As with any other patient problem, taking a history is essential for a gynaecological complaint. At the end of the history-taking you will have formed a hypothesis which will enable you to conduct a targeted examination [Figure 18].
Figure 18
In this section we will briefly dicuss the essential general gynaecological history-taking: what you definitely need to know before you carry out a gynaecological examination. The history-taking is always the commencement of your contact with the patient. We will also pay attention to this aspect.
If the patient presents a complaint, you have to go into further detail regarding the complaint. Keep asking yourself which organ (system) or structure may give rise to these symptoms and what the cause may be (what is wrong). The more specific questions, depending on the patient’s complaint, are discussed in the section “Case scenario’s” for each complaint in question.
Continuously ask yourself before and during the examination: “what do I want to find out during this examination?”, “what does this finding tell me?” and always place this information within the context of the information obtained from the history-taking. Does this finding agree with my hypothesis?
Be aware that the gynaecological examination, more than other physical examinations, is stressful for a woman. It is important that the burden is always kept to a minimum. This can be achieved by paying attention to privacy, taking into account optimal examination conditions, a good examination technique and particularly by maintaining good contact with your patient.
Because the gynaecological examination intrudes on a woman’s personal intimacy more than any other physical examination, it is useful to ask patients if they have ever undergone such an examination before. If they have not, then provide information about what you will be doing, in addition to how and why it is done.
For every gynaecological examination, regardless of the indication, it is important to have a good idea of the hormonal / gynaecological status of the woman you are about to investigate. This allows you to know what to expect during the examination.
Important questions are:
- Age
- Phase of life status of the reproductive organs (menarche / child-bearing age / menopause (date of last menstruation))
- Course of the cycle (length / duration / intensity / regularity)
- Past medical history:
- Obstetrics (including episiotomy scar)
- Gynaecology
- Abdominal surgery
- (Hormonal) medication, both past and current (oestrogen substitution, contraception).