Medical History
Gathering a detailed medical history is crucial in gynecology. It involves understanding the patient's overall health, reproductive history, and any symptoms they may be experiencing.
Menstrual History
Important questions to ask include:
- Age at menarche: At what age did you have your first period?
- Cycle regularity: Are your periods regular or irregular?
- Cycle length: How many days does your menstrual cycle last?
- Flow characteristics: How would you describe your menstrual flow (light, moderate, heavy)?
- Menstrual pain: Do you experience pain during your periods (dysmenorrhea)?
Obstetric History
Questions to consider:
- Gravidity and Parity: How many times have you been pregnant? How many times have you given birth?
- Pregnancy outcomes: Have you had any miscarriages, stillbirths, or abortions?
- Complications: Did you experience any complications during pregnancy, labor, or delivery?
Sexual History
Essential inquiries:
- Sexual activity: Are you currently sexually active?
- Number of partners: How many sexual partners have you had in the past year?
- Contraceptive use: What methods of contraception, if any, are you using?
- Sexual health: Have you experienced any pain during intercourse (dyspareunia) or any other sexual dysfunction?
Gynecological History
Key questions include:
- Previous gynecological conditions: Have you been diagnosed with any gynecological conditions such as PCOS, endometriosis, or fibroids?
- Surgeries: Have you ever had any gynecological surgeries, for example, a hysterectomy or a laparoscopy?
- Screenings: When was your last Pap smear or HPV test?
Medical and Family History
Important aspects:
- Chronic conditions: Do you have any chronic medical conditions like diabetes, hypertension, or thyroid disorders?
- Medications: Are you currently taking any medications, including over-the-counter drugs and supplements?
- Family history: Is there a family history of gynecological cancers or other relevant conditions?
Physical Examination
The physical examination in gynecology involves a general examination, an abdominal examination, and a pelvic examination.
General Examination
This includes:
- Vital signs: Checking blood pressure, heart rate, and temperature.
- General appearance: Assessing the patient's overall health and well-being.
- Breast examination: Checking for lumps, discharge, or any abnormalities.
Abdominal Examination
Steps involved:
- Inspection: Observing for any scars, distention, or visible masses.
- Palpation: Feeling for any tenderness, masses, or organomegaly.
- Percussion and auscultation: Listening for bowel sounds and assessing for ascites.
Pelvic Examination
This is a critical component and includes:
- External genital inspection: Checking for lesions, discharge, or signs of trauma.
- Speculum examination: Inserting a speculum to visualize the cervix and vaginal walls. This allows for the collection of samples for a Pap smear and cultures.
- Bimanual examination: Using two hands to palpate the uterus, ovaries, and adnexa to assess for size, shape, and any tenderness or masses.
- Rectovaginal examination: Sometimes performed to better evaluate the posterior pelvic structures.
Conclusion
A thorough medical history and physical examination are foundational in gynecology. They help in diagnosing conditions, guiding treatment plans, and ensuring comprehensive care for the patient. Each question and examination step provides valuable information that contributes to a holistic understanding of the patient's health.
