1. DR HALIMATUN MANSOR
SPECIALIST
DEPARTMENT OF OBSTETRICS AND GYNAECOLOGY
HSNZ

2.  Gynaecology history and examination are a
modification of a standardized history taking
design for
 elucidation of the presenting problems,
 concluding provisional and differential diagnosis
 Planned for further management

4.  Depending on the presenting complaint
 Age of menarche/menopause
 Marital status- infertility
 LNMP
 Length of menstruation and cycle
 Frequency and regularity of cycle
 Menstrual loss , presence of clots and flooding
 Duration of dysmenorrhea and relation to period

5.  Abnormal bleeding
 Intermenstrual
 Postcoital
 Postmenopausal
 Abnormal PV discharge
 Color, pruritus, offensive odour

6.  Sexual history
 Dyspereunia
 Contraception
 Previous STD
 Hormonal therapy
 Oral / injectable
 HRT

7.  Menopausal symptoms
 Pain
 Onset, duration , nature , site
 Relation to menstrual cycle
 Symptoms of prolapse, unconfortable lumps
in vagina

8.  Urinary problems
 Incontinence, (stress or urge)
 Frequency, nocturia or dysuria
 Other systemic review
 Past obstetric and gynaecology history
 Past medical and surgical history

9.  Social history
 Smoking, alcohol consumption
 Drug history

10.  Always begin with
 Inspection
 Palpation
 Purcussion
 Auscaltation
 Genaral examination
 Specific examination

11.  Inspection of genitalia and urethral meatus
 Evidence of estrogen deficiency, prolapse or
abnormal masses
 Presence of abnormal bleeding or discharge

12.  Speculum Examination
 Inspection of vagina and cervix
 Taking of cervical cytology or microbiology swab
 Assess uterovaginal prolapse and
incontinance

13. 13
Candidiasis Strawberry cervix: Trichomonas
Bacteria vaginosis
Herpes Simplex
Actinomyces
infection
Atrophic
cervicitis

14. Stage IV Complete
eversion

15.  Perform bimanual examination
 Assess uterine
size, shape, ante/retroverted, mobility of uterus
 Tenderness- cervical motion, POD, adnexas
 Presence of abnormal masses at POD or adnexa
 Uterosacral ligament- presence of nodule
 Thickness of the rectovaginal space

16. Imperforate hymen

17. Differential diagnosis
Revise/Prioritise diagnosis
Investigations
Treatment / Management

19.  Ultrasound
 PAP Smear for cervical screening
 Colposcopy procedure

22.  Cheap
 Acceptable
 Good sensitivity and specificity
 Achieved of screening must be 70-80%

23. 23
Cervical Biopsy
Exfoliative cytology test
cells collected are from normally shedding
epithelium .
collected using spatulas or brushes.
Specimen is fixed, stained and
studied for morphology under
microscope.

24. 24
 Initially using vaginal pool smears to
study hormonal status .
 Found cancer cells on a slide containing
a specimen from a woman's uterus.
 Dr. George Papanicolaou reported the
usefulness of the technique for detecting
neoplastic cervical cells in 1941.
 late 1940s to early 1950s, Pap smear
became widely used as a screening
technique.
Dr. George Nicholas
Papanicolaou

25. 25
1. Approximately 80% of
cells sample containing
important diagnostic
imformation is removed with
sampling devices.
2. False negative rate at
least 20% (mainly due to
sampling error).
3. Sampling is a factor in up
to 90% of false negative pap
smear.
( JosephMG. Diagn Cytopathol 1991;7(5):477)
4.Up to 40% of all Pap smears are
compromised by blood, mucus and
inflammation.
(Davey DD.Arch Pathol
Lab Med 1992;116:90)

27. 27
 Sampling
Scanty cells
Blood, mucous, pus
Mainly endocervical cells *
 Preparation
Too thick due to poor spreading
Air drying artifact

28. VIA : Visual inspection with acetic acid.
VILI : Visual inspection with Lugol’s iodine.
28

29.  A tool for screening as well as treatment of
cervical pathology especially at preinvasive
and early stage
 Need training and practice
 Available

32. smooth featureless covering of the cervix

34. Low grade lesion in a satellite pattern