Techniques and tests: How I care for you in my practice

Gynaecological ultrasound

The basic imaging test to see the uterus and ovaries, during the same appointment.

I perform it transvaginally, which gives the most precise image, or abdominally when that suits you better. It shows the uterus and endometrium, the ovaries and their follicles, and can detect fibroids, polyps, cysts, signs of endometriosis or adenomyosis, or check the position of an IUD.

It is painless, uses no radiation and completes the examination in the same visit, so many questions are answered without waiting for another appointment.

Colposcopy and cervical biopsy

A magnified look at the cervix when your smear or HPV test suggests it.

With the colposcope I examine the cervix under magnification, using gentle stains that highlight any areas needing attention.

If I see something that should be looked at more closely, I take a small biopsy during the same visit. It is a short test done in my office, and it lets us decide on solid ground whether monitoring is enough or treatment is needed.

Smear test and human papillomavirus (HPV) typing

Cervical cancer screening, including the virus genotype when it is present.

Most women catch HPV at some point and almost all clear it on their own; what matters is whether the infection persists and which type it is.

The test identifies high-risk genotypes and, together with the smear, sets how often you should be checked. I also look after your vaginal microbiota, because a balanced ecosystem is part of your defence against the virus.

Vaginal and endometrial microbiome testing

A genetic analysis of the bacteria and fungi living in your vagina or endometrium.

A single vaginal swab shows the balance of lactobacilli, bacteria linked to vaginosis, Candida overgrowth and the main sexually transmitted infections. When needed, I add cultures with antibiotic and antifungal susceptibility testing.

The endometrial test uses a small sample from inside the uterus and helps detect chronic endometritis. It is especially useful if infections keep coming back, if your symptoms have no clear explanation or if you are finding it hard to get pregnant.

Cultures and microbiological tests

They are not only for diagnosing sexually transmitted infections: in premenstrual syndrome they can be the key.

A swab from the cervix or vagina, or a urine sample, identifies bacteria, fungi and other microorganisms, and antibiotic or antifungal susceptibility testing shows which treatment will work. As well as sexually transmitted infections (chlamydia, gonorrhoea, mycoplasmas, trichomonas…), I look for low-grade infections that cause few obvious symptoms.

That is why cultures can be the key to diagnosing and treating PMS: chronic inflammation or infection of the cervix and genital tract can be the source of inflammatory mediators that make every cycle worse. Finding it means we can treat the origin, not just the symptoms.

Cytokine profile in endometriosis

A blood test measuring inflammatory markers associated with endometriosis.

Endometriosis is, above all, an inflammatory disease. Measuring certain cytokines in the blood gives one more clue when your symptoms point that way and the scan is inconclusive.

It does not replace the examination or the ultrasound, and it cannot confirm the diagnosis on its own: it is a support that I read alongside the rest of your history.

Non-invasive prenatal test (NIPT)

Screening for the main chromosomal conditions in the baby from a blood sample taken from the mother.

From week 10 of pregnancy, the mother's blood carries fragments of DNA from the placenta. Analysing them estimates the risk of trisomies 21, 18 and 13, among others.

It is a highly reliable screening test, but not a diagnostic one: if the result is abnormal, it is confirmed with an invasive test before any decision is made. I explain everything calmly, before and after.

Thrombophilia testing

A genetic test for variants that increase the tendency to form blood clots.

It looks for variants such as factor V Leiden or the prothrombin mutation. It makes sense in specific situations: a personal or family history of thrombosis, some pregnancy losses, or before choosing a hormonal treatment.

It is not a test for everyone; we decide together whether it adds useful information in your case.

Genetic testing for coeliac disease (HLA-DQ2 and HLA-DQ8)

Finding out whether you carry the genetic predisposition to coeliac disease.

Almost everyone with coeliac disease carries the HLA-DQ2 or HLA-DQ8 genes. If you do not, coeliac disease is very unlikely, which is useful to know when there is unexplained anaemia or iron deficiency, recurrent miscarriage, difficulty getting pregnant or digestive symptoms.

Carrying them does not mean you have coeliac disease: a large part of the population carries them and most never develop it. If the result is positive and there is a suspicion, the diagnosis is completed with blood antibody tests and, when needed, with a gastroenterologist.

Oxidative stress testing

A test measuring the balance between oxidative damage and your antioxidant defences.

Oxidative stress goes hand in hand with many chronic inflammatory processes, such as endometriosis, premenstrual syndrome or some fertility problems. The test measures markers of oxidative damage and your antioxidant capacity in a blood sample.

It does not diagnose any disease on its own: it helps me guide diet, lifestyle and supplements within the integrative approach, and check later whether the plan is working.

Microbiological testing of your partner

When infections keep coming back, sometimes your partner needs to be tested too.

If you have recurrent genital infections or a sexually transmitted infection, testing your partner (with cultures and STI tests, and in men also assessing possible prostatitis) stops the cycle of reinfection.

Treating both of you at the same time is often the missing piece.

Cervical cryotherapy

Cold treatment of superficial lesions of the cervix, done in my office.

A very cold probe is applied to the cervix for a few minutes to destroy the abnormal tissue and let healthy tissue grow back. No operating theatre is needed.

It is indicated for specific lesions that have first been properly assessed with colposcopy. A watery discharge for a few days afterwards is normal.

Treatment of genital warts and molluscum contagiosum

Removal of genital warts and molluscum from the vulva and vagina.

Genital warts are caused by HPV, and molluscum by another skin virus. Depending on their size and location, I treat them in my office with local techniques such as cryotherapy or laser, or with topical treatments.

As well as removing the lesions, we review your HPV status and how to reduce the chance of them coming back.

Vaginal diode laser

A gentle laser applied to the vaginal lining to improve its moisture and elasticity.

The laser stimulates the lining to produce collagen and improves its blood supply. I use it for menopausal dryness and atrophy, mild incontinence and some cases of pain during sex.

It is done in my office in a few sessions and is usually more uncomfortable than painful. It is not the first option for everyone: we consider it when the basic measures have not been enough or are not suitable for you.

Gynaecological ozone therapy

Medical ozone as support for stubborn genital infections and inflammation.

Medical ozone has a local antimicrobial and anti-inflammatory action. I use it as a complement in recurrent infections, in chronic inflammation of the cervix or endometrium, and when it is wise to reduce antibiotics or antifungals.

It is always part of a wider plan and never replaces a treatment your case needs.

Intimate hyaluronic acid (DESIRIAL®)

Hyaluronic acid injections to restore volume and moisture to the vulva and vaginal entrance.

Over the years, or after menopause, the outer labia and the vaginal entrance lose volume and moisture, which can cause discomfort and friction during sex.

Hyaluronic acid, a substance your body already makes, is injected under local anaesthetic to restore moisture and comfort. Its effects are temporary and it is gradually reabsorbed.

Pelvic floor radiofrequency and TECAR therapy (CAPENERGY®)

CAPENERGY radiofrequency, external or intracavitary, for the pelvic floor: pain, tissue recovery and intimate health.

TECAR therapy produces deep, controlled heat that relaxes the muscles, improves circulation and stimulates tissue repair. Using a temperature-controlled vaginal or rectal probe, the CAPENERGY device reaches the pelvic floor muscles and tissues directly.

I use it for pelvic and myofascial pain, vaginismus, painful endometriosis, postpartum scars and vaginal dryness and atrophy after menopause, almost always together with pelvic floor physiotherapy.

Urinary incontinence: vaginal laser and pelvic floor training

Rebuilding pelvic floor strength so that you stop leaking urine.

The foundation is pelvic floor exercises, learnt properly. To reinforce them I use electrical stimulation with biofeedback, which teaches you to activate the right muscles and concentrates the work into a few sessions.

For mild or moderate stress incontinence, vaginal laser can be added. If your case needs a different solution, I will tell you clearly.

Neuroadaptive therapy (NAT)

Gentle electromagnetic impulses to rebalance the autonomic nervous system, which silently regulates pain, the bladder and your response to stress.

Your autonomic nervous system works like an automatic control centre: the sympathetic side puts you on alert and the parasympathetic side helps you repair and rest. When one of them dominates for months, your body feels it as pelvic pain, urinary urgency, tension or tiredness.

Using a non-invasive device on the skin, neuroadaptive therapy applies brief electromagnetic impulses similar to the nervous system's own signals, which keep adapting to your body's response to help rebalance the sympathetic and parasympathetic systems. It is painless and done in my office.

I use it as a complementary therapy, within a comprehensive plan, above all for chronic pelvic pain, overactive bladder and symptoms that get worse with stress.

Biophotostimulation (photobiomodulation)

Low-intensity LED or laser light to support the repair of intimate tissues and soothe inflammation.

Low-intensity light, with no heat and no cutting or burning, stimulates cell activity and local circulation, helping tissues to repair and calm down.

I apply it to the vulva and vagina for dryness and the genitourinary syndrome of menopause, for recurrent irritation and vulvovaginitis, for vulvar pain and to help healing, for example after childbirth. It is painless and needs no recovery time.

It is a complementary therapy whose uses in gynaecology are still being studied; I combine it with the rest of your treatment, within a comprehensive plan.

Bioresonance therapy (MORA® device)

A complementary therapy from biological medicine that works with your body's own electromagnetic oscillations.

The MORA device, made by Med-Tronik, picks up your body's electromagnetic oscillations through electrodes on the hands and feet and returns them to you filtered and modulated. It does not apply external currents, and the session is calm and painless.

Within the integrative approach, I use it as support when inflammation, food intolerances, recurrent candidiasis or stress play a part.

It is a complementary therapy with still limited scientific backing: it does not replace a diagnosis or a treatment your case needs, but adds to your plan.

Premenstrual syndrome and premenstrual dysphoric disorder (PMS and PMDD)

When the days before your period change your body, your mood and your life.

Some discomfort before your period is normal. When irritability, sadness, anxiety, pain or fatigue last for days and overwhelm you and those around you, we are talking about severe PMS or PMDD, and it deserves a thorough assessment.

Beyond the hormonal side, I look for what may be making it worse: inflammation, low-grade genital infections, microbiota imbalances, nutritional deficiencies or stress. Your treatment is built with you, step by step.

Endometriosis and adenomyosis

An inflammatory disease that takes far too long to diagnose and deserves a complete approach.

A period so painful that it forces you to stop is not normal. Endometriosis can cause period pain, pelvic pain or pain during sex, difficulty getting pregnant and general symptoms such as fatigue, migraine or digestive problems.

Diagnosis is based on your history, the examination and an expert ultrasound, and sometimes an MRI. Treatment combines pain and inflammation control, diet, hormonal treatment when appropriate, physiotherapy and, if needed, surgery with an expert team.

Polycystic ovary syndrome (PCOS)

Irregular periods, excess androgens and a metabolism that needs attention.

PCOS is the most common hormonal disorder in women of reproductive age. It can cause irregular or absent periods, acne, excess hair, difficulty ovulating and insulin resistance, and it also affects mood.

I diagnose it using international criteria after ruling out other causes. Care starts with diet, exercise and sleep, and is completed with supplements or medication depending on your symptoms and whether you plan to get pregnant.

Uterine fibroids

The most common benign tumours of the uterus: often they only need monitoring.

Most fibroids cause no symptoms. When they do (heavy periods, anaemia, pain or pressure), we need to confirm that they are responsible and not another condition alongside them, such as adenomyosis or polyps.

Beyond treating the fibroid, I check related factors such as vitamin D or iron deficiency, and explain every option, from monitoring to surgery.

Menopause and genitourinary syndrome

A stage to live well informed and without fear, caring for your intimate health too.

Hot flushes, insomnia, mood changes, vaginal dryness, leaking urine or lower desire: not everything is the menopause, and what is can be treated.

I start with lifestyle and move forward step by step: moisturisers and lubricants, local oestrogen, hormone therapy when it is indicated and safe for you, and techniques such as laser, hyaluronic acid or radiofrequency when needed.

Chronic pelvic pain

Pain that stays in your pelvis for months is never normal and always deserves investigation.

Behind it there may be endometriosis, chronic inflammation of the cervix or endometrium, myofascial pain of the pelvic floor, nerve entrapment, interstitial cystitis or digestive problems, and often several causes at once.

Noting when the pain appears and how it changes with your cycle helps a great deal. Treatment is multidisciplinary and adapted to what we find.

Recurrent vulvovaginal candidiasis

Itching, burning and discharge that keep coming back despite treatment.

Many women spend months or years on treatments without finding a solution. The first step is to confirm that it really is Candida (and which species) with microbiome testing and a culture with antifungal susceptibility, and to rule out other conditions that look similar.

I then combine the right antifungal treatment with changes in hygiene and diet, care of your gut and vaginal microbiota, and support in managing stress.

Sexual dysfunction with a physical cause

Pain during sex, dryness or low desire often have a physical cause that can be treated.

Sexuality is body and emotion at the same time. Recurrent infections, vulvodynia, vaginismus, inflammation of the cervix, pelvic floor pain, endometriosis, lichen or the menopause may lie behind it.

A careful gynaecological examination makes it possible to find the cause and treat it. As a sexologist, I also support you with the emotional and relationship side, because what is not talked about cannot be solved.

Preconception consultation

Preparing your body before trying for a pregnancy.

We review your general and gynaecological health, make sure you take folic acid before conception, check your thyroid and vaccinations, and talk about diet, how to avoid toxoplasmosis and how to reduce exposure to toxins and endocrine disruptors.

I also look for anything that may make pregnancy harder: genital tract infections, fibroids, polyps, endometriosis or uterine malformations.

Active cellular nutrition and environmental medicine

Diet, lifestyle and environment as the foundation of any treatment.

Many chronic conditions share low-grade inflammation, oxidative stress and nutritional deficiencies. That is why diet, rest, movement and stress management are part of every plan I make.

We also talk about how to reduce your everyday exposure to pesticides, plastics and other endocrine disruptors. When appropriate, I add specific supplements for what your body needs.