Urogenital: History (F)
  1. Presenting complaint
  2. History of presenting complaint
  3. Menstrual history
  4. Obstetric history
  5. Sexual history
  6. Urinary history
  7. Past medical, surgical history
  8. Family, social, drug history
Presenting complaint
  • What is the problem lately [pt. may omit sexual items, cover with questions].
History of presenting complaint
  • See SOCRATES.
  • Timing: worse at a particular time in cycle.
  • Alleviating factor: better after menstruation.
  • Discharge: colour, consistency, amount, smell.
  • Weight changes: anorexic (amenorrhoea) or obesity (polycystic ovary, OCP).
  • Feverish.
  • Itch, dryness, irritation, relieved by cream.
  • Hirsutism, hair loss: severity, how controlled (polycystic ovary).
  • Voice changes, acne (androgen-secreting tumour).
  • Prolapse, air expelled from front passage.
  • Does it interfere with your day-to-day life.
  • Bowel, stool problems (RLQ pain from IBD).
  • General health: good?
Menstrual history
  • First day of your last period.
  • Length of cycles, length of period.
  • Periods regularity, shortest and longest times.
  • Severity increasing as time goes on.
  • Spells of no periods in absence of pregnancy.
  • Periods heavy, clots, flooding.
  • Pads or tampons used, number required.
  • Periods painful.
  • Bleeding between periods, after intercourse. 
  • Time of menarche, menopause.
  • If menopause: hot flushes, night sweats [assesses severity of decreasing estrogen].
  • Bleeding before puberty, after menopause.
Obstetric history
  • Possibility of currently pregnant.
  • Number of children, weights at birth.
  • Number of times been pregnant [do math for miscarriages, terminations]: what month, why, how.
  • Problems during gestation, delivery.
  • Bleeding during pregnancy.
Sexual history
  • Sexually active.
  • Number of partners.
  • Contraception: on OCP? which one?
  • Contraception: others currently using, used previously.
  • Physical, other difficulties during intercourse.
  • Pain during, after intercourse: deep/ superficial, always/ sometimes.
  • Difficulty in conceiving.
  • Pap smear: last smear's date, result.
Urinary history
  • Colour change.
  • Blood in urine.
  • Frequency, amount changes.
  • Pain, burning sensation.
  • Feeling of incomplete emptying.
  • Hesitancy, nocturia, dribbling.
  • Incontinence, overflow incontinence, stress incontinence.
Past medical, surgical history
  • Similar problem in the past. If so, how treated (D&C, hormones).
  • Recent front passage injuries.
  • UTIs, urinary obstructions.
  • STD's, salpingitis [tubes infection].
  • Hypertension.
  • Hemophilia, other bleeding disorders.
  • TB, appendicitis. 
  • IBD (RLQ pain).
  • Diabetes, gout [urinary].
  • Childhood bedwetting after 3 [urinary].
  • MI, cerebrovascular dz [urinary].
  • Infertility treatments [if infertile].
  • Seen a gynecologist before?
  • Previous operations, D&C
Family history
  • The current complaint in parents/ siblings: health, cause of death, age of onset, age of death.
  • Hereditary dz suspected: do a family tree 
  • Thyroid dz, diabetes.
  • ADKD, Alport's [urinary].
Social history
  • Smoking: ever smoked, how many per day, for how long, type [cigarette, pipe, chew] (bladder CA).
  • Alcohol: do you drink. If yes: type, how much, how often.
  • Present, past occupations:
    Rubber industry (bladder CA 2 to aromatic amines).
    Stressful job or runner (amenorrhoea).
  • Travel to Africa (bladder CA 2 to schistosomiasis). 
  • Who is with you there at home.
  • Feel stressed (amenorrhoea).
  • Any other factors that you wish to mention?
Drug history
  • Prescriptions currently on.
  • Steroids, immunosuppressants, drugs with disturb renal-function.
  • Over-the-counters.
  • Estrogen replacements [if menopausal], other hormones.
  • Iron replacement.
  • Allergies.
  • Drug allergies: assess if s/e or allergic reaction.

Urogenital (F) Exam