Obstetrics and Gynecology · MU Sofia

41. Gynecological history. Clinical gynecological examination. Normal findings at pelvic exam

Covers the gynaecological history, including presenting complaints, menstrual, sexual, obstetric and cervical screening details, plus past, drug, family and social history. Then describes the examination in order: general and abdominal inspection, vulval inspection, speculum and bimanual examination, and rectovaginal examination when needed, with a note on virgins and children. A table sets out normal findings for the vulva, vagina, cervix, uterus, adnexa and pouch of Douglas, and the note closes by contrasting a fixed retroverted uterus with a mobile one.

Inside: 4 sections · 1 table · 15 flashcards · 2 min

Topic 41 of 61 in the MU Sofia syllabus for Obstetrics and Gynecology (Medicine, Year 5). The free AceMed note covers it in 4 sections, about 227 words (2 min of reading), with 15 flashcards.

In this note

  1. Introduction
  2. Gynaecological history
  3. Examination
  4. Normal findings

Introduction

The gynaecological history and examination are the basis of every diagnosis in gynaecology. They must be done with privacy, consent and, for the intimate examination, a chaperone.

Gynaecological history

  • Presenting complaint: bleeding, pain, discharge, mass, infertility, urinary symptoms, prolapse.
  • Menstrual history: menarche, LMP, cycle length and regularity, duration and amount of bleeding (clots, flooding, pads), dysmenorrhoea, intermenstrual and postcoital bleeding, menopause and any postmenopausal bleeding.
  • Sexual history: activity, dyspareunia, partners, contraception, STI risk.
  • Obstetric history: pregnancies and their outcomes.
  • Cervical screening: date and results of the last test.
  • Past medical and surgical history, drugs (hormones, anticoagulants), family history (breast, ovarian, bowel cancer), social history.

Examination

  1. General: BMI, pallor, hirsutism, lymph nodes, breasts when relevant.
  2. Abdominal: inspection (distension, scars), palpation for masses arising from the pelvis (you cannot get below them), tenderness, ascites.
  3. Inspection of the vulva: skin, lesions, discharge, prolapse on straining.
  4. Speculum examination (Cusco bivalve; Sims for prolapse): vaginal walls, cervix (ectropion, polyp, ulcer, tumour), discharge; take swabs and cervical screening sample.
  5. Bimanual examination: two fingers in the vagina, the other hand on the abdomen: uterus size, position, mobility, tenderness; adnexa; cervical motion tenderness; pouch of Douglas.
  6. Rectovaginal examination when needed (endometriosis nodules, parametrium, cancer staging).

In virgins and children: no speculum; rectal examination or ultrasound instead.

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