Pelvic assessment & Sexual health Flashcards
S: severe perineal itching
O: “It started about 4 days ago. I noticed itching in my pubic area, and it’s been getting worse.”
P: “It gets worse at night and when I sweat. Scratching makes it worse, but I can’t help it. I tried using soap and shaving, but it didn’t help.”
Q: Intense itching
R: Localized to pubic area
S: “I’d say it’s an 8 out of 10. It’s very uncomfortable and keeps me awake at night.”
T: “The itching is worse at night and after showering. It’s pretty constant during the day too.”
I: “It’s embarrassing and I avoid being intimate with my partner. I’m also not sleeping well and feel anxious.”
U: No prior experience with this
A: “Yes, I noticed red bumps and some blueish spots. There’s also some irritation from scratching.”
Pediculosis Pubis
O: excoriations, redness, dark lice, and nits (eggs) near the base of pubic hair, sometimes found in eyebrows or eyelashes.
O: “About 4 days ago. I started feeling tingling and burning before the sores showed up.”
P: “Tight underwear and urinating make it worse. Taking a warm bath helps a little.”
Q: “It feels like a burning, stinging pain, like little cuts. The area also feels very sensitive.”
R: “Mostly in the genital area, but sometimes I feel pain in my lower back and inner thighs.”
S: Painful, rated 7/10
T: Started suddenly, still ongoing
I: “It’s stressful. I’m avoiding intimacy and I’m scared to tell my partner. It’s also painful to walk or sit for too long.”
U: First time I’ve had this
A: “Yes, I had a slight fever, body aches, and swollen glands before the sores appeared.”
Herpes Simplex Virus Type 2 (Herpes Genitalis)
O: “I first noticed the sore about 10 days ago. It started as a small bump and became an open sore.”
P: “It doesn’t really hurt, even when I touch it. Nothing seems to make it better or worse.”
Q: “It’s a round, firm, painless sore. It looks clean but hasn’t gone away.”
R: “It’s on my genitals. It hasn’t spread, and there are no other sores.”
S: “It doesn’t hurt at all, so the pain is 0 out of 10. But it’s worrying me.”
T: “It’s been there for over a week. It hasn’t changed much, and this is the first time I’ve had anything like this.”
I: “It’s making me anxious and I’ve avoided intimacy. I’m nervous about what it could be.”
U: “I thought it might be an ingrown hair at first, but now I’m not sure. I think it might be something more serious.”
A: “No pain, fever, or discharge. Just the one sore and maybe some swollen lymph nodes in my groin.”
Syphilitic Chancre
intense itching.
O: “The rash started about two days ago.”
P: “It gets worse after peeing or when I wear tight underwear. It feels a bit better when I rinse with cool water.”
Q: “It’s very itchy and stings a little. The skin looks red and irritated.”
R: “It’s on the outside of my vagina — around the labia. It hasn’t spread beyond that.”
S: “The itching is around 7 out of 10. It’s really uncomfortable.”
T: “It started suddenly and hasn’t gone away since yesterday.”
I: “It’s hard to focus, and I avoid walking or wearing underwear because it rubs too much.”
U: “I think it’s from that new wash or maybe my laundry soap.”
A: “Just redness, itching, and a bit of swelling. No discharge or pain inside.”
Contact Dermatitis
S: History of contact with an irritant and intense pruritus.
Red, swollen vesicles that may weep, crust, or scale. Thickened skin and scratch marks may be seen.
O: “I noticed small bumps around my genital area about two weeks ago. They weren’t painful at first.”
P: “The bumps itch sometimes, especially after sweating or wearing tight clothes. Wearing loose underwear helps.”
Q: “They’re soft, flesh-colored bumps. Some are flat, others look like little cauliflower patches.”
R: “They’re around the vulva and near the anus, but nowhere else.”
S: “They don’t hurt, but the itching and embarrassment make it a 6 out of 10 for me.”
T: “They’ve been slowly getting bigger over the past two weeks. I think there might be more now.”
I: “I feel really embarrassed. I haven’t wanted to be intimate with anyone. I also feel anxious and gross.”
U: Never seen this before
A: “Just the bumps and occasional itching. No discharge or pain.”
Human Papillomavirus (HPV) Genital Warts
No pain, but soft, moist, flesh-colored warts that may cluster in a cauliflower-like shape. Found around the vulva, anus, or cervix. Warts may go unnoticed.
O: “I started feeling pain and swelling on one side of my vagina about 3 days ago. It got worse quickly.”
P: “Sitting, walking, and wearing tight clothes make it worse. It feels a bit better when I lie down or use a warm cloth.”
Q: “It’s a throbbing, sharp pain. The area feels swollen, tender, and hot.”
R: “The pain is on the lower side of my vaginal opening, just on one side. It doesn’t really spread, but it makes the whole area uncomfortable.”
S: “It’s around an 8 out of 10. It’s hard to sit or move comfortably.”
T: “The pain has been constant since it started, and the swelling has been getting worse each day.”
I: “I can’t sit normally, walk properly, or wear underwear comfortably. I feel very uncomfortable and stressed.”
U: “I didn’t know what it was at first. I thought it might be an ingrown hair or something, but the swelling is too big.”
A: “It’s red, swollen, and painful. I also had a slight fever yesterday and some clear discharge.”
Abscess of Bartholin’s Gland
Severe localized pain. The labia are red, hot, and swollen. A mass is felt in the posterior part of the labia with a red spot at the duct opening. Pus may be seen.
O: “The burning when I pee started about two days ago.”
P: “It burns more when I pee or after sex. Drinking more water seems to help a little.”
Q: “It’s a burning, stinging feeling when I urinate. It feels irritated all the time.”
R: “It’s just at the urethral opening. No pain elsewhere.”
S: “The burning is about a 6 out of 10 when I pee. It’s uncomfortable even when I’m not peeing.”
T: “It’s been constant for two days. The discomfort doesn’t go away.”
I: “It’s hard to focus at work. I don’t want to have sex and I feel uncomfortable all day.”
U: “I think it might be from unprotected sex. I’ve never had this before.”
A: “I noticed some discharge and my urethra looks red. No fever or belly pain.”
Urethritis
When touching the anterior vaginal wall, it feels red, tender, and swollen. Pus may come from the urethral opening.
O: “I noticed a small red lump near my urethra about a week ago. It wasn’t painful at first, but now it’s sore.”
P: “It hurts more when I wipe or after I urinate and during sexual intercourses. A warm compress seems to help a little.”
Q: “It’s a dull, sore feeling, and the lump is tender. Sometimes there’s a burning sensation when I pee.”
R: “It’s right at the urethral opening. No pain spreading anywhere else.”
S:”The discomfort is about a 5 out of 10. It’s annoying more than painful.”
T: “It’s there all the time, but it feels worse when I use the bathroom or sit too long.”
I: “It’s uncomfortable and makes me nervous to go to the bathroom. I also avoid sexual activity because I’m self-conscious.”
U: “I wasn’t sure what it was. I thought it might be a cyst or irritation from menopause.”
A: “Just mild burning and discomfort. No fever, discharge, or major pain.”
Urethral Caruncle
S: Tenderness, pain with urination, urinary frequency, hematuria, dyspareunia, or no symptoms. Burning or sharp pain during intercourse.
O: A small red lump at the urethral opening that may bleed.
O: “I started feeling pressure in my vagina about two weeks ago. It felt like something was bulging down there.”
P: “It gets worse when I stand for a long time, lift heavy things, or strain during bowel movements. Lying down helps relieve the pressure.”
Q: “It feels like a heaviness or fullness in my pelvic area. Sometimes it feels like something is falling out.”
R: “The discomfort is mainly in my lower pelvis and vagina. It doesn’t really spread elsewhere.”
S: “It’s about a 6 out of 10 when I’m standing or walking. Less noticeable when I’m resting.”
T: “It’s worse by the end of the day or after physical activity. It started mildly but has gotten worse.”
I: “It’s uncomfortable and makes it hard to stay active. I also have trouble completely emptying my bladder.”
U: “I think my bladder is slipping down. I read that this can happen after childbirth or with age.”
A: “Yes, I have some urinary urgency and trouble starting to pee. I also feel like I need to go again after urinating.”
Cystocele (With Bladder Prolapse)
O: When the patient strains, the vaginal opening widens, and a soft bulge from the front vaginal wall appears, showing bladder prolapse.
O: Sensation of pressure in vagina, possibly constipation. Noticed over a few weeks
P: “It gets worse when I strain to have a bowel movement or stand for a long time. Lying down or using a stool softener helps.”
Q: “It feels like pressure or fullness in my vagina, especially when I need to go to the bathroom.”
R: “The feeling is mostly in the back wall of my vagina. It doesn’t spread, but it feels uncomfortable.”
S: “The discomfort is about a 6 out of 10, especially when I’m constipated.”
T: “It’s worse at the end of the day or after bowel movements. The bulge comes and goes depending on how active I am.”
I: “I have to strain to have a bowel movement, and I sometimes feel like I haven’t finished. It’s frustrating and uncomfortable.”
U: “I think part of my bowel is pressing into my vagina. I read that it can happen after childbirth.”
A: “Yes, I’m often constipated, and sometimes I have to push on the vaginal wall to help myself go.”
Rectocele
On straining, a soft bulge from the back vaginal wall appears, showing rectal prolapse into the vagina.
O: “The bleeding after sex started a few weeks ago. At first, I didn’t think much of it, but then it kept happening.”
P: “It only seems to happen after intercourse. There’s no bleeding at other times, and it doesn’t seem to respond to anything I do. Using a pad helps with the spotting afterward.”
Q: “There’s no real pain, just a small amount of bleeding. It’s more like spotting, and sometimes there’s a little bit of discharge.”
R: “The bleeding seems to come from inside the vagina.”
S: “The spotting is mild — I don’t need a full pad, just a panty liner. No heavy bleeding or clots.”
T: “It doesn’t happen every time I have sex, but it’s frequent enough to worry me. There’s no set schedule — it’s just occasional, but only linked to intercourse.”
I: “The discharge is a bit annoying, and the bleeding is embarrassing. I’ve started avoiding intimacy because I’m nervous about the spotting.”
U: “I don’t know what’s causing it. I’ve never had this before, and I didn’t think bleeding after sex was normal.”
A: “No pain, no fever, no odor. Just that mild bleeding and a bit of clear or mucous discharge.”
Polyp
A bright red, soft growth is seen coming from the cervical opening. Must be biopsied to confirm it’s benign.
O: “The bleeding started a couple of months ago, but I thought it was just irregular periods. It’s been getting more frequent, especially after sex.”
P: “It happens after intercourse or sometimes randomly. Nothing really makes it better. Sitting or resting doesn’t help much either.”
Q: “The bleeding isn’t heavy, but it’s persistent. It’s sometimes mixed with watery discharge. I also feel a dull ache in my lower back now.”
R: “It seems to come from deep inside, like the cervix. The ache is mostly in my lower abdomen and back.”
S: “The bleeding is light to moderate, but it’s scary. The pain is about a 2 out of 10, but it’s more the worry that makes it hard.”
T: “The bleeding is irregular, but more frequent now — it started as just post-sex bleeding, now it happens even without sex.”
I: “It’s really stressful. I don’t feel comfortable being intimate, and I’m always worried I’ll start bleeding unexpectedly. I’m also more tired than usual.”
U: No history like this
A: “Yes, I’ve had some vaginal discharge that smells bad, lower back pain, and I feel more tired lately. No fever or weight loss yet.”
Carcinoma
S: Carcinoma may manifest as bleeding between menstrual periods or after menopause or as unusual vaginal discharge.
Exam may show a chronic ulcer or hardened lesion. Pap smear and biopsy are used for diagnosis.
O: “The dryness and discomfort started a few months after I stopped getting my periods. At first, I thought it was just aging.”
P: “It feels worse during sex or after urinating. Using a bit of lubricant helps, but not completely. Sitting for a long time also makes it more noticeable.”
Q: “It feels dry, itchy, and sometimes there’s a slight burning sensation. Sex has become painful, and the skin feels thin or fragile.”
R: “The discomfort is in the vagina and vulva. It doesn’t really spread, but sometimes there’s a bit of pressure in the lower pelvis.”
S: “The dryness and burning are around a 6 out of 10, especially during or after sex. The itching is mild but constant.”
T: “It’s pretty much constant now, but the symptoms get worse at night or after using the bathroom.”
I: “It’s affecting my sex life and making me uncomfortable throughout the day. I avoid intimacy because of the pain.”
U: “I think it’s related to menopause, but I didn’t expect this level of discomfort.”
A: “There’s some clear discharge now and then, and I had a bit of spotting once. No odor or fever.”
Atrophic vaginitis
S: Postmenopausal vaginal itching, dryness, burning sensation, dyspareunia (pain during sex), mucoid discharge (may be flecked with blood).
O: “The itching and discharge started about 3 days ago. It came on pretty quickly.”
P: “It gets worse when I wear tight underwear or after I shower. It feels a bit better when I sit in a warm bath or don’t wear anything tight.”
Q: “It’s very itchy, with a burning feeling sometimes. There’s also thick, white discharge like cottage cheese.”
R: “It’s mostly in the vaginal area and around the vulva. The itching doesn’t spread anywhere else.”
S: “The itching is about an 8 out of 10. It’s really uncomfortable, especially at night.”
T: “It’s been constant for the last 3 days, with no real improvement.”
I: “I can’t focus, I feel uncomfortable all day, and I’ve avoided sex because it’s too irritating.”
U:”I think it’s a yeast infection. I’ve had one before, and this feels the same.”
A: “Yes, there’s redness and swelling, and a burning feeling when I pee.”
Candidiasis (Moniliasis)
Discharge looks like cottage cheese. Often triggered by antibiotics, diabetes, pregnancy, or high pH.
O:“It started about 5 days ago.”
P: “Sexual activity and my period makes the discomfort worse. Nothing really makes it better.”
Q: “It’s an itchy, burning feeling down there. There’s also a strange discharge.”
R: “It’s in the vaginal area. The itching stays local.”
S: “I’d say it’s about a 6. Very uncomfortable.”
T: “The itching is mostly constant, but the discharge seems to come more at certain times of day.”
I: “It’s making it hard to sleep and I avoid being intimate with my partner.”
U: “I’m not sure, but I thought it could be an infection from sex.”
A: “Yes, there’s a foul-smelling, frothy greenish discharge and some burning when I pee (at the end of urination). Increased in frequency.”
Trichomoniasis
Worse during menstruation. Vagina looks red and spotty, and discharge is yellow-green and frothy. Microscopy shows moving cells.
Heavy discharge with a fishy smell. Discharge is thin, grey-white, and coats the vaginal walls. No visible inflammation. Wet mount shows “clue cells.”
O: “The smell and discharge started around 3 days ago.”
P: “It’s worse after sex or during my period. Nothing makes it better.”
Q: “It’s a thin, greyish discharge with a strong fishy odor.”
R: “It’s coming from the vagina. No pain spreading anywhere else.”
S: “The smell is very strong and uncomfortable. I’d rate it 5 out of 10.”
T: “It’s constant but more noticeable after sex or when I sweat.”
I: “I feel embarrassed and avoid intimacy or going out because of the smell.”
U: “I thought it was maybe a yeast infection, but there’s no itching.”
A: “No burning or itching, just the smell and unusual discharge.”
Bacterial Vaginosis (Gardnerella vaginalis, Haemophilus vaginalis, or Nonspecific Vaginitis)
O: “I noticed spotting after sex recently and I have pelvic pain.”
P: “It gets worse with intercourse. Nothing really makes it better.”
Q: “It’s mild pain with some discharge.”
R: “It’s in the vaginal area only.”
S: “About a 3 out of 10.”
T: “It comes and goes.”
I: “I noticed some yellow discharge and it’s making me anxious.”
U: “I have no history of STIs and wasn’t expecting this.”
A: “There’s mucopurulent yellow discharge and the cervix bleeds when touched. I have more frequent urination”
Chlamydia
O: “I started noticing symptoms about 4 days ago.”
P: “It gets worse during sex or when I pee. Nothing seems to relieve it.”
Q: “It’s a burning feeling when I pee and I’ve had some thick discharge.”
R: “It’s in the vaginal area. No pain spreading elsewhere.”
S:“Around 5 out of 10. It’s not unbearable, but it’s bothering me a lot.”
T: “It comes and goes.”
I: “The discharge and pain make me uncomfortable. I avoid sex now.”
U: “I wasn’t expecting this. I didn’t think I was at risk.”
A: “Thick yellow-green discharge, pain when peeing, and bleeding between periods. Small lump on one side of the vaginal entry”
Gonorrhea
Often silent. When symptomatic: discharge, painful urination, bleeding, or Bartholin gland abscess. Purulent discharge may be present. Untreated cases may lead to PID.
Missed period, fatigue, breast swelling, nausea, and weight gain. Signs include bluish vaginal and cervical tissue (Chadwick’s sign) and a soft cervix (Hegar’s sign).
O: “My period is late by about 2 weeks, and I’ve been feeling different for the past week.”
P: “Smells and certain foods make me nauseous. Rest and ginger tea help a little.”
Q: “I feel light cramping, breast tenderness, and mild nausea.”
R: “The cramping is low in the abdomen. It doesn’t spread.”
S: “The symptoms are mild – I’d rate it 3 out of 10.”
T: “Nausea mostly happens in the morning. The rest is on and off.”
I: “It’s affecting my energy and appetite. I’m more tired than usual.”
U: “I think I might be pregnant – I took a home test that was positive.”
A: “Nausea, fatigue, breast tenderness, bloating, and mild cramping.”
Pregnancy
Often no symptoms. If present: pelvic pressure, bloating, heavy bleeding, pain during sex, back pain, or frequent urination. The uterus feels enlarged, irregular, and firm.
O: “I started noticing heavy periods and pelvic pressure a few months ago.”
P: “It feels worse during/before my period or after standing for a long time. Lying down helps a little.”
Q: “It’s a dull, heavy pressure in my lower abdomen with painful cramps.”
R: “The pain is in the lower abdomen and sometimes in my lower back.”
S: “About 6 out of 10 during my period, otherwise more like a 2 or 3.”
T: “It’s worse during menstruation and comes in waves throughout the day.”
I: “It’s affecting my work and sleep because of heavy bleeding and pain.”
U: No
A: “Heavy bleeding, long periods, bloating, pelvic pressure, and frequent urination.”
Myomes (Fibroids)
O: “I started spotting a few weeks ago, and I’ve already gone through menopause years ago.”
P: “The bleeding happens randomly. Nothing seems to trigger or stop it.”
Q: “It’s light bleeding, like spotting, sometimes with mild cramping.”
R: “The cramping is in the lower abdomen. It doesn’t move anywhere else.”
S: “The pain is mild, about 2 or 3 out of 10, but the bleeding worries me.”
T: “The spotting is irregular – not every day, but it keeps happening.”
I: “It’s making me anxious. I’m scared because I thought I was done with bleeding.”
U: “I don’t know what’s causing this. I’ve never had anything like this since menopause.”
A: “Some bloating, light pelvic pain, and unexpected bleeding. No fever or discharge.”
Endometrial Cancer
Bleeding between periods or after menopause, and discharge. Pain and weight loss happen later. The uterus may be enlarged. Requires endometrial biopsy for diagnosis.
O: “I’ve had painful periods since I was a teenager, but it’s gotten worse over the past year.”
P: “The pain gets worse during my period, when I go to the bathroom, or during sex. A heating pad helps a little.”
Q: “It’s a deep, sharp pelvic pain, sometimes cramping, sometimes stabbing.”
R: “It’s in my lower abdomen and pelvis. Sometimes the pain goes to my lower back or thighs.”
S: “During my period, it’s a 7 or 8 out of 10. At other times, it’s about a 3.”
T: “It’s worst during my period and ovulation, but I also get flare-ups at other times.”
I: “It affects my daily life. I miss work and can’t exercise or be intimate when it’s bad.”
U: No
A: “Painful periods, pain during sex, fatigue, bloating, and painful bowel movements.”
Endometriosis
Cyclic or constant pelvic pain, painful periods or sex, backache, or irregular bleeding. Uterus feels fixed and tender. Nodular tender masses may be felt near uterus or ovaries.
O: “The pain started suddenly about 2 days ago. It’s been getting worse.”
P: “It’s worse when I move, during sex, or when I pee. Lying still helps a bit.”
Q: “It’s a sharp, cramping pain in my lower belly, like something is squeezing inside.”
R: “It’s in both lower quadrants, especially on the sides. Sometimes it radiates to my lower back.”
S: “I’d rate it 7 or 8 out of 10. It’s really painful and constant.”
T: “It’s constant, but it spikes when I move or press on my abdomen.”
I: “I’ve been lying down all day. I can’t work or even walk much because of the pain.”
U: “I was told it’s related to an infection, but I’m not sure how serious it is.”
A: “I have fever, chills, nausea, unusual discharge, and pain during sex and urination.”
Acute Salpingitis (PID)
Fever, lower abdominal pain, and purulent discharge. Abdomen may feel rigid and painful with cervical motion tenderness.
O: “I started having sharp pain in my lower belly about 2 days ago. It came on suddenly. I missed my period and now there’s bleeding.”
P: “It gets worse when I move, cough, or have a bowel movement. Nothing really helps.”
Q: “It’s a sharp, stabbing pain that feels like it’s deep inside on one side.”
R: “The pain is on my lower right side. Sometimes it goes to my shoulder or back.”
S: “It’s about 8 out of 10. Very intense, I’ve never felt anything like this.”
T: “It started suddenly and hasn’t gone away.”
I: “I can’t stand up straight or walk properly. I’m scared and feel weak.”
U: No
A: “I’ve had light vaginal bleeding, dizziness, and feel like I might faint. My shoulder hurts too.”
Ectopic Pregnancy
Missed period, bleeding, and pelvic pain. Tender, mobile pelvic mass felt on one side. Pain with uterine or cervical movement. Needs urgent evaluation.
O: “The pain started about a week ago and got sharper over the last few days.”
P: “It gets worse with physical activity or when I press on my belly. Lying still helps a little.”
Q: “It’s a dull ache most of the time, but sometimes it feels sharp or crampy.”
R: “It’s low in my pelvis, mostly on the right side. Sometimes it spreads to my back or thigh.”
S: “I’d say it’s a 5 out of 10 when dull, and 7 when it gets sharp.”
T: “The pain comes and goes. It’s more noticeable during my period or after exercise.”
I: “It makes it uncomfortable to exercise or even sit too long.”
U: No
A: “Some bloating, pressure, and more painful periods than usual. No fever or vomiting. Mobile, smooth mass”
Ovarian Cyst
Usually no symptoms. If present: pressure or pain. On palpation, a soft, mobile, smooth, round mass is found on the ovary. Must be monitored.
O: “I’ve been feeling bloated and full quickly after eating for about 2 months now.”
P: “The bloating and discomfort get worse throughout the day. Lying down helps a little.”
Q: “It’s a constant pressure or fullness in my lower belly. Sometimes there’s a dull ache.”
R: “The pressure is in my lower abdomen and sometimes spreads to my lower back.”
S: “I’d rate it around 4 out of 10. Not sharp pain, but very uncomfortable.”
T: “It’s pretty constant, but gets worse after meals or toward the evening.”
I: “I can’t eat as much, my clothes feel tight, and I’m tired all the time.”
U: “I don’t really understand what’s causing this. I thought it was just menopause or stress.”
A: “I feel bloated, have trouble eating full meals, pee more often, and feel very fatigued. Fixed, solid mass”
Ovarian Cancer
Often silent. May cause abdominal bloating or weight gain. A solid, immobile, poorly defined pelvic mass is suspicious for malignancy. Needs biopsy.
Frequent urination, burning, urgency, lower abdominal pain, cloudy or bad-smelling urine, and possibly fever. May be asymptomatic during pregnancy. If untreated, can lead to kidney infection and pregnancy complications.
O: It started about 2–3 days ago.
P: It gets worse when I urinate. Nothing really helps.
Q : It feels like a burning or stinging sensation.
R: The pain is mostly in the lower abdomen and urethra.
S: It’s around 6 or 7 out of 10 when I pee.
T: It happens every time I go to the bathroom.
I: I’ve been going to the bathroom a lot more, and it’s hard to focus or rest.
U: I think it might be an infection—I’ve had this before.
A: I’ve also noticed cloudy and smelly urine, and I sometimes feel a pressure or discomfort in my lower belly.
Urinary Tract Infections (UTIs)
