Diagnostic procedures and treatments in gynecology
Assisting with diagnostic procedures
The medical assistant can play an important role when assisting with diagnostic procedures in obstetrics and gynecology. The following sections discuss that role.
Specimen collection
During a pelvic examination, several types of specimens may be collected. If the pelvic exam is part of a wellness examination, a specimen for a Pap test may be collected. If the provider wants to evaluate endocrine function, a maturation index may be ordered. If the pelvic examination is for a possible vaginal infection, a specimen may be collected for culture or observation under a microscope.
Pap test
The two methods of specimen collection for a Pap test are the direct smear method and the liquid-based method.
Direct smear method
- The specimen is collected with a cervical spatula.
- The cells are placed (smeared) directly on a microscope slide.
- A fixative must be applied immediately to the slide before it is sent to the laboratory.
Liquid-based method
- The specimen is collected with a plastic-fronded broom.
- Cells are suspended in a bottle of preservative by rinsing the broom in the specimen vial.
- The results of the Pap test are often reported using the Bethesda system.
Vaginal infections
Earlier in this chapter, common vaginal infections were discussed. A pelvic exam needs to be done to determine what type of vaginal infection is occurring. For many vaginal infections, a sterile swab is used to collect a sample of the discharge. The secretion is then swabbed on the microscope slide, and the provider looks at it under a microscope. Common infections, the infectious agents, and the type of specimen and test used to identify each include the following:
- Candidiasis (yeast infection): The provider tests for the presence of Candida albicans. A small amount of discharge is placed on a slide, and a drop of a 10% solution of potassium hydroxide (KOH) is added. The KOH dissolves other cellular debris so that the provider can see the yeast buds.
- Trichomoniasis: A small amount of discharge is placed on a slide, and a drop of saline is added. The provider is looking for Trichomonas vaginalis, which appears as a pear-shaped organism with a flagellum (tail) that moves it around.
- Chlamydia: A sterile swab is used to collect a specimen from the endocervical canal. The swab is then placed in a tube containing a transport medium and sent to the lab for testing. The causative organism frequently is Chlamydia trachomatis.
Assisting with treatments
The following sections discuss the medical assistant’s role in assisting with treatments in obstetrics and gynecology.
Special procedures
There are a number of gynecology-related special procedures that a patient may undergo related to an abnormal Pap test result. Let’s look at the three most commonly performed procedures:
- Cryotherapy
- Colposcopy with or without a biopsy
- Loop electrosurgical excision procedure (LEEP)
Cryotherapy
Depending on the condition of the cervix, cryotherapy, or the application of freezing temperatures, may be used to treat chronic cervicitis and cervical erosion. Freezing causes cellular necrosis, and in approximately 1 month, the dead cells are replaced with healthy cells. The procedure involves placing a probe against the problem area on the cervix and applying liquid nitrogen to the area for approximately 3 to 4 minutes or until the site is frozen. The patient may experience some pain for about 30 minutes after the procedure and a slight watery discharge for up to a week. If any signs of infection, foul discharge, or pain develop, the patient should call the provider’s office. Advise the patient not to engage in sexual intercourse for 1 month and to expect a heavier than usual menstrual flow for the first cycle after the procedure.
Colposcopy with or without a biopsy
Colposcopy is the visual examination of the vagina and cervical surfaces with a colposcope. The colposcope is a microscope with a light source and a magnifying lens that can be used during a vaginal examination to do the following:
- Locate and evaluate abnormal cells
- Detect cancer of the cervix in the early stages
- Examine tissue from which an abnormal Pap test result has been obtained
- Monitor areas of the cervix where malignant lesions have been removed
The provider may wash the cervix with acetic acid to remove mucus and allow the provider to see abnormal areas more easily. In addition, the acetic acid will stain the abnormal areas white. An iodine solution (Schiller’s or Lugol’s solution) may also be used. This iodine solution will stain normal tissue brown, leaving abnormal tissue unchanged.
In combination with a colposcopy, a cervical biopsy may be performed. A major advantage of obtaining a biopsy during colposcopy is that the instrument permits visualization of the suspicious area so that the biopsy can be taken from the most atypical site. Multiple biopsies may be taken. The provider is looking for abnormalities on the cervix and will take a biopsy specimen when one is seen. You may be receiving the sample from the provider. It is very important to accurately label each specimen container with the location of the biopsy. The provider uses the face of a clock to determine the location of the biopsy. The specimen container label should indicate that location (e.g., 2:00). Silver nitrate sticks or Monsel’s paste may be used to stop the bleeding from the biopsies.
Loop electrosurgical excision procedure (LEEP)
LEEP uses a thin wire loop carrying a low-voltage electrical current to excise abnormal tissue from the cervix. Because the excised tissue is sent to a pathology lab for analysis, LEEP serves a dual purpose: it’s diagnostic, since the tissue sample confirms the diagnosis, and it’s therapeutic, since the abnormal tissue is removed in the same procedure. LEEP is typically performed as a follow-up to an abnormal Pap test or colposcopy finding, most often to treat cervical dysplasia (abnormal, precancerous cell changes) before it can progress to cervical cancer.