Outpatient Procedures
There are many common procedures that gynecologists perform in an outpatient or office setting.
Intrauterine Device (IUD) Insertion
Intrauterine devices (IUDs) are small devices inserted into the uterus for prevention of pregnancy. An IUD uses either copper or hormone to prevent pregnancy.
When you come to an appointment for IUD insertion, your doctor will help you decide which IUD is the best choice for you. If you have already decided and you have a prescription, please bring the IUD with you to your appointment. Your doctor will ask questions to ensure the IUD is safe for you. If you are comfortable, the IUD can be inserted the same day as this appointment. However, if you need time to think about your options or make a plan for pain control during IUD insertion, you can book a follow up appointment to have the IUD inserted another day.
You may be asked to produce a urine sample to test for pregnancy and infection prior to having an IUD inserted.
During an IUD insertion, you may feel pelvic pain, pressure, and cramping. Some patients also experience light-headedness, sweating, nausea, or fainting (this is called a vasovagal reaction). The procedure is short and takes only a few minutes.
Many patients prefer to use pain medications during IUD insertion. You can consider taking over-the-counter pain medications before your appointment (such as Tylenol and Advil). You can also discuss with your doctor to see if other pain medications may be an option for you. Sometimes we prescribe oral pain medicines (ex. narcotics), sedatives (ex. benzodiazepines), or even inhaled anesthetic (ex. Penthrox). Local anesthetic (injected or sprayed numbing medication) can be used during IUD insertion. If patients experience significant pain, sometimes IUD insertion is performed in a hospital with conscious sedation. If you have used anesthetic medications, narcotics, or sedatives, you will require someone to drive you home after the procedure.
During the IUD insertion, you will be asked to remove clothing below the waist and cover with a drape. You will lie on an examination table with foot rests. Your doctor may do a pelvic examination that includes two fingers inserted into the vagina, to check the size and position of your uterus. A speculum will be inserted into the vagina, which allows the doctor to see the cervix. A grasping instrument will be placed on the cervix, and another instrument is inserted into the uterus to measure the space. The IUD is then inserted using a plastic guiding tube. Strings that are attached to the bottom of the IUD will pass through the cervix and these are trimmed. All the tools will then be removed.
You may have some cramping and vaginal bleeding after an IUD has been inserted. Back-up contraception may be required (your doctor will discuss this with you). You can resume normal activity after the IUD is inserted.
Endometrial
Biopsy
Your doctor may recommend an endometrial biopsy at the time of your gynecology appointment. This test is done to check for abnormal cells in the endometrium (the inner lining of the uterus). A biopsy can test for precancerous cells, cancer, or even benign (non-cancerous) abnormalities such as endometrial polyp. There are several reasons why your doctor might suggest a biopsy:
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abnormal bleeding from the uterus/vagina
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bleeding between periods
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bleeding after menopause
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presence of risk factors for endometrial cancer
During an endometrial biopsy, you may feel pelvic pain, pressure, and cramping. Some patients also experience light-headedness, sweating, nausea, or fainting (this is called a vasovagal reaction). The procedure is short and takes only a few minutes. Some patients prefer to use pain medications during endometrial biopsy. You can consider taking over the counter pain medications before your appointment (such as Tylenol and Advil). You can also discuss with your doctor to see if other pain medications may be an option for you.
The biopsy does not have to be done the same day as your first appointment. You are welcome to follow up and have the biopsy completed on another day if that makes you more comfortable.
Your doctor may ask you to provide a urine sample (for pregnancy testing or infection testing) prior to the biopsy. Once you are ready to proceed, you will be asked to remove clothing below the waist and cover with a drape. You will lie on an examination table with foot rests. Your doctor may do a pelvic examination that includes two fingers inserted into the vagina, to check the size and position of your uterus. A speculum will be inserted into the vagina, which allows the doctor to see the cervix. A grasping instrument will be placed on the cervix, and a thin plastic straw is inserted into the uterus to take a small sample of endometrial tissue. All the tools will then be removed.
You may have some cramping and vaginal bleeding after the endometrial biopsy is completed. You can resume normal activity after your endometrial biopsy. Your results will usually be available in 4-6 weeks.
Colposcopy
A colposcopy examination is a detailed look at the vulva, vagina, and cervix. An abnormal pap smear result or an abnormal HPV test are the most common reasons to be referred for colposcopy. However, colposcopy is also used for assessment of vulvar or vaginal abnormalities. A sample of tissue called a biopsy is often done during colposcopy (ex. cervical biopsy, vaginal biopsy, or vulvar biopsy).
Although a pap smear cannot be completed if you are bleeding, you can still have a colposcopy appointment during your period. You can also have a colposcopy appointment safely during pregnancy, although we often avoid taking biopsies during pregnancy.
During your colposcopy appointment, your doctor will explain the test and ask you questions. You will be asked to remove clothing below the waist and cover with a drape. You will lie on an examination table with foot rests. If the focus of the examination is the vulva, sometimes examination within the vagina is not required. Usually, a speculum will be inserted into the vagina, which allows the doctor to see the deeper vagina and cervix. A “colposcope” is used to look at your vulva/vagina/cervix in detail. The colposcope is a large microscope that looks like binoculars on a stand. The colposcope does not go inside the vagina. The doctor may use liquid solutions on your cervix (for example, diluted vinegar or iodine) to highlight any abnormal areas.
If a cervical biopsy is done, you will feel a pinching/cramping sensation. Your doctor will walk you through this procedure. A biopsy takes under a minute and the pain resolves soon after. If the biopsy is from the vulva/external skin, numbing medication will be injected into the area before the biopsy is taken. Numbing medication can also be injected into the cervix for cervical biopsies; however, this involves inserting a needle, which also causes pinching and cramping (so we don’t usually use this).
After the biopsy, a substance is applied to the cervix to stop bleeding. All the tools are then removed. It takes 4-6 weeks to get results back on biopsy samples.