[Gynaecology] Medical history

Gynaecology histories are often straightforward, but there are a lot of points which are unlikely to be mentioned unless you remember to specifically and directly ask each of them. The patient may be embarrassed but it is essential to be direct and clear. It's important to be warm and caring, but be careful to avoid behaving appearing flippant.

A map of the key points in a gynaecology history. Created from the recommended questions in the Oxford Handbook of Clinical Specialties

• Symptoms 
• Ask about any pains, beware severe acute pain, SOCRATES mnemonic is useful
• Has it happened before?
• How many times has it happened?
• Menstruation
• When did it begin?
• When did it end?
• How is normal menstruation for her?
• Was the last menstrual period normal? 
• Has it become irregular?
• Obstetrics
• How many conceptions?
• How many miscarriages?
• How far into pregnancy?
• How many abortions?
• How many deliveries? 
• How were they delivered?
• Sex and contraception
• Which contraception now?
• Why was contraception needed?
• Which contraception in the past?
• Sexually active?
• Recent and previous STI screening?
• Number of sex partners?
• Any fertility treatments?
• Other
• General health
• Other medical/surgical history
• General lifestyle questions
• Smoking
• Recreational drug abuse

A lot of the questions in the history concern iatrogenic factors. Important factors include contraception, previous abortions, previous surgeries and fertility treatments.


It is not unusual for patients with certain mental health diseases (particularly emotionally unstable personality disorder), to present to general practice, gynaecology, or even the Emergency Department, with complaints about abdominal or pelvic pain, or distress about their menstruation. These patients must go through the necessary tests or treatments, and sometimes pathology is found. Impulsivity and risky behaviour result in a higher risk than the general population for STIs and unplanned pregnancies. If no pathology can be found, the appropriate diagnosis may be somatoform disorder. It is essential to explain clearly what the results show and what it could mean. It would be helpful to take steps to facilitate good mental health care for patients with somatoform disorders, for example, referrals to a community mental health team.