Block 4 - Reproductive Flashcards
What are the 6 main areas to be explored in the female reproductive history?
The main specific areas to be explored are:
1) Menstrual History
2) Sexual History
3) Contraception
4) Crevical Screening Tests / Pap smears
5) Fertility/Infertility
6) Breast health
Female Reproductive History Protocol?
Female Reproductive History Protocol
1. Introduction
2. Presenting Complaint
3. Past Medical History
4. Sexual History
5. Cervical Screening Tests
6. Pregnancy History
7. Menstrual History
8. Breast Health
9. Treatments/Medications
10. Allergies
11. Social history
12. Family history
13. Systems Review - Urogenital & GIT
COMMON PRESENTING SYMPTOMS IN GYNAECOLOGY?
Female Reproductive History - What questions should you ask about past medical history? (4)
Female Reproductive History - Past Medical History
1. General – medical (active/inactive)
2. General - surgical
3. Hypertension
4. Clotting/bleeding disorders
Female Reproductive History - What questions should you ask about Sexual history? (6)
Female Reproductive History - Sexual History
1. Sexually active?
2. Number of partners?
3. Hx of STIs – treatment?
4. Contraception – What are they using? What have they used in the past? - barrier methods, OCP, injectable progesterone, IUD? Any problems with any contraceptives?
5. Dyspareunia – deep, superficial?
6. Post coital bleeding?
5 High risk groups for STIs?
10 possible symptoms of an STI?
Female Reproductive History - What questions should you ask about Cervical Screening Tests? (5)
Female Reproductive History - Cervical Screening Tests
1. Up to date?
2. Any abnormal results?
3. When - what treatment required
4. Any negative experiences as to why they haven’t had them?
5. Colposcopy?
Female Reproductive History - What questions should you ask about Pregnancy History? (4)
Female Reproductive History - Pregnancy History
1. How many pregnancies? How many live births? Gx.Px. (gravida, parity), include miscarriages and termination.
2. Gestation in weeks?
2. What type of birth? e.g. Caesarean (emergency or planned), vaginal birth, assisted delivery & why?
3. Any pregnancy complications e.g. high blood pressure, gestational diabetes
4. Any complications following birth? - eg. tearing? postpartum haemorrhage?
4. Breast feeding?
5. Baby - weight?
6. If recent birth - mental health? - eg. “how are you coping?”
Female Reproductive History - What questions should you ask about Menstrual History? (6)
Female Reproductive History - Menstrual History
1. Menarche – Age of onset of menstruation
2. Menopause – if appropriate
3. Length of cycle – day one bleeding → day one of bleeding next cycle. Regular cycle?
4. Amount of bleeding compared to patient’s “normal” - how many pads/tampons? Any flooding or clots? Days of bleeding?
5. Intermenstrual bleeding?
5. Post-coital bleeding?
6. Post menopausal bleeding?
Female Reproductive History - What questions should you ask about Breast Health? (3)
Female Reproductive History - Breast Health
1. Does the patient perform self checks?
2. History of lumps – investigation/diagnosis treatment
3. Screening mammograms age 50-74yrs
Female Reproductive History - What questions should you ask about Treatment/Medications? (3)
Female Reproductive History - Treatment/Medications
1. General – medications?
2. OTC?
3. Herbal?
4. Contraception?
5. HRT?
6. Tamoxifen?
Female Reproductive History - What questions should you ask about Family History? (3)
Female Reproductive History - Family History
1. Mother’s age at menopause?
2. Breast or ovarian cancer?
3. Stroke?
4. Thrombophilias?
5. Recurrent miscarriage?
6. Infertility?
Pelvic Examination Protocol? (9)
Pelvic Examination Protocol
The components of pelvic examination are inspection, speculum, Cervical Screening Test, swabs and bimanual examination.
- Inform patient of Cervical Screening Test registry and obtain consent
- Discuss how to obtain results
What are you looking for during the female pelvic examination - externally? (6)
Female Pelvic Exam - External Inspection
1. Skin conditions
2. Lumps/Growths
3. Ulceration
3. Discharge
4. Bleeding
5. Evidence of gross prolapse
6. Signs female genital mutilation
What are you looking for during the female pelvic examination - internally? (8)
Female Pelvic Examination - Speculum Exam
1. Cervix size, colour, shape?
2. Discharge?
3. Growths
4. Ulceration
5. Bleeding
6. Transformation zone
7. IUD strings
8. Vaginal wall for colour, texture, discharge, abnormalities.
