1. Cytodiagnostics Normally cells are released from the mucous membrane of the vagina and uterus, which are the object of study by cytology. The material is collected by a gynecologist or general practitioner with sterile instruments. It is not necessary for the patient to have had sexual intercourse and to have performed other dialysis or medical procedures several days before the examination – at least 2-3. In case of evidence of colpitis or cervicitis, the material is taken after treatment. Cytodiagnosis has two directions: • Hormonal cytodiagnosis – consists in collecting material from the upper third of the vagina on day 5-8 of the monthly cycle. According to characteristic morphological features of the cells and calculation of indexes by counting different types of cells, the hormonal activity of the ovaries is assessed • Tumor cytodiagnosis – the study is used for early diagnosis of cervical cancer. It allows to detect even the smallest deviations in the development of epithelial cells. The material for examination, according to recent studies, is best taken with a cervical brush – so the cells are of the highest quality and vital for observation. The basis of the method was laid by George Pappanicolaou, from where the name of the results system – Pap – the system: Pap I – normal cells; Pap II – atypical cells, but without malignant changes; a characteristic result in the presence of inflammation; Pap III – cells suspicious for malignancy without it being obvious; Pap IV – cells highly suspicious for malignancy; Pap V cells with definite evidence of malignancy. 2. Colposcopy This is an endoscopic method for examining the lower genital tract – cervix, vagina, vulva, perineum and anus. Optics are used, increasing the image 40 times. The test is performed by applying three different solutions and recording changes in the color of the mucosa afterwards. The acetic acid test looks for areas that turn white—typical of atypical cells. Lugol’s solution (iodine-based) stains normal mucosa dark brown, and areas with atypical cells remain unstained. The third solution is methylene blue, which stains only atypical cells blue. 3. Probing the uterus Also called hysterometry. This is a method of determining the condition of the cervical canal and uterine cavity. It is performed before other invasive manipulations – abortion, curettage, conization of the cervix, insertion of an intrauterine pessary. The examination is performed under venous anesthesia with a special instrument – a probe, with a ball on the tip, which prevents injury to the uterus when it reaches its bottom. 4. Puncture of the Douglas space The Douglas space is the lowest point of the abdominal cavity, where it is possible to deposits liquid. Puncture through the posterior vaginal wall has important diagnostic value in confirming or rejecting hemoperitoneum or purulent collection. The obtained material is examined cytologically and microbiologically. NEWS_MORE_BOX 5.Extended biopsy – conization It is applied to patients who need a detailed diagnosis of the cervix. Modern gynecology uses both classical surgical conization and laser excision. Surgical conization consists in cutting with a scalpel a cone-shaped piece of the cervix, the base of which covers the altered area. The procedure is performed under anesthesia and requires a hospital stay of at least 24 hours. An advantage of this method is the provision of fully suitable material for and minimal risk of missing invasion. In laser excision, material is taken for examination using a laser. The advantages are high efficiency, safety and atraumaticity. Electrosurgical excision is another method of conization. With it, a piece of tissue is taken from the cervix using an electric loop. A disadvantage is the risk to histological evaluation due to thermal changes in the material. 6. Curettage If material from the endometrium is needed, it is taken by curettage. The uterine curette is a metal elliptical loop that can scrape mucosa only when pulled out. It is introduced carefully to the bottom of the uterus and with moderate pressure on the wall is pulled out. There are several types of curettage. The ribbon is performed using a small curette inserted to the bottom of the uterus. It is pulled out once and scrapes the anterior uterine wall. The resulting strip is fixed and sent to the laboratory. This type of curettage is suitable for studying cyclic changes in the endometrium. The test serves in a diagnostic plan to determine the functional state of the endometrium, the presence of volume-occupying processes, precancerous and cancerous changes of the uterine mucosa. It is performed under a short intravenous anesthesia in two stages: first, expansion of the cervical canal and second, the curettage itself.The ribbon is performed using a small curette inserted to the bottom of the uterus. It is pulled out once and scrapes the anterior uterine wall. The resulting strip is fixed and sent to the laboratory. This type of curettage is suitable for studying cyclic changes in the endometrium. The test serves in a diagnostic plan to determine the functional state of the endometrium, the presence of volume-occupying processes, precancerous and cancerous changes of the uterine mucosa. It is performed under a short intravenous anesthesia in two stages: first, expansion of the cervical canal and second, the curettage itself.The ribbon is performed using a small curette inserted to the bottom of the uterus. It is pulled out once and scrapes the anterior uterine wall. The resulting strip is fixed and sent to the laboratory. This type of curettage is suitable for studying cyclic changes in the endometrium. The test serves in a diagnostic plan to determine the functional state of the endometrium, the presence of volume-occupying processes, precancerous and cancerous changes of the uterine mucosa. It is performed under a short intravenous anesthesia in two stages: first, expansion of the cervical canal and second, the curettage itself.