reply to jennifer

 
Comprehensive exams in women’s health need to
As with any assessment, the chief complain is often what drives what our questions are and what clinical pathways we explore.  With women’s health that approach is not any different, as we need to explore the “what was”, “what is” and “what will be” for the patient.  The comprehensive assessment is one that is longer in nature and normally saved for the first visit, as if this patient will be a returning patient a more focused examine comes during their following appointments.  The follow is a “blanket” comprehensive assessment that can be tweaked for any patient (Elson, 2008);

Chief complaint (is this a focused complaint or a first meeting or annual meeting)
History of present illness
 Menstrual History

 Age at menarche
Last menstrual period
Menstrual characteristics

Length
How long is flow
Amount of flow

Other symptoms? (breast tenderness, pelvic pain, etc)5
Pain?
Intermenstrual bleeding
Perimenopause/menopause

Bleeding pattern
Vasomotor symptoms

 Contraception

Current method; is it working?
Previous method; any complications and reason for change

Cervical and vaginal cytology

Results and date of most recent pap
Hx of abnormal paps? Why? Treatment?

 Infections

Hx of STD?
Hx of vaginitis (types, frequency and treatment)
Hx of PID

 Fertility/infertility

Any desire for future?
Difficulty conceiving? Treatments in past?

Sexual hx

Type
Concerns about libido, orgasm, dyspareunia
Any hx of abuse? Assault?

Obstetric hx

Describe each pregnancy and outcome
Any maternal, fetal or neonatal complications?

Past medical history

Current and past illnesses
Hospital admissions
Surgical hx

GYN and Non-gyn

 Medications/allergies

OTC, prescribed, herbal
Allergies to meds, food, environment and reactions?

Family hx

Significant illnesses of family
Hereditary concerns

Social hx

Relationship status
Level of education
Occupation

R.O.S.
Abdomino-pelvic

GYN
GI
GU

Breast
Others

18.Health Maintenance

Smoking, alcohol use, drug use
Diet
Supplement intake
Exercise
Regular screenings (mammo, pap, colonoscopy)
Immunizations and dates

Health maintenance is very important for all ages when related to women’s health.  The following are some ideas of health maintenance for each age group (Well-Woman Recommendations, 2018);

Adolescents

If sexually active the patient should have discussion with provider on sexually transmitted diseases and contraceptive use
Drugs and alcohol use
Peer pressure with sexual situations

Childbearing

Annual blood work to identify challenges in anemia, TSH, Cholesterol and minerals.
Breast self-awareness
Reproductive health plan
Imitate partner violence

Peri-menopausal

Hormone therapy
Mammograms
Advance directives
Problems with sexual encounters (pain, dry, etc)

Menopausal

Sleep patterns
Changes of the body (hair growth, hormonal changes, sexual changes)
Breast self-awareness

Geriatric Women

Sexual function
Injury prevention
Neglect/abuse

Elson, N. B. (2008, July). The Gynecologic History and Examination. Retrieved from The Global Library of Womens Health: https://www.glowm.com/section_view/heading/TheGynecologicHistoryandExamination/item/3#3521
Well-Woman Recommendations. (2018, January 5). Retrieved from The American College of Obstetricians and Gynecologists: https://www.acog.org/About-ACOG/ACOG-Departments/Annual-Womens-Health-Care/Well-Woman-Recommendations?IsMobileSet=false