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Gynaecological history

Introduction

  • Wash hands
  • Introduce self
  • Ask Patient’s name, DOB and what they like to be called
  • Explain and obtain consent

Presenting complaint

  • Determine symptoms which brought patient in

History of presenting complaint

  • Explore every symptom
    • Timeframes
  • Relevant systems reviews (see systems review)
    • General
    • Gynaecological (The 4 P’s)
    • Gastrointestinal (∆∆ IBS, malignancy, appendicitis, diverticulitis etc.)
    • Urological (∆∆ UTI, incontinence etc.)

The 4 P’s

PV bleeding: menorrhagia, intermenstrual, post-coital, post-menopausal

PV discharge

Pain: pelvic, dysmenorrhoea, dyspareunia

Pregnancy (chance of pregnancy)

Menstrual history

  • 1st day of last menstrual period
  • Menarche (usually 12-13 years) ± menopause (usually 48-55 years)
  • Regularity and cycle length (range from 21-35 days)
  • Duration of periods (range from 3-7 days)
  • Character of periods (heaviness, number of pads per day, flooding, pain)

Obstetric history – GMC

  • Gravida and para
    • Gravida/gravidity = pregnancies
    • Para/parity = birth of fetuses over 24 weeks, regardless if born alive or not
  • Miscarriages, ectopic pregnancies and terminations
    • Stage
    • Treatment
    • Complications
  • Children (living)
    • Number
    • Ages
    • Birthweights
    • Type of deliveries
    • Previous problems during pregnancy/delivery

Sexual history

  • Partners
    • Current partner (male/female, relationship duration)
    • Previous partners (last three or all in last 6 months), high-risk encounters
  • Intercourse: type, pain/discomfort, contraception used
  • Subfertility

Contraception and cervical smear history

  • Contraception: current use, previous methods
  • Cervical smears: date of last smear, results

Rest of history as normal

  • PMHx: including previous abdominal surgery
  • DHx: including HRT/hormones, over-the-counter remedies, allergies
  • FHx: breast/bowel/ovarian cancer
  • SHx

Test your knowledge with a few questions!

A 45 year old female presents pelvic pain. What is in your gynaecological differential diagnosis and which clinical features would help differentiate these causes?

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How would you classify PV bleeding? List three causes of each.

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Time to try some OSCE stations…

  1. Pelvic pain I
  2. Pelvic pain II
  3. Abdominal pain during pregnancy
  4. Vaginal discharge
  5. Find lots more here
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