Gynaecological History And Examination

Question 1

In what order should the questions be asked in a gynaecological hx?

Answer 1

Start with those most relevant to the presenting complaint

Question 2

List the things we would like to know about menstruation

Answer 2

1. LMP
2. Cycle length and regularity
3. Length of menses (<8 days)
4. Heaviness
5. Intermenstrual bleeding
6. Post coital bleeding
7. Postmenopausal bleeding

Question 3

List the things we would like to know about sex/contraception

Answer 3

1. Are they sexually active
2. Dyspareunia - at penetration or deep
3. Contraception
4. Hx of STI’s

Question 4

List the things we would like to know about cervical smears

Answer 4

1. Last smear

2. Ever any abnormal smears and treatment

Question 5

List what we would like to know about urinary symptoms/prolapse

Answer 5

1. Frequency
2. Urgency
3. Incontinence
4. Dysuria
5. Lump at interoitus
6. Heaviness or dragging sensation in vagina

Question 6

What do we need to ask about the past obstetric history?

Answer 6

List and give details of any pregnancies and miscarriages

Question 7

What is important in the family hx?

Answer 7

1. Breast and ovarian cancer
2. DM
3. VTE
4. Heart disease or HTN

Question 8

List the steps of the gynaecological exam

Answer 8

1. General (+/- breast)
2. Abdomen
3. Cervical/vaginal palpation - speculum
4. Pelvic palpation - digital

Question 9

In examination of the abdomen, what indicates that a mass arises from the pelvis?

Answer 9

If you can’t get below the mass it arises from the pelvis

Question 10

What are we looking for on inspection of the external genitalia?

Answer 10

Vulva and vaginal oriface - ulcers, lumps, ?prolapse

Question 11

What is Cusco’s speculum used for?

Answer 11

Inspection of the cervix and vaginal walls; can also take a smear

Question 12

What is Sim’s speculum used for?

Answer 12

Inspection of the vaginal walls mainly for prolapse and rarely fistulae

Question 13

What are we looking for on bimanual exam?

Answer 13

1. Assess vaginal walls
2. Locate cervix and assess size, shape and consistency
3. Gently move cervix from side to side to assess for any tenderness (cervical excitation)
4. Assess uterine size, consistency, regularity, mobility and position (anteverted/retroverted)
5. Examine the adnexal structures - ovaries, masses and tenderness