For gynecologic care, a woman should choose a health care practitioner with whom she can comfortably discuss sensitive topics, such as sex, birth control, pregnancy, and problems related to menopause. The practitioner may be a doctor, a nurse-midwife, a nurse practitioner, or a physician assistant.
A gynecologic evaluation includes the gynecologic history and gynecologic examination.
For the gynecologic history, doctors ask about the problem prompting the visit, past and present menstrual periods, past pregnancies, sexual activities, and gynecologic symptoms, disorders, and treatments that the woman has had in the past.
Questions about menstrual periods include the following:
How old the woman was when menstrual bleeding began (menarche)
How often, regular, and long menstrual periods are
How heavy menstrual bleeding is
When did the last menstrual period begin and end
Whether the woman has symptoms (such as pain, cramps, headaches, or loose stools) during menstrual periods
Whether the woman has or has had abnormal bleeding—too much, too little, or between menstrual periods
Questions about past pregnancies include the following:
How many pregnancies a woman has had
What the dates of those pregnancies were
How those pregnancies ended (such as in a live birth or a miscarriage)
Whether complications (such as bleeding, high blood pressure, nausea, or vomiting) occurred
The doctor usually asks about sexual activities to assess the risk of gynecologic infections, injuries, and pregnancy and to determine whether a woman has any sexual problems. A woman is asked whether she uses or wants to use birth control and whether she is interested in counseling or other information. Doctors may ask about sexual identity and gender identity issues to give adolescent girls and women an opportunity to talk about such issues.
The doctor asks whether the woman has pain during intercourse, in the middle of the menstrual cycle (which may indicate that the pain coincides with ovulation), or under other circumstances. If she has pain, she is asked how severe the pain is and what provides relief.
The doctor also asks about breast problems, such as pain, lumps, areas of tenderness or redness, and discharge from the nipples. The woman is asked whether she examines her breasts, how often, and whether she needs any instruction on breast examination technique.
The doctor reviews the woman's history of past gynecologic disorders and usually obtains a general medical and surgical history that includes previous health problems.
The doctor reviews all the drugs a woman is taking, including prescription and nonprescription drugs, tobacco, and alcohol, because many of them affect gynecologic function.
The woman is asked about mental, physical, or sexual abuse—whether she or other members of her household are being or have been abused.
Some questions about urination are asked to find out whether the woman has a urinary tract infection or has problems with leakage of urine (incontinence).
