Gynecological
Gynaecological History
1. Introduce + Name/Age/Occupation/LMP
2. PC
3. HPC
4. Gynae questions: MSC SOUR
a. Menstrual History
i. Menarche
ii. LMP (most important)
iii. Cycle length (inc how many of those days are bleeding)
iv. Regularity
v. Heavy periods? Painful period? Bleeding inbetween? (menorrhagia, dysmenorrhea, IMB)
vi. Menopause
vii. Post-menopausal bleeding?
b. Sexual History (ask sexually active? If no then ever been sexually active?)
i. Current sexual active?
1. Regular or casual partner? Any other partners?
2. Contraception/protection?
3. Last time had sex?
4. Pain on sex (superfic/deep) or bleeding after? (dyspareunia, post-coital bleed)
5. Discharge:
a. Smell
b. Colour
c. Itchiness
d. Redness
ii. Prior STIs?
iii. Any discharge?
iv. Age of first intercourse
v. How many partners in past?
vi. HPV vaccine? (risk of cervical cancer)
c. Contraceptive History What contraceptives have they used in past + now?
d. Smear History Attending + normal results?
e. Obstetric history
i. G, P, A
1. If none, has she tried to get pregnant? For how long? How often having sex?
Unprotected? Any kids in past from either partner?
2. If some, did she breast feed?
ii. Issues during pregnancy Delivery Birth weight Post-natal problems
f. Urinary + Bowel history UTI/bowel habit or pain?
g. ROS
5. PMH (cancer), FH (ovarian, breast, endomet, cervical cancer), DH (tamoxifen, COCP, HRT), SH (smoking)
a. IF ON HRT, ASK WHAT TYPE AND FOR HOW LONG!!!
6. Summary
,7. Ix:
a. Initials:
i. Physical exam
1. Abdominal
2. Bimanual
3. Speculum
ii. Urine dip and NAAT and PREGNANCY TEST
iii. High vaginal swabs + Endocervical swabs
iv. Smear/LBC
1. Colposcopy
2. Loop/Cone biopsy
v. Bloods (b-hCG, AFP, LDH, CA-125, FSH+LH, Estrogen+testosterone, TFTs, Prolactin)
vi. Abdominal + TV-USS
vii. Pipelle biopsy
viii. Laparoscopy OR hysteroscopy
b. Abnormal smear: Colposcopy ± loop OR cone biopsy
c. PMB: Endometrial biopsy, CT ± TAH-BSO (hysterectomy ONLY if adequate stage + pre-meno)
, Specific Questions Which Are Not (Necessarily) Asked in Gynae RoS
Menorrhagia AND IMB/irregular bleeding
o How long for? How many periods has this happened for? Is it getting worse?
o How much blood Using more pads + How many? Any flooding?
o What colour? Any clots?
o Staining bed?
o Do you feel tired, SOB, chest pain? Effect on life?
o Any itching, burning or pain on the genitalia? (anatomical causes)
o Feeling of fullness OR pain in tummy? (Fibroids or PID)
o Hair growing in abnormal places? Weight gain? Acne? (PCOS) (IRREGULAR BLEED)
o Any bleeding elsewhere or bruising? (Platelet disorders)
Dysmenorrhea + Deep Dyspareunia
o How long for? Since around the time of first ever period or more recently?
o SOCRATES
o Endometriosis:
Any pain in the middle of cycle?
Have you been pregnant before/any problems with fertility?
Any bowel or bladder problems?
o Fibroids/Adenomyosis/PID:
Any feeling of constant fullness OR pain within abdomen?
Superficial Dyspareunia + Post-Coital Bleeding:
o How long for? (SOCRATES if dyspareunia)
o Any itching?
o Any bleeding?
o Any problem with lubrication or arousal?
o Does it feel like the muscles of your pelvis are tensing on intercourse?
o Any bleeding or spotting (atrophy)?
o Any discharge? (cervicitis)
(Relation to menopause)
Lower abdominal pain + bleeding (ectopic, miscarriage, hydatidiform, PID, ovarian torsion) SEE OBS
o Bleeding (has it ever happened before, when did it start, how has it changed, colour, any clots, using padding, is it like a
period or different, fatigue, SOB)
o Any bleeding/abdominal pain (opposite symptom)?
SOCRATES
o Discharge
o Dizzy
o Chest pain
o N+V (yes + resolving = ectopic/miscarriage; yes + worsening = hydatidiform)
Gynaecological History
1. Introduce + Name/Age/Occupation/LMP
2. PC
3. HPC
4. Gynae questions: MSC SOUR
a. Menstrual History
i. Menarche
ii. LMP (most important)
iii. Cycle length (inc how many of those days are bleeding)
iv. Regularity
v. Heavy periods? Painful period? Bleeding inbetween? (menorrhagia, dysmenorrhea, IMB)
vi. Menopause
vii. Post-menopausal bleeding?
b. Sexual History (ask sexually active? If no then ever been sexually active?)
i. Current sexual active?
1. Regular or casual partner? Any other partners?
2. Contraception/protection?
3. Last time had sex?
4. Pain on sex (superfic/deep) or bleeding after? (dyspareunia, post-coital bleed)
5. Discharge:
a. Smell
b. Colour
c. Itchiness
d. Redness
ii. Prior STIs?
iii. Any discharge?
iv. Age of first intercourse
v. How many partners in past?
vi. HPV vaccine? (risk of cervical cancer)
c. Contraceptive History What contraceptives have they used in past + now?
d. Smear History Attending + normal results?
e. Obstetric history
i. G, P, A
1. If none, has she tried to get pregnant? For how long? How often having sex?
Unprotected? Any kids in past from either partner?
2. If some, did she breast feed?
ii. Issues during pregnancy Delivery Birth weight Post-natal problems
f. Urinary + Bowel history UTI/bowel habit or pain?
g. ROS
5. PMH (cancer), FH (ovarian, breast, endomet, cervical cancer), DH (tamoxifen, COCP, HRT), SH (smoking)
a. IF ON HRT, ASK WHAT TYPE AND FOR HOW LONG!!!
6. Summary
,7. Ix:
a. Initials:
i. Physical exam
1. Abdominal
2. Bimanual
3. Speculum
ii. Urine dip and NAAT and PREGNANCY TEST
iii. High vaginal swabs + Endocervical swabs
iv. Smear/LBC
1. Colposcopy
2. Loop/Cone biopsy
v. Bloods (b-hCG, AFP, LDH, CA-125, FSH+LH, Estrogen+testosterone, TFTs, Prolactin)
vi. Abdominal + TV-USS
vii. Pipelle biopsy
viii. Laparoscopy OR hysteroscopy
b. Abnormal smear: Colposcopy ± loop OR cone biopsy
c. PMB: Endometrial biopsy, CT ± TAH-BSO (hysterectomy ONLY if adequate stage + pre-meno)
, Specific Questions Which Are Not (Necessarily) Asked in Gynae RoS
Menorrhagia AND IMB/irregular bleeding
o How long for? How many periods has this happened for? Is it getting worse?
o How much blood Using more pads + How many? Any flooding?
o What colour? Any clots?
o Staining bed?
o Do you feel tired, SOB, chest pain? Effect on life?
o Any itching, burning or pain on the genitalia? (anatomical causes)
o Feeling of fullness OR pain in tummy? (Fibroids or PID)
o Hair growing in abnormal places? Weight gain? Acne? (PCOS) (IRREGULAR BLEED)
o Any bleeding elsewhere or bruising? (Platelet disorders)
Dysmenorrhea + Deep Dyspareunia
o How long for? Since around the time of first ever period or more recently?
o SOCRATES
o Endometriosis:
Any pain in the middle of cycle?
Have you been pregnant before/any problems with fertility?
Any bowel or bladder problems?
o Fibroids/Adenomyosis/PID:
Any feeling of constant fullness OR pain within abdomen?
Superficial Dyspareunia + Post-Coital Bleeding:
o How long for? (SOCRATES if dyspareunia)
o Any itching?
o Any bleeding?
o Any problem with lubrication or arousal?
o Does it feel like the muscles of your pelvis are tensing on intercourse?
o Any bleeding or spotting (atrophy)?
o Any discharge? (cervicitis)
(Relation to menopause)
Lower abdominal pain + bleeding (ectopic, miscarriage, hydatidiform, PID, ovarian torsion) SEE OBS
o Bleeding (has it ever happened before, when did it start, how has it changed, colour, any clots, using padding, is it like a
period or different, fatigue, SOB)
o Any bleeding/abdominal pain (opposite symptom)?
SOCRATES
o Discharge
o Dizzy
o Chest pain
o N+V (yes + resolving = ectopic/miscarriage; yes + worsening = hydatidiform)
