Female Sexual History
Vulval itching
Wash hands, introduce, check patient name and DOB
Causes = candida, genital herpes,
- Explain that you need to take a sexual history chlamydia/gonorrhoea, vaginal atrophy (post-
- Will involve some personal questions, but we ask these to
menopause), lichen sclerosis (white patches on vulva)
everyone to assess risk of STI, so please don’t take any of the
questions personally.
- Everything you tell me today will be confidential, unless I felt Genital skin changes
that you or someone else was in significant danger, in which Genital herpes = blisters/ulcers – vagina/cervix
case I might have to break this confidentiality to prevent Genital warts = non-painful lesions around perineal
harm
- If you would prefer not to answer a particular question, or
area
would like to stop at any point, please just let me know.
Systemic symptoms of STIs
- Fever – secondary to PID
Tell me about why you’ve come to see me today. Can - Malaise
you tell me more about that? - Weight loss – HIV
- Rash
VAGINA QUESTIONS - Swelling of large joints, conjunctivitis,
Pain – Socrates cervicitis = Reiter’s syndrome secondary to
- Radiation – shoulder tip in ectopic chlamydia
- Time – menstrual cycle
- Affecting ADL? Past gynaecological history
Causes of abdo/pelvic pain = ectopic, ruptured cyst, Conditions:
endometriosis, PID and ovarian torsion - Ectopic pregnancy
- STIs
Vaginal discharge - Endometriosis
- Any changes? Amount, colour, consistency, - Bartholin’s cysts
smell? - Cervical ectropion
Causes = gonorrhoea, chlamydia, bacterial vaginosis - Cervical/endometrial/ovarian malignancy
(fishy, without soreness), trichomonas vaginalis Surgery:
(yellow, frothy, vaginal itching) - Abdominal/pelvic surgery
- C section
Abnormal vaginal bleeding - Loop excision of transitional zone
- After sex = chlamydia/gonorrhoea, cervical - Vaginal prolapse repair
ectropion and cervical cancer - Hysterectomy
- Between periods = chlamydia/gonorrhoea, Cervical screening
cervical/endometrial cancer, uterine fibroids, - When was your last screening test?
endometriosis, pregnancy, Mirena coil - Was it normal?
- Have you been vaccinated against HPV?
Dyspareunia (pain during sex) Obstetric history
- Location (superficial/deep) - How many times have you been pregnant?
- Duration of pain - And how many babies have you carried past
- Nature of pain 24weeks
Causes = chlamydia/gonorrhoea, endometriosis,
vaginal atrophy, malignancy Current pregnancy
- How many weeks are you
Dysuria - What symptoms are you experiencing –
- Increased urinary freq. nausea/vomiting/back pain
- Pain/stinging when passing urine - Any complications? Pre-eclampsia, cervical
Causes = UTI, or STI – neck incompetence
chlamydia/gonorrhoea/trichomonas/herpes - Results of recent scans
