Gynaecology Assessment & Common Disorders

As gynaecology issues uncommonly present on the ward, many doctors have difficulties with the standard framework for addressing these issues. The classic referrals to gynaecology are:

  • The nursing staff have noted vaginal bleeding. Could this be assessed?
  • Could this abdominal pain be gynaecological?
  • The abdominal scan has shown a pelvic mass or ovarian cyst. What shall we do?

Having a framework will enable you to provide a clear referral expediting care for your patient so bear in mind the important aspects listed below. Each section is linked to relevant resources for you to help categorise the exact condition your patient might be affected by.

Gynaecological History:

  • PV bleeding
    • Consider whether bleeding may be from the rectum or urethra
    • When does the bleeding occur? e.g. postcoital, intermenstrual
    • Are they on anticoagulation? Do they have symptomatic anaemia?
  • Abdominal pain
    • Never forget pregnancy in any woman of childbearing age (think ectopic)
    • More detailed systems review of known gastrointestinal/urological & gynaecological disease
  • For incidental mass on CT/MRI
    • Focus on red flags: weight loss, fever, night sweats, bloating 
    • Risk factors: smoking, fertility history, family or personal history of cancer 
  • Vulval disorders
    • Itch, discharge (quantity, colour, odour), burning sensation, bleeding, dyspareunia, dysuria, warts, lumps
    • Consider autoimmune disorders & diabetes
  • Menstrual history: Last menstrual period, duration, quantity (pads/tampons), menopause status
  • Smear history
  • Previous sexually transmitted infections
  • Previous gynaecological procedures: hysteroscopies/laparoscopies
  • Obstetric history: parity, mode of delivery, complications
  • Contraception: type, duration, any problems
    • Also for women of childbearing age, consider whether medications are teratogenic or reduce the efficacy of contraception 
    • Also, consider the impact of hormonal contraceptives which could interact with medication you’re prescribing 
    • If in doubt, check with your pharmacist!
  • Associated symptoms: abdominal pain, fever, vomiting, gastrointestinal/urological/gynaecological disease
  • Relevant medical history
  • Medication history (have they tried anything in the past?)

Examination

  • Abdominal examination (usual tenderness, peritonism & masses)
  • Speculum
    • If bleeding: identify whether this is external, vaginal, cervical or uterine & the extent of blood
  • Bimanual (masses or adnexal tenderness)

Investigations:

  • Usual bloods, pregnancy test (beta HCG) & tumour markers (CA 125)
  • High vaginal swabs
  • Consider abdominal ultrasound (particularly for abdominal pain)
  • Transvaginal ultrasound scan is usually best

Causes of PV bleeding

  • Physiological from menstruation, fibroids, miscarriage, endometriosis/adenomyosis, ectopic pregnancy, trauma, deranged clotting
  • Often on a ward setting, you are assessing a patient with postmenopausal bleeding

Causes of abdominal pain

  • Gynae: ruptured ectopic pregnancy, ovarian torsion, pelvic inflammatory disease, endometriosis, adenomyosis, fibroids
  • Non-gynae: gastrointestinal, urological, functional

Vulval disorders

  • Atrophic vaginitis, lichen sclerosus, lichen planus, herpes simplex, syphilis, trichomonas, human papillomavirus, bacterial vaginosis, candidiasis, chlamydia, gonorrhoea

Written by Paula Busuulwa, FY3 London
Edits by Dr Akash Doshi CT2

How useful was this post?

Click on a star to rate it!

Average rating 4.8 / 5. Vote count: 5

No votes so far! Be the first to rate this post.

As you found this post useful...

Follow us on social media!

We are sorry that this post was not useful for you!

Let us improve this post!

Tell us how we can improve this post?

Leave a Comment

Your email address will not be published. Required fields are marked *

Related Posts

Hypercalcaemia
Hypercalcaemia
Serum calcium concentration is tightly regulated between 2.1-2.6mmol/L....
Transfusion
Transfusion
In this article, we will go through the three most common scenarios...
Oral and Maxillofacial Surgery
Applying to Oral and Maxillofacial Surgery (OMFS)
Oral and Maxillofacial Surgery is a mouthful (no pun intended),...

Follow us

Our Newsletter

Trending Now

Passing the Prescribing Safety Assessment (PSA)
The PSA is aimed at final year medical students and those graduating overseas to assess their competency...
Junior Doctor Pay Calculator
We’ve created a junior doctor pay calculator which will help you better understand your salary,...
Referral Cheat Sheet
Our referral cheat sheet is our most popular resource having been downloaded thousands of times! It has...
Audits & Quality Improvement Projects (QIPs)
Audits & QIPs are a way to identify issues, drive changes and assess the effects they have. It is...
How to take a psychiatric history
Psychiatry, as a specialty is unique in that diagnostic methods, rely very heavily on symptomatology,...
How to Be Prepared for the MSRA
The Multiple Specialty Recruitment Assessment (MSRA) is a computer-based exam increasingly being used...
e-Portfolio
Your e-Portfolio is an online tool to gather and store evidence of progression throughout your time as...

Sign up for our awesome resources

Join over 25,000 users who have signed up for our free weekly webinars, referral cheat sheet & other amazing content!