Ultrasound in Gynaecology

Ultrasound is a very useful method of examining internal organs to identify any abnormality.

A gynaecological ultrasound or a pelvic scan is an examination of the female reproductive organs usually where the patient is not pregnant. These scans are usually done to investigate causes of lower abdominal and pelvic pain, abdominal mass or heavy or irregular bleeding.

Menstrual Disorders
Menstrual disorders may present as heavy bleeding with or without pain or bleeding in between periods or infrequent periods. These disorders are caused either by hormonal imbalance or an abnormality in the womb (uterus). Clinical examination, blood tests and pelvic ultrasound are often required as workup for a diagnosis.

Incontinence in Women

Many women experience bladder symptoms such as increased daytime frequency, urgency and increased night time frequency. Some notice leak of urine while coughing, sneezing or with exercise. Urinary symptoms can be variable in terms of severity and effect on quality of life. Pregnancy and childbirth, increasing age and menopause predispose to urinary problems.

Pelvic Organ Prolapse
Pelvic organ prolapse is bulging of one or more of the pelvic organs into the vagina, and can affect the front, top or back of the vagina. The organs that can prolapse are the bowel, bladder, uterus, and the top of the vagina (vault) after a previous hysterectomy. The main symptoms are of a sensation of lump ‘down below’ and backache. Sometimes there may be difficulty in passing water or with bowel movements.

Ovarian Cysts

An ovarian cyst is a fluid-filled sac in an ovary and is a common occurrence. Most ovarian cysts occur as part of the normal working of the ovaries, and are less than 4cm in diameter. These cysts are generally silent and disappear without treatment in a few months. Cysts that are larger than 4cm tend to persist and give rise to pelvic pain or discomfort. Ovarian cysts detected after menopause should be investigated further to exclude cancer.

Fibroids

Fibroids are benign tumours that grow in the muscles of the uterus. They are very common and affects almost 30% of women in child bearing age, and are hormone dependent. They shrink with loss of or reduced ovarian activity and become smaller in size after menopause. Symptoms are usually of heavy periods and lower abdominal discomfort and ache.

Endomatriosis

Endometriosis is a condition where cells of the endometrium are abnormally located outside the uterine cavity, commonly in the pelvis,  behind the uterus and ovaries, and may cause pelvic pain and infertility.

Diagnosis is by a combination of history, clinical examination, pelvic ultrasound and laparoscopy. Management includes medical methods in the first instance, but may require surgical procedures such as laparoscopic ablation by helica or diathermy, laparoscopic excision of endometriotic nodules, ovarian cystectomy, and in severe cases hysterectomy with removal of ovaries.

Cervical Smear and HPV testing

A cervical smear is taken by scraping superficial cells from the neck of the womb using a soft brush and looking for any abnormal cells in the laboratory. Abnormal changes can be low grade or high grade.

A smear with low grade changes will be tested for high risk subtypes of the human papilloma virus (HPV) as these have a higher risk of leading to cervical cancer.  If the smear is positive for high risk HPV, the woman will be referred for colposcopy.

When a smear shows high grade changes, the woman is referred for colposcopy without testing for high risk HPV.

Colposcopy

Colposcopy is a diagnostic procedure to examine an illuminated, magnified view of the cervix and the tissues of the vagina. A colposcopic examination follows an abnormal cervical smear report. Special dyes are applied to the cervix which is then examined under magnification.