SPECIAL PROCEDURES

What is a hysterectomy?

hysterectomy is the surgical removal of the uterus.

What are the reasons for having a hysterectomy?

A hysterectomy may be done to treat conditions that affect the uterus:

  • Uterine fibroids
  • Endometriosis
  • Pelvic support problems (such as uterine prolapse)
  • Abnormal uterine bleeding
  • Cancer
  • Chronic pelvic pain

What are the types of hysterectomy?

There are several types of hysterectomy:

  • Total hysterectomy—The entire uterus, including the cervix, is removed. 
  • Supracervical (also called subtotal or partial) hysterectomy—The upper part of the uterus is removed but the cervix is left in place.
  • Hysterectomy with removal of the fallopian tubes and ovaries

How is hysterectomy performed?

There are three ways that hysterectomy can be performed: 1) vaginal hysterectomy, 2) abdominal hysterectomy, 3) and laparoscopic hysterectomy.

How is a vaginal hysterectomy performed?

In a vaginal hysterectomy, the uterus is removed through the vagina. Because the incision is inside the vagina, the healing time may be shorter than with abdominal surgery. There may be less pain during recovery. Vaginal hysterectomy causes fewer complications than the other types of hysterectomy and is a very safe way to remove the uterus. It also is associated with a shorter hospital stay and a faster return to normal activities than abdominal hysterectomy.

How is an abdominal hysterectomy performed?

In an abdominal hysterectomy, the surgeon makes an incision through the skin and tissue in the lower abdomen to reach the uterus. This type of hysterectomy gives the surgeon a good view of the uterus and other organs during the operation. This procedure may be chosen if you have large tumors or if cancer may be present. Abdominal hysterectomy may require a longer healing time than vaginal or laparoscopic surgery, and it usually requires a longer hospital stay.

How is a laparoscopic hysterectomy performed?

In a laparoscopic hysterectomy, a laparoscope is used to guide the surgery. A laparoscope is a thin, lighted tube that is inserted into the abdomen through a small incision in or around the navel. It allows the surgeon to see the pelvic organs on a screen. Additional small incisions are made in the abdomen for other instruments used in the surgery. In a total laparoscopic hysterectomy, the uterus is detached from inside the body and then removed in small pieces through the incisions or through the vagina. In a laparoscopic assisted vaginal hysterectomy, the uterus is removed through the vagina, and the laparoscope is used to guide the procedure. In a robot-assisted laparoscopic hysterectomy, the surgeon uses a robot attached to the instruments to assist in the surgery.

What are the risks associated with hysterectomy?

Hysterectomy is one of the safest surgical procedures. But as with any surgery, problems can occur:

  • Infection
  • Bleeding during or after surgery
  • Injury to the urinary tract or nearby organs
  • Deep vein thrombosis (DVT), which is a risk with any surgery
  • Problems related to anesthesia
  • Death
  • Bowel blockage from scarring of the intestines
  • Formation of a blood clot in the wound

What should I expect during my recovery?

You will be urged to walk around as soon as possible after your surgery. Walking will help prevent DVT. You also may receive medicine or other care to help prevent DVT.

You can expect to have some pain for the first few days after the surgery. You will be given medication to relieve pain. You will have bleeding and discharge from your vagina for several weeks. Sanitary pads can be used after the surgery.

Do not put anything in your vagina during the first 6 weeks. That includes douching, having sex, and using tampons.

What are the physical changes that occur after hysterectomy?

After hysterectomy, your periods will stop. If the ovaries are left in place and you have not yet gone through menopause, they will still produce estrogen, a hormone that affects the body in many ways. Depending on your age, if your ovaries are removed during hysterectomy, you will have signs and symptoms caused by a lack of estrogen, which include hot flashes, vaginal dryness, and sleep problems. You also may be at risk of a fracture caused by osteoporosis at an earlier age than women who go through natural menopause. Most women who have these intense symptoms can be treated with estrogen therapy.

What are the emotional effects that may occur after having a hysterectomy?

Some women feel depressed because they can no longer have children. Other women may feel relieved because the symptoms they were having have now stopped.

What sexual changes may occur after having a hysterectomy?

Some women notice a change in their sexual response after hysterectomy. Because the uterus has been removed, uterine contractions that may have been felt during orgasm will no longer occur.

Some women feel more sexual pleasure after hysterectomy. This may be because they no longer have to worry about getting pregnant. It also may be because they no longer have the discomfort or heavy bleeding caused by the problem leading to hysterectomy.

Glossary

Cervix: The opening of the uterus at the top of the vagina.

Deep Vein Thrombosis (DVT): A condition in which a blood clot forms in a deep vein, usually in the leg.

Endometriosis: A condition in which tissue similar to that normally lining the uterus is found outside of the uterus, usually in the ovaries, fallopian tubes, and other pelvic structures.

Estrogen: A female hormone produced in the ovaries.

Fallopian Tubes: Tubes through which an egg travels from the ovary to the uterus.

Fibroids: Benign (noncancerous) growths that form in the muscle of the uterus.

Hormone: Substance produced by the body to control the functions of various organs.

Hysterectomy: Removal of the uterus.

Laparoscope: A slender, light-transmitting instrument that is used to view abdominal and pelvic organs or perform surgery.

Menopause: The time in a woman’s life when the ovaries have stopped functioning, defined as the absence of menstrual periods for 1 year.

Osteoporosis: A condition in which the bones become so fragile that they break more easily.

Ovaries: Two glands, located on either side of the uterus, that contain the eggs released at ovulation and that produce hormones.

Uterine Prolapse: A condition in which the uterus drops down into the vagina.

Uterus: A muscular organ located in the female pelvis that contains and nourishes the developing fetus during pregnancy.

Vagina: A tube-like structure surrounded by muscles leading from the uterus to the outside of the body.

 

 

 

What is ultrasound?

Ultrasound is energy in the form of sound waves. The most common type of ultrasound exam is called two-dimensional (2D) ultrasound. In this type of ultrasound, a transducer sends sound waves through the body. The sound waves hit tissues, body fluids, and bones. The waves then bounce back, like echoes. The transducer receives these echoes, which are converted into images of the internal organs and—during pregnancy—the fetus.

How is ultrasound used in women’s health care?

Ultrasound can be used to diagnose and monitor certain problems, such as a pelvic mass, a breast lump, abnormal bleeding, pelvic pain, or infertility. It also can be used during pregnancy to monitor the fetus.

How is ultrasound used during pregnancy?

Ultrasound is used during pregnancy to find out whether the growing fetus inside your uterus is developing normally. It can be used to check the anatomy of the fetus for defects or problems. It also can be used to find out the following information:

  • Age of the fetus
  • Location of the placenta
  • Fetal position, movement, breathing, and heart rate
  • Amount of amniotic fluid in the uterus
  • Number of fetuses

Ultrasound may be used to screen for certain birth defects, such as Down syndrome. Ultrasound also is used duringchorionic villus sampling and amniocentesis to help guide these procedures.

How many ultrasound exams will I have during my pregnancy?

You may have at least one standard exam during your pregnancy. This ultrasound exam usually is performed at about 16–20 weeks of pregnancy. Some women may have an ultrasound exam in the first trimester of pregnancy. If a problem occurs during pregnancy, such as bleeding or pelvic pain, ultrasound may be used to help find the cause.

Where is an ultrasound exam done?

An ultrasound exam may be done in a health care provider’s office or a hospital.

Who performs the ultrasound exam?

It may be performed by your health care provider or a specially trained technician.

How is the ultrasound exam performed?

During an ultrasound exam, the transducer is either moved across your abdomen (transabdominal ultrasound) or placed in your vagina (transvaginal ultrasound).

What type of ultrasound exam will I have?

The type of ultrasound exam you have depends on what types of images your health care provider needs and why the exam is being done. If you are pregnant, it also depends on how far along you are in your pregnancy. Transvaginal ultrasound often is used in early pregnancy. Transabdominal ultrasound often is used after about 10 weeks of pregnancy. Your weight also can determine which type of exam is needed.

What do I need to do to prepare for a transabdominal ultrasound exam?

If you are having a transabdominal ultrasound exam, wear loose-fitting clothes. This will allow your abdomen to be exposed easily. You may need to drink several glasses of water during the 2 hours before your exam. This will make your bladder full. A full bladder is helpful because sound waves pass more easily through liquid than through air.

What happens during a transabdominal ultrasound exam?

For this exam, you will lie on a table with your abdomen exposed from the lower part of the ribs to the hips. A gel is applied to the surface of the abdomen. This improves contact of the transducer with the skin surface. The handheld transducer then is moved along the abdomen.

What happens during a transvaginal ultrasound exam?

For a transvaginal ultrasound exam, you will be asked to change into a hospital gown or undress from the waist down. You do not need to fill your bladder before the test. You will lie on your back with your feet in stirrups, like for a pelvic exam. The transducer for this exam is shaped like a wand. It is covered with a latex sheath, like a condom, and lubricated before it is inserted into the vagina.

What is a specialized ultrasound exam?

A specialized ultrasound exam often uses additional technology to examine a particular organ. If your health care provider suspects a problem based on other tests, you may have a specialized ultrasound exam.

What are the types of specialized ultrasound exams?

Specialized ultrasound exams include Doppler ultrasound, three-dimensional and four-dimensional (3D and 4D) ultrasound, and sonohysterography.

What is Doppler ultrasound?

This test is done during pregnancy using transabdominal ultrasound. Sound waves are used to measure blood flow in the fetus’s umbilical cord or other blood vessels. It also can be used to listen to the heartbeat. A health care provider may order this test if the fetus is not growing normally or with other tests to detect fetal anemia.

What are 3D and 4D ultrasound?

In a 3D ultrasound exam, multiple 2D images are taken at various angles. The images then are assembled into a 3D image. A 4D image is similar to a 3D image, but it shows movement. A 3D or 4D ultrasound sometimes is done when a specific problem is suspected during pregnancy, such as a problem with the placenta or fetus.

What is sonohysterography?

This test is used to look for problems within the uterus, often as part of an infertility evaluation. For sonohysterography, you first have a transvaginal ultrasound exam. Next, a catheter (a thin tube) is inserted through the cervix. A saline solution (salt water) is injected through the catheter into the uterus. The saline makes the inside of the uterus easier to see with ultrasound.

What are the risks of ultrasound exams?

Currently, there is no reliable evidence that ultrasound is harmful to a developing fetus. No links have been found between ultrasound and birth defects, childhood cancer, or developmental problems later in life. However, it is possible that effects could be identified in the future. For this reason, it is recommended that ultrasound exams be performed only for medical reasons by qualified health care providers.

Glossary

Amniocentesis: A procedure in which a needle is used to withdraw and test a small amount of amniotic fluid and cells from the sac surrounding the fetus.

Amniotic Fluid: Water in the sac surrounding the fetus in the mother’s uterus.

Anemia: Abnormally low levels of blood or red blood cells in the bloodstream.

Cervix: The lower, narrow end of the uterus at the top of the vagina.

Chorionic Villus Sampling: A procedure in which a small sample of cells is taken from the placenta and tested.

Down Syndrome: A genetic disorder caused by the presence of an extra chromosome and characterized by intellectual disability, abnormal features of the face, and medical problems such as heart defects.

Fetus: The developing organism in the uterus from the ninth week of pregnancy until the end of pregnancy.

Placenta: Tissue that provides nourishment to and takes waste away from the fetus.

Sonohysterography: A procedure in which sterile fluid is injected into the uterus through the cervix while ultrasound images are taken of the inside of the uterus.

Transabdominal Ultrasound: A type of ultrasound in which a device is moved across the abdomen.

Transducer: A device that emits sound waves and translates the echoes into electrical signals.

Transvaginal Ultrasound: A type of ultrasound in which a device specially designed to be placed in the vagina is used.

Trimester: One of the three 3-month periods into which pregnancy is divided.

Ultrasound: A test in which sound waves are used to examine internal structures. During pregnancy, it can be used to examine the fetus.

Umbilical Cord: A cord-like structure containing blood vessels that connects the fetus to the placenta.

Uterus: A muscular organ located in the female pelvis that contains and nourishes the developing fetus during pregnancy.

 

What is laparoscopy?

Laparoscopy is a way of doing surgery without making a large incision (cut). A thin tube known as the laparoscope is inserted into the abdomen through a small incision. The laparoscope allows your health care provider to see the pelvic organs. If a problem needs to be treated, other instruments are used. These instruments are inserted either through the laparoscope or through other small cuts in your abdomen.

How long will I be in the hospital for laparoscopic surgery?

Laparoscopy often is done as outpatient surgery. You usually can go home the same day, after you have recovered from the anesthesia. More complex procedures, such as laparoscopic hysterectomy, may require an overnight stay in the hospital.

What anesthesia is used for laparoscopic surgery?

Before surgery, you will be given general anesthesia that puts you to sleep and blocks the pain. Regional anesthesia instead of general anesthesia may be used. This type of anesthesia numbs the area, but you remain awake.

How is laparoscopic surgery performed?

Your health care provider will make a small incision in your navel and insert the laparoscope. During the procedure, the abdomen is filled with a gas (carbon dioxide or nitrous oxide). Filling the abdomen with gas allows the pelvic reproductive organs to be seen more clearly.

The laparoscope shows the pelvic organs on a screen. Other incisions may be made in the abdomen for surgical instruments. These incisions usually are no more than one half an inch long. Another instrument, called a uterine manipulator, may be inserted through the cervix and into the uterus. This instrument is used to move the organs into view.

What is involved in recovery?

If you had general anesthesia, you will wake up in the recovery room. You will feel sleepy for a few hours. You may have some nausea from the anesthesia. If you have had an outpatient procedure, you must have someone drive you home.

For a few days after the procedure, you may feel tired and have some discomfort. You may be sore around the incisions made in your abdomen and navel. Sometimes, the tube put in your throat to help you breathe during the surgery may give you a sore throat for a few days. If so, try throat lozenges or gargle with warm salt water. You may feel pain in your shoulderor back. This pain is from the gas used during the procedure. It goes away on its own within hours or a day or two. If pain and nausea do not go away after a few days or become worse, you should contact your health care provider.

Your health care provider will let you know when you can get back to your normal activities. For minor procedures, it is often 1–2 days after the surgery. For more complex procedures, it can take longer. You may be told to avoid heavy activity or exercise. Contact your health care provider right away if you have any of the following signs or symptoms:

Your health care provider will let you know when you can get back to your normal activities. For minor procedures, it is often 1–2 days after the surgery. For more complex procedures, it can take longer. You may be told to avoid heavy activity or exercise. Contact your health care provider right away if you have any of the following signs or symptoms:

  • Fever
  • Pain that is severe or gets worse
  • Heavy vaginal bleeding
  • Redness, swelling, or discharge from the incision
  • Fainting

What are the risks of laparoscopic surgery?

As with any surgery, there is a small risk of problems with laparoscopy. These risks include:

  • Bleeding or hernia in the incision sites
  • Internal bleeding
  • Infection
  • Injury to internal organs
  • Problems caused by anesthesia

Sometimes the problems do not appear right away. The risk that a problem will occur is related to the type of surgery that is performed. The more complex the surgery, the greater the risk. Be sure to ask your health care provider about the risks associated with your specific surgery. There also may be other ways to treat your condition besides surgery, such as medications.

In some cases, the surgeon decides that a laparoscopy cannot be done during the surgery. An abdominal incision is made instead. If this happens, you may need to stay in the hospital for a day or two. Your recovery also will take longer.

What are the benefits of laparoscopic surgery?

Laparoscopy has many benefits. There is less pain after laparoscopic surgery than with open abdominal surgery, which involves larger incisions, longer hospital stays, and a longer recovery. The risk of infection also is lower. You will be able to recover from laparoscopic surgery faster than from open abdominal surgery. It often can be done as outpatient surgery, so you usually will not have to spend the night in the hospital. The smaller incisions that are used allow you to heal faster and have smaller scars.

Glossary

General Anesthesia: The use of drugs that produce a sleep-like state to prevent pain during surgery.

Regional Anesthesia: The use of drugs to block sensation in certain areas of the body.

 

What is dilation and curettage (D&C)?

D&C is a surgical procedure in which the cervix is opened (dilated) and a thin instrument is inserted into the uterus. This instrument is used to remove tissue from the inside of the uterus (curettage).

Why is a D&C done?

D&C is used to diagnose and treat many conditions that affect the uterus, such as abnormal bleeding. A D&C also may be done after a miscarriage. A sample of tissue from inside the uterus can be viewed under a microscope to tell whether anycells are abnormal. A D&C may be done with other procedures, such as hysteroscopy, in which a slender device is used to view the inside of the uterus.

Where is a D&C done?

A D&C can be done in a health care provider’s office, a surgery center, or a hospital.

What preparation is needed for a D&C?

Your health care provider may want to start dilating your cervix before surgery using laminaria. This is a slender rod of natural or synthetic material that is inserted into the cervix. It is left in place for several hours. The rod absorbs fluid from the cervix and expands. This causes the cervix to open. Medication also may be used to soften the cervix, making it easier to dilate. You also may receive some type of anesthesia before or during your D&C.

What happens during the procedure?

During the procedure, you will lie on your back and your legs will be placed in stirrups. A speculum will be inserted into your vagina. The cervix will be held in place with a special instrument.

The cervix will then be slowly dilated. This is done by inserting a series of slender rods that become progressively larger through the cervical opening. Usually only a small amount of dilation is needed (less than one half inch in diameter).

Tissue lining the uterus will be removed, either with an instrument called a curette or with suction. In most cases, the tissue will be sent to a laboratory for examination.

What are the risks of D&C?

Complications include bleeding, infection, or perforation of the uterus (when the tip of an instrument passes through the wall of the uterus). Problems related to the anesthesia used also can occur. These complications are rare.

In rare cases, after a D&C has been performed after a miscarriage, bands of scar tissue, or adhesions, may form inside the uterus. This is called Asherman syndrome. These adhesions may cause infertility and changes in menstrual flow. Asherman syndrome often can be treated successfully with surgery.

What should I expect after the surgery?

After the procedure, you probably will be able to go home within a few hours. You will need someone to take you home. You should be able to resume most of your regular activities in 1 or 2 days. Pain after a D&C usually is mild. You may have spotting or light bleeding.

Is there anything I should watch out for or not do right after my D&C?

You should contact your health care provider if you have any of the following:

  • Heavy bleeding from the vagina
  • Fever
  • Pain in the abdomen
  • Foul-smelling discharge from the vagina

After a D&C, a new lining will build up in the uterus. Your next menstrual period may not occur at the regular time. It may be early or late.

Until your cervix returns to its normal size, bacteria from the vagina can enter the uterus and cause infection. It is important not to put anything into your vagina after the procedure. Ask your health care provider when you can have sex or use tampons again.

Glossary

Adhesions: Scarring that binds together the surfaces of tissues.

Anesthesia: Relief of pain by loss of sensation.

Cells: The smallest units of a structure in the body; the building blocks for all parts of the body.

Cervix: The opening of the uterus at the top of the vagina.

Hysteroscopy: A procedure in which a device called a hysteroscope is inserted through the cervix and vagina into the uterus. The hysteroscope is used to view the inside of the uterus or perform surgery.

Laminaria: A slender rod made of natural or synthetic material that expands when it absorbs water; it is inserted into the opening of the cervix to widen it.

Miscarriage: Early pregnancy loss.

Speculum: An instrument used to hold open the walls of the vagina.

Uterus: A muscular organ located in the female pelvis that contains and nourishes the developing fetus during pregnancy.

 

 

What is hysteroscopy?

Hysteroscopy is used to diagnose or treat problems of the uterus. A hysteroscope is a thin, lighted telescope-like device. It is inserted through your vagina into your uterus. The hysteroscope transmits the image of your uterus onto a screen. Other instruments are used along with the hysteroscope for treatment.

Why is hysteroscopy done?

One of the most common uses for hysteroscopy is to find the cause of abnormal uterine bleeding. Abnormal bleeding can mean that a woman’s menstrual periods are heavier or longer than usual or occur less often or more often than normal. Bleeding between menstrual periods also is abnormal.

Hysteroscopy also is used in the following situations:

  • Remove adhesions that may occur because of infection or from past surgery
  • Diagnose the cause of repeated miscarriage when a woman has more than two miscarriages in a row
  • Locate an intrauterine device
  • Perform sterilization, in which the hysteroscope is used to place small implants into a woman’s fallopian tubes as a permanent form of birth control

How is hysteroscopy performed?

Before the procedure, you may be given a medication to help you relax, or general anesthesia or local anesthesia may be used to block the pain. If you have general anesthesia, you will not be awake during the procedure.

Hysteroscopy can be done in a doctor’s office or at the hospital. It will be scheduled when you are not having your menstrual period. To make the procedure easier, your health care provider may dilate (open) your cervix before your hysteroscopy. You may be given medication that is inserted into the cervix, or special dilators may be used.

speculum is first inserted into the vagina. The hysteroscope is then inserted and gently moved through the cervix into your uterus. Carbon dioxide gas or a fluid, such as saline (salt water), will be put through the hysteroscope into your uterus to expand it. The gas or fluid helps your health care provider see the lining more clearly. The amount of fluid used is carefully checked throughout the procedure. Your health care provider can view the lining of your uterus and the openings of the fallopian tubes by looking through the hysteroscope. If a biopsy or other procedure is done, small instruments will be passed through the hysteroscope.

What should I expect during recovery?

You should be able to go home shortly after the procedure. If you had general anesthesia, you may need to wait until its effects have worn off.

It is normal to have some mild cramping or a little bloody discharge for a few days after the procedure. You may be given medication to help ease the pain. If you have a fever, chills, or heavy bleeding, call your health care provider right away.

What are the risks of hysteroscopy?

Hysteroscopy is a safe procedure. However, there is a small risk of problems. The uterus or cervix can be punctured by the hysteroscope, bleeding may occur, or excess fluid may build up in your system. In rare cases, hysteroscopy can cause life-threatening problems.

Glossary

Adhesions: Scars that bind together affected surfaces of the tissues inside the abdomen or uterus.

Biopsy: A minor surgical procedure to remove a small piece of tissue that is then examined under a microscope in a laboratory.

Cervix: The opening of the uterus at the top of the vagina.

Fallopian Tubes: Tubes through which an egg travels from the ovary to the uterus.

General Anesthesia: The use of drugs that produce a sleep-like state to prevent pain during surgery.

Intrauterine Device: A small plastic device inserted in the uterus to prevent pregnancy.

Local Anesthesia: The use of drugs that prevent pain in a part of the body.

Miscarriage: Early pregnancy loss.

Speculum: An instrument used to open the walls of the vagina.

Sterilization: A permanent method of birth control.

Uterus: A muscular organ located in the female pelvis that contains and nourishes the developing fetus during pregnancy.

Vagina: A tube-like structure surrounded by muscles leading from the uterus to the outside of the body.

 

What is cervical cancer screening?

Cervical cancer screening is used to find changes in the cells of the cervix that could lead to cancer. Screening includes the Pap test and, for some women, testing for human papillomavirus (HPV).

How is cervical cancer screening done?

Cervical cancer screening is simple and fast. It takes less than a minute to do. With the woman lying on an exam table, aspeculum is used to open the vagina. This device gives a clear view of the cervix and upper vagina.

For a Pap test, a small number of cells are removed from the cervix with a brush or other tool. The cells are put into a liquid and sent to a lab testing. For an HPV test, sometimes the same sample taken for the Pap test can be used. Sometimes, two cell samples are taken.

Who should have cervical cancer screening and how often?

You should start having cervical cancer screening at age 21 years. How often you should have cervical cancer screening depends on your age and health history:

  • Women aged 21–29 years should have a Pap test every 3 years.
  • Women aged 30–65 years should have a Pap test and HPV test (co-testing) every 5 years (preferred). It is acceptable to have a Pap test alone every 3 years.

When can I stop having cervical cancer screening?

You can stop having cervical cancer screening after age 65 if you do not have a history of moderate or severe cervicaldysplasia or cervical cancer and if you have had either three negative Pap test results in a row or two negative co-test results in a row within the past 10 years, with the most recent test performed within the last 5 years.

What happens if I have an abnormal screening test result?

You most likely will have additional testing after an abnormal test result. This testing can be simply a repeat Pap test, An HPV test, or a more detailed examination called a colposcopy (with or without a biopsy). If results of follow-up tests indicate precancerous changes, you may need treatment to remove the abnormal cells.

Are cervical cancer screening results always accurate?

As with any lab test, cervical cancer screening test results are not always accurate. Sometimes, the results show abnormal cells when the cells are normal. This is called a "false-positive" result. The tests also may not detect abnormal cells when they are present. This is called a "false-negative" result. Many factors can cause false results:

  • The sample may contain too few cells.
  • There may not be enough abnormal cells to study.
  • An infection or blood may hide abnormal cells.
  • Douching or vaginal medications may wash away or dilute abnormal cells.

To help prevent false-negative or false-positive results, you should avoid douching, sexual intercourse, and using vaginal medications or hygiene products for 2 days before your test. You also should not have cervical cancer screening if you have your menstrual period.

Glossary

Biopsy: A minor surgical procedure to remove a small piece of tissue that is then examined under a microscope in a laboratory.

Colposcopy: Viewing of the cervix, vulva, or vagina under magnification with an instrument called a colposcope.

Dysplasia: A noncancerous condition that occurs when normal cells are replaced by a layer of abnormal cells. Dysplasia can be mild, moderate, or severe.

Human Papillomavirus (HPV): The name for a group of related viruses, some of which cause genital warts and are linked to cervical changes and cervical cancer.

Pap Test: A test in which cells are taken from the cervix and vagina and examined under a microscope.

Speculum: An instrument used to hold open the walls of the vagina.

 

What is a loop electrosurgical excision procedure (LEEP) and why is it done?

If you have an abnormal cervical cancer screening result, your health care provider may suggest that you have a loop electrosurgical excision procedure (LEEP) as part of the evaluation or for treatment. LEEP is one way to remove abnormal cells from the cervix by using a thin wire loop that acts like a scalpel (surgical knife). An electric current is passed through the loop, which cuts away a thin layer of the cervix.

How is LEEP performed?

A LEEP should be done when you are not having your menstrual period to give a better view of the cervix. In most cases, LEEP is done in a health care provider’s office. The procedure only takes a few minutes.

During the procedure you will lie on your back and place your legs in stirrups. The health care provider then will insert aspeculum into your vagina in the same way as for a pelvic exam. Local anesthesia will be used to prevent pain. It is given through a needle attached to a syringe. You may feel a slight sting, then a dull ache or cramp. The loop is inserted into the vagina to the cervix. There are different sizes and shapes of loops that can be used. You may feel faint during the procedure. If you feel faint, tell your health care provider immediately.

After the procedure, a special paste may be applied to your cervix to stop any bleeding. Electrocautery also may be used to control bleeding. The tissue that is removed will be studied in a lab to confirm the diagnosis.

What are the risks of LEEP?

The most common risk in the first 3 weeks after a LEEP is heavy bleeding. If you have heavy bleeding, contact your health care provider. You may need to have more of the paste applied to the cervix to stop it.

LEEP has been associated with an increased risk of future pregnancy problems. Although most women have no problems, there is a small increase in the risk of premature births and having a low birth weight baby. In rare cases, the cervix is narrowed after the procedure. This narrowing may cause problems with menstruation. It also may make it difficult to become pregnant.

What should I expect during recovery from LEEP?

After the procedure, you may have

  • a watery, pinkish discharge
  • mild cramping
  • a brownish-black discharge (from the paste used)

It will take a few weeks for your cervix to heal. While your cervix heals, you should not place anything in the vagina, such as tampons or douches. You should not have intercourse. Your health care provider will tell you when it is safe to do so.

You should contact your health care provider if you have any of the following problems:

  • Heavy bleeding (more than your normal period)
  • Bleeding with clots
  • Severe abdominal pain

Will I need follow-up visits?

After the procedure, you will need to see your health care provider for follow-up visits. You will have cervical cancer screening to be sure that all of the abnormal cells are gone and that they have not returned. If you have another abnormal screening test result, you may need more treatment.

You can help protect the health of your cervix by following these guidelines:

  • Have regular pelvic exams and cervical cancer screening.
  • Stop smoking—smoking increases your risk of cancer of the cervix.
  • Limit your number of sexual partners and use condoms to reduce your risk of sexually transmitted diseases.

Glossary

Cervix: The opening of the uterus at the top of the vagina.

Electrocautery: A procedure in which an instrument works with electric current to destroy tissue.

Local Anesthesia: The use of drugs that prevent pain in a part of the body.

Sexually Transmitted Diseases: Diseases that are spread by sexual contact, including chlamydia, gonorrhea, human papillomavirus infection, herpes, syphilis, and infection with human immunodeficiency virus (HIV, the cause of acquired immunodeficiency syndrome [AIDS]).

Speculum: An instrument used to hold apart the walls of the vagina so that the cervix can be seen.

 

 

What is endometrial ablation?

Endometrial ablation destroys a thin layer of the lining of the uterus and stops the menstrual flow in many women. In some women, menstrual bleeding does not stop but is reduced to normal or lighter levels. If ablation does not control heavy bleeding, further treatment or surgery may be required.

Why is endometrial ablation done?

Endometrial ablation is used to treat many causes of heavy bleeding. In most cases, women with heavy bleeding are treated first with medication. If heavy bleeding cannot be controlled with medication, endometrial ablation may be used.

Who should not have endometrial ablation?

Endometrial ablation should not be done in women past menopause. It is not recommended for women with certain medical conditions, including the following:

  • Disorders of the uterus or endometrium
  • Endometrial hyperplasia
  • Cancer of the uterus
  • Recent pregnancy
  • Current or recent infection of the uterus

Can I still get pregnant after having endometrial ablation?

Pregnancy is not likely after ablation, but it can happen. If it does, the risk of miscarriage and other problems are greatly increased. If a woman still wants to become pregnant, she should not have this procedure. Women who have endometrial ablation should use birth control until after menopause. Sterilization may be a good option to prevent pregnancy after ablation.

A woman who has had ablation still has all her reproductive organs. Routine cervical cancer screening and pelvic exams are still needed.

What techniques are used to perform endometrial ablation?

The following methods are those most commonly used to perform endometrial ablation:

  • Radiofrequency—A probe is inserted into the uterus through the cervix. The tip of the probe expands into a mesh-like device that sends radiofrequency energy into the lining. The energy and heat destroy the endometrial tissue, while suction is applied to remove it.
  • Freezing—A thin probe is inserted into the uterus. The tip of the probe freezes the uterine lining. Ultrasound is used to help guide the procedure.
  • Heated fluid— Fluid is inserted into the uterus through a hysteroscope, a slender, light-transmitting device. The fluid is heated and stays in the uterus for about 10 minutes. The heat destroys the lining.
  • Heated balloon—A balloon is placed in the uterus with a hysteroscope.
  • Heated fluid is put into the balloon. The balloon expands until its edges touch the uterine lining. The heat destroys the endometrium.
  • Microwave energy—A special probe is inserted into the uterus through the cervix. The probe applies microwave energy to the uterine lining, which destroys it.
  • Electrosurgery—Electrosurgery is done with a resectoscope. A resectoscope is a slender telescopic device that is inserted into the uterus. It has an electrical wire loop, roller-ball, or spiked-ball tip that destroys the uterine lining. This method usually is done in an operating room with general anesthesia. It is not as frequently used as the other methods.

What should I expect after the procedure?

Some minor side effects are common after endometrial ablation:

  • Cramping, like menstrual cramps, for 1–2 days
  • Thin, watery discharge mixed with blood, which can last a few weeks. The discharge may be heavy for 2–3 days after the procedure.
  • Frequent urination for 24 hours
  • Nausea

What are the risks associated with endometrial ablation?

Endometrial ablation has certain risks. There is a small risk of infection and bleeding. The device used may pass through the uterine wall or bowel. With some methods, there is a risk of burns to the vagina, vulva, and bowel. Rarely, the fluid used to expand your uterus during electrosurgery may be absorbed into your bloodstream. This condition can be serious. To prevent this problem, the amount of fluid used is carefully checked throughout the procedure.

Glossary

Cervix: The lower, narrow end of the uterus that extends into the vagina.

Endometrial Hyperplasia: A condition in which the lining of the uterus grows too thick; if left untreated for a long time, it may lead to cancer.

General Anesthesia: The use of drugs that produce a sleep-like state to prevent pain during surgery.

Menopause: The process in a woman’s life when ovaries stop functioning and menstruation stops.

Pelvic Exam: A manual internal and external examination of a woman’s reproductive organs.

Sterilization: An operation that prevents a woman from becoming pregnant or a man from fathering a child.

Uterus: A muscular organ located in the female pelvis that contains and nourishes the developing fetus during pregnancy.

Vulva: The external female genital area.

 

What is colposcopy?

Colposcopy is a way of looking at the cervix through a special magnifying device called a colposcope. It shines a light into the vagina and onto the cervix. A colposcope can greatly enlarge the normal view. This exam allows the health care provider to find problems that cannot be seen by the eye alone.

Why is colposcopy done?

Colposcopy is done when results of cervical cancer screening tests show abnormal changes in the cells of the cervix. Colposcopy provides more information about the abnormal cells. Colposcopy also may be used to further assess other problems:

  • Genital warts on the cervix
  • Cervicitis (an inflamed cervix)
  • Benign (not cancer) growths, such as polyps
  • Pain
  • Bleeding

Sometimes colposcopy may need to be done more than once. It also can be used to check the result of a treatment.

How is the procedure performed?

Colposcopy is done in a doctor’s office. You may be referred to another health care provider or to a special clinic to have it done.

The procedure is best done when a woman is not having her menstrual period. This gives the health care provider a better view of the cervix. For at least 24 hours before the test, you should not

  • douche
  • use tampons
  • use vaginal medications
  • have sex

As with a pelvic exam, you will lie on your back with your feet raised and placed on foot rests for support. A speculum will be used to hold apart the vaginal walls so that the inside of the vagina and the cervix can be seen. The colposcope is placed just outside the opening of your vagina.

A mild solution will be applied to your cervix and vagina with a cotton swab or cotton ball. This liquid makes abnormal areas on the cervix easier to see. You may feel a slight burning.

When is a biopsy done during colposcopy?

During colposcopy, the health care provider may see abnormal areas. A biopsy of these areas may be done. During a biopsy, a small piece of tissue is removed from the cervix. The sample is removed with a special device.

Cells also may be taken from the canal of the cervix. A special device is used to collect the cells. This is called endocervical curettage (ECC).

What should I expect during recovery?

If you have a colposcopy without a biopsy, you should feel fine right away. You can do the things you normally do. You may have a little spotting for a couple of days.

If you have a colposcopy with a biopsy, your vagina may feel sore for 1 or 2 days. You may have some vaginal bleeding. You also may have a dark discharge for a few days. This may occur from medication used to help stop bleeding at the biopsy site. You may need to wear a sanitary pad until the discharge stops.

Your health care provider may suggest you limit your activity for a brief time. While the cervix heals, you will be told not to put anything into your vagina for a short time:

  • Do not have sex.
  • Do not use tampons.
  • Do not douche.

Call your health care provider right away if you have any of these problems:

  • Heavy vaginal bleeding (using more than one sanitary pad per hour)
  • Severe lower abdominal pain
  • Fever
  • Chills

Glossary

Biopsy: A minor surgical procedure to remove a small piece of tissue that is then examined under a microscope in a laboratory.

Cervix: The opening of the uterus at the top of the vagina.

Polyps: Benign (noncancerous) growths that develop from membrane tissue, such as that lining the inside of the uterus.

Speculum: An instrument used to hold apart the walls of the vagina so that the cervix can be seen.

Vagina: A passageway surrounded by muscles leading from the uterus to the outside of the body; also known as the birth

 

What is hysterosalpingography (HSG)?

Hysterosalpingography (HSG) is an X-ray procedure that is used to view the inside of the uterus and fallopian tubes. It often is used to see if the fallopian tubes are partly or fully blocked. It also can show if the inside of the uterus is of a normal size and shape. All of these problems can lead to infertility and pregnancy problems.

HSG also is used a few months after some tubal sterilization procedures to make sure that the fallopian tubes have been completely blocked. HSG is not done if a woman has any of the following conditions:

  • Pregnancy
  • Pelvic infection
  • Heavy uterine bleeding at the time of the procedure

What should I do to prepare for HSG?

Your health care provider may recommend that you take an over-the-counter pain reliever an hour before the procedure. Discuss this decision with your health care provider. In some cases, he or she also may prescribe an antibiotic for you to take before HSG. Most people can drive themselves home after having HSG. However, you may not feel well after the procedure, so you may want to make arrangements for someone to drive you home.

How is HSG done?

HSG is done in a hospital, clinic, or health care provider’s office. It is best to have HSG done in the first half (days 1–14) of the menstrual cycle. This timing reduces the chance that you may be pregnant.

During HSG, a contrast medium is placed in the uterus and fallopian tubes. This is a fluid that contains a dye. The dye shows up in contrast to the body structures on an X-ray screen. The dye outlines the inner size and shape of the uterus and fallopian tubes. It also is possible to see how the dye moves through the body structures.

The procedure is performed as follows:

  1. You will be asked to lie on your back with your feet placed as for a pelvic exam. A device called a speculum is inserted into the vagina. It holds the walls of the vagina apart to allow the cervix to be viewed. The cervix is cleaned.
  2. The end of the cervix may be injected with local anesthesia (pain relief). You may feel a slight pinch or tug as this is done.
  3. One of two methods may be used to insert the dye. In one method, the cervix is grasped with a device to hold it steady. An instrument called a cannula is then inserted into the cervix. In the other method, a thin plastic tube is passed into the cervical opening. The tube has a small balloon at the end that is inflated. The balloon keeps the tube in place in the uterus.
  4. The speculum is removed, and you are placed beneath an X-ray machine.
  5. The fluid slowly is placed through the cannula or tube into the uterus and fallopian tubes. The fluid may cause cramping. If the tubes are blocked, the fluid will cause them to stretch.
  6. X-ray images are made as the contrast medium fills the uterus and tubes. You may be asked to change position. If there is no blockage, the fluid will spill slowly out the far ends of the tubes. After it spills out, the fluid is absorbed by the body.
  7. After the images are made, the cannula or tube is removed.

What should I expect after the procedure?

After HSG, you can expect to have a sticky vaginal discharge as some of the fluid drains out of the uterus. The fluid may be tinged with blood. A pad can be used for the vaginal discharge. Do not use a tampon. You also may have the following symptoms:

  • Slight vaginal bleeding
  • Cramps
  • Feeling dizzy, faint, or sick to your stomach

What are the risks associated with HSG?

Severe problems after an HSG are rare. They include an allergic reaction to the dye, injury to the uterus, or pelvic infection. Call your health care provider if you have any of these symptoms:

  • Foul-smelling vaginal discharge
  • Vomiting
  • Fainting
  • Severe abdominal pain or cramping
  • Heavy vaginal bleeding
  • Fever or chills

Are there alternatives to HSG?

There are other procedures that can give your health care provider some of the same information as HSG:

  • Laparoscopy —This surgical procedure requires general anesthesia.
  • Hysteroscopy —This procedure can give a detailed view of the inside of the uterus. However, it cannot show whether the fallopian tubes are blocked.
  • Sonohysterography —This technique uses ultrasound to show the inside of the uterus. Like hysteroscopy, it does not give information about the fallopian tubes.

Glossary

Contrast Medium: A substance injected into the body that highlights internal structures during an imaging study.

Fallopian Tubes: Tubes through which an egg travels from the ovary to the uterus.

Hysteroscopy: A procedure in which a slender, light-transmitting device, the hysteroscope, is inserted into the uterus through the cervix to view the inside of the uterus or perform surgery.

Infertility: A condition in which a couple has been unable to get pregnant after 12 months of trying without the use of any form of birth control.

Laparoscopy: A surgical procedure in which a slender, light-transmitting instrument, the laparoscope, is inserted into the pelvic cavity through small incisions. The laparoscope is used to view the pelvic organs. Other instruments can be used to perform surgery.

Local Anesthesia: The use of drugs that prevent pain in a part of the body.

Sonohysterography: A procedure in which sterile fluid is injected into the uterus through the cervix while ultrasound images are taken of the inside of the uterus.

Sterilization: A permanent method of birth control.

Uterus: A muscular organ located in the female pelvis that contains and nourishes the developing fetus during pregnancy.

 

What is stress urinary incontinence (SUI)?

SUI is a type of urinary incontinence. With SUI, a woman leaks urine when she coughs, laughs, or sneezes or during certain activities, such as walking, running, or exercising.

What causes SUI?

SUI is a pelvic floor disorder. These disorders occur when tissues and muscles that support the urethrabladderuterus, orrectum are damaged. In SUI, the sphincter muscle that controls the urethra weakens, which may occur from pregnancy, childbirth, or aging.

What nonsurgical treatment options may help with SUI?

Lifestyle changes, such as drinking less fluid, limiting caffeine, stopping smoking, and losing weight, can help decrease the number of times you leak urine. Other nonsurgical options include pelvic muscle exercises (Kegel exercises), physical therapy and biofeedback, or use of a pessary.

What are the surgical treatment options for SUI?

There are different types of surgery for SUI:

  • Injections
  • Urethral sling
  • Colposuspension

Urethral slings and colposuspension can be done through an incision in the abdomen (abdominal), through the vagina(vaginal), or with laparoscopy (laparoscopic). Injections can be given into the tissues around the urethra without an incision.

What factors are considered when deciding which SUI surgery is appropriate for me?

The type of surgery you have depends on many factors:

  • Age
  • Future childbearing plans
  • Lifestyle
  • Need for hysterectomy or treatment of other pelvic problems
  • Medical history (if you have had radiation therapy for pelvic cancer or have already had surgery for incontinence)
  • General health
  • Cause of the problem

Before you have surgery, you should weigh all of the risks and benefits of your surgical options. Your health care provider can discuss these risks and benefits with you.

How are injections for SUI done?

Synthetic materials are injected into the tissue around the urethra to provide support and to tighten the opening of the materials are injected into the tissue around the urethra to provide support and to tighten the opening of the bladder neck. The procedure usually is performed in your health care provider’s office with local anesthesia. A lighted scope is inserted into the urethra and the material is injected through a thin needle. The procedure takes less than 20 minutes. It may take two to three or more injections to get the desired result. The injections may improve symptoms but usually do not result in a complete cure of incontinence.

What types of urethral slings are available to treat SUI?

There are two types of urethral slings that are used to treat SUI:

  1. Midurethral sling—The midurethral sling is the most common type of surgery used to correct SUI. The sling is a narrow strap made of synthetic mesh that is placed under the urethra. It acts as a hammock to lift or support the urethra and the neck of the bladder.
  2. Traditional sling—In this type of surgery, the sling is a strip of your own tissue taken from the lower abdomen or thigh. The ends of the sling are stitched in place through an incision in the abdomen.

What are some of the benefits and risks of midurethral sling surgery?

Midurethral sling surgery usually takes less than 30 minutes to perform. It is an outpatient procedure, meaning that you usually can go home the same day. Recovery time generally is quicker than with other procedures for SUI.

If synthetic mesh is used, there is a small risk (less than 5%) that the mesh will erode through the vaginal tissue. Infection, long-term pain, and other problems can occur with the use of synthetic mesh. Additional surgery may be needed to fix these problems. Another risk is possible injury to the bladder or other pelvic organs by the instruments used to place the midurethral sling. These injuries usually do not lead to long-term problems.

What are some of the benefits and risks of traditional sling surgery?

With traditional slings, there are none of the risks associated with synthetic mesh. However, this type of surgery requires more recovery time than midurethral sling surgery. You usually will need to stay in the hospital for a few days when having traditional sling surgery. Risks of this type of surgery include urinary problems after the surgery, such as urgency or difficulty urinating. If these problems occur, the sling may need to be adjusted.

What is colposuspension?

In colposuspension, the part of the urethra nearest to the bladder is restored to its normal position. The most common type of colposuspension performed is called the Burch procedure. The bladder neck is supported with a few stitches placed on either side of the urethra. These stitches keep the bladder neck in place and help support the urethra.

What are some of the benefits and risks of colposuspension?

Colposuspension can be performed with an abdominal incision or with laparoscopy. When performed through an abdominal incision, the recovery time is similar to that of a traditional sling procedure. When performed by laparoscopy, you often can go home the same day.

Risks include urinary problems after the surgery. The stitches may need to be loosened if this happens.

What are some of the general risks associated with surgery for SUI?

The following risks are associated with any type of surgery for SUI:

  • Injury to the bladder, bowel, blood vessels, or nerves
  • Bleeding
  • Infection of the urinary tract or wound infections
  • Urinary problems after the procedure (difficulty urinating or urgency symptoms)
  • Problems related to the anesthesia used

What should I expect during recovery from an SUI procedure?

After surgery, discomfort may last for a few days or weeks. During this time, you may be told to avoid anything that puts stress on the surgical area, such as the following activities:

  • Excessive straining
  • Strenuous exercise
  • Heavy lifting

Some women may find it hard to urinate for a while or notice that they urinate more slowly than they did before surgery. They may need to use a catheter to empty their bladders a few times each day. In rare cases, if a woman is not able to void on her own, the stitches or the sling may need to be adjusted or removed.

Glossary

Anesthesia: Relief of pain by loss of sensation.

Bladder: A muscular organ in which urine is stored.

Catheter: A tube used to drain fluid from or administer fluid to the body.

Hysterectomy: Removal of the uterus.

Incontinence: Inability to control bodily functions such as urination.

Kegel Exercises: Pelvic muscle exercises that assist in bladder and bowel control as well as sexual function.

Laparoscopy: A surgical procedure in which an instrument called a laparoscope is inserted into the pelvic cavity through a small incision. The laparoscope is used to view the pelvic organs. Other instruments can be used with it to perform surgery.

Pelvic Floor Disorder: Any disorder affecting the muscles and tissues that support the pelvic organs; these disorders may result in loss of control of the bladder or bowels or cause one or more pelvic organs to drop downward (prolapse).

Pessary: A device inserted into the vagina to support sagging organs that have dropped down (prolapsed) or to help control urine leakage.

Radiation Therapy: Treatment with high-energy radiation.

Rectum: The last part of the digestive tract.

Sphincter Muscle: A muscle that can close a bodily opening, such as the sphincter muscle of the urethra.

Synthetic: Made by a chemical process, usually to imitate a natural material.

Urethra: A tube-like structure through which urine flows from the bladder to the outside of the body.

Uterus: A muscular organ located in the female pelvis that contains and nourishes the developing fetus during pregnancy.

Vagina: A tube-like structure surrounded by muscles leading from the uterus to the outside of the body.

 

What is sonohysterography?

Sonohysterography is a technique in which fluid is injected through the cervix into the uterus, and ultrasound is used to make images of the uterine cavity. The fluid shows more detail of the inside of the uterus than when ultrasound is used alone. The procedure can be done in a health care provider’s office, hospital, or clinic. It usually takes about 15 minutes.

Why is sonohysterography done?

Sonohysterography can find the underlying cause of many problems, including abnormal uterine bleeding, infertility, and repeated miscarriage. A sonohysterogram may be ordered when a woman has had a normal ultrasound exam but is still having symptoms. This procedure can detect the following conditions:

  • Abnormal growths inside the uterus, such as fibroids or polyps
  • Scarring inside the uterus
  • Abnormal uterine shape

Sonohysterography also is done before and after some surgical procedures.

When is sonohysterography done?

The procedure will be scheduled when you are not having your menstual period. If you are bleeding, the results may not be as clear. The test may be postponed until the bleeding stops. The procedure is not done if you are or could be pregnant, or if you have a pelvic infection or pelvic inflammatory disease. You may be given a urine test to rule out pregnancy.

What preparation is involved before the procedure?

Sonohysterography is done when your bladder is empty. You will be asked to undress from the waist down and lie on an exam table. Your health care provider may do a pelvic exam to check if you have any tenderness or pain. In some situations, you may be given antibiotics.

How is sonohysterography performed?

Sonohysterography has two parts. A transvaginal ultrasound exam is done first. Next, a fluid is injected through the cervix into the uterus, and an ultrasound exam is done again.

  • In a transvaginal ultrasound exam, an ultrasound transducer—a slender, handheld device —is placed in the vagina. It sends out sound waves that are used to make images of the internal organs. These images are shown on a screen.
  • After the first transvaginal ultrasound exam, the transducer is removed. A speculum is placed in the vagina. It holds the vagina open. The health care provider passes a swab through the speculum to clean the cervix.
  • Next, a thin tube called a catheter is inserted through the vagina. It is placed in the opening of the cervix or in the uterine cavity. The speculum then is removed.
  • The transducer is placed in the vagina again. A sterile fluid is slowly passed through the catheter. Cramping may occur as the fluid goes into the uterus. A transabdominal ultrasound exam also may be done while the fluid is passed into the uterus. In this type of ultrasound exam, a transducer is moved over the abdomen.
  • When the cavity is filled with fluid, ultrasound images are made of the inside of the uterus and the uterine lining.

What can I expect after the procedure?

Most women are able to go home right away and return to their normal level of activity that day. Some of the following symptoms may occur after the procedure:

  • Cramping
  • Spotting
  • Watery discharge

What are the risks associated with sonohysterography?

This procedure is safe, but there is a rare risk of pelvic infection. Call your health care provider if you have any of the following symptoms:

  • Pain or fever in the day or two after you go home
  • A change in the type or amount of discharge

What are some alternatives to sonohysterography?

There are alternatives to sonohysterography that also can be used to diagnose problems of the uterus:

  • Hysterosalpingography—This X-ray procedure is used to view the inside of the uterus and fallopian tubes and can show whether the tubes are blocked. Radiation is used and a fluid that contains a dye. Some women may be allergic to the dye that is used. 
  • Hysteroscopy—A slender, light-transmitting device with a small camera attached—the hysteroscope —is inserted into the vagina and through the cervix to look inside the uterus. Unlike sonohysterography, this test usually requires general anesthesia or local anesthesia
  • Magnetic resonance imaging (MRI)—This imaging test is used to view the internal organs, but it does not show the inside of the uterus as clearly as sonohysterography.

Glossary

Antibiotics: Drugs that treat infections.

Cervix: The opening of the uterus at the top of the vagina.

Fallopian Tubes: Tubes through which an egg travels from the ovary to the uterus.

Fibroids: Benign growths that form in the muscle of the uterus.

General Anesthesia: The use of drugs that produce a sleep-like state to prevent pain during surgery.

Hysterosalpingography: A special X-ray procedure in which a small amount of fluid is placed into the uterus and fallopian tubes to detect abnormal changes in their size and shape or to determine whether the tubes are blocked.

Hysteroscopy: A procedure in which a slender, light-transmitting device, the hysteroscope, is inserted into the uterus through the cervix to view the inside of the uterus or perform surgery.

Local Anesthesia: The use of drugs that prevent pain in a part of the body.

Pelvic Exam: A manual examination of a woman’s reproductive organs.

Pelvic Inflammatory Disease: An infection of the uterus, fallopian tubes, and nearby pelvic structures.

Polyps: Benign (noncancerous) growths that develop from tissue lining an organ, such as that lining the inside of the uterus.

Speculum: An instrument used to hold open the walls of the vagina.

Transabdominal Ultrasound: A type of ultrasound in which a transducer is moved across the abdomen.

Transvaginal Ultrasound: A type of ultrasound in which a transducer specially designed to be placed in the vagina is used.Ultrasound: A test in which sound waves are used to examine internal structures.

Uterus: A muscular organ located in the female pelvis that contains and nourishes the developing fetus during pregnancy.

 

 

What is pelvic organ prolapse?

Pelvic organ prolapse is a disorder in which one or more of the pelvic organs drop from their normal position.

What organs can be affected by pelvic organ prolapse?

The organs that can be affected include the following:

  • Uterus
  • Top of the vagina in women who have had a hysterectomy (the vaginal vault)
  • Front (anterior) wall of the vagina (usually with thebladder, which is called a cystocele)
  • Back (posterior) wall of the vagina (usually with therectum, which is called a rectocele)
  • The pouch between the rectum and back wall of the uterus (usually with a part of the small intestine, which is called anenterocele)

What are the symptoms of pelvic organ prolapse?

In severe prolapse, the woman can see or feel a bulge of tissue at or past the vaginal opening. Most women have mild prolapse—the organs drop down only slightly and do not protrude from the opening of the vagina—and do not have any signs or symptoms. Some women with mild prolapse and women with severe prolapse do have symptoms, which can include the following:

  • Feeling of fullness or heaviness in the pelvic region
  • Pulling or aching feeling in the lower abdomen or pelvis
  • Painful or uncomfortable sex
  • Difficulty urinating or having a bowel movement

How is pelvic organ prolapse treated?

If you do not have any symptoms or if your symptoms are mild, you do not need any special follow-up or treatment beyond having regular checkups. If you have symptoms, prolapse may be treated with or without surgery.

What are the nonsurgical treatments for pelvic organ prolapse?

Often the first nonsurgical option tried is a pessary. This device is inserted into the vagina to support the pelvic organs. Targeting specific symptoms may be another option. Kegel exercises may be recommended in addition to symptom-related treatment to help strengthen the pelvic floor. Weight loss can decrease pressure in the abdomen and help improve overall health.

When should I consider surgery to treat pelvic organ prolapse?

If your symptoms are severe and disrupt your life, and if nonsurgical treatment options have not helped, you may want to consider surgery.

What factors should I consider when deciding whether to have surgery?

The following factors should be considered when deciding whether to have surgery:

  • Your age—If you have surgery at a young age, there is a chance that prolapse will recur and may possibly require additional treatment. If you have surgery at an older age, general health issues and any prior surgery may affect the type of surgery that you have.
  • Your childbearing plans—Ideally, women who plan to have children (or more children) should postpone surgery until their families are complete to avoid the risk of prolapse happening again after corrective surgery.
  • Health conditions—Any surgical procedure carries some risk, such as infection, bleeding, blood clots in the legs, and problems related to anesthesia. Surgery may carry more risks if you have a medical condition, such as diabetes, heart disease, or breathing problems, or if you smoke or are obese.
  • New problems—Surgery also may cause new problems, such as pain during sex, pelvic pain, or urinary incontinence.

What are the types of surgery for pelvic organ prolapse?

In general, there are two types of surgery: 1) obliterative surgery and 2) reconstructive surgery.

How does obliterative surgery treat pelvic organ prolapse?

Obliterative surgery narrows or closes off the vagina to provide support for prolapsed organs. Sexual intercourse is not possible after this procedure.

How does reconstructive surgery treat pelvic organ prolapse?

Reconstructive surgery reconstructs the pelvic floor with the goal of restoring the organs to their original position. Some types of reconstructive surgery are done through an incision in the vagina. Others are done through an incision in the abdomen or with laparoscopy.

What are the types of reconstructive surgery?

The types of reconstructive surgery include the following:

  • Fixation or suspension using your own tissues (uterosacral ligament suspension and sacrospinous fixation)—These procedures are performed through the vagina and may involve less recovery time than those performed through the abdomen. A procedure to prevent urinary incontinence may be done at the same time.
  • Anterior and posterior colporrhaphy—Because these procedures are performed through the vagina, recovery time usually is shorter than with procedures performed through the abdomen.
  • Sacrocolpopexy and sacrohysteropexy—These abdominal procedures may result in less pain during sex than procedures performed through the vagina.
  • Surgery using vaginally placed mesh—Mesh placed through the vagina has a significant risk of complications, including mesh erosion, pain, and infection. Because of these risks, vaginally placed mesh for pelvic organ prolapse usually is reserved for women in whom previous surgery has not worked, who have a medical condition that makes abdominal surgery risky, or whose own tissues are too weak to repair without mesh.

What is involved in recovery after surgery to treat pelvic organ prolapse?

Recovery time varies depending on the type of surgery. You usually need to take a few weeks off from work. For the first few weeks, you should avoid vigorous exercise, lifting, and straining. You also should avoid sexual intercourse for several weeks after surgery.

Glossary

Anesthesia: Relief of pain by loss of sensation.

Bladder: A muscular organ in which urine is stored.

Colporrhaphy: A type of surgery performed through the vagina to repair anterior vaginal prolapse and posterior vaginal prolapse by reinforcing (or repairing) a woman’s own tissues.

Cystocele: Bulging of the bladder into the vagina.

Enterocele: Bulging of the intestine into the upper part of the vagina.

Hysterectomy: Removal of the uterus.

Incontinence: Inability to control bodily functions such as urination.

Kegel Exercises: Pelvic muscle exercises that assist in bladder and bowel control as well as sexual function.

Laparoscopy: A surgical procedure in which an instrument called a laparoscope is inserted into the pelvic cavity through a small incision. The laparoscope is used to view the pelvic organs. Other instruments can be used with it to perform surgery.

Ligament: A band of tissue that connects bones or supports large internal organs.

Obliterative Surgery: A type of surgery for pelvic organ prolapse in which the vagina is narrowed or closed off to provide support for prolapsed organs.

Pelvic Organ Prolapse: A condition in which pelvic organs, such as the uterus or bladder, drop downward. It is caused by weakening of the muscles and tissues that support these organs.

Pessary: A device inserted into the vagina to support sagging organs that have dropped down (prolapsed) or to help control urine leakage.

Reconstructive Surgery: Surgery to repair or restore a part of the body that is injured or damaged.

Rectocele: Bulging of the rectum into the vaginal wall.

Rectum: The last part of the digestive tract.

Sacrocolpopexy: A type of surgery to repair vaginal vault prolapse in which the vaginal vault is attached to the sacrum with surgical mesh.

Sacrohysteropexy: A type of surgery to repair uterine prolapse in which the cervix is attached to the sacrum with surgical mesh.

Uterus: A muscular organ located in the female pelvis that contains and nourishes the developing fetus during pregnancy.

Vagina: A tube-like structure surrounded by muscles leading from the uterus to the outside of the body.

Vaginal Vault: The top of the vagina after a hysterectomy.