This post covers the most important aspects of the health history of a woman. It will be useful to pregnant women as well as medical professionals such as doctors, nurses etc.

Questions related to pregnancy

Important questions related to pregnancy include:

Have you ever been pregnant?

How many times have you been pregnant?

How many living children do you have?

Have you ever had an abortion/miscarriage?

How many times?

Any difficulties/ illnesses during previous pregnancies?

Was the abortion/’s spontaneous or induced?

What was the timing and the circumstances surrounding the abortion?

Does the patient use any contraception?

Is she satisfied with the method of contraception chosen by her and/or her partner.

Does she have any questions regarding the options for contraception?

How long has she been having the amenorrhoea? ie of pregnancy

It is important to note that amenorrhoea followed by heavy bleeding suggests a threatened abortion or dysfunctional uterine bleeding related to lack of ovulation.

It is also important to ask for symptoms of pregnancy such as tingling, tenderness or increase in size of the breasts; increased frequency of passing urine, nausea and vomiting; easy fatigability; fetal movements (feelings that the baby is moving -usually noted around 20 weeks of gestation)

What does the gravida-para system mean and how to interpret it?

Most obstetricians record the pregnancy history using the “gravida-para” system

G means gravida (The total number of pregnancies)

P means para (Outcomes of pregnancies)

After the P, there may be further notations F(Full-term), P (Premature), A(Abortion), and L (Living child).

Questions related to the vulva (external genitalia) and vagina

Vaginal discharge and local itching are the most common vulvovaginal symptoms.

Is there a discharge?

What is the colour, amount,consistency and odour ofthe discharge?

Are there any sores or lumps in the vulvar area?(lumps around the vagina or where you urinate)

Is there any itching near your vagina?

Questions related to sexual activity

Important questions to ask in sexual history include;

i)Are you satisfied with your sex life?

ii)Are you having problems with sex?

iii)Has there been any significant change in your sex life in the past few years?

iv)Are you satisfied with your ability to perform sexually?

v)Is your partner satisfied?

vi)Is your partner satisfied with the frequency of sexual activity?

vii)Do you have any concerns regarding sexual activity?

If there are concerns regarding sexual activity, ask her to tell you about it.

Direct questions are also very helpful in assessing each phase of the sexual response:

Desire

Do you have interest in sex?

Do you have appetite for sex?

Arousal

Do you get sexually aroused?

Do you lubricate easily?

Do you get wet or slippery easily?

Do you remain dry during intercourse?

Orgasm

Are you able to reach climax?

Are you able to reach orgasm?

Are you able to “Come”?

History of pain during sexual intercourse(Dyspareunia)

Do you have pain during sex?

Is the pain near the outside or deep inside the vagina?

Does the pain occur at the start of intercourse?

Superficial dyspareunia suggests local inflammation, inadequate lubrication or atrophic vaginitis.

Deep pain suggests PID (Pelvic inflammatory disease),other pelvic disorders or even pressure on a normal ovary.

Vaginismus refers to involuntary spasm of the muscles surrounding the vaginal orifice that makes penetration during sexual intercourse very painful or impossible. Vaginismus may be either due to physical causes or psychological causes.

References:

Pages 432 to 435,Chapter 12. The Female Genetalia. Bate’s Guide to Physical Examination and History Taking. Ninth edition.

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