The gynecologic history and pelvic examination
- Daniela A Carusi, MD, MSc
Daniela A Carusi, MD, MSc
- Assistant Professor of Obstetrics & Gynecology
- Harvard Medical School
Assessment of the gynecologic history and the pelvic examination is part of the assessment of female patients in many clinical contexts. Clinician familiarity with the gynecologic evaluation can help reduce anxiety for both patients and healthcare professionals .
The gynecologic history and physical examination in adult women are reviewed here. The initial assessment of pregnant women, evaluation of breast complaints, general approaches to patient interviewing as well as pelvic examination in children are discussed separately. (See "Initial prenatal assessment and first-trimester prenatal care" and "Clinical manifestations and diagnosis of a palpable breast mass" and "Approach to the patient" and "Gynecologic examination of the newborn and child".)
Overview — Individual women vary tremendously in their knowledge of, and comfort with, their own bodies. While some may be quite open in disclosing their sexual, reproductive, and genital concerns, others will find such discussions embarrassing or socially inappropriate. Thus, it is essential that providers maintain a sensitive and nonjudgmental approach during this encounter.
The history should be obtained in a relaxed and private setting, before the patient is asked to disrobe. She should be interviewed alone under most circumstances, unless there is a hearing or language barrier. Questioning should proceed from very straightforward, objective information to more delicate issues. The provider should evaluate and respond to the patient's comfort level and make every effort to remain supportive.
It is particularly important to avoid making assumptions about a woman's background; as an example, that she is sexually active or is heterosexual.
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- GYNECOLOGIC HISTORY
- Basic history
- Problem focused history
- - Vaginal discharge
- - Abnormal genital tract bleeding
- - Pelvic pain
- - Urinary incontinence and pelvic organ prolapse
- - Sexual function
- - Infertility
- PELVIC EXAMINATION
- Timing issues
- - Age at initial examination
- - Indications and frequency for examination
- - When to discontinue examinations
- Preparing for the examination
- - Patient consent
- - Chaperone
- - Patient anxiety or refusal
- - Patient positioning
- - Equipment
- Components of the examination
- - Abdomen
- - External genitalia
- - Bartholin and paraurethral glands
- - Speculum examination
- - Bimanual examination
- - Rectovaginal examination
- SPECIAL CONSIDERATIONS
- Examination of infants and children
- Examination of women with limited mobility or obesity
- Examination after hysterectomy
- SUMMARY AND RECOMMENDATIONS