How do gynecologists proceed with diagnosing Ovarian Cysts?

Although we do not see an increase in the rate of ovarian cysts after tubal reversal surgery, polycystic or simply cystic ovaries are one of the concerns some patients have expressed after tubal reversal surgery. For most, a thorough and complete examination after the tubal reversal surgery, or close monitoring after the tubal reversal surgery will alleviate these fears.  Predicting whether a cyst is benign or malignant is not always straightforward. Clinical examination such as serum concentrations of CA 125, and ultrasonography are the main diagnostic protocols available. Clinical examination is often unsatisfactory, with 30-65% of ovarian tumors being unnoticed and mostly overlooked by most doctors. Ultrasound studies of ovarian cysts confirm the presence or absence of cysts in nearly all cases. When combined with a pelvic exam, this will lead to diagnosing close to 100% of all cysts. Vaginal ultrasonography is one of the most widely performed and accurate procedure for prediction of the benign nature of a cyst.

How do Gynecologists conduct the evaluation?

1. Gynecologists extract a detailed medical history of the patient and perform a physical examination. During the physical examination, the expert gynecologist will perform a pelvic exam.

2. In a regular pelvic exam the gynecologist will place an instrument called a speculum into the vagina and will examine the vaginal walls and the cervix. The gynecologist takes number of samples of vaginal discharge or perform a Pap smear (removing cells from the cervix with a small brush). Samples are sent to a laboratory for microscopical examination.

3. The gynecologist will test by performing bimanual exam by inserting two fingers into the vagina and placing the other hand on the abdomen to examine the size and shape of the uterus and ovaries. Ovaries sometimes may feel larger than normal and, in this exam, may make the patient have discomfort. Cysts are often felt by manual checkup and the gynecologist will suggest additional laboratory and diagnostic tests.

4. Some of the common Laboratory tests include;
a) complete blood count (CBC) & WBC to perceive infection, if any.
b) pregnancy test is done to identify ectopic pregnancy.

5. Diagnostic tests often include an ultrasound, Doppler studies, Vaginal ultrasonography, and if needed, an x-ray and laparoscopy.

6. Ultrasound is mostly done to able to shows size, numbers and what the cysts are made of.If the patient having the cyst is consisted of solid materials or a combination of fluid and some other solid materials, the gynecologist may suggest an x-ray to find whether it is a benign cyst or a malignant tumor.

7. Laparoscopic procedure involves the placing of a laparoscope (a narrow tube with a fiberoptic light at one end) into the lower abdomen. This is done via a small incision just below the navel to detect the ovaries. In case your gynecologist feels the necessity, he may drain the fluid from the cyst, or he can remove the cyst entirely.

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