Urogynaecology Flashcards
Questions you should ask regarding pain in urogynaecology history?
SOCRATES
o Onset
o Ask whether the patient has had any previous investigation or treatment.
o Discuss relationship to menses (dysmenorrhoea, Mittelschmerz)
o Discuss relationship to intercourse (dyspareunia)
o Determine the effect of the pain on life and work.
o ICE
Questions you should ask regarding dyspareunia in urogynaecology history?
o Determine whether this is superficial (vaginismus, episiotomy scar) or deep (uterine, cervical or adnexal).
o Note whether there is radiation.
o Ask whether it is preventing penetration or full intercourse.
o Ask whether libido and foreplay are adequate.
o Discuss positional factors. Pain relating to deep penetration may come from the ovaries.
o Ask whether there is dryness/atrophy.
o Note whether there is any rash.
o Ask whether it is intermittent/recurrent or always present.
o Establish the degree of distress.
o Note whether there is evidence of mood disorder.
o Discuss relationship to menses. Note whether the patient is postmenopausal.
Questions you should ask regarding urinary symptoms in urogynaecology history?
o If pain is a urinary symptom, discuss relationship to micturition.
o Establish whether there is urethral discharge.
o Discuss frequency of micturition (day and night).
o Establish urgency.
o Urge incontinence - note whether this leads to partial or total voiding.
o Stress incontinence - note what provokes this and whether it leads to partial or total voiding.
o Discuss whether there is restriction on normal activities and plans.
o Ask whether symptoms are intermittent/recurrent or always present.
Questions you should ask regarding vaginal discharge in urogynaecology history?
o Establish the colour of vaginal discharge and whether or not it is bloodstained.
o NB: physiological discharge is usually scanty, mucoid and pale/colourless; it should not be offensive.
Therefore, discuss with the patient:
o Discharge odour.
o Consistency of discharge.
o Whether there is associated itch, burn or fever.
o Discuss use of gels, douches, vaginal deodorants or perfumed bath additives.
o Ask whether there is associated localised tenderness (eg, Bartholinitis).
Questions you should ask regarding abnormal vaginal bleeding in urogynaecology history?
Note whether the patient has clotting and/or flooding.
o Establish whether there is intermenstrual or postcoital bleeding.
o Establish periodicity.
o Discuss relationship to menses and relationship to coitus.
o Ask whether there is possibility of pregnancy.
Menstrual hx in urogynaecology history?
- Age at menarche
- Ask whether the patient is sexually active and, if so, when last active.
- Ask about contraceptive method and whether they are trying for a baby.
- Amenorrhoea
- Pattern of the menstrual cycle
- The normal menstrual cycle
- Abnormal patterns of bleeding
What are the features of primary amenorrhoea?
o Presence of secondary sexual characteristics.
o Consider imperforate hymen.
o Look for features suggesting genetic abnormality- e.g. Turner syndrome.
o Look for features of hyperandrogenism.
Causes of secondary amenorrhoea
o Physiological: Pregnancy, lactation.
o Psychological: look for mood abnormalities.
o Record BMI (low BMI suggests anorexia nervosa)
o Extrinsic hormonal causes: such as the contraceptive pill.
o Intrinsic hormonal causes: hypothalamic, pituitary, thyroid and adrenal disorders.
o Ovarian factors: polycystic ovaries, ovarian tumours, ovarian infection, primary ovarian failure.
How do you assess pattern of the menstrual cycle?
Record:
o First day of last normal menstrual period.
o Days of blood loss.
o Length of cycle.
o Whether blood loss was heavy: number of tampons and/or pads, whether clots were present.
o What form of contraception is used.
o Any discharge other than the menses.
What is the normal menstrual cycle?
o Range is 21 to 35 days and average is 28.
o Most healthy, fertile women have regular cycles with 1 or 2 days of variation.
o Blood loss is 50-200 mls and averages 70 mls.
o Guide to loss is use of pads and tampons.
o Passage of large clots suggests excessive bleeding.
What are the abdominal patterns of bleeding?
o Polymenorrhoea: Unusually frequent periods.
o Oligomenorrhoea: unusually infrequent or scanty periods (common around puberty).
o Menorrhagia: unusually heavy periods.
o Intermenstrual bleeding (bleeding between periods):
-Breakthrough bleeding on the pill
-Diseases of the uterus and cervix.
-Mucosal disorders
-Postcoital bleeding (usually local cervical or uterine disease)
o Postmenopausal bleeding: bleeding occurring over 12 months after amenorrhoea of menopause
o Dysfunctional uterine bleeding:
-Abnormal bleeding that cannot be ascribed to pelvic pathology.
-Regular pattern suggests ovulation occurring.
-Irregular pattern suggests anovulatory cycles.
What is included in the psychosexual hx in urogynaecology hx?
• A history should include enquiry about:
o Relationship details, including issues of sexuality.
o Intercourse and sexual practices.
o Libido.
o Orgasm.
o Association of other symptoms.
o If it seems relevant/there are cues, ask about previous negative sexual experiences
Cause of loin pain
o Urinary calculi can cause ureteric obstruction and lead to severe loin pain which radiates to the symphysis pubis and groin.
o The sudden onset of pain in renal colic or acute urinary retention contrasts with the gradual build-up of pain from a renal tumour or the slow development of urinary symptoms from outflow obstruction.
o Ask about associated features such as pain, haematuria or incontinence.
Causes of urinary incontinence
o May be stress incontinence
o Detrusor instability
o Detrusor underactivity
o Urethral obstruction
Why is it important to ask about foreign travel in urogynaecology history?
- Travel to Egypt or Africa may result in exposure to schistosomiasis.
- Dehydration during time in a hot climate may lead to development of kidney stones.
