Cultures

Bacterial cultures can sometimes be helpful in determining the cause for vaginal or vulvar symptoms such as pain, burning or itching. The cultures can be in addition to a wet mount, or supplementary to a wet mount.

Bacterial cultures for Strep, E. coli and other pathogens may then indicate a course of treatment that would not necessarily be obvious from either the gross appearance of the vagina or the wet mount.

STDs

Some physicians routinely test for gonorrhea and chlamydia on all of their patients at each routine visit. Others test for these STDs only among high risk patients or those with unexplained pelvic pain. The wisest course for you depends on the frequency with which these STDs are found in your population.

Blood in the Stool

While some physicians routinely perform a rectal exam on all patients, others perform a rectal only on selected individuals in certain clinical circumstances, such as after age 50.

Routine screening with sigmoidoscopy every 5 years after age 50 is recommended by many physicians.

After the rectal exam, the small particles of stool left on the examining glove can be evaluated for the presence of occult blood. This is most useful after the age of 50.

Screening for occult blood is not needed in the presence of frank rectal bleeding. The indication for evaluation is already present.

Wet Mount

Vaginal discharge can be evaluated using a “wet mount.”

Mix a small amount of discharge with 10% potassium hydroxide (KOH), place it on a glass slide and cover it with a coverslip. The KOH dissolves cell membranes, making it easier to see yeast organisms under the microscope.

Mix another small amount of discharge with a drop of normal saline, place it on a glass slide with a coverslip, and examine it under the microscope. With saline, active trichomonad organisms can be seen moving and “clue cells,” indicating bacterial vaginosis can be seen.

Ultrasound

This scan can be done abdominally, transvaginally, or both. The abdominal scan tends to give a larger field of view, but less detail, particularly for structures deep in the pelvis and partially hidden by the pubic symphysis. See Gynecologic Ultrasound Scan.

Mammography

Mammography is a useful method of evaluating the breasts for the possible presence of early malignancy.

While not 100% accurate, mammography is probably around 80% accurate, particularly in detecting the very small, early malignancies not appreciated by physical examination.

Recommendations for frequency of mammograms vary, but the following general guidelines can be followed:

Women with a disquieting symptom (eg bloody nipple discharge) or physical finding may benefit from an indicated mammogram.

Women with no significant high risk factors will probably benefit from routine mammogram screening every other year, from age 40 to 50, and annually after age 50.

Women with a strong family history of breast cancer or other significant high risk factor may benefit from more frequent mammogram screening, and starting at a younger age.