente RJ. Self-obtained Vaginal Swabs for Diagnosis of Treatable Sexually Transmitted Diseases in Adolescent Girls. Archives of Pediatrics & Adolescent Medicine. 2001; 155 (6): p.676. doi: 10.1001/archpedi.155.6.676 . | Open in Read by QxMD
  11. Brian Chinnock, Mackensie Yore, Jessica Mason, Mallory Kremer, Leyla Farshidpour, Diana Lopez, Jannet Castaneda. Self‐obtained vaginal swabs are not inferior to provider‐performed endocervical sampling for emergency department diagnosis of Neisseria gonorrhoeae and Chlamydia trachomatis. Academic Emergency Medicine. 2021 . doi: 10.1111/acem.14213 . | Open in Read by QxMD
  12. Centers for Disease Control and Prevention.. Recommendations for the laboratory-based detection of Chlamydia trachomatis and Neisseria gonorrhoeae--2014.. MMWR Recomm Rep. 2014; 63 (RR-02): p.1-19.
  13. Qaseem A, Humphrey LL, Harris R, Starkey M, Denberg TD. Screening Pelvic Examination in Adult Women: A Clinical Practice Guideline From the American College of Physicians. Ann Intern Med. 2014; 161 (1): p.67. doi: 10.7326/m14-0701 . | Open in Read by QxMD
  14. GOH BT, VARIA KB, AYLIFFE PF, LIM SKS. Diagnosis of Gonorrhea by Gram-stained Smears and Cultures in Men and Women. Sex Transm Dis. 1985; 12 (3): p.135-139. doi: 10.1097/00007435-198507000-00008 . | Open in Read by QxMD
  15. Chourin S, Georgescu D, Gray C, et al. Value of CA 15-3 determination in the initial management of breast cancer patients. Ann Oncol. 2009; 20 (5): p.962-964. doi: 10.1093/annonc/mdp061 . | Open in Read by QxMD
  16. Gadducci A, Cosio S, Carpi A, Nicolini A, Genazzani AR. Serum tumor markers in the management of ovarian, endometrial and cervical cancer. Biomed Pharmacother. 2004; 58 (1): p.24-38.

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