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Vaginoscopy

Vaginoscopy is a diagnostic procedure for inspecting the vagina. Also known as the 'no-touch procedure' Vaginoscopy is most commonly performed in children or more specifically young prepubescent girls.


A cystoscope is used for Vaginoscopy. The visuals aid in diagnosing anatomical abnormalities or lesions affecting the vaginal wall.


When do parents seek appointment ?

Parents seek appointment with doctors when their little girl complains of vaginal pain with or without foul smelling vaginal discharge. It could be due to an infection that is treatable. But there are instances linked to sexual abuse, congenital malformations, vulvar skin disease, vaginal neoplasms and presence of a foreign body. Discharge or bleeding may also be caused by trauma to the area or a sexually transmitted infection.

Health care professionals have a great degree of responsibility in assessing each patient and being sensitive to possible hidden or underlying concerns of parents regarding doubts of molestation. Likewise, clinicians educate the parents not to worry that Vaginoscopy may affect the child's virginity. There is no harm to the tissues including the hymen.


Vaginoscopy Indications

To a great extent, gynecological diseases in childhood and adolescent are primary reasons for unexplained pain or discharge or bleeding from vagina. When parents consult General Practitioner, the first line of treatment is prescribing medicines and tips to improve hygiene. If a clinical examination (pelvic exam) does not help, the family doctor or gynecologist would then recommend Vaginoscopy. Also, pelvic ultrasound, plain radiography and MRI are not always helpful in detecting and diagnosing.


  • Recurrent vulvovaginitis

  • Vaginal bleeding

  • Recurring genital infections

  • Foreign bodies

  • Tumors

  • Traumas after accidents and sexual crimes

  • Abnormalities (intersexuality, malformations)

  • Premature or delayed development

  • Gyneco-surgical diseases

  • Gyneco-urological diseases

Preparing for Vaginoscopy

In all, it takes one hour for the entire procedure. Examining the vagina through Vaginoscopy takes few minutes. Vaginoscopy is done in the operating suite under sedation or anesthesia. Post admission, topical anesthetic is applied to the vulva, about five minutes before inserting the vaginoscope. To reduce the anxiety or apprehension the child may have, the clinician takes simple yet effective proactive steps. For example, the child is informed that she will be able to see in the video monitor what that the doctor sees inside her body.


The operative procedure begins with surgical positioning of the patient on the operating table. Then the doctor in-charge will gently put the lubricated cystoscope into the vagina. All care is taken to prevent nil damage to the hymen. The doctor will look at the video monitor to see if there is anything abnormal. If any foreign object is stuck inside, the doctor can view the object with the cystoscope. A swab from the wall of the vagina is taken to test for infection. After the procedure is completed, polydine solution, an antiseptic combination is used to prevent urinary tract infection.

The result of the procedure and the swab test is reviewed by the surgeon. The consulting team includes pediatric urologist and gynecologist to determine the best plan of care for the child. The course of action is discussed with the parents of the young girl.


In terms of physical discomfort after Vaginoscopy, the bladder can be irritated. The child may express frequent need to urinate. It is best for the child to empty the bladder rather than 'holding' back. While urinating, for a few days it is normal to see a small amount of blood in the urine. The doctor would recommend the patient to drink plenty of water. The amount of water intake directly impacts the color of the urine. Unless specifically informed by the doctor, the child can resume normal activities the very next day.


Cystoscopy

Cystoscopy is done to examine and diagnose disorders of the urinary bladder and urinary tract. In this procedure, the internal structure of the urinary bladder and the urinary tract can be examined by using the cystoscope. Cystoscopes are administered as both diagnostic and treatment tools. Cystoscopy is predominantly done for patients experiencing recurrent urinary tract or bladder infection, urinary incontinence, hematuria and pain because of obstruction in the urinary tract. The procedure is performed by a urologist by inserting a tube called cystoscope through the urethra to identify disorder.


Cystoscopy Procedure

The duration of the procedure depends upon the condition of the patient. The procedure usually lasts about 45 minutes and it is performed under local, spinal or general anesthesia. Pathological specimens of the urinary bladder can also be obtained by using cystoscopes. Patients are advised to abstain from taking food or water six hours prior to the procedure. In case of rigid cystoscopy, the inserted cystoscope is used to remove any kind of lesions present in the urinary tract or the bladder. In the flexible cystoscopy procedure, the internal lining of the urinary bladder and the urinary tract are examined for abnormalities.

With cystoscopy, small bladder stones or foreign objects can be removed; thereby eliminating surgical intervention. Cystoscopy is useful in examining enlarged prostate, kidney stones and urethral blockage. This procedure is used to place urethral catheters or stents.

Complications of Cystoscopy

The complications associated with the cystoscopy procedure are mostly due to a perforation in the urinary tract. These perforations are caused during the procedure and might lead to urinary tract infection and bleeding. In men epididymitis occurs if testicles are involved during the procedure. The other complications include difficulty in passing urine and abdominal pain. In order to avoid the onset of urinary tract infection after the procedure patients are advised to take fluids preferably water every hour.


Bladder Cancer

Bladder cancer usually surfaces in the lining of the bladder (transitional cells )and later spreads to other areas. Cases of bladder cancer are mostly noticed in persons over 60 years. Bladder cancer is often hereditary. Smoking and exposure to toxic chemicals increase the risk of bladder cancer. Men are more likely to develop bladder cancer than women. Persons who have repeated instances of urinary infection or have been using catheters for long are at increased risk for bladder cancer. Superficial bladder cancer in the initial stages indicates that the cancer is restricted to the surface of the inner lining of the bladder. Later it spreads to the inner lining and invades the wall of the bladder. The surrounding tissues, lymph nodes and other organs are the next to get affected by the cancerous cells.


Symptoms of bladder cancer include pain during urination and increased frequency of urination. The patient suffering from bladder cancer is likely to have pelvic pain. Blood is noticed in the urine. Blood clots are also sometimes noticed in the urine. Often there are no symptoms during the early stages of bladder cancer. A urologist will check the functioning of the kidneys and conduct a physical examination. IVU (Intravenous Urogram) is a diagnostic imaging tool that allows the doctor to examine the kidneys, ureters and bladder. Blood tests and chest x-ray aids in diagnosis of bladder cancer. The urologist might use a cystoscope to examine inside the bladder. A biopsy is often conducted.


Surgery, chemotherapy or radiation therapy are resorted to while treating bladder cancer. The treatment is based on the stage of bladder cancer. Drinking plenty of water and increasing the consumption of cruciferous vegetables such as cabbage and broccoli can minimize the chances of developing bladder cancer.

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Bibliography / Reference

Collection of Pages - Last revised Date: September 23, 2019