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By Michele Hickford
Published: Monday, January 21, 2008 - 02:40

I know they mean well, but I really wish doctors weren't so interested in sticking things all the places the sun doesn't shine. The variety and purpose of diagnostic tools at your physician's disposal gets wider by the day - the problem is, your holes aren't getting any bigger to accommodate them. Still, it beats the heck out of getting cut open. Here are ten of the most common diagnostic tests that go "up yours" one way or another (and I can tell you, 5 of them have already gone up mine).

10. Pelvic Exam

If you're female, and over the age of about 13, you know ALL about this. For you gentlemen, welcome to our world. The annual pelvic exam is used to assess the health of the vagina, uterus, fallopian tubes and ovaries and generally consists of two parts: a speculum exam and manual exam. For the exam, you undress from the waist down and cover your lower half with something like a disposable paper tablecloth. You lie on your back on the examining table with your knees bent and put your feet in metal footrests (stirrups). Then you spread your knees apart.

For the first part of the examination, the doctor will insert a device called a speculum in order to separate the walls of your vagina so he or she can see inside. The speculum consists of a hollow cylinder with a rounded end that is divided into two hinged parts, somewhat like the beak of a duck. Once the speculum is inserted, the doctor can open up the hinged parts for a clear view. As it is inserted, the doctor also shines a light inside to see the walls of your vagina as well as the cervix-the outermost part of your uterus. Generally part of this exam includes a Pap test where a small amount of cervical cells are scraped off for testing.

The doctor removes the speculum for the second part of the exam. With a lubricated, gloved hand, he or she presses inside the vagina with one or two fingers while pressing on the lower abdomen with the other hand in order to feel the shape and condition of the uterus. The doctor can feel if the uterus is enlarged, or whether it is lumpy from fibroids. Then the doctor will insert another finger into your rectum, to better feel the area between the uterus and rectum. That finger can also feel for any lumps in the wall of the rectum, and can obtain a sample of stool to be tested for any sign of bleeding.

As an aside, research published by the Harvard Women's Health Watch indicates pelvic exams without "stirrups" are no less effective for exams, and may actually make women feel more comfortable, and therefore more apt to have them regularly. In a randomized trial of stirrups versus no stirrups for routine gynecological exams, researchers found that women who were allowed to keep their feet on the examining table felt significantly more comfortable than those whose feet were placed in stirrups. I once went to a doctor who put fuzzy socks on the stirrups. That didn't make it any better either. The study also demonstrated that it's possible to perform pelvic exams and obtain Pap smears effectively without using stirrups.

Cystoscopy

9. Cystoscopy

If there's a problem with your bladder, you might need a cystoscopy, which involves sticking a small camera through the urethra into your bladder. A very small camera (you hope). For this test, you wear a hospital gown and lie on your back on a table with your knees bent and your feet in footrests (those stirrups again - but this for the enjoyment of men as well). The opening to your urethra (at the end of the penis or just outside the vagina) and the skin around it is cleaned and then most patients have a squirt or two of a jelly-like numbing medicine pushed inside the opening of the urethra with a plastic syringe so the camera can be inserted without too much discomfort (you hope).

A tubular instrument called a cystoscope, about the width of a pencil (uh, it's not THAT small), is pushed inside the urethra and moved forward until its end is inside the bladder. Clear saline solution is pumped through the tube into your bladder to expand it so your doctor can see clearly see inside. A tiny camera with its own tiny light transmits pictures of your bladder to a TV screen. The test takes about five minutes from the time the camera is inserted. And those five minutes seem like a very long time indeed.

Anoscope

8. Anoscopy

If you're having problems with your Number Twos, you might need an anoscopy. Using a tube called an "anoscope," this test is used to look at the inside of your anus and rectum to diagnose hemorrhoids, anal fissures (tears in the lining of the anus), and some cancers. The test can be done in the doctor's office, and of course you'll need to "drop trow" and either lie on your side on the exam table with your knees bent or bend forward over the table.

The anoscope is 3 to 4 inches long and about the width of a banana (with peel). The doctor coats the anoscope with a lubricant and then gently pushes it into your back door. The doctor may ask you to "bear down" or push as if you were going to have a bowel movement, and then relax (as if). This helps the doctor insert the anoscope more easily and identify any bulges along the lining of the rectum. The doctor will then shine light up this tube for a clear view of the lining of your lower rectum and anus.

Sigmoidoscopy and Colonoscopy

7. Sigmoidoscopy and Colonoscopy

Why is a cowboy hat and a colonoscopy alike? Because sooner or later, every asshole gets one. Both sigmoidoscopy and colonoscopy are used to find early cancers and potentially cancerous polyps (growths on the colon lining), and starting at age 50, you should have one or the other. Both tests use a half-inch-wide endoscope that is passed through the anus and up the large intestine (colon). The sigmoidoscopy goes up about two feet, while the colonoscopy goes up about 5 feet.

A sigmoidoscopy is an effective screening test for colon cancer if you have it done every five years starting at age 50, and it's done in conjunction with a fecal occult blood test (FOBT), which detects trace amounts of blood in the stool. The American Cancer Society and The American College of Gastroenterology both say regular screening is the key.

So how does it work? First of all, for the doctor to get a clear view of your large intestine, it needs to be completely cleared out. Most people feel the prep for the test is worse than the test itself. The day before the procedure, you'll have to drink up to 8 glasses of special laxative fluid to flush everything out. The night before the procedure you'll need to drink only clear liquids (does tequila count?) and some doctors may recommend an additional enema 30-60 minutes before the colonoscopy.

Before the test, you will probably receive a sedative to make you relaxed and sleepy. You'll wear a hospital gown for the test and lie on your side on the table. After putting on a glove and applying some clear jelly, the doctor will feel the inside of your rectum with a finger. He or she gently inserts one end of the colonoscope into your rectum and gradually advances it up the colon. The doctor will also fill your intestine with air so that the camera at the end of the colonoscope gets a good view and images of the interior of your colon will appear on a video screen. If your doctor sees a suspicious place on the bowel lining, he or she might use some small clippers on the end of the scope to take a biopsy.

If your doctor sees a polyp, a loop of wire pushed is through the colonoscope. The doctor tightens the loop around the polyp's stem and sends a brief electric current through the wire to burn the stem and separate it from your intestine. The polyp can be removed using vacuum pressure on the colonoscope or another tool on the end of the scope. When the doctor is finished, the extra air is sucked out of your intestine and the colonoscope gently removed. The test usually takes 20-90 minutes, depending on whether any polyps are removed.

Transvaginal Ultrasound

6. Transvaginal Ultrasound

Although it sounds like the name of some hip, ethno-fusion band, a transvaginal ultrasound uses sound waves instead of radiation to generate snapshots or moving pictures of structures in your abdomen - primarily uterus and ovaries - with the help of a rather alarming-looking "wand" sensor. This imaging technique works in a manner similar to radar and sonar, developed in World War II to detect airplanes, missiles, and submarines that were otherwise invisible - of course nothing of THAT size is going to go unnoticed in YOUR uterus. The transducer in the sensor sends sound waves into your body and picks up the echoes of the sound waves as they bounce off internal organs and tissue. A computer transforms these echoes into an image that is displayed on a monitor. During the test, a doctor or technician covers the sensor with a condom and some jelly before inserting it into your vagina. When the sensor is in place, a picture will appear on a video screen. The technician or doctor moves the sensor on your abdomen or in your vagina to see the uterus and ovaries from many different views. A computer then transforms these sonic echoes into an image that is displayed on a monitor.

Transrectal Ultrasound

5. Transrectal Ultrasound

Gentleman, lest you feel left out by all this sonic probing simply because you lack one essential aperture, rest assured there are special tests for you as well. A transrectal ultrasound and biopsy is recommended if you've had a rectal exam or blood tests that suggest that you might have prostate cancer. For this test, a urologist takes tissue samples from several places in your prostate to be examined for cancer. The transrectal ultrasound helps the urologist see the prostate during the procedure. In most cases, you will lie on your side with your knees bent up to your chest - in a hospital gown. The ultrasound sensor-a short rod about the width of two fingers-is covered with a condom and clear jelly and gently inserted into your rectum. Once the sensor is in place, an image of your prostate appears on a video screen. The ultrasound sensor surveys the whole prostate gland and pinpoints specific areas for biopsy. Then the doctor removes this first sensor and replaces it with a slightly smaller one. In addition to generating an ultrasound image, the smaller sensor has a small tube on its side called a needle guide. Your doctor points the needle guide at the questionable spots in your prostrate, and the guide releases a spring-loaded needle to take biopsies from different parts of the prostate, allowing the needle to move into and out of the prostate very quickly. You are likely to feel some discomfort from each biopsy, but because the needle moves so quickly, any pain lasts only for a second at a time. The bad news is, doctors usually collect multiple samples. Your doctor will probably give you antibiotics at the end of the procedure to prevent infection.

Infected Sinus

4. Endoscopic sinus exam

Don't forget your openings aren't just south of the border. Doctors can go "up yours" above your shoulders as well. An endoscopic sinus exam allows your doctor to see all the structures inside the nose and the sinuses, to diagnose sinusitis or to see if surgery must be done for other reasons. Before inserting the nasal endoscope, the passages inside the nose are opened up with a decongestant medication and numbed with an anesthetic. The endoscope is guided up through a nostril and into the sinus opening, but it isnot able to be inserted into the sinus itself. The test is usually done by an ear, nose, and throat (ENT) specialist (also called an otolaryngologist or otorhinolaryngologist if you're good at spelling). It can be done in the doctor's office and takes 5 to 10 minutes.

Endoscopy

3. Endoscopy

If you have symptoms such as difficulty swallowing, abdominal pain or vomiting up blood, your doctor might recommend an upper endoscopy. This test inspects your esophagus and stomach, also using an endoscope. It can diagnose irritation, acid reflux, ulcers, and cancers of the lining of the esophagus and stomach. During this type of endoscopy, the doctor can also take biopsy samples of tissue.

For this test, you'll probably be given a sedative intravenously, which means you'll probably sleep through the whole procedure. Wearing a hospital gown, you'll lie on your side against a backrest. A local anesthetic will be sprayed into your throat to prevent you from gagging when the endoscope is inserted. In this test, the endoscope used is about half an inch in diameter and long enough to reach from your mouth through your stomach and into the first part of your small intestine. As pictures from scope's camera appear on a video screen, your doctor will watch for any suspicious lesions on the lining of your stomach or esophagus. If any appear, your doctor might use some small clippers on the end of the scope to remove a tiny piece of tissue for a biopsy. The exam takes about 10-15 minutes.

Bronchoscopy

2. Bronchoscopy

Don't forget - you have two passages accessible from your mouth: your esophagus and your trachea. While the upper endoscopy heads down your esophagus, a bronchoscopy can go all the way into the airways of your lungs. This test is usually done to obtain a sample of deep lung mucus or lung tissue to help diagnose cancer, pneumonia, or other lung disease.

A bronchoscopy can be done either in an outpatient clinic or in a hospital. Generally you will need to fast after midnight on the night before the test. This precaustion ensures you have an empty stomach in case you experience nausea from sedatives or have a choking sensation or nausea when the camera is first lowered past your throat. Of course you'll wear a hospital gown during the procedure and most probably an IV (intravenous) line. In some cases, doctors may decide this procedure would be safer or easier a plastic tube is placed through your mouth into your main airway (intubation). If you are intubated, you are able to breathe, but you cannot speak while the tube is in place, as it passes between your vocal cords in your voice box. Intubation is always done with the assistance of an anesthesiologist, who gives you medicines to relax your throat muscles and make you unconscious for a minute or two while the tube is placed. Most patients do not require intubation.

If you are not intubated, your doctor or nurse will spray a numbing medicine onto the back of your throat just before the procedure to make it easier for placement of the bronchoscope. While you lie on your back, your doctor will move one end of the bronchoscope through your mouth and throat and into your trachea (windpipe). You may cough or gag briefly while this is done, but the bronchoscope is much narrower than your trachea, so you'll be able to breathe easily during the procedure. As with all "-scopy" procedures, your doctor will be able to see into your lungs by watching images on a TV screen transmitted from the camera
on the end of the bronchoscope. In addition, a miniature vacuum at the end of the scope allows your doctor to take a sample of mucus from inside the lung or even a tissue biopsy using a needle moved through the scope. The test takes about 20 minutes.

Laparoscopy

1. Laparoscopy

Of course, just because there's no hole doesn't mean there won't be a test! A laparoscopy allows your physician to look directly at the contents of your abdomen or pelvis, including fallopian tubes, ovaries, uterus, small bowel, large bowel, appendix, liver, and gallbladder via tiny incisions. A laparoscopy may be used to detect endometriosis, ectopic pregnancy, pelvic inflammatory disease, cancer or appendicitis.

The surgeon makes a small cut below your belly button and inserts a needle into the area. Carbon dioxide gas is then passed into the area to help move your abdominal wall and any organs out of the way, creating a larger space to work in and help the surgeon see the area better. A small tube is then placed through the cut in your belly area and a tiny video camera goes through this tube to see the inside of your body. Additional small cuts may be made if other instruments are needed to get a better view of certain organs. But if it makes you feel any better, laparoscopy is often called "band-aid" surgery because only small incisions need to be made to accommodate the small surgical instruments are used to view the abdominal contents and perform the surgery. Oh that's a comfort, isn't it?

Topic of the week: How to keep children from obsessing over their appearance

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