Zbieranie wywiadu z zakresu układu płciowego żeńskiego | Taking a Female Reproductive System History

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pacjenta”, “Chief Complaint (CC)”: “Główna dolegliwość”, “abnormal vaginal bleeding”: “Nieprawidłowe krwawienie z pochwy”, “intermenstrual bleeding”: “Krwawienie międzymiesiączkowe”, “postcoital bleeding”: “Krwawienie po stosunku”, “menorrhagia”: “Obfite krwawienie miesiączkowe”, “hormonal imbalances”: “Zaburzenia hormonalne”, “uterine fibroids”: “Mięśniaki macicy”, “polyps”: “Polipy”, “malignancy”: “Nowotwór złośliwy”, “dysmenorrhea”: “Bolesne miesiączkowanie”, “primary dysmenorrhea”: “Pierwotne bolesne miesiączkowanie”, “secondary dysmenorrhea”: “Wtórne bolesne miesiączkowanie”, “endometriosis”: “Endometrioza”, “amenorrhea”: “Brak miesiączki”, “primary amenorrhea”: “Pierwotny brak miesiączki”, “secondary amenorrhea”: “Wtórny brak miesiączki”, “dyspareunia”: “Ból podczas stosunku”, “vaginal discharge”: “Wydzielina z pochwy”, “bacterial vaginosis”: “Bakteryjna waginoza”, “vulvovaginal candidiasis”: “Kandydoza sromu i pochwy”, “sexually transmitted infections (STIs)”: “Infekcje przenoszone drogą płciową”, “pelvic pain”: “Ból miednicy”, “ovarian cysts”: “Torbiele jajników”, “pelvic inflammatory disease (PID)”: “Zapalenie narządów miednicy mniejszej”, “dysuria”: “Bolesne oddawanie moczu”, “urinary tract infections”: “Zakażenia dróg moczowych”, “polyuria”: “Wielomocz”, “infertility”: “Niepłodność”, “ovulatory disorders”: “Zaburzenia owulacji”, “breast changes”: “Zmiany w piersiach”, “fibrocystic changes”: “Zmiany włóknisto-torbielowate”, “breast cancer”: “Rak piersi”, “History of Present Illness (HPI)”: “Historia obecnej choroby”, “lower abdomen”: “Podbrzusze”, “pelvic inflammatory disease”: “Zapalenie narządów miednicy mniejszej”, “cramp-like pain”: “Ból przypominający skurcze”, “uterine contractions”: “Skurcze macicy”, “sharp pain”: “Ostry ból”, “throbbing aches”: “Pulsujące bóle”, “associated symptoms”: “Objawy towarzyszące”, “nausea”: “Nudności”, “vomiting”: “Wymioty”, “diarrhea”: “Biegunka”, “radiation of pain”: “Promieniowanie bólu”, “menstrual cycle”: “Cykl miesiączkowy”, “severity of pain”: “Nasilenie bólu”, “Past Medical History”: “Historia chorób”, “menstrual disorders”: “Zaburzenia miesiączkowania”, “polycystic ovary syndrome (PCOS)”: “Zespół policystycznych jajników”, “uterine fibroids”: “Mięśniaki macicy”, “hysterectomy”: “Histerektomia”, “oophorectomy”: “Usunięcie jajnika”, “cesarean section”: “Cesarskie cięcie”, “hormone replacement therapy (HRT)”: “Hormonalna terapia zastępcza”, “Family History”: “Historia rodzinna”, “reproductive cancers”: “Nowotwory układu rozrodczego”, “Medications”: “Leki”, “hormonal contraceptives”: “Antykoncepcja hormonalna”, “fertility treatments”: “Leczenie niepłodności”, “over-the-counter drugs”: “Leki bez recepty”, “herbal supplements”: “Suplementy ziołowe”, “Social History”: “Historia społeczna”, “sexual history”: “Historia seksualna”, “substance use”: “Używanie substancji”, “physical activity”: “Aktywność fizyczna”, “nutrition”: “Odżywianie”, “drug allergies”: “Alergie na leki”, “environmental allergies”: “Alergie środowiskowe”, “Environmental and Occupational Exposures”: “Narażenia środowiskowe i zawodowe”, “workplace exposures”: “Narażenia w miejscu pracy”, “heavy metals”: “Metale ciężkie”, “endocrine disruptors”: “Zaburzacze hormonalne”, “Closing the Consultation”: “Zakończenie konsultacji”, “physical exam”: “Badanie fizykalne”, “painful menstruation”: “Bolesne miesiączkowanie”, “abnormal bleeding”: “Nieprawidłowe krwawienie”, “uterine polyps”: “Polipy macicy”, “pain during intercourse”: “Ból podczas stosunku”, “hormonal changes”: “Zmiany hormonalne”, “chronic pelvic pain”: “Przewlekły ból miednicy”, “ovarian cysts”: “Torbiele jajników”, “hormonal therapies”: “Terapie hormonalne”, “reproductive health conditions”: “Stany zdrowotne układu rozrodczego”, “menstrual irregularities”: “Nieregularne miesiączki”, “uterine fibroid management”: “Leczenie mięśniaków macicy”, “anatomical issues”: “Problemy anatomiczne”, “pelvic pain assessment”: “Ocena bólu miednicy”, “infections and irritations”: “Infekcje i podrażnienia”, “endocrine disruption”: “Zaburzenia endokrynne”, “chronic inflammation”: “Przewlekłe zapalenie”, “fertility treatment options”: “Opcje leczenia niepłodności”, “irregular sleep patterns”: “Nieregularne wzorce snu”, “metrorrhagia”: “Krwawienie maciczne”, “uterine fibroid”: “Mięśniak macicy”, “primary symptom”: “Główny objaw”, “female reproductive system”: “Żeński układ rozrodczy”, “intrauterine polyps”: “Polipy wewnątrzmaciczne”, “fibroid treatment”: “Leczenie mięśniaków”, “uterine pathology”: “Patologia macicy”, “reproductive history”: “Historia rozrodcza”, “secondary amenorrhea causes”: “Przyczyny wtórnego braku miesiączki”, “hormonal contraceptive use”: “Stosowanie antykoncepcji hormonalnej”, “medication regimen”: “Schemat leczenia”, “reproductive system examination”: “Badanie układu rozrodczego”, “uterine evaluation”: “Ocena macicy”, “symptom severity assessment”: “Ocena nasilenia objawów”, “menstrual health”: “Zdrowie menstruacyjne”, “contraceptive history”: “Historia antykoncepcji”, “infertility evaluation”: “Ocena niepłodności”, “chronic menstrual pain”: “Przewlekły ból menstruacyjny”, “acute pelvic pain”: “Ostry ból miednicy”, “uterine malignancy assessment”: “Ocena nowotworu macicy”, “reproductive health management”: “Zarządzanie zdrowiem rozrodczym” }; // Normalize keys in the dictionary const normalizedWordsToTooltip = {}; for (const [key, value] of Object.entries(wordsToTooltip)) { const cleanedKey = key.replace(/(.*?)/g, ”).trim(); // Remove anything in parentheses normalizedWordsToTooltip[cleanedKey.toLowerCase()] = value; } function processNode(node) { if (node.nodeType === Node.TEXT_NODE && node.nodeValue.trim()) { let content = node.nodeValue; // Regex to match only the main words (ignores parentheses) const regex = new RegExp( `b(${Object.keys(normalizedWordsToTooltip).join(‘|’)})b`, ‘gi’ ); if (regex.test(content)) { const wrapper = document.createElement(‘span’); wrapper.innerHTML = 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Opening Consultation

Before starting, review the patient’s medical records for relevant musculoskeletal history if available.

Confirm the patient’s identity politely.

Introduce yourself warmly, stating your name and role.

Chief Complaint (CC)

The Chief Complaint (CC) refers to the primary symptom or concern that a patient presents with during a medical consultation. Common complaints related to the female reproductive system include:

Complaint	Description
Dysmenorrhea	Dysmenorrhea refers to painful menstruation, classified as primary (due to uterine contractions) or secondary (due to conditions like endometriosis or fibroids). Assessing severity and impact on daily activities is essential for management.
Abnormal Vaginal Bleeding	Abnormal bleeding can present as intermenstrual bleeding, postcoital bleeding, or heavy menstrual bleeding (menorrhagia). Causes may include hormonal imbalances, uterine fibroids, polyps, or malignancy. A thorough evaluation is necessary to determine the underlying cause and appropriate management.
Menorrhagia	Menorrhagia is characterized by excessive or prolonged menstrual bleeding. This condition may be associated with fibroids, hormonal imbalances, or other underlying health issues. Evaluating the volume and duration of bleeding is crucial for diagnosis.
Metrorrhagia	Metrorrhagia refers to irregular bleeding between periods. It may be caused by hormonal fluctuations, uterine fibroids, or malignancies. A thorough investigation is needed to understand the etiology.
Amenorrhea	Amenorrhea is the absence of menstruation. It can be classified as primary (failure to start menstruating by age 16) or secondary (cessation of menstruation after a period of regular cycles). Potential causes include pregnancy, hormonal imbalances, or stress.
Dyspareunia	Dyspareunia refers to pain during intercourse. This condition can result from various factors, including infections, hormonal changes, or anatomical issues. Understanding the location and nature of the pain is essential for effective management.
Vaginal Discharge	Changes in vaginal discharge, including odor, color, and consistency, can indicate infections such as bacterial vaginosis, vulvovaginal candidiasis, or sexually transmitted infections (STIs). A detailed history of associated symptoms is necessary for diagnosis.
Pelvic Pain	Pelvic pain may be acute or chronic and can result from various conditions such as ovarian cysts, endometriosis, pelvic inflammatory disease (PID), or uterine fibroids. Understanding the nature, location, and duration of the pain is crucial for diagnosis and treatment planning.
Dysuria	Dysuria refers to painful urination, which can indicate urinary tract infections or irritations in the bladder. Assessing the nature of the pain and any accompanying urinary symptoms is important for diagnosis.
Polyuria	Polyuria refers to the condition of producing abnormally large volumes of urine. It can be indicative of diabetes mellitus or other metabolic disorders, and understanding the context and associated symptoms is essential.
Infertility	Infertility is defined as the inability to conceive after one year of unprotected intercourse. Causes may include ovulatory disorders, anatomical issues, or male factors. A comprehensive evaluation of the couple’s reproductive history is essential.
Breast Changes	Changes in breast tissue, such as tenderness, lumps, or discharge, may indicate benign conditions like fibrocystic changes or more serious issues like breast cancer. Regular self-examinations and clinical assessments are essential for monitoring.

History of Present Illness: Dysmenorrhea

The History of Present Illness (HPI) focuses on the patient’s current symptoms and the progression of their condition, specifically in relation to dysmenorrhea, which refers to painful menstruation. This condition can significantly impact a woman’s quality of life and daily functioning. Utilizing the SOCRATES framework helps to systematically assess the patient’s experience, providing valuable insights into the nature and implications of their symptoms.

SOCRATES Assessment of Dysmenorrhea:

S – Site: Identifying the location of the pain is critical for diagnosing dysmenorrhea. Pain is typically felt in the lower abdomen, often described as cramp-like. It may also radiate to the lower back, thighs, or groin. Understanding the specific areas affected can help differentiate between primary dysmenorrhea, which is linked to the menstrual cycle, and other conditions such as pelvic inflammatory disease, endometriosis, or ovarian cysts.

O – Onset: Determining when the pain started is important for diagnosis. Dysmenorrhea often begins shortly before menstruation (typically 1-2 days) and may continue throughout the menstrual period. Understanding whether the pain is cyclical or has started suddenly can help identify underlying conditions or abnormalities.

C – Character: Describing the nature of the pain aids in the assessment of dysmenorrhea. Patients may report a variety of sensations, ranging from sharp, cramp-like pains to dull, throbbing aches. Differentiating between primary dysmenorrhea, typically associated with uterine contractions, and secondary dysmenorrhea, which may be related to conditions such as endometriosis or fibroids, is essential for effective management.

A – Associated Symptoms: Inquiring about other symptoms that accompany dysmenorrhea is crucial for understanding the severity and potential underlying causes. Symptoms such as nausea, vomiting, diarrhea, fatigue, headaches, and emotional changes can accompany menstrual pain.

R – Radiation: Identifying if the pain radiates to other areas is critical. While dysmenorrhea pain is primarily localized in the abdomen, it can radiate to the lower back, thighs, or groin. Assessing the pattern of pain radiation can help evaluate its source and differentiate between dysmenorrhea and other pelvic or abdominal conditions.

T – Timing: Understanding when the pain occurs in relation to the menstrual cycle is essential for diagnosis. Dysmenorrhea typically starts a few days before menstruation, peaks during the first days of menstruation, and may last throughout the period.

S – Severity: Assessing the severity of dysmenorrhea is essential for understanding its impact on daily life. Patients should be asked to rate their pain on a scale from 0 to 10. Evaluating how the pain affects their ability to carry out daily activities, work, and social interactions can help guide treatment decisions.

Past Medical History

A thorough review of the patient’s past medical history can help identify underlying risk factors related to the female reproductive system:

• Menstrual Disorders: A history of menstrual irregularities such as dysmenorrhea (painful periods), menorrhagia (heavy menstrual bleeding), or amenorrhea (absence of menstruation) can indicate underlying health issues. Conditions such as polycystic ovary syndrome (PCOS) or uterine fibroids may contribute to these symptoms.
• Pelvic Inflammatory Disease (PID): A history of PID, which often results from sexually transmitted infections, can lead to complications such as chronic pelvic pain or infertility. Understanding past episodes can provide insight into potential reproductive health issues.
• Endometriosis: Previous diagnoses of endometriosis can lead to chronic pain and may affect fertility. It is important to assess the severity and impact of this condition on the patient’s quality of life.
• Previous Surgeries: Past gynecological surgeries, including hysterectomy, oophorectomy, or cesarean sections, may influence current reproductive health and the risk of complications. It is important to note the reasons for surgery and any resulting issues.
• Hormonal Therapies: History of hormonal treatments, including contraceptives or hormone replacement therapy (HRT), can have implications for current health and symptoms. Understanding the duration and reasons for these therapies is essential.
• Sexually Transmitted Infections (STIs): A history of STIs can lead to reproductive health complications, including infertility or chronic pain. Documenting past infections and treatments is crucial for assessing risks.

Family History

A detailed family history can help identify hereditary reproductive health conditions:

• Menstrual Disorders: A family history of menstrual irregularities can suggest a genetic predisposition to similar issues in the patient. Conditions like PCOS or endometriosis may have familial links.
• Reproductive Cancers: Family history of cancers such as breast, ovarian, or uterine cancer can increase the patient’s risk for these diseases. Identifying these risks is essential for early screening and prevention strategies.
• Infertility: Understanding familial patterns of infertility may provide insights into the patient’s reproductive health and guide evaluation strategies.

Medications

Understanding the patient’s current and past medications provides insight into their treatment history and potential drug-related causes for reproductive health symptoms:

• Current Medications: Assess any current medications, especially hormonal contraceptives, fertility treatments, or medications for menstrual disorders. Evaluate their effectiveness and adherence to treatment regimens.
• Recent Changes in Medications: Inquire about any recent changes in medication regimens that could affect symptoms, including new prescriptions or dosage adjustments.
• Medications with Side Effects: Some medications may have reproductive health-related side effects. For instance, certain antidepressants or hormonal therapies may impact libido or menstrual cycles.
• Over-the-Counter and Herbal Supplements: These may interact with prescribed medications or have effects on reproductive health. It’s important to identify any supplements the patient is taking.

Social History

Understanding the patient’s social history is essential for identifying lifestyle factors that contribute to reproductive health:

• Sexual History: Assess the patient’s sexual history, including the number of partners, use of protection, and history of STIs. This information is vital for evaluating risks and informing treatment.
• Substance Use: Evaluate the impact of smoking, alcohol, and drug use on reproductive health. Substance use can affect hormonal balance, fertility, and pregnancy outcomes.
• Physical Activity and Nutrition: Understanding exercise habits and diet can reveal lifestyle factors influencing reproductive health. A balanced diet and regular exercise are essential for hormonal regulation and overall health.

Allergies

Assessing allergies helps identify potential triggers and guides management, particularly in patients with reproductive health conditions:

• Drug Allergies: Identify any medications that cause allergic reactions, especially those used for treating reproductive health issues, such as hormonal therapies or antibiotics.
• Environmental Allergies: Understanding environmental allergies can help identify any exacerbating factors that may affect the patient’s reproductive health, although they are not directly related.

Environmental and Occupational Exposures

Environmental and occupational factors can significantly affect reproductive health:

• Workplace Exposures: Exposure to harmful substances, such as heavy metals or endocrine disruptors, can impact fertility and reproductive health.
• Lifestyle Factors: Chronic stress, shift work, and irregular sleep patterns can also affect hormonal balance and reproductive function.

Closing the Consultation

Summarize the main points discussed during the history-taking to confirm understanding and ensure no details were missed.

Ask the patient if they have any remaining questions or concerns before moving forward with the examination.