Medicine an Surgery notes

Apr 24th, 2015
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INTRODUCTIONFor many women, gynecologic and reproductive health care represent their only regular connection to the medical system. The gynecologic evaluation can provoke anxiety in both patients and health care professionals [1,2]. The provider's proficiency will go a long way in establishing positive relationships with female patients and providing them with complete and sensitive care.The gynecologic history and physical examination in adult women will be reviewed here. The initial assessment of pregnant women and general approaches to patient interviewing are discussed separately. (See "The initial prenatal assessment and routine prenatal care"and "Approach to the patient".)GYNECOLOGIC HISTORYOverview-Individual women vary tremendously in their knowledge of and comfort with their own bodies. While some may be quite open in disclosing their sexual, reproductive, and genital concerns, others will find such discussions embarrassing or socially inappropriate. Thus, it is essential that providers maintain a sensitive and nonjudgmental approach during this encounter.The history should be obtained in a relaxed and private setting, before the patient is asked to disrobe. She should be interviewed alone under most circumstances. Questioning should proceed from very straightforward, objective information to more delicate issues. The provider should evaluate and respond to the patient's comfort level, and make every effort to remain supportive. It is particularly important t

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