The gynaecological history

taking and physical

examination

ASSOCIATE PROFESSOR
DR.YIN MOE HAN

Associate Professor Dr.Yin Moe Han 02/12/20

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 HISTORY TAKING

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 PATIENT ID

 Name
 Age
 Parity
 Occupation

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 MAIN COMPLAINT & DURATION

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 History of present
complaints

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1.Irregular bleeding per
vagina

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2.A mass in lower abdomen

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3.Pelvic pain

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4.Vaginal discharge

Amount , color etc… Foul smelling

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Menstrual history

LMP
 Age of menarche
 Usual duration of each
period and length of cycle
eg. 3/28 , regular or not,
amount, dysmenorrhoea +/-
 First day of last menstrual
period.( L.M.P)

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Previous obstetric history

 Number of children with ages and

birth weights.
 Any abnormalities with pregnancy,
labour or the puerperium.
 Any termination of pregnancy with
record of gestation age and any
complications
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Previous gynaecological
history
H/O Gyn surgery & treatment Last Pap smear date

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Sexual history

 Dyspareunia, post-coital bleeding ( PCB )

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Associate Professor Dr.Yin Moe Han 02/12/20
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 Contraceptive history

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Pastmedical history
Family history

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Enquiry about other systems

 Appetite, weight loss, weight gain.

 Bowels
 Micturation.
 Other systems.
Social history
 Socio-economical status
 Smoking, alcohol intake.
Drug history

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Summary

 It is important to summarize the history in one or two

sentences before proceeding to examination to alert the
examiner to the sailent features.

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History taking

 ID
 C/O
 HOPC
 Menstrual H/O
 Past Gyn H/O
 Past Obs H/O
 Sexual & C/C H/O
 PMH& PSH
 Family H/O
 Systemic review
 Social H/O
 Summary
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 EXAMINATION

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Examination

 Smiles, introduces her/himself, charperone, privacy.

General examination
 Anaemia, jaudice
 Lymphnode
 Thyroid gland
 Extremities
Chest
Breasts – particularly relavant if there is indication.
CVS, Respiratory system

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Abdominal examination

 Empty the bladder before abdominal examination

 She should be comfortable and lying semi-recumbent, with a
sheet covering her from waist down, but the area from the
xiphisternum to the symphysis pubis should be left exposed.
 It is usual to examine the women from her right- hand side.

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Inspection

 The contour of the abdomen should be inspected- obvious

disension or mass
 The presence of surgical scars, dilated veins or striae
gravidarum .
 It is important specially to examine the umbilicus for
laparoscopy scars and just above the symphysis pubis for
Pfannenstiel scar (used for Caesarean section, hystrectomy,
etc….) , herniae or not

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Pfannenstiel scar laparoscopy scars

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Palpation

 First, if the patient has any abdominal pain , she should

be asked to point to the site.This area should not be
examined until the end of the palpation.Palpation using
the right hand is performed, examining the left lower
quadrant and proceeding in a total of four steps to the
right lower quadrant of the abdomen.

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 Examination for masses, liver, spleen and kidneys.
 Mass (site, size, shape, consistency, margin, tenderness,
mobility)
 If the patient has pain, palpated gently and look for signs of
peritonism, i.e. guarding, rigidity and rebound tenderness.
 Inguinal herniae and lymphnodes.

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Percussion

 Percussion is particularly useful if free fluid is

suspected.In the recumbent position, ascitic fluid will
settled down into a horseshoes shape and dullness in
the flanks can be demonstrated.
 As the patient moves over to her side, the dullness will
move to her lower most side, this is known as shifting
dullness.A fluid thrill can also be elicited.
 Mass

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Ausculation

 Bowel sounds, bruit.

Pelvic examination
 Consent and female chaperone.Privacy.
 Needs gloves, speculum, lubricant.
 Good light with the patient in the dorsal position, the hips
flexed and abducted and the knees flexed.The left lateral
position is used for examination of prolapse or to inspect
vaginal wall with Sim’s speculum.

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Positions

Dorsal position Lithotomy position

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Sim’s position

Left lateral position

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Inspection

 Pubic hair distribution

 External genitalia- obvious lesion or inflammation,
discolouration , ulcer, mass ( 5’ or 7’ o clock-
Bartholin’s cyst)
 Urethral orifice
 Perineum
 Abnormalities
 Discharge

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Inspection of external
genitalia

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Bartholin’s cyst

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Third degree utero-vaginal
prolapse

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 Cusco’s speculum
examination

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Sim’s speculum examination

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 Ask to strain down to enable the detection of any
prolapse and also to cough, as this will show the sign of
stress incontinence.
 A bivalve ( Cusco’s) speculum is inserted to visualize the
cervix.

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Associate Professor Dr.Yin Moe Han 02/12/20
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Findings

 Cervix - shape ( pinhole os/slit like os ),

 - closed/opened
 -position ( anterior/posterior)
- polyps, growth, ectopy

 Vaginal wall
rugosities, mass, trauma, prolapse, vesicle
discharge

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Pinhole os Slit like os

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Ectopy cervix

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 Findings of cervix

Carcinoma cervix

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Bimanual digital examination

 To use the fingers of right hand in the vagina and to

place left hand on the abdomen.
 In a virgin or a child , only a PR examination .
 Left hand is used to separate the labia minora to expose
the vestibule and the examing fingers of the right hands
are inserted.

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Bimanual examination

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Bimanual examination

 Cervix
size, position, mobility, consistency
( firm in non-pregnant & soft in pregnant uterus)
tenderness ( in ectopic pregnancy )
 Uterus
position- AV/RV, mobility, size, mass related to uterus,
tenderness

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 Both culs
Adnaxal mass +/- ( ovarian cyst )
 POD – Full/ clear, Tenderness +/-
 Discharge on vaginal examination fingers +/-

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 The uterosacral ligaments can be palpated in the
posterior fornix- scarred or shortened in endometriosis.
Rectal examination
 An alternative to VE in a virgin or a child
 It may be useful to differentiate between enterocoele
and rectocoele.
 Carcinoma cervix – for staging

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Vaginal examination

1.Inspection
-External genitalia
-Hair distributation
- Cystocoele/rectocoele/second degree PT/Stress
incontinence
- Bleeding/discharge +/-

2.Speculum examination ( Cusco’s/Sim’s )

- Cervix- shape ,opened/closed,position,
normal/abnormal,bleeding/discharge
- Vaginal wall
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 3. Bimanual examination
Cervix –size, position,consistency,
mobility, tenderness+/-
Utreus –size,position, consistency,
mobility, tenderness+/-
Both culs-mass+/-, tenderness+/-
POD - full/clear
tenderness+/-
Discharge +/-

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•Thank you -


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