These are questions that will be asked by your doctor. It is very important in gynaecological disorders.

i)How old were you when the monthly periods (menstrual periods) began. This is the age of menarche.

ii) What is the date of your last period?Can you remember it. What the the period before the last one?

iii)How often do you have your menstrual periods?This is the average date between the periods. It is about 28 days on average.

iv)How regular are your periods?Are the regular or irregular?

v)How long does the menstrual periods last?How many days does it last?

vi)How heavy is the menstrual flow?How many pads or tampons do you use daily?Do you use more than one at a time?

vii)Do you have any bleeding between periods?

viii)Do you bleed after sexual intercourse?

ix)Do you have any pain or discomfort during your periods?If so what is it like? How long does it last?

x) In middle-aged and older women you may ask if she has stopped menstruating.

xi) In adolescent girls you may ask questions like, do you know about monthly periods?, How did you first learn about monthly periods? Have you been bothered sometimes that you periods got delayed?

In the United States girls begin to menstruate between the ages of 9 and 16. It often takes 1 year or more before it settles into a regular pattern.

The average interval between periods ranges from 24 to 32 days. The flow lasts from 3 to 7 days.

History of Menopause

Menopause is a retrospective diagnosis. It is the absence of menses for 12 consecutive months (usually between the ages of 48 and 55 years).

Ask for the history of associated symptoms.

Associated symptoms include hot flashes, flushing, sleep disturbances and flushing.

Have you stopped having your regular periods?

Have your periods stopped completely?

How do you feel about not having your periods anymore? Has this affected your life in any way?

Postmenopausal bleeding

Postmenopausal bleeding is defined as bleeding that occurs six months without periods. It warrants further investigations (because of the high risk of endometrial cancer).

Amenorrhoea

This is absence of periods. There are two types primary amenorrhoea and secondary amenorrhoea.

Primary amenorrhoea refers to a condition where the girl/woman has never had her periods (failure to initiate periods).

Secondary amenorrhoea refers to cessation of periods after it has been established.

However secondary amenorrhoea may also have normal (physiologic forms) such as in pregnancy,lactation and menopause.

Oligomenorrhoea

This refers to infrequent periods which may also be irregular.It occurs for about two years after menarche and also before menopause.

Dysmenorrhoea

This is pain during menstruation.

It is a bearing down, aching or cramping sensation in the lower abdomen/pelvis.

Premenstrual syndrome (PMS)

This refers to a complex of symptoms which usually occur about 4 to 10 days prior to the onset on menses. Symptoms include irritability, depression,mood swings,weight gain, edema, bloating,tenderness of the breast ,headache,nervousness and tension. These symptoms are usually mild.

Sometimes women may present with severe and disabling PMS symptoms.

Polymenorrhoea

This refers to abnormally frequent periods.

Metrorrhagia

This is bleeding in between periods. It is also known as intermenstrual bleeding.

Postcoital bleeding

This is bleeding after sexual intercourse or other forms of vaginal contact such as douching etc.

References:

Pages 432 to 435. Health History. The female genitalia. Chapter 12. Bates guide to physical examination and  history taking.9th edition. Lynn. S. Bickley.

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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