Patient History: This section covers the patient's medical, surgical, and family history, as well as details on menstrual cycles, sexual activity, and any current symptoms.
Physical Examination: This part records observations from the physical exam, including an abdominal and pelvic examination.
Laboratory Tests: Blood tests, urine tests, and cultures can provide crucial information about infections, hormone levels, and other conditions.
Imaging Studies: Ultrasounds, MRIs, and CT scans help in visualizing the internal reproductive organs.
Diagnosis: Based on the findings, the gynecologist provides a diagnosis which could range from infections to more complex conditions like
endometriosis or
ovarian cysts.
Treatment Plan: This outlines the recommended treatment options, which may include medications, lifestyle changes, or surgical interventions.
