History/Examination

Question 1

What are the key aspects of gynaecology history?

Answer 1

PC
HOPC
Menstrual history
Sexual history
Contraception history
Obstetric history 

PMHx
PSHx
DHx
FHx
SHx

Question 2

What symptoms should you ask about in gynaecology history?

Answer 2

Pain
Dyspareunia (painful intercourse) - superficial or deep
Vaginal discharge - amount, colour, smell. itch. When does it happen?
Prolapse
Incontinence - stress or urge
Bowel symptoms
Faecal incontinence

Question 3

Describe uterine pain vs ovarian pain

Answer 3

Uterine pain may be colicky and felt in the sacrum and groins
Ovarian pain tends to be felt in iliac fossa and radiates down front of thigh to knee

Question 4

What should you ask about menstrual history?

Answer 4

Date of last menstrual period or menopause
Was last period normal
Cycles:
Number of days bleeding, number of days from day 1 of period to next (e.g. 5/26)
Regular
Heavy?
Clots? Floods?
Painful? - does pain precede the start of the period?
Any associated bowel symptoms?
Intermenstrual, postcoital or postmenopausal bleeding?
Age at menarche?

Question 5

What should you ask about sex and contraception?

Answer 5

Sexually active?
Physical or emotional problems with sex
Contraception she is using?
What has she previously tried?
Problems conceiving?
Any treatment for sub fertility?
Previous STIs?
Date and result of last cervical smear? Any history of abnormal smears?

Question 6

What should you ask about obstetric history?

Answer 6

How many children?
For each pregnancy:
Antenatal problems, delivery, gestation outcome, weights of babies, puerperium?
Terminations or miscarriages - at what stage? Why? For terminations, how?

Question 7

Describe gynaecological examination

Answer 7

Introduce, explain, consent, chaperone

General :
Well or ill
Abdomen:
Inspect, palpate of tenderness and pegitonism, mass
If distended percuss for ascites

Vaginal examination:
Inspect vulva
Use speculum to examine vagina and cervix and fingers to assess the uterus and annexe bimanually
Examination is done with patient on her back or in the left lateral position

Cusco’s (bivalve) speculum
Used for inspecting the cervix with the aid of a light
Lubricate with jelly (unless taking smear, then use warm water)
Insert closed with blades parallel to labia, aim for the sacrum
Rotate
Open
Take swabs/smear if needed
Close speculum gradually as you withdraw