tailieunhanh - The Gynecologic Examination

An understanding of the patient’s current and past sexual activity aids in assessment of sexually transmitted disease risk and contraceptive needs. The physician should strive to avoid assumptions about a patient’s sexuality. One way is to ask, “Are you sexually active with men, women, or both?” Similarly, inquiring whether the patient is interested in contraception rather than as- suming a patient is only choosing between birth control methods will lead to a more productive interaction. Current and prior expression of sexual identity may vary. The obstetric history includes live births as well as spontaneous or elective abortions. The standard shorthand for tallying the patient’s obstetric history begins with gravidity, which. | 1 The Gynecologic Examination Pamela Charney MD The complete gynecologic examination screens for infection as well as breast cervical uterine ovarian and colon cancer. Symptoms commonly evaluated with the gynecologic examination include breast lumps or pain changes in menstrual bleeding patterns vaginal discharge lower abdominal pain dyspareunia and urinary incontinence. Essential elements include a careful history preparation and the breast and pelvic examinations. Each will be discussed with particular emphasis on the pelvic examination. Gynecologic History Box 1-1 Elements of the Gynecologic History Presenting problem Medical and surgical history Medications and allergies Menstrual history Sexual history Obstetric history Last Pap smear History of abnormal Pap smears Intimate partner violence screening Family history . breast and gynecologic cancers Vaccine history . HPV hepatitis B MMR varicella Urinary and rectal symptoms The complete gynecologic history addresses issues that the patient may consider deeply personal Box 1-1 . Discussion can trigger emotional reactions that may lead the patient to withhold information 1 . Therefore ideally the gynecologic history should be obtained without observers and while the patient is still dressed. The initial reproductive history includes the patient s menstrual pattern history of all previous pregnancies results of any recent Pap smear and the initial day of the most recent 1 2 Practical Gynecology menses. A review of the patient s usual menstrual pattern should include the interval between menses duration of menses and any menstrual problems such as midcycle pain intermenstrual bleeding or dysmenorrhea. The physician should ask about abnormal vaginal discharge and should also inquire about past gynecologic problems such as abnormal Pap smears fibroids endometriosis sexually transmitted diseases and pelvic infections. For adolescents and women younger than 27 years one should offer the human papilloma virus HPV .