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

Exploreevery symptom
- Timeframes
- Symptom-specific questions (see exploring symptoms)
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

1^st 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.