In-Office Procedures

3D Ultrasound and 4D Ultrasound

From an OB/GYN perspective, it is important to get a quality ultrasound in order to evaluate the total health of a baby. Therefore, we are excited to offer 3D and 4D technology to patients in our office here in the Youngstown, OH area. A 3D ultrasound and a 4D ultrasound are upgrade options when compared with regular 2D ultrasounds. Similar to standard ultrasounds, sound waves are used to create an image of the infant in a mother's womb.

3D ultrasound is different in that it shows a three-dimensional image of the baby. Meanwhile, a 4D ultrasound shows a baby's live activity during the procedure in a video-like format. Parents like 3D and 4D ultrasounds because the baby's face is clearly visible, while doctors like 3D and 4D ultrasounds because they show the birth defects that may not show up on a normal ultrasound. If you decide to have either a 3D ultrasound or 4D ultrasound, the best time to have a 3D or 4D scan is when you're between 26 weeks and 30 weeks pregnant.

Colposcopy

A colposcopy is a simple 10 to 15-minute procedure performed at the OBGYN office that allows the doctor to closely examine the patient’s cervix, vagina and vulva for signs of disease. The doctor may recommend a colposcopy if the Pap test shows abnormal results.

During a colposcopy, the patient is positioned on the examination table like she would for Pap smear. After the OBGYN doctor preps the patient for the procedure, the doctor then uses a colposcope—which is a large, microscope that is positioned in front of the vagina to view the cervix. A bright light at the end of the colposcope lets the gynecologist see the cervix clearly. While doing the colposcopy, the OBGYN doctor focuses on the areas of the cervix where changes in an abnormal cervix are seen as white areas. The whiter the area is, the worse the cervical dysplasia is. Abnormal vascular (blood vessel) changes are also apparent through the colposcope. Typically, the worse the vascular changes are, the worse the dysplasia.

If the obstetrician/gynecologist can see an abnormal area with the colposcope, a tissue biopsy is then taken from the abnormal area and sent to the lab for more testing. Note: the doctor may do more than just one biopsy; how many biopsies depend on how many abnormal areas are found. Once the biopsies are done, the doctor then completes an ECC—also known as an Endocervical Curettage—which takes samples from the canal of the cervix.

Test results are usually back within two weeks, at which time the OBGYN doctor has the patient come back to the office to go over the results and determine the next best step to take. After the procedure, the doctor recommends no sex, tampons, or douching for 2 weeks or until the patient comes back for the results. This is so the cervix heals from the biopsies.

Diagnostic and Therapeutic Hysteroscopy

A diagnostic and therapeutic hysteroscopy is an examination of the cervix and the lining of the uterus (endometrium). A woman may need a diagnostic hysteroscopy if she is experiencing:

  • Heavy, prolonged, or irregular menstruation
  • Bleeding after menopause
  • Bleeding due to hormone therapy
  • Difficulty getting pregnant


The obstetrician/gynecologist may also request a diagnostic hysteroscopy if an ultrasound reveals:

  • The lining of a woman’s uterus is thicker than normal
  • A tissue sample is needed to check for abnormal cells that may be cancerous
  • Endometrial biopsies and polypectomies are needed

During an endometrial biopsy, a tissue sample is taken from the lining of the uterus. The sample is later examined for any abnormal cells or signs of cancer. This procedure may be done with or without anesthesia.

Polypectomy is a procedure used to remove polyps that may be the cause of abnormal bleeding. The ultimate goal of the procedure is to stop abnormal bleeding and to inspect the tissue removed to rule out the presence of cancer.

Hysteroscopic Sterilization (Essure®)

Essure is a form of permanent birth control in which the fallopian tubes are blocked using a natural barrier.

Essure offers all of the following:

  • Nonsurgical procedure
  • Short procedure time
  • No general anesthesia
  • Nonhormonal
  • No guessing—the doctor can confirm Essure is in place
  • Quick recovery time
  • Proven 99% effective
  • FDA-approved

Essure does not require cutting into the body or the use of radio frequency energy to burn the fallopian tubes like some other birth control options. Instead, the physician inserts soft, flexible inserts through the body’s natural pathways (vagina, cervix and uterus) and into the fallopian tubes. The very tip of the device remains outside the fallopian tube, which provides the woman and the doctor with immediate visual confirmation of placement.

During the three months following the procedure, the body and the inserts work together to form a natural barrier that prevents sperm from reaching the egg. During this period, a woman must continue using another form of birth control (other than an IUD).

After three months, the OBGYN doctor performs a confirmation test in which a dye and special type of x-ray are used to make sure the inserts are in place and the fallopian tubes are completely blocked.

Unlike birth control pills, patches, rings and some forms of IUDs, Essure does not contain hormones that interfere with the natural menstrual cycle. A woman’s periods should more or less continue in their natural state.

IUD Insertion

One of many birth control options, an IUD is a “T”-shaped birth control device placed inside the uterus to prevent pregnancy. Before the procedure, the OBGYN doctor may test for pregnancy and for sexually transmitted infections or other infections to make sure it is safe for the patient to get an IUD. If a patient has any kind of pelvic infection, she may need treatment before getting an IUD. Before and during the procedure, the doctor explains the procedure, risks and benefits of the IUD. The patient may also be given a pain reliever, such as ibuprofen.

The OBGYN doctor:

  • Has the patient lie on the exam table as she would for a pelvic exam or Pap test
  • Checks the position of the uterus
  • Swabs the cervix with antiseptic
  • Inserts a probe through the cervix to determine how far the IUD should go into the uterus
  • Loads the IUD into an insertion tube, which flattens the arms of the IUD forming the top of the “T”
  • Inserts the IUD through the cervix into the uterus
  • Pulls the insertion tube all the way out
  • Trims the IUD string to about 1 inch from the cervix
  • Removes the forceps and speculum


The patient may experience some cramping during the procedure. Afterward, the obstetrician/gynecologist discusses how to check for IUD placement each month after each period.

Labiaplasty

A labiaplasty is a cosmetic reduction of abnormally enlarged labia. This procedure is performed for a variety of reasons, including correction of damage done to the labia during childbirth or for aesthetic reasons. Before the procedure, conscious sedation is combined with local anesthesia. During the procedure, labial tissue that is redundant, scarred or torn is surgically removed and incisions are closed with small absorbable sutures.

LEEP (Loop Electrosurgical Excision Procedure)


Loop Electrosurgical Excision Procedure (LEEP) treats pre-cancerous conditions (cervical dysplasia) on the cervix. LEEP is used after abnormal Pap results have been confirmed by colposcopy and cervical biopsy. Tissue removed during the procedure is then sent for histological examination.

Local anesthesia is used on the cervix in this procedure. In addition, a thin wire loop electrode is attached to an electrosurgical generator that transmits a painless electrical current. This electric current quickly cuts away the affected cervical tissue in the immediate area of the loop wire, causing the abnormal cells to rapidly heat and burst, and separating the tissue as the loop wire moves through the cervix.

This technique allows the OBGYN doctor to send the excised tissue to the lab for additional evaluation. Further testing ensures the lesion was completely removed and allows for a more accurate assessment of the abnormal area.

Pap Test

A Pap test analyzes a sample of cells taken from a woman's cervix or vagina. The test is done during a pelvic exam and used to look for changes in the cells of the cervix and vagina that show cancer or conditions that may develop into cancer. It is the best tool to detect precancerous conditions and hidden, small tumors that may lead to cervical cancer. If detected early, cervical cancer can be cured.

Pap screen testing:

  • Should begin once sexually active or at age 21, whichever is first
  • Is recommended every three years for women 21-65
  • Is recommended every five years for women 30 to 65 (who have a normal Pap test with a negative HPV test)


A Pap test is not painful but may be somewhat uncomfortable. Here are the steps:

  • The doctor uses a device called a speculum to widen the opening of the vagina
  • The cervix and vagina are examined
  • A plastic spatula and small brush are used to collect cells from the cervix
  • The cells are gathered and placed into a solution
  • The solution is sent to a lab for testing
  • Test results are generally available after about a week


Avoid these things 48 hours before the test to ensure the Pap test is as accurate as possible:

  • Sex
  • Douching
  • Vaginal creams

Removal of Moles or Pigmented Lesions

Removing moles or pigmented lesions is considered an excisional biopsy and is done under local anesthesia. The tissue is then sent for a histological evaluation.

Removal of Vulvar Warts with Electrocautery

Electrocautery removes genital warts on the vulva or around the anus by burning them with a low-voltage electrified probe. A local anesthetic is usually used for pain control, however, a general anesthetic may be advised if the warts are extensive.

Vulvar Procedures

A number of different procedures are offered for the diagnosis and treatment of vulval conditions such as:

  • Vulvodynia
  • Vaginismis
  • Lichen sclerosis

A partial hymenectomy may be recommended in certain cases of chronic vulval pain (vulvodynia) or vulvar vestibulitis—redness and inflammation near the opening of the vagina.

In a partial hymenectomy, conscious sedation is combined with local anesthesia, then the over-sensitive areas of hymenal skin are identified and surgically excised. Small absorbable sutures are placed as needed.