Instrumental Investigations in Gynecological Patients

1. Diagnostic Office Procedures

• Speculum Examination – visualization of the vagina and cervix for discharge, color, erosion, and lesions
• Saline (Plain Slide) / Wet Mount – microscopic examination of vaginal discharge for Trichomonas, Candida, and bacterial vaginosis (clue cells)
• Potassium Hydroxide (KOH) Test – detection of fungal mycelia in vaginal discharge
• Fern Test – cervical mucus spread on a slide to determine ovulation based on fern-like pattern
• Schiller / Acetic Acid Test – painting the cervix with Lugol's iodine or acetic acid to identify neoplastic/precancerous areas
• Biopsy
  • Vulva and Vagina (punch/scalpel biopsy)
  • Cervix (colposcopically directed biopsy or 4-quadrant biopsy)
  • Endometrium (using flexible cannulas such as the Pipelle)
• Colposcopy – binocular microscope (up to 60× magnification) for direct visualization of the cervix; identifies dysplasia and vascular abnormalities
• Hysteroscopy – fiberoptic visualization of the uterine cavity; used for abnormal uterine bleeding, synechiae, polyps, IUD removal, myoma resection, and endometrial ablation
• Culdocentesis – needle aspiration through the cul-de-sac into the pouch of Douglas to obtain peritoneal fluid (blood → ectopic pregnancy; pus → salpingitis; ascitic fluid → malignancy)

2. Radiographic Diagnostic Procedures

• Plain Film (Flat Film X-ray) – identifies calcified lesions, dermoid cyst rings, pelvic masses
• Hysterography (Hysterosalpingography) – contrast medium instilled through the cervix to outline the uterine cavity and oviducts; assesses tubal patency, congenital malformations, submucous myomas, and endometrial polyps
• Sonohysterography – uterine cavity filled with fluid while ultrasound delineates endometrial architecture; detects polyps and other lesions
• Angiography – radiographic contrast to visualize pelvic vasculature; used for postoperative bleeding, cancer-related bleeding, uterine artery embolization for myomas
• Computed Tomography (CT) – high-resolution 2D imaging with contrast; used for retroperitoneal lymphadenopathy, myometrial invasion in endometrial carcinoma, extrauterine spread, pelvic abscesses, and pelvic thrombophlebitis
• Magnetic Resonance Imaging (MRI) – non-ionizing radiation; best for staging and follow-up of pelvic cancers, differentiating tissue types (inflammatory masses, cancers)
• Ultrasonography – painless, radiation-free imaging; used for early and pathologic pregnancy, ovarian and uterine pathology; performed transabdominally (full bladder) or transvaginally