Understanding Routine Gynaecological Procedures: What You Need to Know

Taking charge of your reproductive health is a vital part of overall well-being, especially for women aged 25–45. Whether you’re planning a pregnancy, managing menstrual health, or simply aiming to stay informed, understanding routine gynaecological procedures can help you feel more confident and prepared when visiting your gynaecologist. 

The why and how of a regular gynecological check-up

Several women in India are careless about their health – they choose to self-medicate or try out home remedies and it is often only when things are going out of hand, that they choose to go to a medical professional. Rather than leaving things for the last minute, going for a annual or bi-annual gynecological check-up is your investment in your own health. 

 

1. The Routine Gynaecological Check-Up

Routine gynaecological check-ups are extremely an important part of preventive health care for women. These visits help identify potential health issues early and provide an opportunity to tackle any major issues like infections, cancer diagnosis and vaccinations early. Here’s what a typical check-up involves:

• Medical History and Discussion: The appointment begins with a conversation about your medical history, menstrual cycle, sexual health, and lifestyle. This discussion helps your doctor understand your basic health and the impact it may have on your reproductive health. . 
• Physical Examination: A general physical exam includes checking your blood pressure, weight, and heart rate. 
• Pelvic Examination: This involves examining the external and internal reproductive organs. This is called a per speculum (PS) and a per vaginal (PV) examination. This is a must when you visit your gynaecologist if you are or have been sexually active. This examination checks for abnormalities in your vagina and cervix on visualization of these organs by inserting an instrument called the Cusco’s speculum into your vagina. It is mostly a painless procedure and you might feel a slight stretching of your vagina during the procedure. The per vaginal examination involves the doctor palpating your uterus , ovaries and pelvic internal organs via two fingers inside your vagina and mild pressure on the lower abdomen. This is important to understand whether these organs are enlarged abnormally or to look for unusual masses or tenderness in your lower abdomen.  
• Breast Examination: Your doctor may also perform a breast exam to check for lumps, changes in size, or any unusual findings. This involves gently palpating your breast with the finger tips in all 4 quadrants of your breasts and your armpits to look for any lumps. 

Apart from these regular gynaecological procedures, there are certain other tests and checks that your doctor might suggest. 

2. Screening Tests: Key to Early Detection

Regular screenings are vital for detecting conditions like cervical cancer, sexually transmitted infections (STIs), and hormonal imbalances. Some of the most common screening tests include:

• Pap Smear (Pap Test): This test collects cells from the cervix to screen for abnormalities that could indicate cervical cancer or pre-cancerous changes. Women aged 35–65 are typically advised to undergo this test every three to five years, depending on individual risk factors. This test involves a per speculum examination with visual inspection of the cervix and vagina and taking a gentle swab with a silicon brush and sending it for microscopic examination to the histopathologist. This smear is graded by the number of abnormal cells seen and the severity of abnormalities. This test is often a precursor of surgeries to confirm cervical cancer and is very important.  
• HPV Testing: Human papillomavirus (HPV) testing is often done alongside a Pap smear, as HPV is the cause of over 90% of  cervical cancers. The HPV test is done from the same sample as that of the PAPS smear.  
• STI Screening: Tests for sexually transmitted infections like chlamydia, gonorrhoea, and Herpes can be done based on your sexual history or symptoms. This involves taking a vaginal swab and sending it to a microbiologist for growth in culture media and checking their sensitivity to different antibiotics.  
• Ultrasound Scans: Pelvic or transvaginal ultrasounds may be used to assess the uterus, ovaries, and fallopian tubes, particularly if you’re experiencing symptoms such as irregular periods, pain, or infertility. This can be done on an out-patient basis and can be done via trans-abdominal method or trans-vaginal method.  

3. Procedures for Menstrual Irregularities

For women experiencing issues like heavy periods, irregular cycles, or severe cramping, specific diagnostic and treatment procedures may be performed:

• Endometrial Biopsy: A small tissue sample is taken from the uterine lining to investigate abnormal bleeding or rule out conditions like endometrial hyperplasia or cancer. This is usually done in an operation theatre under anaesthesia after doing the appropriate pre-operative investigations. Sometimes, it can be done with a small cannula on an out-patient basis.  
• Hysteroscopy: This minimally invasive procedure involves inserting a thin camera (hysteroscope) into the uterus to view the lining and diagnose or treat issues such as polyps, fibroids, or abnormal bleeding. This can be done on an out-patient basis without anaesthesia and is called office hysteroscopy. But in case a surgery or tissue sampling is needed, this procedure is called operative hysteroscopy and is necessarily done under anaesthesia.  
• Dilation and Curettage (D&C): This procedure removes tissue from the uterus, often to diagnose the cause of abnormal bleeding or remove retained products of conception in an incomplete miscarriage.  

4. Family Planning and Contraceptive Procedures

This involves certain OPD procedures for delaying or avoiding pregnancies.

• IUD (Intrauterine Device) Insertion or Removal: IUDs are a popular long-term contraceptive option. The procedure for insertion is quick and performed in a clinic setting, with minor discomfort for most women. 
• Tubal Ligation: Often referred to as “getting your tubes tied,” this is a permanent surgical procedure for contraception. This is done in an Operation Theatre , mostly laparoscopically or by cutting open the abdomen in a small 3-4 cm incision called Mini-Lap TL. This is only done once the consent of both you and your spouse have given consent for the same and both your children have completed their major vaccinations usually by the age of 3-5 years of age.  
• Fertility Assessments: These may include hormonal blood tests, ovulation tracking, and regular ultrasonography for the same . Regular follow-ups are essential to confirm ovulation and fertility.  

5. Procedures for Pelvic Pain or Reproductive Conditions

Pelvic pain or suspected conditions like fibroids, endometriosis, or ovarian cysts may require diagnostic or therapeutic procedures:

• Laparoscopy: This minimally invasive surgery involves inserting a thin, lighted instrument (laparoscope) attached to a special camera through a small 1 cm incision in the abdomen. Gas is filled in your abdomen to enable visibility and surgery.  Special operative instruments are then inserted through smaller 5 mm incisions to do the surgery by watching on a screen in front of the surgeon.
• Myomectomy: This surgery removes uterine fibroids while preserving the uterus. It can be done laparoscopically or via an open surgery by cutting the abdomen. 
• Ovarian Cyst Removal: Large or symptomatic ovarian cysts may be surgically removed to relieve pain and prevent complications. This is usually done laparoscopically unless cancer is suspected or diagnosed.  

6. Addressing Cervical and Uterine Health Issues

• Colposcopy: If a Pap smear reveals abnormal cells,a colposcopy directed biopsy is performed under direct visualization of the abnormal areas of the cervix. 
• LEEP (Loop Electrosurgical Excision Procedure): This procedure removes abnormal or precancerous cells from the cervix using a thin, electrified loop of wire. 
• Hysterectomy: In cases of severe uterine problems like cancer, fibroids, or endometriosis or severe abnormal uterine bleeding not managed by medicines, a hysterectomy is done. Depending on the condition, this can be done through the abdomen, vagina, or laparoscopically. 

7. Pregnancy and Postpartum Care Procedures

• Prenatal Screenings: Regular blood tests, ultrasounds, and genetic screening tests help monitor fetal development and maternal health during pregnancy. 
• Amniocentesis or Chorionic Villus Sampling (CVS): These diagnostic tests check for chromosomal abnormalities in the baby if indicated. 
• Cesarean Section (C-Section): When a vaginal delivery isn’t possible or safe, a cesarean delivery is performed. 
• Postpartum Repairs: Procedures like perineal repair (for tears during delivery) or treatment for pelvic organ prolapse may be necessary after childbirth. 

Tips for a Comfortable Gynaecological Visit

For many women, visiting the gynaecologist can feel intimidating or uncomfortable, even if they are visiting the best gynaecologist in Mumbai. Here are some tips to make your experience smoother:

1. Communicate Openly: Share your symptoms, concerns, and medical history honestly. Our gynaecologist is there to help, not judge. 
2. Schedule Smartly: Avoid scheduling an appointment during your period, unless the issue is related to menstrual bleeding. 
3. Prepare Questions: Write down any questions or concerns beforehand so you don’t forget them during your visit. 
4. Relax and Breathe: Pelvic exams can feel invasive, but deep breathing and relaxation techniques can help reduce discomfort. 

Routine gynaecological procedures are an essential part of a woman’s health journey. By staying informed and proactive, you can take control of your reproductive health and address any issues early. Trust your gynaecologist to take the right decision for you and your health so your quality of life does not get impacted by your gynecological problems.  At Tulsi Clinic, you will have access to not only the best doctors but also the finest array of services.