1. Special Tutorial Programme Professor Deirdre J Murphy Trinity College

2. Introduction to Gynaecology

3. Objectives Gynaecological History Gynaecological examination Cervical screening Practice assessment

4. Gynaecological history Menses Sexual/Contraception Cervical smear Urinary Prolapse Pregnancies

5. Complete History Demographics Specific gynaecological history Past Obstetric history Past Medical/Surgical/Psych history Family history Social history Medication / Allergies Systems review

6. Gynaecological history Heavy bleeding Pelvic pain Leaking urine Failure to conceive

7. Heavy bleeding

8. Menarche / LMP / Menopause How often / How long / Regularity Heavy / volume Intermenstrual bleeding Postcoital bleeding Vaginal discharge Pain [Intercourse / contraception /smear / urinary / prolapse / obstetric]

9. Pelvic pain

10. Features – cyclical/acute/chronic pain Abnormal menses Vaginal discharge Dyspareunia [Intercourse / contraception /smear / urinary / prolapse / obstetric]

11. Leaking urine

12. Urgency Stress symptoms Frequency Nocturia Dysuria Bowel symptoms Prolapse symtoms [Menses /Intercourse / contraception /smear / obstetric]

13. Failure to conceive

14. Subfertility History of a couple Duration Intercourse Previous pregnancies

15. Female Menses Pelvic pain Vaginal discharge Dyspareunia Hirsutism Medical Cervical treatment Previous pregnancies Lifestyle

16. Male Infections Medical illnesses Lifestyle Sterilisation Impotence / Failure to ejaculate

17. Intelligent history Comprehensive but efficient Differential diagnosis Targeted questioning Prioritising diagnosis Focus examination

18. Gynaecological examination

19. Consent / Chaperone / Dignity

20. General examination Appearance Weight Vital signspulse blood pressure temp Cardiovascular Respiratory Breast / Axillae Lymph nodes

21. Abdomen Inspect scars /body hair / distension / herniae Palpate tenderness / masses / umbilicus down Percuss dull /resonant / shifting dullness Auscultate bowel sounds

22. Pelvic examination Inspection Bimanual digital examination Speculum examination [Rectal examination]

23. Inspection Position patient Vulva / Vagina Abnormal skin colour / ulceration /atrophy Lumps Prolapse

24. Bimanual digital examination Cervix os shape / consistency Uterus size / position / consistency / regularity/ mobility / tenderness Adnexae palpable / size / consistency / tenderness

25. Speculum examination Cuscoe’s bivalve speculum Sims’ speculum Positioning Inspect cervix – ulceration / bleeding /irregularity Inspect vaginal walls Removal

26. Basic Gynaecological Skill Careful history Sensitivity Professional examination

27. Further management Differential diagnosis Revise/Prioritise diagnosis Investigations Treatment / Management

28. Objectives Gynaecological history Gynaecological examination Cervical screening Formative assessment

29. Cervical screening

30. What is Screening Apply test to asymptomatic individuals and classify likelihood of disease - early detection with subsequent tests - reduce disease severity/recurrence/mortality

31. Criteria for screening Suitable Disease Serious Pre-symptomatic treatment better High prevalence Suitable test Cheap /painless/ easy to administer Valid sensitivity/specificity Reproducible reliable instrument /observer variability

40. Practice assessment