Biopsies

QUESTION: What type of biopsy is performed in-office, usually without local anesthesia (numbing medicine) or sedation?


. . . 


“Yeaaaaah, we better get you in for a biopsy,” the doctor told me.

I had an odd-looking mole.

I gritted my teeth through the 'numbing' process, then it was a little awkward, staying still through the tugging feels, until the procedure ended.

But overall, no big deal.
 
A patient of mine recently had a polyp removed during a routine colonoscopy. She did the ‘cleanout’, a day dedicated to purposeful diarrhea, and a driver took her to and from the procedure, due to the loopiness from the sedation. She didn't remember the procedure, as is expected with the medication used during colonoscopies.
 
There are many types of biopsies.
 
But one category of biopsy stands alone in medicine as surprisingly painful and invasive, yet without standard use of any type of anesthesia or sedation.



ANSWER: Cervical and endometrial biopsies

Cervical and endometrial biopsies are performed while patients are awake, in regular clinic rooms with recommendations for ibuprofen before the procedure.

I have witnessed and performed these procedures. They are not painless. First, they require the patient remain completely still in the dorsal lithotomy position (laying on your back, knees apart, buttocks slightly hanging off the table, perineum at eye level with medical provider), and often involve muscle spasms and tears. Cramping and bleeding can be expected for hours. This is literally an organ biopsy.

Considering the staggering number of people who menstruate having been sexually assaulted, it's offensive that we in medicine aren't more sensitive. 

No local anesthesia, no sedation.
 
It's an area of medicine I am embarrassed of; we need to update our practices.