GYNECOLOGY
The gynecological visit, even in the absence of disturbances, is useful for prevention and control of the health of the female genital system. In fact, prevention means taking care of your well-being on a regular basis, as well as following a correct lifestyle made up of healthy eating, movement and hygiene standards to be respected.
The guidelines of the ACOG (American College of Obstetricians and Gynecologists) on women’s health indicate between 13 and 15 years the age for the first visit to the gynecologist as an opportunity for prevention, both on personal and sexual well-being. And if you have even occasional sexual intercourse, the advice is to make a gynecological visit a year.
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How a visit to the gynecologist takes place
As in all medical visits, even during gynecological visits there is a first moment dedicated to questions from the specialist to the patient (previous illnesses, allergies, current ailments, but also lifestyles, medicines, interventions and pregnancies, family pathologies), useful for collecting the information necessary to take the medical history and to outline a precise picture of her state of health, before proceeding with the physical examination of the internal (vagina, uterus, ovaries) and external (vulva) female genitalia, through visual inspection , manual exploration and the aid of a speculum. The visit usually does not cause any pain, and it is important that the patient is not afraid.
Withdrawals for screening exams
In the Florentine and Milanese structures where I receive patients, I can complete the gynecological examination with outpatient blood and urine samples or for screening tests (such as the Pap test and the search for HPV – papilloma virus) to be sent to the laboratory for analysis, and/or with a pelvic or transvaginal ultrasound, equally painless (to exclude the presence of fibroids, ovarian cysts, endometrial polyps and other pathologies of the vagina, uterus and ovaries), or even analyzes and preparatory tests for PMA (medically assisted procreation).
Empathy at the center of the visit
In my role as a gynecologist, during the visits I make in Milan and Florence, I try to empathize with my patient, who can often be intimidated the first time, and to put her at ease: I try to act with patience and delicacy in course of manual checks, and to be scrupulous and exhaustive in listening or in medical explanations.
Diagnostic techniques and most important gynecological tests
Below is a list and explanation of the most important gynecological diagnostic techniques, with an indication of those that can be performed during my gynecological visit. For all the other tests, I make use of a network of specialists and dedicated structures, to whom I can refer my patients if the need arises.
Pap smear:
it is a screening test which consists in taking the cells found on the neck of the uterus and inside the cervical canal with special instruments (spatulas and brushing). The material is placed in a special test tube and analyzed under a microscope. This method is an important screening test for the prevention of cervical cancer. Tests I perform in the office.
HPV tests:
research of viral DNA and typing of HPV genotypes in the context of the pap test. It is an important exam as the presence of HPV is an important risk factor for the development of cancer of the uterine cervix. Tests I perform in the office.
Vaginal pH test:
the determination of the vaginal pH can already guide the normality of the vaginal microbiome.
Microbiological tests:
vaginal, endocervical and endourethral swab for the search of common germs, chlamydia, ureaplasmas, mycoplasmas, gonococcus, trichomonas. Tests I perform in the office.
Vulvoscopy:
it consists in the observation with a magnifying glass of the vulva, to highlight some pathologies and lesions. (lichen sclerosis, vulvar condylomas, etc.) Examination to be performed in dedicated structures.
Colposcopy:
consists in the observation, with an instrument called a colposcope, of the mucous membrane of the vagina and the uterine cervix. Colposcopy is indicated in the presence of an abnormal Pap smear or speculum observation of suspicious areas. During the colposcopy it is also necessary that the surfaces to be examined are gently swabbed with a cotton ball soaked in acetic acid and, subsequently, in an iodine solution (Lugol’s solution). These substances, applied to the mucous membranes under examination, have the ability to highlight any abnormal areas that may be present. Exam to be performed in dedicated facilities.
Ultrasound:
it can be transabdominal, performed with a full bladder, and transvaginal, with a particular probe that is inserted into the vagina and allows for a closer and more detailed visualization of the pelvic organs. Exam I take in the office.
SIS or sonohysterography:
it is an examination that allows the ultrasound visualization of the uterus and fallopian tubes; it consists of injecting a few cc of contrast fluid into the uterine cavity on an outpatient basis, using a small catheter positioned in the uterus via the transcervical route. The uterine cavity thus distended can be studied by transvaginal ultrasound, allowing the evaluation of tubal patency. Exam I take in the office.
Endometrial biopsy:
endometrial sampling without hysteroscopy, histological analysis of the endometrium, endometrial culture and research of plasma cells and NK preparatory examination for PMA techniques for infertility, under certain conditions. Exam that I perform in the studio in the Madra and TreeofLife centers.
Hysterosalpingography:
it is an examination that allows a morphological analysis of the uterus and tubes. It consists of injecting a contrast medium into the uterine cavity, transcervically, via a special catheter, then performing some x-rays to visualize the uterine cavity and tubes, obtaining negative images of these structures. Exam to be performed in dedicated facilities.
Hysteroscopy:
it consists in the observation of the uterine cavity by introducing a rigid instrument called a hysteroscope into the cervical canal and uterus. The examination is carried out in case of suspicion of pathology inside the uterus cavity. Exam to be performed in dedicated facilities.
Diagnostic videolaparoscopy:
it is a test performed in very particular conditions, as it is a real surgery which consists in the introduction of a fiber optic probe inside the abdomen after making a small incision at the umbilical level. Exam to be performed in dedicated facilities.
Mammography:
still represents the best screening method for breast cancer. Tumor lesions that are not yet palpable can be identified. The radiations absorbed during the examination are negligible, above all if compared to the advantages. Exam to be performed in dedicated facilities.
Breast ultrasound:
it finds indication for the study of the breast if the woman is less than forty years old and is used to complete the mammography or for the biopsy of lesions previously found. Exam to be performed in dedicated facilities.
Computerized Bone Densitometry:
represents the reference method in the diagnosis of osteoporosis as it measures the mineral heritage of the skeleton, mainly made up of calcium, and allows for the evaluation of small variations in bone mineral density over time. Exam to be performed in dedicated facilities.
Prenatal Safe:
blood sampling with research of fetal DNA in maternal blood for the screening of fetal chromosomal disorders. Tests I perform in the office.
Couple karyotype:
blood sampling with analysis of the couple’s chromosomes as a preparatory test for PMA. Tests I perform in the office.
Thrombophilia tests:
blood sampling with search for the genetic mutations responsible for the increased risk of thrombosis. Tests I perform in the office.
Food intolerance test:
painless buccal mucosa collection for the search for the main food intolerances and celiac disease. Tests I perform in the office.
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As an obstetric gynecologist I receive my patients every week in the offices of Milan and Florence.