Investigation methods for genital tract disorder

1. Gynecological
HistoryTaking
Investigation methods
for genital tract
disorder
By : Ismail Surchi

2. Anamnestic
Data
Name
Age
Address
Occupation
Home town
Marital state
Personal data

3. Presenting
or chief
Complaint
Main complaints
Duration of maincomplaints and
duration.
Eg-
• Urinary incontinence
• Pain
• Lump invulva

4. History of
Presenting
Complaint
Detailed information about the presenting complaint
Onset: acute or insidious
location
severity
Time and duration
Character
Progression
Relieving and Aggravating (What increase/decrease the
symptoms)
Associated factors (Others symptoms to prove or disprove
provisional diagnosis).

5. Past History Any medical or surgical illness and with
dates.

6. FamilyHistory
allergies
diabetic mellitus
hypertension
Any geneticaldisease

7. SocialHistory
and
Systemic
Inquiry Appetite, weight loss, weight gain
Bowel functions
Bladder function
Social situation
Occupation and itsenvironment
Relationships
Smokingand alcohol intake

8. Menstrual
History
Age ofmenarche
Usual duration of eachperiod e.g. 5/28))
Length ofcycle
First day of last period
Pattern of bleeding :regular or irregular
Amount of bloodloss:
more or less than usual
Passage of clots or flooding
Any pain related to period, its severityand time of
onset
Any medication taken during the period

9. Menopause
(ifrelevant)
Date of last period
Any post menopausal bleeding
Any menopausalsymptoms

10. Sexual
and
Contraceptive
history
Type of contraceptiveused
Duration
Any problems regardingit
Sexual active?
Dyspareunia?
post coital bleeding

11. Previous
Gynecological
History Any previous gynaecological treatments or surgery

12. Previous
Obstetric
History
Number of childrenand birth weights
Any abnormalities with pregnancy, labour .
Pattern of birth.
Number of miscarriages and gestation at which they
occurred.
Any terminations of pregnancy with record of
gestational age and any complications.

13.  Systemic Examination(abdominal
,cardiovascular , respiratory ,urology).
Physical
Examination
 General examination
- General appearance of the patient: Gait ,
BMI , Vital signs, Face, Hands.
- Head and neck. (examine the thyroid gland).
- Lower limp for oedema and varicose veins.
 gynecological examination :
 Speculum examination
 Bimanual examination
 External examination
 Breast examination

14.  Abdominal examination :
Inspection for
Abdominal distention , shape, asymmetry , masses, scars, hernia,
dilated veins.
Palpation:
Superficial palpation for: tenderness ,rigidity , guarding.
Deep palpation for: organomegaly. (liver, spleen, kidneys),deep
palpation for any masses and if present determine if arising from
the pelvis.
Percussion: dull if the mass is solid, tympanitic if distended
bowel, shifting dullness and fluid thrill in case of ascites.
Auscultation: usually used postoperatively to detect bowel
sounds.
Physical
Examination

15. Physical
Examination
 gynecological examination :
 Speculum examination
 Bimanual examination
 External examination
 Breast examination

16. Gynecological
and (pelvic)
Examination
 Pap smear
 Speculum and Bimanual vaginal
examination :
 A speculum examination and a bimanual vaginal
examination are often done together. These
examinations are used to evaluate the overall health
of a woman's reproductive organs.
 External Examination :
 Are used to look at vulva and the opening of vagina.
They’re checking for signs of cysts, abnormal
discharge, genital warts, irritation, or other issues.
 Breast examination :
 To inspect breasts for following: changes in size,
shape or symmetry. Check to see if nipples are
turned in (inverted). Inspect breasts with hands
pressed down on hip.

17. Pap
smear
test
A Pap smear, also called a Pap test, is a procedure to assess
women's cervical health, the main purposes for pap test are :
- To screen for malignant and premalignant lesions of the cervix.
- For determine presence of HPV.
- Also used to take a sample of the discharge from cervix by a
cotton swab . This sample will be tested

18. Bimanual
vaginal
examination
Bimanual exam used to check for :
• the size, shape, and position of your uterus.
• tenderness or pain — which might mean infection or
another condition.
• enlarged ovaries, fallopian tubes, ovarian cysts, or tumors.

19. Speculum
examination
speculum The speculum helps to spread apart the walls of the
vagina, allowing the health professional to see the cervix and the
walls of the vagina. Samples of tissue may also be collected for
testing.
Used for looking of any abnormal growth, ulcer, STDs or other
infections,.

20. Laboratory
investigation
INVESTIGATIONS
• We investigate to confirm diagnosis and Exclude
Differentials, Monitor the Treatment Order.
• Priority of request(investigations) will depends on
Necessity ,Availability and cost Includes :
 Hematology
 Serology
 Biochemistry
 Microbiology
 Cytology and Histopathology
 Imaging

21. Hormonal
investigation
Female hormonal testing is recommended when
irregularities are identified in the menstrual cycle
or physical examination.
 Anti Mullerien Hormone (AMH) is a hormone produced by the
ovary, that reflects ovarian reserve and recruitable eggs
available for fertility in a cycle.
 Estrogen is largely responsible for stimulating the development
of the endometrium, the blood-rich mucus membrane that lines
the uterus.
 Progesterone is a hormone produced after ovulation that is
critical to successful implantation.
 (FSH) and (LH) control ovarian function. These hormone tests
are usually recommended for women who have abnormalities in
their menstrual cycles or who do not ovulate normally.

22. Hormonal
investigation
 Testosterone and Other Androgens The ovaries and adrenal
glands usually produce small amounts of androgens (male
hormones), including testosterone. If androgens are
overproduced, normal ovulation can be affected. Indications of
excess androgen include oily skin, acne, and excessive hair
growth.
 Thyroid Tests The thyroid can affect fertility, the ability to
become pregnant and maintain a healthy pregnancy, postpartum
health, successful breastfeeding, and even the health of your
baby.
 (TSH) is tested to detect any problems affecting the thyroid
gland. TSH, which is produced by the pituitary gland, is
measured first because it is a more sensitive indicator of thyroid
function than the thyroid hormone itself.
 Prolactin Excess prolactin, a condition known as
Hyperprolactinemia, can result in an assortment of reproductive
dysfunctions, including irregular ovulation and menstruation,
absence of menstruation, and Galactorrhea (breast milk
production by a woman who is not nursing).

23. Pelvic and
vaginal
investigation
Pelvic pain
-Site ofpain, Its nature, Severity
-Onset of pain, duration ortiming, Radiation
-Relieving factors -Exacerbating factors -Any associated
symptoms.
Vaginal discharge
-Amount,color, odour,presence of blood.
-Relationship to menstrual cycle
-Anyhistoryofsexuallytransmitteddisease(STD)or recenttests
-Anyvaginaldryness(postmenopausal).

24. Cytology and
histology
investigations
The most common investigation in this field is the Pap
test, which is used to screen for potentially precancerous
lesions of the cervix.
Cytology can also be used to investigate disorders of
the ovaries, uterus, vagina and vulva.
The Pap smear bacterial used for detection of bacterial
vaginosis.

25. Uses for
ultrasound in
gynecology
Assessment of pelvic masses and tumors
Diagnosis of polycystic ovaries
Investigation of postmenopausal bleeding
 Imaging and measure of endometrial thickness
Investigation of menorrhagia
 Fibroids and adenomyosis
IUCD and Implantation location
Treatment of ovarian cysts (aspiration) and ectopic
pregnancy (methotrexate)
Evaluation of primary amenorrhoea
Screening for ovarian cancer.
 Too many false positives

26. Uses for
ultrasound in
obstetric
 Obstetrical ultrasound is a useful clinical test to:
– Establish the presence of a living embryo/fetus
– Estimate the age of the pregnancy
– Diagnose congenital abnormalities of the fetus
– Evaluate the position of the fetus
– Evaluate the position of the placenta
- Determine if there are multiple pregnancies
– Determine the amount of amniotic fluid around the
baby
– Assess fetal growth and well-being

27. Hysteroscopy
Hysteroscopy is a procedure done by using a hysteroscop,
which is a thin, lighted tube that is inserted inside the
vagina to check the cervix and inside of the uterus. The
procedure helps to get a closer look at the cervix and
uterus and diagnose the cause of the problem.
indication of doing hysteroscopy can be summarized as:
 If a woman is having abnormal Periods.
 Bleeding after Menopause.
 To diagnose the presence of fibroids, polyps or scar
tissues.
 It can also help to determine any kind of uterine
malformation.
 Recurrent miscarriages.
 If a biopsy is suggested.
 As a part of an Infertility workup.
 To locate the position of an Intrauterine Device (IUD).

28. Colposcopy
Colposcopy is a simple procedure used to look at the cervix,
from opening of vagina.
It may be done if a cervical screening test (smear test) finds
that patient have abnormal cells in cervix.
It also helps to decide if patient need treatment to remove
the cells.
Patient may need a colposcopy if:
 If they had 2 or more positive tests in a row for
the human papillomavirus (HPV)
 some of the cells in screening test sample are abnormal.
 There are risk factor for cancer.
 A colposcopy examination is safe during pregnancy.

29. ThankYou!