Gynaecological Health History: Comprehensive Patient Care Report

This report provides an overview of gynaecological health history, emphasizing the importance of comprehensive patient care. It covers essential aspects of patient interviews, including medical history, sexual health, menstrual cycles, and pregnancy history. The report highlights the significance of addressing patient concerns, performing physical examinations, and recommending appropriate screenings. It also discusses the specific needs of the LGBTQ+ community in gynaecological care, including the disparities in healthcare access and the need for improved training and awareness among healthcare providers. The reflection section discusses the importance of building trust and ensuring patient comfort during sensitive conversations, as well as the need for equal and quality healthcare for all individuals, regardless of their gender identity. The report references key publications and resources to support its findings, providing a well-rounded view of gynaecological health and patient care.

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Building Health History

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Gynaecologic health history
In women’s health, gynaecologists are essential and chief healthcare providers.
During the gynaecologists visit, a complete and exhaustive history and physical check-up
should be conducted with all of patients concerns addressed. Only when the patient’s medical
history is complete, their present specific concern can be focused on. Few symptoms can be
linked to high-risk malignancies so they should be prioritised. The physical check-up is
performed based around the complaints with a general exam. After the exam, suitable
screenings or other specific medical tests can be done (Salazar & Andrade, 2017).
A general questionnaire asking any present or past illnesses, surgical procedures and
hospitalizations, mental health status, allergies and medications and supplements is given to
the patient. Alcohol, drugs, and tobacco use, social and family related inquiry like hereditary
diseases, education, and work history, and most of all their living situation is asked
(Schuiling & Likis, 2017). Patients present living conditions have a big effect on their health,
like if they are living alone or with family and children, if their home is safe and easily
accessible, do they have means of financing their healthcare and maintain their wellbeing.
Their diet and physical activity also play and an important role in general well-being of the
patient.
Open questionnaire
 Sexual orientation and gender identity is noted to provide most appropriate care.
 Present sexual relations, concerns and intimate questions regarding intercourse, sexual
practices, and type of intercourse.
 Menstruation- frequency, duration, latest period date, flow and any irregularities
associated with periods.
 Genital cleanliness and fitness- medication and products used (lube, soaps and
creams, period products), any piercings and hair upkeep.
 Pregnancy history- how many term and preterm births, abortions, and number of
living children.
 Sexually transmitted and vaginal infections- treatment received or any complications
associated with STIs.
 Urologic and rectal wellbeing- infections and bowel inconsistency.

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 Cervical cancer screening- lasts date of test and results should be discussed. This will
help in scheduling future tests and PAP smears.
 Contraceptives used (side effects and method of contraception) and any hormone
replacement therapy that the patient might be undergoing.
 Surgeries or Gynecological procedures undergone in past- complications and
outcomes associated with them.
After these questions are answered, abnormal symptoms and presenting complaint,
any exacerbating factors and symptoms presented such as extraneous bleeding or pain will be
addressed. Gynaecological symptoms identified on the initial visit form the basis for a follow
up and at home maintenance of the patient. Symptoms can vary from Vaginal bleeding
intermenstrual, post menopause or after coitus or inconsistent vaginal discharge of unknown
colour, smell or consistency indicating an infection. Any kind of pelvic or abdominal pain, its
severity, and other associated factors with the experiencing pain (TeachMe Obgyn, 2017).
Based on the initial check-up, medications, and diagnostics test (STI or cancer
screening), pap smears, ultrasound, hysteroscopy, colposcopy, or endometrial biopsy are
recommended. Any issues regarding fertility, mensuration, and menopause as well as
infections require follow up and warrants further clinical tests. Cancer and endometriosis are
also few common conditions that require immediate attention and long-term treatment. A
pelvic and breast examination can be included in the visit depending on the age of the patient
and presented symptoms.
A review and study on LGBTQ communities’ sexual health care shows a lack of
training and familiarity among gynaecologists when treating LGBTQ patient. There is a big
gap in knowledge and practice as well as bias and clinical competency when treating a patient
from LGBTQ population (Mehta et al., 2018) exists and should be reformed. They have
lowest ratio of cervical cancer screening and Pap smears in distinction with cisgender women
(Stewart et al., 2020). The LGBTQ community is also at higher risk of HIV and STI along
with depression, suicide, and substance abuse issues hence they should be provided with
appropriate clinical care. All of this can be amended with equal rights to healthcare.

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Reflection
I believe gynaecologists visit is an opportunity to form a relationship between the
patient and the gynae which can improve the patients’ health and welfare. When questioning
and recording health history, I want to make the patient feel safe and proceed privately with
respect and composure. I would provide assurances on confidentiality and no judgement
when enquiring intimate information regarding patient’s sexual lifestyle and history and
conduct the conversation with dignity. During the first visit, there is a natural awkwardness
and hesitancy when divulging personal information regarding sexual partners and sex
lifestyle. I also encountered self-consciousness among patients regarding their body odor and
hair and reluctance to answering health questions especially among young patients.
I found the entire experience educational and instructive. This has provided me with
information and knowledge that I was unconcerned with, like the procedure and experience
of uncomfortable pap smears, the honest account of private lifestyle and extensive inquiry of
female health. This has provided me with an opportunity to experience compose and poise
ways of conducting interview with patients and a humanizing perspective on building
healthcare history. I have also learnt to view all aspects of the questioning as a professional
and not to express distress and restlessness when dealing with awkward or confused patients.
I found the disproportionate healthcare available to LGBTQ community shocking and I
believe consideration should be given to them for lack of proper genealogical healthcare and
disparities and medical injustice that they face. Everyone is entitled to equal and quality
healthcare irrespective of their gender identity.

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References
Mehta, P. K., Easter, S. R., Potter, J., Castleberry, N., Schulkin, J., & Robinson, J. N. (2018).
Lesbian, Gay, Bisexual, and Transgender Health: Obstetrician–Gynaecologists’
Training, Attitudes, Knowledge, and Practice. Journal of Women’s Health, 27(12),
1459–1465. https://doi.org/10.1089/jwh.2017.6912
Salazar, A., & Andrade, F. F. (2017). Gynaecologic History and Examination of the
Patient. Handbook of Gynecology, 11–19. https://doi.org/10.1007/978-3-319-17798-
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Schuiling, K.D., & Likis, F. E. (2017). Women’s Gynaecological Health (3rd. ed.). Jones and
Bartlett Publishers.
Stewart, T., Lee, Y. A., & Damino, E. A. (2020). Do Transgender and Gender Diverse
Individuals Receive Adequate Gynaecologic Care? An Analysis of a Rural Academic
Centre. Transgender Health, 5(1), 50–58. https://doi.org/10.1089/trgh.2019.0037
TeachMe Obgyn. (2017, December 22). Gynaecological History - OSCE - Key Symptoms
and Signs. https://teachmeobgyn.com/history-taking-examinations/history-taking/
gynaecological/