Transcript Gynae History Taking - Max Brinsmead MB BS PhD

Max Brinsmead MB BS PhD
May 2015
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Listening to the patient tell her story
Generating a hypothesis
Testing the hypothesis
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By interrogation
50 %
By examination
10%
By selective testing
40%
If at first you don’t succeed...
Go back and listen to the patient
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Reproductive tract dysfunction
 Dysmenorrhoea
 Dysfunctional uterine bleeding
 Functional ovarian cysts
 Endometriosis
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Pregnancy
 Miscarriage
 Ectopic
 Pregnancy-related disease
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Reproductive Tract Infections
 Vaginitis
 Pelvic inflammatory disease
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Reproductive Tract Cancer
 Cervix
 Uterus - endometrium
 Ovaries
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Benign tumours
 Fibroids
 Polyps of cervix and endometrium
 Ovarian
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Uterovaginal Prolapse
 Urinary dysfunction
 Anorectal dysfunction
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Psychosexual
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Pelvic Pain
Dyspareunia/ Vaginismus
Sexual Assault
Libido
Homosexuality (not usually a problem for the gynaecologist)
Iatrogenic
 Arising from contraception/HRT
 Arising from other drugs
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Other Diseases
 With pelvic manifestations
 Infertility
 Male
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Menstrual history
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Contraceptive history
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Sexual history
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Past gynaecological and other medical history
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Drug history
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Bladder and Bowel function
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Menarche
Cycle
 Usually expressed as days bleeding/cycle length
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Last menstrual period (LMP)
Intermenstrual bleeding (IMB)
Postcoital bleeding (PCB)
Postmenopausal bleeding (PMB)
Menstrual pain
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How often do your periods come
 From the beginning of one period to the beginning of the next
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What do you mean by regular
 Do they “come early” or do they “come late”
 How much early, how late
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Do you get any bleeding between your periods
 When does it occur in the cycle
 Do you know of anything that brings this on
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Does your period start as a full flow
 How many days of “mucking about”
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When was your last normal period
 First day of the last period
 Not the date of the missed period
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For how long do you have a period
How many heavy days
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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
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Do you pass clots
 How big
 How often
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Do your periods interfere with your life
Have you had any “accidents”
Used loosely means excessive menstrual loss...
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Escapes from normal menstrual protection
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Large clots – frequently
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Changing at night more than once
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Lasts longer than 7 days “full flow”
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Interferes with normal life or duties
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Causes iron deficiency (anaemia)
 Other causes excluded
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Menorrhagia
 Excessive menstrual loss at regular intervals
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Metrorrhagia
 Frequent and irregular menstrual loss
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Polymenorrhoea
 Regular cycles at <21 days
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Oligomenorrhoea
 Infrequent menstruation (>35 days)
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Intermenstrual Bleeding
 Bleeding between menstrual periods
 Requires careful questioning
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Do you get pain with your periods
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Is this the same as its always been
 If changing with time how and when
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Which is the worse day for pain
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What do you do for the pain
 Analgesia used. How many tablets Does it help
 Does the pain interfere with your life. Your sleep
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Describe the pain
 Nature and location. Aggravating factors
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Pain with intercourse
 Frequency
 Nature and location
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Choose your words carefully, sometimes with preamble
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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
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How many partners have you had in (period of time)
 or before your current relationship
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What does you or your partner do to avoid pregnancy
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Does your partner travel
 or spend nights away from home
 or have other sexual partners
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Any other serious illnesses. Any operations
Any gynaecological operations
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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
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Do you have regular Pap tests
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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?
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Any infertility treatment(s)
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Number of pregnancies (G) and births (P)
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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
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Pregnancy complications
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Are you on any drugs or medications
Any hormones
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The pill, injections or implants
Patches or hormone creams
Vaginal pessaries or creams
Details of the drug, dose and dates can be very important
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Any vitamins, minerals , supplements or
herbal remedies?
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Do you smoke?
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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
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Do you ever wet
 If you cough or sneeze
 A little or a lot
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Do you have any difficulty emptying your bladder
 or getting started
 Do you have good stream
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Any bladder infections
Any difficulty getting your bowels emptied
 What happens when you strain
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Can you control your wind
 How about a loose bowel motion?
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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”
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Take a careful “contraceptive history”
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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?
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Read the companion text to this Powerpoint :
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www.brinsmead.net.au/mdoc/MenstrualHistory.pdf