Special Tutorial Programme

Professor Deirdre J Murphy

Trinity College
Introduction to Gynaecology



Objectives

Gynaecological History

Gynaecological examination

Cervical screening

Practice assessment
Gynaecological history
Menses
Sexual/Contraception
Cervical smear
Urinary
Prolapse
Pregnancies
Complete History
Demographics
Specific gynaecological history
Past Obstetric history
Past Medical/Surgical/Psych history
Family history
Social history
Medication / Allergies
Systems review
Gynaecological history
Heavy bleeding

Pelvic pain

Leaking urine

Failure to conceive
Heavy bleeding
Heavy bleeding
Menarche / LMP / Menopause
How often / How long / Regularity
Heavy / volume
Intermenstrual bleeding
Postcoital bleeding
Vaginal discharge
Pain

[Intercourse / contraception /smear /
urinary / prolapse / obstetric]


Pelvic pain
Pelvic pain
Features cyclical/acute/chronic pain
Abnormal menses
Vaginal discharge
Dyspareunia

[Intercourse / contraception /smear /
urinary / prolapse / obstetric]


Leaking urine
Leaking urine
Urgency
Stress symptoms
Frequency
Nocturia
Dysuria
Bowel symptoms
Prolapse symtoms
[Menses /Intercourse / contraception
/smear / obstetric]

Failure to conceive
Subfertility
History of a couple

Duration
Intercourse
Previous pregnancies


Female
Menses
Pelvic pain
Vaginal discharge
Dyspareunia
Hirsutism
Medical
Cervical treatment
Previous pregnancies
Lifestyle
Male
Infections
Medical illnesses
Lifestyle
Sterilisation
Impotence / Failure to ejaculate
Intelligent history
Comprehensive but efficient
Differential diagnosis
Targeted questioning

Prioritising diagnosis
Focus examination
Gynaecological examination
Consent / Chaperone / Dignity
General examination
Appearance
Weight
Vital signs pulse
blood pressure
temp
Cardiovascular
Respiratory
Breast / Axillae
Lymph nodes

Abdomen
Inspect
scars /body hair / distension / herniae
Palpate
tenderness / masses / umbilicus down
Percuss
dull /resonant / shifting dullness
Auscultate
bowel sounds
Pelvic examination
Inspection

Bimanual digital examination

Speculum examination

[Rectal examination]

Inspection

Position patient

Vulva / Vagina
Abnormal skin
colour / ulceration /atrophy
Lumps
Prolapse



Bimanual digital examination
Cervix
os shape / consistency
Uterus
size / position / consistency /
regularity/ mobility / tenderness
Adnexae
palpable / size / consistency /
tenderness
Speculum examination
Cuscoes bivalve speculum
Sims speculum

Positioning
Inspect cervix ulceration / bleeding
/irregularity
Inspect vaginal walls
Removal
Basic Gynaecological Skill

Careful history

Sensitivity

Professional examination
Further management
Differential diagnosis
Revise/Prioritise diagnosis
Investigations
Treatment / Management

Objectives

Gynaecological history

Gynaecological examination

Cervical screening

Formative assessment
Cervical screening
What is Screening
Apply test to asymptomatic individuals
and classify likelihood of disease

- early detection with subsequent tests
- reduce disease
severity/recurrence/mortality


Criteria for screening
Suitable Disease
Serious
Pre-symptomatic
treatment better
High prevalence
Suitable test
Cheap /painless/ easy to
administer
Valid
sensitivity/specificity
Reproducible
reliable instrument
/observer variability



Practice assessment