This document provides guidance on performing a gynecological history and examination. It discusses collecting relevant information from the patient depending on their presenting complaint, such as menstrual history, abnormal bleeding, sexual history and menopausal symptoms. The examination involves inspection, palpation, percussion and auscultation of the general and specific genital areas. Common gynecological conditions that may be observed during examination are also outlined. Appropriate investigations like ultrasound, pap smear and colposcopy are recommended to revise diagnoses and guide treatment.

1. DR HALIMATUN MANSOR
SPECIALIST
DEPARTMENT OF OBSTETRICS AND GYNAECOLOGY
HSNZ

2.  Gynaecology history and examination are a
modification of a standardized history taking
design for
 elucidation of the presenting problems,
 concluding provisional and differential diagnosis
 Planned for further management

4.  Depending on the presenting complaint
 Age of menarche/menopause
 Marital status- infertility
 LNMP
 Length of menstruation and cycle
 Frequency and regularity of cycle
 Menstrual loss , presence of clots and flooding
 Duration of dysmenorrhea and relation to period

5.  Abnormal bleeding
 Intermenstrual
 Postcoital
 Postmenopausal
 Abnormal PV discharge
 Color, pruritus, offensive odour

6.  Sexual history
 Dyspereunia
 Contraception
 Previous STD
 Hormonal therapy
 Oral / injectable
 HRT

7.  Menopausal symptoms
 Pain
 Onset, duration , nature , site
 Relation to menstrual cycle
 Symptoms of prolapse, unconfortable lumps
in vagina

8.  Urinary problems
 Incontinence, (stress or urge)
 Frequency, nocturia or dysuria
 Other systemic review
 Past obstetric and gynaecology history
 Past medical and surgical history

9.  Social history
 Smoking, alcohol consumption
 Drug history

10.  Always begin with
 Inspection
 Palpation
 Purcussion
 Auscaltation
 Genaral examination
 Specific examination

11.  Inspection of genitalia and urethral meatus
 Evidence of estrogen deficiency, prolapse or
abnormal masses
 Presence of abnormal bleeding or discharge

12.  Speculum Examination
 Inspection of vagina and cervix
 Taking of cervical cytology or microbiology swab
 Assess uterovaginal prolapse and
incontinance

13. 13
Candidiasis Strawberry cervix: Trichomonas
Bacteria vaginosis
Herpes Simplex
Actinomyces
infection
Atrophic
cervicitis

14. Stage IV Complete
eversion

15.  Perform bimanual examination
 Assess uterine
size, shape, ante/retroverted, mobility of uterus
 Tenderness- cervical motion, POD, adnexas
 Presence of abnormal masses at POD or adnexa
 Uterosacral ligament- presence of nodule
 Thickness of the rectovaginal space

16. Imperforate hymen

17. Differential diagnosis
Revise/Prioritise diagnosis
Investigations
Treatment / Management

19.  Ultrasound
 PAP Smear for cervical screening
 Colposcopy procedure

22.  Cheap
 Acceptable
 Good sensitivity and specificity
 Achieved of screening must be 70-80%

23. 23
Cervical Biopsy
Exfoliative cytology test
cells collected are from normally shedding
epithelium .
collected using spatulas or brushes.
Specimen is fixed, stained and
studied for morphology under
microscope.

24. 24
 Initially using vaginal pool smears to
study hormonal status .
 Found cancer cells on a slide containing
a specimen from a woman's uterus.
 Dr. George Papanicolaou reported the
usefulness of the technique for detecting
neoplastic cervical cells in 1941.
 late 1940s to early 1950s, Pap smear
became widely used as a screening
technique.
Dr. George Nicholas
Papanicolaou

25. 25
1. Approximately 80% of
cells sample containing
important diagnostic
imformation is removed with
sampling devices.
2. False negative rate at
least 20% (mainly due to
sampling error).
3. Sampling is a factor in up
to 90% of false negative pap
smear.
( JosephMG. Diagn Cytopathol 1991;7(5):477)
4.Up to 40% of all Pap smears are
compromised by blood, mucus and
inflammation.
(Davey DD.Arch Pathol
Lab Med 1992;116:90)

27. 27
 Sampling
Scanty cells
Blood, mucous, pus
Mainly endocervical cells *
 Preparation
Too thick due to poor spreading
Air drying artifact

28. VIA : Visual inspection with acetic acid.
VILI : Visual inspection with Lugol’s iodine.
28

29.  A tool for screening as well as treatment of
cervical pathology especially at preinvasive
and early stage
 Need training and practice
 Available

32. smooth featureless covering of the cervix

34. Low grade lesion in a satellite pattern