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
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
Features – cyclical/acute/chronic pain Abnormal menses Vaginal discharge Dyspareunia [Intercourse / contraception /smear / urinary / prolapse / obstetric]
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 signspulse 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 Cuscoe’s 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