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PERTINENT HISTORY & PHYSICAL EXAM FOR GYNECOLOGIC DISEASES
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Accurate diagnosis and treatment of gynecologic disease begins with obtaining a complete history and physical examination. A thorough history should include
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First day of the most recent menstrual cycle
Current genital tract symptoms
Age at first menses (menarche)
Interval from starting one menses to the next (cycle length)
Duration and amount of menstrual flow
Presence or absence of irregular or unexplained bleeding
Symptoms associated with each menstrual cycle such as cramping before or during menses
Other genital tract symptoms such as urinary or fecal incontinence, prolapse, dyspareunia, discharge, or pruritus
Sexual history including assessment of risk factors such as knowledge of safe sex practices, age of first intercourse (coitarche), number and gender of partners, and presence of any history of abuse
Number of pregnancies and subsequent outcome including term delivery, mode of delivery, preterm delivery, miscarriage, or abortion
Contraceptive use including type, duration
History of sexually transmitted disease such as infection with human papillomavirus (HPV), gonorrhea, or Chlamydia
Adequacy of cervical cancer screening with Pap tests including date of most recent screen and any prior history of abnormal screens
History of any gynecologic surgery including type, date, and indication
Age of menopause
Presence of postmenopausal bleeding regardless of amount of flow
Hormone therapy of any type including oral contraceptives, postmenopausal estrogen replacement therapy, hormone therapy of breast cancer, etc
Family history of pertinent cancer sites including ovarian cancer, endometrial cancer, breast cancer, and colorectal cancer. Determine the age at time of cancer diagnosis and relationship of the affected individual to the patient
Determine the ethnicity of the patient regarding potential for hereditary diseases
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Perform a complete pelvic examination. Inspect external genitalia including vulva and urethra for development, symmetry, and visible lesions. Place a vaginal speculum to inspect the vagina and cervix for symmetry, or visible lesions and perform Pap test, cultures, or wet mount tests as indicated to evaluate symptoms or update screening. Bimanual examination is then performed with careful compression of pelvic viscera between the examiner’s hand on the abdominal wall and the finger(s) in the vagina. The process is repeated with the rectovaginal examination whereby one finger is placed in the vagina and one is inserted into the rectum. The rectovaginal exam allows the examiner to feel higher into the pelvis and may improve the ability to feel the cardinal and uterosacral ligaments, cul de sac peritoneum, ovaries, rectocele, and sphincter integrity. The rectovaginal exam is particularly important for assessing pelvic masses or malignancies, rectocele, and fecal incontinence.
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Development of the reproductive tract in the female fetus results from fusion and differentiation of the Müllerian ducts and the urogenital sinus. Fusion defects may result in duplication, malformation, or absence of genital tract structures. The most common defects are imperforate hymen, presence of longitudinal or transverse septae within the vagina, congenital absence of the vagina, and duplication defects ...