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Chapter: Obstetrics and Gynecology: The Woman’s Health Examination

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Gynecologic History

The gynecologic history focuses on the menstrual history, which begins with menarche, the age at which menses began.

GYNECOLOGIC HISTORY

 

The gynecologic history focuses on the menstrual history, which begins with menarche, the age at which menses began. The basic menstrual history includes:

 

·            Last menstrual period (LMP)

 

·            Length of periods (number of days of bleeding)

 

·            Number of days between periods

 

·            Any recent changes in periods

 

Episodes of bleeding that are “light, but on time” should be noted as such, because they may have diagnostic signifi-cance. Estimation of the amount of menstrual flow can be made by asking whether the patient uses pads or tam-pons, how many are used during the heavy days of her flow, and whether they are soaked or just soiled when they are changed. It is normal for women to pass clots during menstruation, but normally they should not be larger than the size of a dime. Specific inquiry should be made about irregular bleeding (bleeding with no set pattern or duration), intermenstrual bleeding (bleeding between menses), or postcoital bleeding (bleeding during or im-mediately after coitus).

 

The menstrual history may include perimenstrualsymptoms such as anxiety, fluid retention, nervousness,mood fluctuations, food cravings, variations in sexual feel-ings, and difficulty sleeping. Cramps and discomfort during the menses are common, but abnormal when they interfere with daily activities of living (ADLs) or when they require more analgesia than provided by non-narcotic analgesia. Menstrual pain is mediated through prostaglandins and should be responsive to nonsteroidal anti-inflammatory drugs (NSAIDs). Inquiry about duration (both how long the patient has noted this pain and how long each episode of pain lasts), quality, radiation of the pain to areas outside the pelvis, and association with body position or daily activities, completes the pain history.

 

The term menopause refers to the cessation of menses for greater than 1 year. Perimenopause is the time of transition from menstrual to non-menstrual life when ovarian function begins to wane, often lasting 1 to 2 years. Significant and dis-ruptive perimenopausal symptoms require treatment. The perimenopausal period often begins with increasing men-strual irregularity and varying or decreased flow, associ-ated with hot flushes, nervousness, mood changes, and decreased vaginal lubrication with sexual activity and altered libido.

 

The gynecologic history also includes a sexual history. Taking a sexual history is facilitated by behaviors, attitudes, and direct statements by the physician that project a nonjudg-mental manner of acceptance and respect for the patient’s lifestyle. A good opening question is, “Please tell me aboutyour sexual partner or partners.” This question is gender-neutral, leaves the issue of number of partners open, and also gives the patient considerable latitude for response. However, these questions must be individualized to each patient.

 

Data that should be elicited in the sexual history in-clude whether the patient is currently or ever has been sexually active, the lifetime number of sexual partners, the partners’ gender/s, and the patient’s current and past methods of contraception. A patient’s contraceptive his-tory should include the method currently used, when it was begun, any problems or complications, and the pa-tient’s and her partner’s satisfaction with the method. Previous contraceptive methods and the reasons they were discontinued may prove relevant. If no contracep-tive actions are being taken, inquiry should be made as to why, which may include the desire for conception or con-cerns about contraceptive options as understood by the patient. Finally, patients should be asked about behaviors that put them at high risk for the acquisition of human immunodeficiency virus (HIV), hepatitis, or other sexu-ally transmitted infections.

 

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