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Each woman knows the basic gynecological examination for sure. Although disliked because it is very intimate, it should be performed once a year. Others, more complicated – depending on the doctor’s recommendations.
Gynecological examination
It is a subjective examination, i.e. an interview, and a physical examination – consisting in checking the condition of the reproductive organs by touch. It is performed through the vagina (per vaginam) or through the rectum (per rectum). Every woman should undergo a preventive examination once a year.
Purpose: To detect any pathologies.
Preparation: It is advisable to empty the bladder and observe all hygiene rules. There are bathrooms in the offices that can be used before the examination.
The examination begins with viewing the vulva and perineal area. Then, using an appropriately sized speculum, the doctor looks at the vaginal walls and the cervical disc. Take a vaginal smear or swab if indicated. After removing the speculum, he proceeds to internal examination. Its purpose is to use the fingers to check the vaginal vault, the cervix and its external opening. With the other hand, resting on the patient’s lower abdomen, he checks the position of the uterus, its topography in relation to the pelvic walls, as well as its size and consistency. Thanks to the ability to feel the ovaries and fallopian tubes, it can determine their size, texture and pain.
If, during the examination, the patient feels pain (not touch, pressure), she should absolutely report it.
Contraindications: They are performed in women of all ages. It can be repeated many times.
Prices: In a private clinic: PLN 80-200.
Colposcopy
The examination consists in viewing the cervix, the lower part of its canal, the vagina and the vulva with a colposcope, which provides a “three-dimensional image” magnified up to 30 times.
Objective: Assessment of lesions. Detection of preclinical forms of cervical cancer (the cure rate at this stage is almost 100%). Collection of material for histopathological examination.
Preparation: Do not have intercourse, irrigate or undergo a gynecological examination for several days before the examination.
The doctor will insert a speculum to visualize the vaginal part of the cervix. Then, using a colposcope, he looks at the secretions that cover the cervix. In case of suspicion of high-grade dysplasia or neoplastic changes, the doctor, after anesthesia, takes a targeted section and scrapings from the cervical canal.
Contraindications: Performed at any age. It can be repeated many times.
Prices: Performed at the request of a gynecologist. In a private clinic: PLN 150.
ultrasound
The ultrasound examination complements the gynecological examination. It provides additional information on the structure of the pelvic organs, the location and dynamics of lesions. It allows you to evaluate the course of treatment. It is performed using the transabdominal (TA) and transvaginal (TV) methods. They are increasingly used as a treatment method.
Aim: Examination of the pelvic organs and the retroperitoneal space, detection of pathological changes (cysts, fibroids, neoplasms), assessment of the tubulo-bladder angle and residual urine.
Preparation: Before an abdominal ultrasound, the bladder must be full. They are performed in the same way as ultrasound of other abdominal organs.
The examination does not guarantee a precise assessment of changes in organs, therefore, in order to precisely define them, a transvaginal ultrasound should be performed. It involves the insertion of a probe 1-2 cm in diameter into the vagina. Thanks to it, the doctor can assess the reproductive organs and observe any changes.
Contraindications: Performed at any age. It can be repeated many times.
Prices: Private: PLN 90 (TA), PLN 100 (TV).
Hysteroscopy
The test involves magnifying the uterine cavity using a hysteroscope, which is inserted through the vagina into the cervix and then into the uterine cavity. Using additional instruments, specimens are taken for histopathological examination and therapeutic procedures are performed. The indications for the examination are: bleeding of undetermined etiology, uterine defects, suspicion of intrauterine adhesions, the need to inspect the walls of the cervical canal.
Objective: To assess pathological changes and determine their scope. It can be combined with a procedure, e.g. removal of intrauterine adhesions or polyps.
Preparation: Performed under general anesthesia.
Contraindications: If necessary, the test may be repeated.
Prices: The examination is performed at the request of a gynecologist in a hospital setting. In a private clinic: PLN 1750.
Microbial smear from the vagina
The test allows the assessment of vaginal discharge and the type of microorganisms present in it.
Aim: Diagnoses symptoms, such as itching, burning of the vagina, vulva, vaginal discharge, indicative of inflammation. Determines its type (bacterial, fungal, trichomoniasis).
Preparation: Vaginal medications and irrigation should not be used for several days before the examination. It is not performed during menstruation.
The doctor collects vaginal discharge using a thin wire bent at the end into a loop (loop) or a cotton swab from several places – from the Skene, Bartholin, urethra, vestibule and vaginal forks. Then the material is subjected to microscopic evaluation in the microbiological laboratory.
Contraindications: It is performed in women of all ages. It can be repeated many times.
Prices: In a private clinic: PLN 30-50.
Pap smear
It is based on a microscopic assessment of the appearance of epithelial cells that cover the vaginal mucosa. Most often, microscopic evaluation of cells of the multilayered squamous epithelium covering the vaginal part of the cervix is performed.
Aim: To assess the degree of risk of cancer development and its possible detection. The diagnosis is based on the Papanicolaou or Bethesda classification. The Papanicolaou result is one of five groups: I is normal, II – benign changes, without cells with dysplasia, III – changes suspecting cancer and the presence of cells with dysplasia, IV – pre-invasive neoplasm, V – malignant changes.
The test should be performed regularly from the start of sexual intercourse: – once a year in women at high risk of developing cervical cancer (frequent changes of partners, group II or III in the previous study, recurrent inflammation of the vagina, contact bleeding from the vagina, e.g. during intercourse), at least every three years in women at low risk of developing cervical cancer.
Preparation: 4 days before the examination, no vaginal medications or irrigation should be used. Also, do not have intercourse during this time. For the examination, the doctor puts in a vaginal speculum and takes the cellular material by rubbing the surface of the vaginal tissues with special brushes. In the case of looking for neoplastic changes, the material is collected in a targeted manner – from the cervical disc and from the mouth of its external canal. Then it is subjected to microscopic evaluation in the cytology laboratory.
Contraindications: Performed at any age. Can be repeated many times.
Prices: In a private clinic: PLN 30-50.
Text: Marta Lenkiewicz
Consultation: PIOTR RACZYŃSKI, MD, PhD, gynecologist-obstetrician, Damian Medical Center; Warsaw, ul. Wałbrzyska 46, ul. Foksal 3/5; tel. 0 22 566 22 22
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