Generality
Diagnostic hysteroscopy is an endoscopic gynecological exam, useful for identifying the pathologies that can affect the uterus, the cervix or the endometrium.
Diagnostic hysteroscopy requires special preparation, which also includes a series of tests aimed at establishing a woman's fitness for the procedure in question.
Duration of 10-15 minutes, the diagnostic hysteroscopy involves the insertion in the uterine cavity, through the vaginal opening, of the hysteroscope, which acts as an exploratory probe.
Diagnostic hysteroscopy is a safe and therefore low-risk procedure.
Those who undergo diagnostic hysteroscopy can go back to their daily activities as early as the day following the procedure.
If the diagnostic hysteroscopy detects anomalies, the gynecologist who performed it immediately informs the patient, also exposing her to the possible remedy or cure as far as established with the procedure in question.
A brief review of what is Isteroscopy
Hysteroscopy is an endoscopic gynecological procedure, which allows to evaluate from the inside the state of health of the uterus - in particular the uterine cavity, cervical canal and endometrium - and, in case of need, to intervene surgically, in order to cure some medical condition.
Hysteroscopy is based on the use of an instrument known as a hysteroscope ; the latter is a long tube, similar to a drinking straw, which, thanks to a camera and a connection system to a monitor, acts as an exploratory probe of the uterus and cervix, after its insertion into the uterine cavity, through the vaginal opening.
Hysteroscopy is a procedure generally performed in an outpatient or day surgery setting ; therefore, except in special cases, it never provides for hospitalization of the patient.
Hysteroscopy is a matter for gynecological doctors, or doctors with a specialization in gynecology .
What is Diagnostic Hysteroscopy?
Diagnostic hysteroscopy is hysteroscopy whose purpose is to evaluate from the inside the state of health of the uterus .
The diagnostic hysteroscopy is, therefore, an endoscopic gynecological examination, which, thanks to the use of the hysteroscope, allows to evaluate the state of health of the uterine cavity, the cervical canal and the endometrium .
Operative hysteroscopy
When hysteroscopy, instead of having diagnostic purposes, has therapeutic purposes, it takes the specific name of operative hysteroscopy (or therapeutic hysteroscopy ).
uses
Diagnostic hysteroscopy has many uses; in fact, it can be useful to:
- Ascertain the presence of uterine fibroids or polyps ;
- To ascertain the presence of benign tumors of the uterus other than fibroids and uterine polyps;
- To ascertain the presence of intrauterine adhesions ( Asherman's syndrome );
- Understanding the reasons for infertility ;
- Evaluate the general state of health of the endometrium during menopause;
- Evaluate the phenomenon of endometrial hyperplasia ;
- Go back to the causes of an irregularity in the menstrual cycle ;
- Go back to the causes of abnormal blood loss from the uterus ;
- Research the causes of menstruation in women who have passed menopause ;
- Plan in detail for uterine surgery;
- Understanding the reasons that lead a woman to have recurrent spontaneous abortions ;
- Verify the abnormal presence of endometrial tissue in the myometrium ( adenomyosis );
- To ascertain the presence of a congenital anomaly affecting the uterus (eg: bicorne uterus, didelphic uterus, septum uterus, uterine agenesis, etc.);
- Take a sample of endometrium to be subsequently subjected to appropriate laboratory analysis ( biopsy ). This practice makes it possible to ascertain the presence of an endometrial carcinoma (a malignant tumor of the endometrium) and to establish its progress.
Preparation
Diagnostic hysteroscopy requires special preparation, which serves to discover a woman's suitability for such a procedure and to inform her of how she should behave, so that everything goes well.
The preparation in question, therefore, includes health assessment exams and an illustration of how the patient should act on the day of the procedure and in the event that an anesthetic practice is required.
Health assessment exams
To establish the suitability for diagnostic hysteroscopy, the possible future patient must undergo:
- A careful gynecological examination, with the trusted specialist;
- An accurate medical history (or clinical history ). It includes a series of investigations, which serve to clarify important aspects such as: past illnesses of the papabile patient and his family; any drugs taken by the eligible patient at the time of the checks; the habits of the patient papabile (ex: cigarette smoke); etc.;
- A cervico-vaginal swab . It is used to determine if an infection is occurring in the cervical or vaginal area;
- A transvaginal ultrasound . Provides information on the anatomy and health status of the pelvic organs, such as the vaginal canal, uterus, ovaries and fallopian tubes;
- Blood analysis . They are used to verify the presence or absence of any coagulation disorders;
- A pregnancy test . As will be seen later, pregnancy is a contraindication to diagnostic hysteroscopy.
Important note
The above examinations are also planned in case of possible operative hysteroscopy.
On the day of the procedure: how to behave?
Remember that: at this point in the preparation, there is suitability for the diagnostic hysteroscopy procedure.
On the day of diagnostic hysteroscopy, the patient should wear comfortable and practical clothes, because then she will have to remove them in favor of a hospital gown specially prepared for her by the medical staff.
How to behave if anesthesia is provided?
Under certain circumstances, diagnostic hysteroscopy may require local anesthesia .
Local anesthesia for diagnostic hysteroscopy does not require special preparations.
Did you know that ...
Unlike in the case of diagnostic hysteroscopy, anesthesia for operative hysteroscopy is general .
Frequently Asked Questions: for menstruating women, when is it best to perform Diagnostic Hysteroscopy?
For menstruating women, the best time to perform diagnostic (but also operative) hysteroscopy is in the first 7 days following menstruation . In fact, the execution of the procedure in this period of the menstrual cycle allows gynecologists a better and more detailed view of the uterus and its internal cavities.
Procedure
FIRST PART
Once the patient has worn the hospital gown, a nurse of the medical staff invites her to sit on a special bed (equipped with a support for the legs etc.) and makes her assume the so-called gynecological position, with a favorable inclination to the introduction of the various tools necessary for the procedure.
As soon as the patient is in position and feels at ease, the gynecologist intervenes, who, thanks to a speculum, opens the vagina and gently introduces the hysteroscope, in order to lead him into the uterine cavity.
To facilitate the hysteroscope in the uterus, the gynecologist needs to stretch the walls of the cervix, cervical canal and uterine cavity; on the occasion of diagnostic hysteroscopy procedures, this work of distension is achieved through the hysteroscope and the insufflation, through this fundamental instrument, of air rich in carbon dioxide .
The hysteroscope is hollow on the inside just to allow the passage of gas, liquids or thin surgical instruments.
The distension (or dilation) of the uterus is essential not only to facilitate the conductance of the hysteroscope inside the uterus, but also to allow a better analysis of the internal anatomy of the organ and to make the entire pain less painful procedure .
In this phase of the procedure, careful monitoring by the entire medical staff of intrauterine pressure is important, which must remain at a value between 60 and 70 mmHg. The maintenance of these pressure values, in fact, avoids the over-distension of the walls constituting the uterine cavity.
SECOND PART
When the hysteroscope is finally in the uterus and the latter has expanded sufficiently, the gynecologist starts the visual exploration of the uterine cavity, endometrium and cervical canal. Remember that what resumes the hysteroscope, through its camera and with the help of the light source, is visible by all the medical staff on a special external monitor.
If diagnostic hysteroscopy is a biopsy, it is at this time in the procedure that the endometrium sample collection operations are performed.
PART THREE
Once the gynecologist has finished exploring, he will gently extract the hysteroscope; the extraction operation of the hysteroscope is important and is also part of diagnostic hysteroscopy: in fact, it serves to evaluate the integrity of the uterine isthmus, ie the point of passage between the internal cavity of the uterus and the cervical canal .
Where is Anesthesia placed, when scheduled?
In the aforementioned description of the various procedural steps that characterize diagnostic hysteroscopy, local anesthesia is located after the patient is settled, but before the speculum and hysteroscope are inserted.
Once administered, the anesthetics go into action within minutes.
When anesthesia is provided, another professional figure is added to the medical staff composed by the gynecologist and his nurses: the anesthesiologist . The anesthesiologist is a doctor who specializes in anesthesia and resuscitation practices.
Instrumentation for Diagnostic Hysteroscopy
The instrumentation for diagnostic hysteroscopy includes: hysteroscope, speculum (vaginal valve), forceps, dilators, cannulae, insufflator, video camera system, sterile gauze, fiber optic cable, CO2 conductor cable etc.
The preparation of this instrumentation - however obviously sterilized properly - takes place while the patient is wearing the gown provided for the procedure.
Did you know that ...
There are two types of hysteroscopes: the hysteroscope for diagnostic hysteroscopy procedures, whose diameter is between 4 and 5 millimeters, and the hysteroscope for operative hysteroscopy procedures, whose diameter is 7-8 millimeters.
How do patients feel during a Diagnostic Hysteroscopy?
Without the practice of anesthesia, the patient subjected to diagnostic hysteroscopy may experience a slight discomfort / pain during the introduction of the hysteroscope into the vagina and cervical canal. This feeling, however, is temporary, as, as readers will remember, the gynecologist follows, when the hysteroscope is introduced, dilation of the uterine cervix and uterus.
What is the Duration of Diagnostic Hysteroscopy?
As a rule, a diagnostic hysteroscopy procedure takes 10-15 minutes .
Did you know that ...
Operative hysteroscopy has a longer duration than diagnostic hysteroscopy; it can last, in fact, between 30 and 60 minutes.
When is the return home expected after a Diagnostic Hysteroscopy?
After a diagnostic hysteroscopy, the patient can return home immediately, even if she has received local anesthesia.
Recovery
Recovery from diagnostic hysteroscopy is quite rapid, so that the patient can return to her working activities (if they are not heavy) already the day after the procedure.
What can a woman do after a Diagnostic Hysteroscopy?
After a diagnostic hysteroscopy, the patient can safely eat and drink as usual, and take a shower.
What can't a woman do after a Diagnostic Hysteroscopy?
For women who have undergone a diagnostic hysteroscopy, gynecologists recommend abstention from sexual activity for about 7 days or, in the presence of vaginal bleeding, up to the end of the latter. This is a precautionary measure to prevent infections .
Risks and Complications
Diagnostic hysteroscopy is a safe procedure for most women. In fact, it is very rare that it can lead to adverse effects or, worse still, complications.
Did you know that ...
On the occasion of a hysteroscopy, the risk of complications is less than 1%, therefore a real rarity.
In general, diagnostic hysteroscopy is less risky than operative hysteroscopy.
Adverse effects
For adverse effects of a diagnostic or operative procedure, the doctors intend to deal with minor and temporary problems.
The possible adverse effects of diagnostic hysteroscopy include:
- Mild vaginal bleeding . Result of injuries caused by the passage of the hysteroscope, along the cervix and cervical canal, this adverse effect can last from a few days to even a little over a week;
- Abdominal pain and cramps . Often, the painful sensation is controllable with an analgesic, such as paracetamol or ibuprofen (an NSAID);
- Feeling tired and / or unwell ;
- Reflex pain in the shoulder, deriving from the use of gas rich in carbon dioxide.
Complications
For complications of a diagnostic or operational procedure, doctors understand problems of a certain clinical relevance, which can take place during or after the aforementioned procedure.
The potential complications of diagnostic hysteroscopy procedures include:
- Uterine perforation ;
- Bladder perforation ;
- The development of an infection at the pelvic level (eg: metritis ).
Curiosity: how common are the complications of diagnostic hysteroscopy?
According to a study by the Royal College of Obstetrics and Gynecology, only 8 patients undergoing diagnostic hysteroscopy per 1, 000 would be subject to uterine perforation and only 3 patients per 10, 000 would experience utero-bladder perforation and a pelvic infection.
How to recognize any complications?
The symptoms that characterize the possible complications of diagnostic hysteroscopy include:
- Intense and protracted abdominal pain that does not fade with the most common analgesics;
- Fever above 38 ° C;
- Large and recurrent vaginal bleeding.
Contraindications
Diagnostic hysteroscopy presents a series of contraindications, which, however, also apply in the case of operative hysteroscopy. Specifically, the contraindications in question are:
- Cervical cancer ;
- Endometrial carcinoma ;
- Pregnancy
- Pelvic inflammatory states, such as endometritis, metritis, pelvic peritonitis, acute vaginitis and acute cervicitis .
Doctors also advise against performing diagnostic hysteroscopy in case of: nulliparity, intact hymen and cervical stenosis .
Results
If the diagnostic hysteroscopy procedure shows the presence of a serious condition, the gynecologist immediately informs the patient of any problems or anomalies and explains the possible treatments.
If, on the other hand, nothing significant emerges from the gynecological examination in question, the results are available after a few days.
In the event that the purpose of diagnostic hysteroscopy is an endometrial biopsy, the results of the latter will be ready within 10-14 days.
