What is a gynecologist? Gynecology deals with the prevention, diagnosis and treatment of disorders of the female sexual and reproductive organs. These include the uterus, fallopian tubes, ovaries, and breasts in non-pregnant women. Obstetrics is a specialized field within gynecology.
This specialty treats women during pregnancy and birth.
Gynecological disorders include all disorders that affect the female sex and reproductive organs. The most common gynecological disorders and issues include endometriosis, myomas, menopausal complaints, hormonal disruptions and irregular cycles, and a variety of menstruation-related complaints such as period pain or so-called pre-menstrual syndrome. Inflammatory disorders of the female reproductive organs are also common complaints for patients to present with. These include, for instance, ovarian inflammation, uterine inflammation, vaginitis and mastitis.
The diagnostic range of treatment within gynecology includes ultrasound examinations of the female sex and reproductive organs, measuring hormonal levels and mammography. Obstetrics includes pregnancy testing, preventative care for pregnancy and prenatal diagnostics.
What is hysteroscopy?
What is hysteroscopy, and when is it used? If an ultrasound examination is not sufficient to determine what is causing a patient’s disorder, hysteroscopy is frequently used.
Hysteroscopy is a gynecological procedure which involves an endoscopic examination and evaluation of the uterus. It is also known as uterine endoscopy.
This procedure can be used for both diagnostic and operating purposes. In both cases, the physician inspects the inside of the uterus with a specialized endoscope which is inserted through the cervix.
During the first step, the use of general anesthesia is uncommon, since only a diagnostic procedure is being conducted. If the diagnostic procedure shows that more extensive treatment is required, the patient must generally make a second appointment.
Hysteroscopy procedure and risks! Diagnostic hysteroscopy has almost no side effects, and can be conducted on an outpatient basis without anesthesia. The physician inserts a speculum into the vagina and inspects the cervix. The cervix is gripped using specialized instruments, and the opening is carefully expanded if necessary. Then a 3-5 mm illuminated tube (the hysteroscope) is inserted into the cervix through the vagina. Since the uterus is not normally unfolded, it is expanded and unfolded slightly, for instance by introducing gas (carbon dioxide) or a specialized irrigation fluid. The illuminated tube is connected to a screen via a video camera. This allows the physician to closely inspect an enlarged image of the inside of the uterus and the ends of the fallopian tubes. Gynecologists can use hysteroscopy to determine possible causes of menstrual disorders and infertility issues.
Changes in the endometrium or myomas are likewise visible. Rarely, diagnostic hysteroscopy can cause minor injuries, although these generally heal without issue. In addition, patients may experience temporary, brief disruption of their normal menstrual cycles.
The cervix must be dilated up to eight millimeters for operational hysteroscopy. Therefore, this is conducted under general anesthesia. Since operations always cause bleeding, the viscous fluid serves to not only expand the uterus, but also to flush the operation area at the same time. The physician can reposition or remove intrauterine devices which have become displaced during hysteroscopy.
Mucous membranes can also be removed (called mucosal ablation) in order to prevent having to conduct a hysterectomy to address heavy bleeding. Other possible indications for hysteroscopy include investigating abnormal ultrasound results or bleeding disorders associated with suspected pathologies such as polyps, myomas or carcinomas. Hysteroscopy is also used for fertility diagnostics, to address post-menopausal bleeding and other abnormal vaginal bleeding.
It can be used therapeutically for targeted removal of pathological findings (operational hysteroscopy). This is the case, for instance, to remove polyps (cervical or endometrial polyps), resection of submucosal myomas and endometrium resection.
Uterine endoscopy may not be conducted during a confirmed or potential (wanted) pregnancy. Generally, uterine endoscopy is not recommended to address a known cervical carcinoma or if there is a suspicion of uterine cancer (endometrial carcinoma). Infections near the cervix or endometrium should be treated and should have subsided before the hysteroscopy. Endometrial ablation may not be conducted on women who wish to become pregnant. In general, operational hysteroscopy is a very safe procedure with few complications. Patients are informed fully regarding very rare, yet potential complications such as uterine injuries, bleeding, thrombosis or infection before treatment.
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Sources: Diagnostik in der Gynäkologie – amboss.com (accessed: 12/15/2020) Gynäkologische Laparoskopie - gynecology-guide.com (accessed: 12/15/2020) Operationen mittels Gebärmutterspiegelung (Hysteroskopie) - operieren.de (accessed: 12/15/2020) Gebärmutterspiegelung/Hysteroskopie – frauenaerzte-im-netz.de (accessed: 12/15/2020)
