Gynecologic Assessment of Women

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Gynecologic Assessment of Women

• Eileen Hawkins, MSN, ARNP

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Purpose of GYN Interview

• Detection, diagnosis, and tx. of GYN problems
• Screening for other existing or potential health
  problems
• General health promotion

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Health History

• Identifying data
• Chief complaint
• HPI, PMH, FH
• Introductory statement
• Gravidity, parity, term or preterm, LC, menarche,
  LMP, PMP

• Menstrual history
• Contraceptive history
• Sexual history
• Pap S results
• If older, menopause date, HRT

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Common Conditions

• Variations in menstruation
• Vaginal discharge/irritation
• Pelvic pain

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Normal Menses

• Menarche 11-14 yrs.
• Menopause 45-55 yrs.
• Menstrual interval 21-35 or 45 days
• Duration 2-8 days

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Defining Abnormal

• Vaginal or uterine bleeding that is not the
  result of normal menses.
• Organic
• Non-organic
• Menorrhagia, hypomenorrhea, metorrhagia,
  menometrorrhagia, polymenorrhea, oligomenorrhea,
  postmenopausal

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Differential Diagnosis

• Anovulation
• Contraceptive complications
• Complications of pregnancy
• PID
• Trauma, foreign bodies
• Neoplasms
• Blood dyscrasias

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Abnormal Bleeding History

• Patient age
• History
• Symptoms
• STD, PID
• Coagulation defect, medication use, dietary
  extreme
• Trauma
• CNS disorder

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Physical Exam

• Vital signs
• HEENT
• Neck
• Heart, lungs, breast
• Abdomen
• Pelvic

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Physical Exam

• Pallor
• Pelvic mass
• Fever, leukocytosis, pelvic tenderness
• Hair texture, hypoactive or slow-reactive
  reflexes
• Ecchymosis, multiple bruises

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Amenorrhea

• Primary - Menarche not occurred
• Secondary - no menses for 3-6 months

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Secondary Amenorrhea

• Pregnancy
• Psychogenic (stress)
• Weight changes
• Exercise induced
• Post-pill
• Pituitary disease
• Premature ovarian failure

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Pelvic Pain

• Dysmenorrhea
• Primary
• Secondary
• Acute
• Mittelschmerz, ectopic pregnancy, SAB, ovarian
  torsion, Bartholinitis
• Chronic
• Endometriosis, PID, dysmenorrhea, adhesions

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Vaginal Discharge/Irritation

• Forgotten tampon in vagina
• Feminine hygiene products
• Spermicidal preparations
• Suppositories
• Pinworms
• Clothing
• Soaps
• Items used in sexual activity

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Vaginitis STDS

• Physiologic
• Trichomonal
• Gonococcal
• Bacterial vaginosis (BV)
• Chlamydia
• Candida
• Herpes
• HPV
• Atrophic

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Pelvic Relaxation

• Cystocele
• Rectocele
• Uterine prolapse

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• A 46 yr. old woman, G3P3, presents with an 8
  month history of progressively longer and heavier
  menstruation. Prior to 8 months ago, her
  menstruation included 6 days of average flow.
  She has no other problems except that in the last
  few months she has felt tired. Physical exam
  shows an enlarged uterus , irregular.
• What differential diagnosis will you consider?
• What further information will you want to obtain?

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• A 32 yr. old G2P2 comes in with one of her yeast
  infections that has not responded to OTC
  remedies. She has vaginal and vulvar itching,
  mild dysuria, and a thick discharge with mild
  vaginal odor. Exam shows copious amt. of a yellow
  to gray discharge on vaginal walls.
• What differential diagnoses will you consider?

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• A 23 year old married mother of 3 presents with
  complaint of something growing down there (on
  her labia) for 3 weeks. The growths have
  persisted and enlarged but cause no symptoms.
• Describe the lesion you would most likely see.
• What would you consider in your differential
  diagnosis and why?