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Claudio Giorlandino

Professional European Excellency in Obstetric and Gynaecology

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Gynecology

The patient should be encouraged to visit periodically a gynecologyst and tell the physician why she has sought help. Questions such as, “What is the nature of the problem that brought you to me?” or, “How may I help you?” are good ways to begin. The patient should be able to present the problem as she sees it, in her own words, and should be interrupted only for specific clarification of points or to offer direction if she digresses too far. During the interview the physician should face the patient with direct eye contact and acknowledge important points of the history either by nodding or by a word or two. Such an approach allows the physician to be involved in the problem and demonstrates a degree of caring to the patient. When the patient has completed the history of her current problem, pertinent open-ended questions should be asked with respect to specific points made by the patient. This process allows the physician to develop a more detailed data-base. Directed questions may be asked where pertinent to clarify points. In general, however, the patient should be encouraged to tell her story as she sees it rather than to react with short answers to very specific questions. Under the latter circumstance the physician may get the answers he or she is looking for, but they may not be accurate answers.
The outline is given in a specific order for general orientation. The information, however, may be collected through any comfortable discussion with the patient that seems appropriate in the circumstances. It is important that all aspects be covered.

A pertinent gynecologic history can be divided into several parts. It begins with a menstrual history, in which the age of menarche, duration of each monthly cycle, number of days during which menses occur, and regularity of the menstrual cycles should be noted. The dates of the last menstrual period and previous menstrual period should be obtained. In addition, the characteristics of the menstrual flow, including the color, the amount of flow, and accompanying symptoms, such as cramping, sweating, headache, or diarrhea, should be noted. In general, menstruation that occurs monthly (range 21 to 40 days), lasts 4 to 7 days, is bright red, and is often accompanied by cramping on the day preceding and the first day of the period is characteristic of an ovulatory cycle. Menstruation that is irregular, often dark in color, painless, and frequently short or very long may indicate lack of ovulation. ( From Katz 2007.modified,)