Female Reproductive History
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Introduction
Age
Gravity and parity
LMP, menopause, hysterectomy
Chief Complaint
urinary symptoms:
- what makes patient leak urine
- quantify
- frequency, urgency, nocturia (>2 per night), dysuria, pain
- obstructive symptoms: weak urinary stream, straining to empty bladder, incomplete emptying
- prolapse symptoms:
- bowel symptoms: constipation, diarrhea, fecal or flatal incontinence, rectal urgency, difficulty emptying bowel
past medical history
- illnesses: conditions which could contribute to problem
social history
- married vs single
- working
- smoking, drinking
- caffeine fludi consumption
Physical exam
- vitals
- weight
- abdomen (surgical incisions, palpable masses, hepatosplenomegaly)
- brief neuro exam (clitoral reflex: S2,3,4)
- vulva: atrophy, cough stress test, valsava prolapse
- perineum
- scars
- normal innervation
- speculum exam: cervix/vault
- one blade: anterior, posterior walls
Q-tip test (use xylocaine)
- insert until no resistance = in bladder; pull back a bit
- measure resting angle and excursion ar rest and with coughing
- a change in over 30 degrees suggests uretheral hypermobility and could provide information for incontinence
- bimanual: if uterus present, assess size, tenderness, direction (anteverted, retroverted)
- adnexal masses or tenderness
- valsava: UVJ mobility
- pelvic floor muscle strength (Kegels: score our of 5)
rectocele
urolog
mdstream urine
post-void residual
pad-test
cystoscopy/urethroscopy
urodynamics
Resources and References
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