1. Investigational Methods in Gynecology Michal Mára Dept. of Obstetrics & Gynecology, 1 st Medical Faculty of Charles University Prague

2. basicbasic inflammatory diseases / pelvic paininflammatory diseases / pelvic pain gyn-endocrinologygyn-endocrinology infertility & ARTinfertility & ART urogynecologyurogynecology gyn-oncologygyn-oncology Investigational Methods in Gynecology

3. Basic methods external physical examination (vitals !, acute abdomen !, external genitalia)external physical examination (vitals !, acute abdomen !, external genitalia) spec.spec. vag. (bimanual)vag. (bimanual) rectalrectal lablab USGUSG

4. Ultrasonography findings, not diagnosisfindings, not diagnosis abdominalabdominal transvaginaltransvaginal transperineal, rectaltransperineal, rectal Doppler !Doppler ! other imaging methods (non-gynecologists)other imaging methods (non-gynecologists)

5. Interdisciplinary approach sub-specialists inside OB&GYNsub-specialists inside OB&GYN IC specialistsIC specialists surgeonssurgeons urologistsurologists othersothers nurses, midwifesnurses, midwifes

6. basicbasic inflammatory diseases / pelvic paininflammatory diseases / pelvic pain gyn-endocrinologygyn-endocrinology infertility & ARTinfertility & ART urogynecologyurogynecology gyn-oncologygyn-oncology Investigational Methods in Gynecology

7. colpitis (vulvo-vaginitis), cervicitiscolpitis (vulvo-vaginitis), cervicitis not always pathologynot always pathology mycosis (C.albicans)mycosis (C.albicans) BVBV native microscope, culturesnative microscope, cultures special exams (PCR)special exams (PCR) Vaginal discharge

8. PIDPID wide ddx ! (gyn x non-gyn)wide ddx ! (gyn x non-gyn) history & clinical picturehistory & clinical picture USG, culturesUSG, cultures lab.: inflammatory markers !lab.: inflammatory markers ! laparoscopylaparoscopy (Sub)Acute pelvic pain

9. Endometriosis (or normal finding)Endometriosis (or normal finding) wide ddx !!! (gyn x non-gyn)wide ddx !!! (gyn x non-gyn) history & clinical picturehistory & clinical picture USG, cultures, lab tests (Ca 125)USG, cultures, lab tests (Ca 125) invasiveness !invasiveness ! ATB !ATB ! laparoscopylaparoscopy Chronic pelvic pain

10. basicbasic inflammatory diseases / pelvic paininflammatory diseases / pelvic pain gyn-endocrinologygyn-endocrinology infertility & ARTinfertility & ART urogynecologyurogynecology gyn-oncologygyn-oncology Investigational Methods in Gynecology

11. children (puberty)children (puberty) tests before COC or HRTtests before COC or HRT PCOsPCOs CAHCAH premature ovarian failurepremature ovarian failure climacteric medicineclimacteric medicine RIARIA Endocrinology

12. basicbasic inflammatory diseases / pelvic paininflammatory diseases / pelvic pain gyn-endocrinologygyn-endocrinology infertility & ARTinfertility & ART urogynecologyurogynecology gyn-oncologygyn-oncology Investigational Methods in Gynecology

13. primary x secondaryprimary x secondary infertility x repeated abortions (terminology)infertility x repeated abortions (terminology) social problem (10-20%)social problem (10-20%) Infertility

14. tuboperitoneal (HSG, laparoscopy)tuboperitoneal (HSG, laparoscopy) anovulation (BT, USG, progesterone)anovulation (BT, USG, progesterone) male factor (sperm analysis)male factor (sperm analysis) basal hormones assay (FSH, LH, E2, PRL, TSH, androgens from 2 nd till 4th day of cycle)basal hormones assay (FSH, LH, E2, PRL, TSH, androgens from 2 nd till 4th day of cycle) genetics, reprod. immunology (PCT), …genetics, reprod. immunology (PCT), … Infertility & ART

15. basicbasic inflammatory diseases / pelvic paininflammatory diseases / pelvic pain gyn-endocrinologygyn-endocrinology infertility & ARTinfertility & ART urogynecologyurogynecology gyn-oncologygyn-oncology Investigational Methods in Gynecology

16. urinary incontinence (stress + urgent)urinary incontinence (stress + urgent) R/O infectionR/O infection historyhistory functional tests (pad-weight)functional tests (pad-weight) urodynamicsurodynamics USGUSG Urogynecology

17. basicbasic inflammatory diseases / pelvic paininflammatory diseases / pelvic pain gyn-endocrinologygyn-endocrinology infertility & ARTinfertility & ART urogynecologyurogynecology gyn-oncologygyn-oncology Investigational Methods in Gynecology

18. depends on locationdepends on location screening !??screening !?? tumor markerstumor markers imaging methods + furtherimaging methods + further pre-bioptic tests / LEEP cervixpre-bioptic tests / LEEP cervix US, D&C, hysteroscopy endometriumUS, D&C, hysteroscopy endometrium US / Ca 125, surgery ovaryUS / Ca 125, surgery ovary Oncology

19. colposcopycolposcopy cytologycytology PAP smear (I-V) PAP smear (I-V) Bethesda system Bethesda system Pre-bioptic tests (cervix)

20. Diagnosis & Tx (minimally invasive surgery)Diagnosis & Tx (minimally invasive surgery) Hysteroscopy, LaparoscopyHysteroscopy, Laparoscopy Colposcopy, culdoscopyColposcopy, culdoscopy Fetoscopy, faloscopy, fertiloscopy (TVHL)Fetoscopy, faloscopy, fertiloscopy (TVHL) Gyn-endoscopy