Clinical methods of assessing a gynaecological patients.

• History taking

The most important information is always provided by the patient or relatives. History taking tactics are required for it is concerned with discussing intimate matters. Therefore, privacy is essential in order to get reliable information from the patient.

1. Personal data: This includes name, age, address, next of kin, occupation, religion, tribe etc.
2. Presenting complaints: eg Pain onset

• Where it is felt
• Intensity
• Defecation or micturition
• Dyspareunia

      3. History of presenting complaints.

1. Obstetric history: Number of pregnancies, abortion, type of delivery, history of trauma, prolonged labour etc.
2. Menstrual cycle: Menarche, regularity, duration and length of cycles, volume of blood loss etc. 
3. Social history: Look out for marital status, life style, smoking, alcohol, occupation etc. 
4. Past medical and surgical history: Has she ever suffered from a serious disease eg. Tuberculosis, had an accident which involved the spine, pelvis and lower limbs or any operation on her pelvic organs.
5. Gynaecological history: Has she ever had any gynaecological condition like fibroids, rectal vaginal fistula, vesicle vaginal fistula, perennial tears, abortions etc., any operations on the cervix or dilation and curettage. 

        4.  Examination 

1. General examination

The general examination is important in gynaecology. This is done from head to toe. Note. 

• General appearance of the patient
• Behavior
• Look out for signs of anaemia
• Examine breasts: Look for signs of pregnancy and any discharge.  Examine the breast to exclude malignancies.
• Abdomen It is inspected for size and shape and palpated for tumours.
• Pelvic examination: This is the last examination done to confirm the diagnosis already suspected during history taking.

Note:

• The patient should consent for the examination, if not married, parents can consent for her because the hymen can be broken.
• The patients bladder and bowels must be empty.
• Good light is also needed.

      2. Vaginal examination

Each part of the genital tract should be examined in a logical sequence;

• Vulva
• Vagina
• Cervix (inspect for tears, prolapse etc.)
• Body of the uterus
• Pouch of Douglas

NB: The cervix and uterus should be examined for size, shape, position and tenderness.

Special procedures and investigations

These are useful to fill gaps which remain after history taking during clinical assessment.

1. Evacuation: It refers to removal of the contents of a cavity. It is done when pelvic examination has not been possible. Its disadvantage is that important signs of tenderness are missed out. (examination is done under anaesthesia)
2. Curettage:  Refers to scrapping of the internal surface of an organ or body cavity by means of a spoon shaped instrument called a curette. It is done to; Remove retained products of conception and to obtain a specimen for diagnostic purposes
3. Biopsy:  This is the removal of a small piece of leaving tissue from an organ or part of the body for microscopic examination so as to exclude certain diseases. It can be obtained from the cervix, endometrium etc.
4. Ultra sound scan: The use of ultrasound produces images of structures in the human body using sound waves of high frequency. This is now used widely to detect diseases of the pelvic organs and pregnancy.
5. Hysterosalpingography: Refers to x-ray imaging of the uterus and fallopian tubes. It is useful in diagnosing;

• Tubal obstruction
• Peritubal and intrapelvic adhesions
• Malformations of the uterus
• Small intracavity tumours
• Detect the internal os of the cervix causing abortion and premature labour.

      6. Laparoscopy: Examination of abdominal structures by means of a laparoscope (type of endoscope). This is passed through a small incision in the wall of the abdomen. Used when;

• Taking a biopsy
• Aspirating cysts
• Dividing adhesions
• Collecting ova for vitro fertilization