Obstetric and gynecologic history are often considered a distinct part of the medical history. This history includes past medical history related to reproductive and overall gynecologic health, including pregnancies, menstrual periods, sexual health issues, birth control, and menopause.
For gynecologic care, a woman should choose a health care professional with whom she can comfortably discuss sensitive topics, such as sexual function concerns, birth control, pregnancy, and menopause. The clinician may be a doctor, including a gynecologist, primary care physician, nurse-midwife, nurse practitioner, or physician assistant. Gynecologic evaluation of children and adolescent girls if needed can usually be done by the child's pediatrician.
A gynecologic evaluation includes the obstetric and gynecologic history and, usually, a pelvic examination.
For the gynecologic history, clinicians ask about past and present menstrual periods, past pregnancies, sexual activities, and gynecologic symptoms, disorders, and treatments that a woman has had in the past or is currently experiencing.
Questions about menstrual periods include the following:
How old a woman was when menstrual bleeding began (menarche)
How often, regular, and long menstrual periods are
How heavy menstrual bleeding is
When the last menstrual period began and ended
Whether a woman has symptoms (such as pain, cramps, headaches, or loose stools) during menstrual periods
Whether a woman has or has had abnormal bleeding—too much, too little, or between menstrual periods
Questions about past pregnancies include the following:
How many pregnancies a woman has had
What the dates of those pregnancies were
How those pregnancies ended (such as in a live birth or a miscarriage) and at what gestational age
Whether complications (such as excessive bleeding during or after pregnancy, high blood pressure, diabetes) occurred
Gynecologic symptoms discussed when the clinician is taking a history include the following:
Incontinence of urine or stool
The clinician usually asks about sexual activities to assess the risk of sexually transmitted infections, birth control, pregnancy, and sexual health concerns. A woman is asked whether she uses or wants to use birth control and whether she is interested in counseling about birth control, preparing for pregnancy, or other information.
The clinician asks whether a woman has pain during intercourse, in the middle of the menstrual cycle (which may indicate that the pain coincides with ovulation), or under other circumstances. If she has pain, she is asked about location, when it started, whether it started gradually or abruptly, duration, severity, associated symptoms, and relieving or aggravating factors.
The clinician also asks about breast problems, such as pain, lumps, areas of tenderness or redness, and discharge from the nipples. A woman is asked whether she needs any information about self breast examination technique.
The clinician asks about a woman's general medical and surgical history.
The clinician reviews all the medications a woman is taking, including prescription and nonprescription medications or supplements, tobacco, and alcohol, because many of them affect gynecologic function.
The woman is asked about mental, physical, or sexual abuse—whether she is being or has been abused.
