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Module 2 discussion

Gynecological history can be a little different from any adult or pediatric history. Menstrual History is a very important part of gynecological history since it can be a clue for possible pregnancy or other gynecological problems. Age at menarche is a very important part of the menstrual history. Menstrual history also investigates the date of the last normal menstrual period, cycle length, duration, flow, or any menstrual irregularities or symptoms associated with menses. The second part of the gynecologic history is sexual health. Some important questions to ask about are gender identity and sexual orientation. Also, some details about the current sexual relationships including whether oral, anal, vaginal, or other sexual activity. Some more deep details about sexual activity including pain with sex, sexual concerns., sexual satisfaction and orgasm are also helpful in diagnosing some reproductive tract anomalies. Also, this is a very good opportunity to counsel about safe sex practices. Contraceptive use is the third item of the gynecologic history, and it gives the provider details about present and past contraceptive use including the type, duration used, satisfaction, side effects, and consistency of use. An extensive history of vaginal and sexually transmitted diseases should be taken since some infections can cause inflammatory, fibrotic lesions or strictures in the reproductive tract. It is very important to know the type of infection, number of infections, a treatment used, and complications. Other nearby urologic and rectal infections should be investigated as well. Also, information about genital and breast hygiene should be communicated after that since this is a very good opportunity to counsel the patient about hygiene (Schuiling & Likis, 2022, p.103).

History of Pregnancy is another item that should be covered under the gynecological history. Gravida and para are terms to describe if there are live fetuses in the uterus and how many of them made it to birth respectively. The course of pregnancy should be described including the duration, whether the birth is normal (occipitals, breech, etc.) or caesarian, or any complications. More information about the baby’s sex, weight, health status is important in this section of the gynecologic history. Also, some pregnancy abnormalities as abortions, ectopic pregnancy, and molar pregnancies are important to mention in the pregnancy section. Other gynecologic procedures and surgeries should be investigated as well. Finally, cervical cancer screening should be done by asking about the last testing and whether there are abnormal results (Schuiling & Likis, 2022, p.103).

The GTPAL system is a system established by obstetricians to get an idea about the reproductive status of women in brief. So, G= Gravida refers to the total number of pregnancies including the current pregnancy if applicable. T= Term is the number of pregnancies reaching 37 weeks or greater. Preterm is the number of pregnancies that reached 20- 36 weeks of gestation regardless of the pregnancy fate. A= Abortion is the number of spontaneous and induced abortions before 20 weeks of gestation. L or Living children is the number of total living children whether they were term or preterm (Schuiling & Likis, 2022, p.105).

Mrs. G.R. is a 66-year-old female patient who visits you at the office for the first time with only positive health history of hysterectomy 10 years ago due to fibroids. She has not seen a physician for 5 years. A woman above the age of 65 should be screened for many diseases. Blood pressure should be checked and if the patient has also diabetes, heart, and/or kidney disease, the blood pressure should be checked more than once a year. The breast should be screened every 1-2 years up to the age of 75. If the cholesterol level is normal, it should be checked every 5 years. however, if the patient has high cholesterol, diabetes, kidney problems, or heart disease, cholesterol levels should be checked more frequently. Colorectal cancer screening should be done by any means including fecal occult blood every year, CT colonoscopy every 5 years, or colonoscopy every 10 years. Colonoscopy screening can be done more frequently if the patient has ulcerative colitis, adenomatous polyps, or personal or family history of colorectal cancer. A dental exam should be done once or twice a year. Diabetes screening should be done every 3 years unless the patient is overweight or has other risk factors for diabetes. An eye exam should be done every1-2 year or every year if the patient has diabetes. The patient should also receive a pneumococcal immunization since she is above 65. She also should get a flu shot every year. She also should get TDaP every 10 years. Shingles shot is also recommended for women above 50 years of age because of their weakened immunity. Skin cancer can be checked for skin cancer. DEXA scan to check for osteoporosis is appropriate for this patient as well (Medline plus, n.d.).

A 35-year-old female with a BMI of 40 came to ask about hormonal contraceptives. However, a patient’s age is a major contraindication to the use of hormonal contraception. A BMI of 40 is very high and the patient has extreme obesity which is also a major contraindication to the use of this was of contraception. Smoking is the third contraindication of hormonal contraception. Finally, DVT, hypertension, and migraines are added contraindications to the hormonal birth control methods (Coleman-Minahan et al., 2021, p.909).

References

Coleman-Minahan, K., Ela, E. J., White, K., & Grossman, D. (2021). Contraindications to Hormonal Contraception Among Postpartum Women in Texas. Obstetrics and gynecology, 137(5), 907–915. https://doi.org/10.1097/AOG.0000000000004347

Schuiling, K. D., Likis, F. E. (2022). Gynecologic Health Care with an Introduction to Prenatal and Postpartum Care (4th Ed). Jones & Bartlett Learning, Burlington, MA. ISBN: 9781284182347

U.S. National Library of Medicine. (n.d.). Health screenings for women aged 65 and Older: Medlineplus medical encyclopedia. MedlinePlus. https://medlineplus.gov/ency/article/007463.htm.