max brinsmead phd franzcog february 2010
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Gynae History Taking

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A Diagnosis is Made by:. Listening to the patient tell her story Generating a hypothesis Testing the hypothesisBy interrogation50 %By examination10%By selective testing 40% If at first you don\'t succeed... Go back and listen to the patient. Major Hypotheses in Gynaecology 1. Reproducti

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a diagnosis is made by
A Diagnosis is Made by:
  • Listening to the patient tell her story
  • Generating a hypothesis
  • Testing the hypothesis
      • By interrogation
      • 50 %
      • By examination
      • 10%
      • By selective testing
      • 40%
  • If at first you don’t succeed...
  • Go back and listen to the patient
major hypotheses in gynaecology 1
Major Hypotheses in Gynaecology 1
  • Reproductive tract dysfunction
    • Dysmenorrhoea
    • Dysfunctional uterine bleeding
    • Functional ovarian cysts
    • Endometriosis
  • Pregnancy
    • Miscarriage
    • Ectopic
    • Pregnancy-related disease
major hypotheses in gynaecology 2
Major Hypotheses in Gynaecology 2
  • Reproductive Tract Infections
    • Vaginitis
    • Pelvic inflammatory disease
  • Reproductive Tract Cancer
    • Cervix
    • Uterus - endometrium
    • Ovaries
  • Benign tumours
    • Fibroids
    • Polyps of cervix and endometrium
    • Ovarian
  • UterovaginalProlapse
    • Urinary dysfunction
    • Anorectal dysfunction
major hypotheses in gynaecology 3
Major Hypotheses in Gynaecology 3
  • Psychosexual
    • Pelvic Pain
    • Dyspareunia/ Vaginismus
    • Sexual Assault
    • Libido
    • Homosexuality (not usually a problem for the gynaecologist)
  • Iatrogenic
    • Arising from contraception/HRT
    • Arising from other drugs
  • Other Diseases
    • With pelvic manifestations
    • Infertility
    • Male
components of a gynae history
Components of a Gynae History
  • Menstrual history
  • Contraceptive history
  • Sexual history
  • Past gynaecological and other medical history
  • Drug history
  • Bladder and Bowel function
menstrual history
Menstrual History
  • Menarche
  • Cycle
    • Usually expressed as daysbleeding/cyclelength
  • Last menstrual period (LMP)
  • Intermenstrual bleeding (IMB)
  • Postcoital bleeding (PCB)
  • Postmenopausal bleeding (PMB)
  • Menstrual pain
menstrual history tips
Menstrual history tips
  • How often do your periods come
    • From the beginning of one period to the beginning of the next
  • What do you mean by regular
    • Do they “come early” or do they “come late”
    • How much early, how late
  • Do you get any bleeding between your periods
    • When does it occur in the cycle
    • Do you know of anything that brings this on
  • Does your period start as a full flow
    • How many days of “mucking about”
  • When was your last normal period
    • First day of the last period
    • Not the date of the missed period
assessing menstrual loss
Assessing menstrual loss
  • For how long do you have a period
  • How many heavy days
    • How many light days
    • What do you call heavy
    • How many pads or tampons
    • How often do you change
  • Do you change at night
    • How often
    • How many nights
  • Do you pass clots
    • How big
    • How often
  • Do your periods interfere with your life
  • Have you had any “accidents”

Used loosely means excessive menstrual loss...

what is excessive menstrual loss
What is excessive menstrual loss?
  • Escapes from normal menstrual protection
  • Large clots – frequently
  • Changing at night more than once
  • Lasts longer than 7 days “full flow”
  • Interferes with normal life or duties
  • Causes iron deficiency (anaemia)
    • Other causes excluded
patterns of abnormal menstrual loss
Patterns of abnormal menstrual loss
  • Menorrhagia
    • Excessive menstrual loss at regular intervals
  • Metrorrhagia
    • Frequent and irregular menstrual loss
  • Polymenorrhoea
    • Regular cycles at <21 days
  • Oligomenorrhoea
    • Infrequent menstruation (>35 days)
  • Intermenstrual Bleeding
    • Bleeding between menstrual periods
    • Requires careful questioning
assessing pelvic pain
Assessing pelvic pain
  • Do you get pain with your periods
  • Is this the same as its always been
    • If changing with time how and when
  • Which is the worse day for pain
  • What do you do for the pain
    • Analgesia used. How many tablets Does it help
    • Does the pain interfere with your life. Your sleep
  • Describe the pain
    • Nature and location. Aggravating factors
  • Pain with intercourse
    • Frequency
    • Nature and location
obtaining a sexual history
Obtaining a sexual history
  • Choose your words carefully, sometimes with preamble
  • How long have you been in your current relationship
    • Is sexual intercourse occurring
    • Have you ever been in a relationship
    • When was the last relationship
  • How many partners have you had in (period of time)
    • or before your current relationship
  • What does you or your partner do to avoid pregnancy
  • Does your partner travel
    • or spend nights away from home
    • or have other sexual partners
past gynaecological history
Past gynaecological history
  • Any other serious illnesses. Any operations
  • Any gynaecological operations
    • on your tubes, ovaries or uterus
    • Any vaginal surgery
    • Any curettes or keyhole surgery
    • Any treatment to the cervix for pre cancer changes
  • What was done in those operations
    • What were you told after
  • Do you have regular Pap tests
    • When was the last or where was it done
    • What was the result
    • Has there ever been any abnormality
    • How many have you had in (period of time)
  • Have you ever been treated for inflammation of the pelvis, tubes or for a sexually transmitted disease?
  • Did you have any trouble getting pregnant?
past obstetric history
Past obstetric history
  • Any infertility treatment(s)
  • Number of pregnancies (G) and births (P)
    • Gravida = number of pregnancies
    • Para = births after 20w (and twins =1)
    • T= termination of pregnancy
    • A= miscarriage E=ectopic
  • Birthweights and mode of delivery
    • Spontaneous or assisted vaginal birth
    • Birth trauma
  • Pregnancy complications
drug history
Drug history
  • Are you on any drugs or medications
  • Any hormones
    • The pill, injections or implants
    • Patches or hormone creams
    • Vaginal pessaries or creams
    • Details of the drug, dose and dates can be very important
  • Any vitamins, minerals , supplements or herbal remedies?
  • Do you smoke?
bladder and bowel functions
Bladder and bowel functions
  • Do you get up at night to pass urine
  • Do you have to get there in a hurry
    • Ever wet before you get there
    • How long can you hold on during the day
  • Do you ever wet
    • If you cough or sneeze
    • A little or a lot
  • Do you have any difficulty emptying your bladder
    • or getting started
    • Do you have good stream
  • Any bladder infections
  • Any difficulty getting your bowels emptied
    • What happens when you strain
  • Can you control your wind
    • How about a loose bowel motion?
infertility questions
Infertility Questions
  • The most important calculation is the number of months that the woman has been exposed to the possibility of pregnancy but has not conceived
    • This may not be the same as the couple’s view of how long they have been “trying”
  • Take a careful “contraceptive history”
  • Other useful questions
    • Have you ever been pregnant
    • Have you ever fathered a pregnancy (in any other relationship or tried)
    • How often is intercourse occurring
    • Any (intercourse) problems?