what to ask a patient with pelvic inflammatory disease while obtaining her history? quizlet

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Taking a sexual history is a key skill that all medical students demand to larn. This guide discusses what questions need to be asked and how they can exist phrased when taking a sexual history.

It is actually important to brand sure you lot clarify the language the patient uses. "Sex" is non synonymous with penetration, and personal preference over descriptive words for genitals should be best-selling where possible and appropriate. You besides need to be aware of the assortment of social issues which you may come beyond during the process of taking a sexual history (e.1000. historic period of patient/partner(southward), alcohol or drug intoxication, partner notification, consent).

Download the sexual history taking PDF OSCE checklist, or use our interactive OSCE checklist. You may likewise be interested in our sexual health guides.

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Opening the consultation

Launder your hands and don PPE if appropriate.

Innovate yourself to the patient including your proper noun and role.

Confirm the patient'southward proper name and date of birth.

Explain that you'd similar to take a history from the patient.

"Today I need to take a sexual history from you, this is going to involve me asking some personal questions. We ask these questions to accurately assess your gamble of specific sexually transmitted infections, so please don't take any of the questions personally. Everything you lot tell me is confidential within the boundaries of the squad looking after your care. If however, nosotros felt you lot or someone else was in significant danger, we might accept to break this confidentiality, to prevent harm. If you would prefer not to reply a detail question or you'd like to stop the consultation at whatsoever point, please let me know."

Gain consent to proceed with history taking.

Full general communication skills

It is important you do not forget the full general communication skills which are relevant to all patient encounters. Demonstrating these skills will ensure your consultation remains patient-centred and not checklist-like (just because yous're running through a checklist in your head doesn't mean this has to exist obvious to the patient).

Some general communication skills which employ to all patient consultations include:

• Demonstrating empathy in response to patient cues: both verbal and not-verbal.
• Active listening: through trunk language and your verbal responses to what the patient has said.
• An appropriate level of center contact throughout the consultation.
• Open, relaxed, yet professional trunk language (due east.g. uncrossed legs and arms, leaning slightly forward in the chair).
• Making sure not to interrupt the patient throughout the consultation.
• Establishing rapport (eastward.g. asking the patient how they are and offering them a seat).
• Signposting: this involves explaining to the patient what y'all have discussed so far and what you plan to hash out adjacent.
• Summarising at regular intervals.

You might too be interested in our OSCE Flashcard Collection which contains over 2000 flashcards that cover clinical examination, procedures, communication skills and data interpretation.

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Presenting complaint

Useopen questioning to explore the patient'spresentingcomplaint:

• "What's brought you in to see me today?"
• "Tell me nigh the issues you've been experiencing."

Provide the patient with enough time to answer and avert interrupting them.

Facilitate the patient toaggrandize on theirpresentingcomplaint if required:

• "Ok, can you tell me more nigh that?"
• "Can you explain what that pain was similar?"

Open vs closed questions

History taking typically involves a combination of open up and closed questions. Open questions are effective at the start of consultations, allowing the patient to tell yous what has happened in their own words. Closed questions can allow you to explore the symptoms mentioned by the patient in more than detail to gain a better understanding of their presentation. Airtight questions can also be used to place relevant risk factors and narrow the differential diagnosis.

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Things to enquire people with a vagina

Once the patient has had time to communicate their presenting complaint, yous should then begin to explore the consequence with further open and closed questions.

SOCRATES

TheSOCRATES acronym is a useful tool for exploring each of the patient'south presenting symptoms in more than detail. It is almost normally used to explore pain, but information technology can be applied to other symptoms, although some of the elements of SOCRATES may non be relevant to all symptoms.

Site

Ask about the location of the symptom:

• "Where is the hurting?"
• "Tin can you betoken to where you experience the hurting?"

Onset

Clarify how and when the symptom developed:

• "Did the pain come on suddenly or gradually?"
• "When did the pain first first?"
• "How long have you been experiencing the pain?"

Character

Enquire nearly the specific characteristics of the symptom:

• "How would you lot depict the hurting?" (eastward.g. tiresome ache, throbbing, sharp)
• "Is the hurting abiding or does it come and get?"

Radiations

Enquire if the symptom moves anywhere else:

• "Does the pain spread elsewhere?"(e.g. shoulder tip hurting in ectopic pregnancy)

Associations

Ask if there are other symptoms which are associated with the primary symptom:

• "Are at that place any other symptoms that seem associated with the hurting?" (e.grand. abnormal vaginal belch in gonorrhoea)

Time form

Clarify how the symptom has inverse over fourth dimension:

• "How has the pain changed over fourth dimension?"

Ask if the symptom has whatsoever relationship to the menstrual cycle:

• "Have you noticed if this symptom is worse at a particular time in the calendar month?"

Exacerbating or relieving factors

Inquire if anything makes the symptom worse or better:

• "Does anything make the pain worse?"
• "Does anything make the pain better?"

Severity

Appraise the severity of the symptom by asking the patient to class it on a calibration of 0-x:

• "On a scale of 0-10, how severe is the pain, if 0 is no hurting and ten is the worst pain you lot've ever experienced?"

Inquire the patient if the symptom is having a pregnant impact on their day to day life:

• "How is the pain impacting your daily life?"

Key symptoms

Once you lot have completed exploring the history of presenting complaint, y'all demand to move on to more focused questioning relevant to people with a vagina.

Nosotros have included a focused list of the key symptoms to ask people with a vagina, followed past some background information on each, should you desire to know a little more.

Summary of key symptoms

Primalsymptoms to enquire people with a vagina about include:

• Abdominal and pelvic pain: causes include ectopic pregnancy, ruptured ovarian cyst, endometriosis, pelvic inflammatory illness and ovarian torsion.
• Post-coital vaginal bleeding: vaginal haemorrhage occurring after sexual intercourse. Causes include cervical ectropion, cervical cancer, gonorrhoea, chlamydia and vaginitis.
• Intermenstrual vaginal bleeding: vaginal bleeding occurring betwixt menstrual periods. Causes include contraception (e.g. Mirena coil), ovulation, miscarriage, gonorrhoea, chlamydia, uterine fibroids, perimenopause and malignancy (east.thou. uterine cancer, cervical cancer, vaginal cancer).
• Post-menopausal haemorrhage: bleeding that occurs later the menopause. Causes include gonorrhoea, chlamydia, vaginal atrophy, hormone replacement therapy and malignancy (due east.g. uterine cancer, cervical cancer and vaginal cancer).
• Abnormal vaginal discharge: causes include bacterial vaginosis, chlamydia, trichomonas vaginalis and gonorrhoea.
• Dyspareunia: causes include endometriosis, vaginal atrophy, gonorrhoea and chlamydia.
• Vulval skin changes and itching: causes include vaginal thrush, gonorrhoea, genital canker, chlamydia, vaginal atrophy and lichen sclerosis.
• Systemic symptoms: fatigue (e.g. anaemia), fever (e.g. pelvic inflammatory disease) and weight loss (e.g. malignancy).

Vaginal discharge

All healthy women will take some caste of regular vaginal discharge, then it is important to distinguish betwixt normal and abnormal vaginal belch when taking a sexual health history.

Y'all should ask if the patient has noticed any changes to the following characteristics of their vaginal belch:

• Volume: "Accept you noticed any change in the amount of vaginal discharge?"
• Colour (e.g. green, yellow or blood-stained): "Have you noticed whatever change in the colour of your belch?"
• Consistency (eastward.g. thickened or watery): "Have you noticed that your belch has become more watery or thickened recently?"
• Odour: "Have you lot noticed any change in the smell of the vaginal discharge?"

Several STIs can cause aberrant vaginal belch:

• Gonorrhoea and chlamydia commonly present with abnormal vaginal discharge.
• Bacterial vaginosis typically presents with an offensive, fishy-smelling vaginal discharge, without whatever associated soreness or irritation.
• Trichomonas vaginalis typically presents with yellowish frothy discharge with associated vaginal itching and irritation.

Vaginal haemorrhage

Abnormal vaginal haemorrhage is an important symptom that can be relevant to a wide range of gynaecological disease.

Post-coitalbleeding refers to vaginal bleeding occurring after sexual intercourse. Potential causes include infection (e.g. chlamydia and gonorrhoea), cervical ectropion and cervical cancer.

Intermenstrual bleeding refers to vaginal bleeding occurring between menstrual periods. Potential causes include infection (e.k. chlamydia and gonorrhoea), malignancy (eastward.g. cervical or endometrial cancer), uterine fibroids, endometriosis, hormonal contraception (e.g. Mirena curl) and pregnancy.

Questions to ask:

• "Have you noticed any vaginal bleeding afterward sex?"
• "Have you noticed any vaginal haemorrhage betwixt your periods?"

Dyspareunia

Dyspareunia refers to pain that occurs during sexual intercourse. It has several causes including sexually transmitted infections (gonorrhoea and chlamydia), endometriosis, vaginal atrophy and malignancy.

The location of the hurting varies between patients:

• Superficial dyspareunia: pain at the external surface of the genitalia (eastward.yard. genital herpes)
• Deep dyspareunia: pain deep in the pelvis (more mutual with gonorrhoeal or chlamydial infection)

You should clarify:

• the elapsing of the symptom
• the location of the hurting (eastward.g. superficial or deep)
• the nature of the pain (e.grand. sharp, aching, called-for)

Dysuria

Dysuria can be a symptom of a simple urinary tract infection, simply may also indicate an underlying sexually transmitted infection such as chlamydia, gonorrhoea, trichomoniasis or herpes.

Questions to enquire:

• "Practice y'all have any pain or stinging when passing urine?"
• "Do you feel y'all are passing urine more often?"

Vulval itching/soreness

Vulval itching and soreness are mutual symptoms which tin exist caused by a wide range of underlying pathology including:

• Candida (thrush)
• Genital canker
• Chlamydia
• Gonorrhoea
• Vaginal cloudburst occurs in post-menopausal women and can lead to itching and haemorrhage of the vagina
• Lichen sclerosis appears equally white patches on the vulva and is associated with itching

Questions to enquire:

• "Practice you accept whatever itching down below?"
• "Have y'all noticed any recent vaginal soreness?"

Genital peel changes

Genital skin changes can occur secondary to several sexually transmitted infections including:

• Genital herpes: painful crops of blisters/ulcers affecting the vagina and cervix.
• Genital warts: non-painful lesions that can be located on the labia, clitoris, urethral meatus, introitus, vagina, cervix, perineum, perianal area and anal canal.

Questions to ask:

• "Accept you noticed any pare changes around your vagina?"
• "Have you noticed any blisters, spots or ulcers around your vagina or anus?"

Abdominal or pelvic pain

Intestinal and pelvic hurting has many possible causes, but in the context of sexual health, pelvic inflammatory disease (PID) secondary to chlamydia or gonorrhoea is relatively common. Another cause of abdominal pain not to be missed in females is ectopic pregnancy. The acronym SOCRATES (shown above) is useful for exploring abdominal and pelvic hurting.

Systemic symptoms

Sexually transmitted infections can also cause systemic symptoms such as:

• Fever (secondary to pelvic inflammatory disease)
• Malaise
• Weight loss (e.g. HIV)
• Rash
• Swelling of large joints, conjunctivitis and cervicitis  (reactive arthritis secondary to chlamydia)

Questions to ask:

• "Have you felt feverish at all recently?"
• "Accept yous noticed any rashes elsewhere on your body?"
• "Do you have any swelling or pain in your joints?"

Menstrual history

A menstrual history involves exploring the characteristics of the patient's menstrual cycle.

Duration

Ask the patient almost the duration of their periods:

• "How long do your periods typically last?"

The boilerplate duration of menstruation is 5 days, with more than 7 days considered prolonged.

Frequency

Ask the patient about the frequency of their periods:

• "How often practice your periods occur?"
• "Are they regular and anticipated?"

Periods typically occur every 28 days, however, there is meaning variation between individuals (21-40 days).

Menstrual blood flow

Enquire the patient about the volume of their periods:

• "Are your current periods heavier than your usual periods?"
• "Have yous been flooding through sanitary towels?"
• "Have yous been passing blood clots larger than a 10p coin?"
• "Are the heavy periods impacting your day to 24-hour interval life?"

The boilerplate menstrual blood loss is approximately 40mls (viii teaspoons). Heavy menstrual claret loss is divers every bit more than 80mls (16 teaspoons) or having periods that last longer than seven days.

The definition of what is a "heavy period" compared to a "normal catamenia" is highly subjective, therefore you should ask the woman how the current periods compare to her usual loss. If the volume of bleeding is impacting on the woman's day to day life, it is pregnant.

Past gynaecological history

It is of import to ask most a woman's previous gynaecological history, every bit this may influence further investigations and management options.

Gynaecological conditions

Ask if the patient has previously had any gynaecological problems:

• Ectopic pregnancy
• Sexually transmitted infections
• Endometriosis
• Bartholin's cyst
• Cervical ectropion
• Malignancy (e.g. cervical, endometrial, ovarian)

Gynaecological surgery or procedures

Enquire the patient if they've previously undergone whatsoever surgery or procedures in the by such as:

• Abdominal or pelvic surgery
• Caesarean section
• Loop excision of the transitional zone (LETZ)
• Vaginal prolapse repair
• Hysterectomy

Cervical screening

Clarify the patient'southward cervical screening history:

• Confirm the date and issue of the last cervical screening test.
• Ask if the patient received any treatment (if the cervical screening test was aberrant) and ask if follow upward is in place.
• Ask if the patient has been vaccinated against HPV.

Obstetric history

It is important to have a brief obstetric history as part of a sexual history, as it may exist relevant to the patient's presentation and may influence management decisions. This is less detailed than a focused obstetric history.

Gravidity and parity

Gravidity is the number of times a adult female has been pregnant, regardless of the result.

Parity is the total number of pregnancies carried over the threshold of viability (typically 24 + 0 weeks).

Electric current pregnancy

Gather fundamental details about the patient's current pregnancy (if relevant):

• Gestation
• Symptoms associated with pregnancy (e.1000. nausea, vomiting, back pain)
• Complications (e.g. pre-eclampsia, cervical neck incompetence)
• Contempo scans results

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Things to ask people with a penis

The presenting complaints of people with a penis tin can exist initially explored using questions from the SOCRATES acronym explained earlier in the guide.

Key symptoms

We have included a focused list of the central symptoms to ask people with a penis about, followed past some background information on each of the symptoms, should you desire to know a little more.

Summary of key symptoms

Keysymptoms to ask people with a penis about include:

• Abdominal and pelvic pain: causes include orchitis/epididymo-orchitis (referred hurting) and prostatitis.
• Testicular pain or swelling: causes include orchitis/epididymo-orchitis (e.g. chlamydia, gonorrhoea).
• Itching or sore skin: causes include genital herpes, thrush, gonorrhoea and chlamydia.
• Skin lesions: these tin present anywhere in the anogenital region and may be acquired by canker simplex, HPV and syphilis (chancre).
• Urethral discharge: causes include chlamydia and gonorrhoea.
• Dysuria: causes include chlamydia, gonorrhoea and canker simplex.
• Systemic symptoms: joint hurting(e.thou. reactive arthritis), fever (east.thousand. prostatitis) and weight loss (east.g. malignancy).

Testicular pain and/or swelling

Testicular pain and swelling may suggest a diagnosis of epididymo-orchitis, which is ofttimes secondary to chlamydia or gonorrhoea.

Questions to ask:

• "Have you noticed whatever pain in your testicles?" (clarify the details of the hurting using the SOCRATES method mentioned previously)
• "Have you noticed any change in the size of your testicles?"

Itching and/or sore pare

Itching and sore peel in the genital region may be acquired past infection with candida, herpes simplex virus or genital warts.

Questions to inquire:

• "Take you noticed whatsoever itching effectually your genitals?"
• "Is the peel around your penis and/or testicles sore?"
• "Is the head of your penis sore?"

Skin lesions (anogenital region)

The virtually common causes of new skin lesions in the anogenital region are genital warts (HPV) and herpes simplex. Genital warts are typically painless, withal, patients sometimes tin experience itching and haemorrhage. Genital herpes simplex lesions typically present as crops of painful blisters/ulcers in the genital area (including the urethra).

Questions to enquire:

• "Accept you noticed any lumps, bumps or ulcers around your penis, testicles or anus?"
• "Are the lesions itchy or painful?"
• "Have you lot noticed any tingling or burning in the area of the lesions?"

Urethral discharge

Urethral belch may advise underlying chlamydial or gonorrhoeal infection.

Questions to ask:

• "Have you noticed any discharge from your penis?"

Dysuria

Dysuria can be a symptom of a simple urinary tract infection, but may also indicate an underlying sexually transmitted infection such every bit chlamydia, gonorrhoea or herpes.

Questions to ask:

• "Do y'all take any pain or burning in your genitals when y'all pass urine?"
• "Do you feel you are passing urine more oftentimes?"
• "Is at that place any claret in your urine?"

Systemic symptoms

Sexually transmitted infections can also cause systemic symptoms such every bit:

• Fever
• Angst
• Weight loss (due east.g. HIV)
• Rash
• Swelling of large joints (reactive arthritis secondary to chlamydia), conjunctivitis

Questions to ask:

• "Have you felt feverish at all recently?"
• "Have you lot noticed any rashes elsewhere on your body?"
• "Practice you lot accept whatsoever swelling or pain in your joints?"

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Last sexual contact

Sign-posting

Sign-posting here is of do good to ensure the patient is prepared for the nature of the questions surrounding their sexual history.

"Next, I'm going to move on to talk over your sexual history, some of these questions are quite in-depth and personal. The reason we enquire these questions is and then that we tin accurately assess the run a risk of sexually transmitted infections. We ask the same questions to everyone, and so please don't have anything personally. If y'all feel uncomfortable and would prefer non to answer, simply let me know."

Timing

Enquire about the timing of the last sexual contact:

• "When did you last have a sexual run across?"

Consent

Ask if the patient feels this sexual encounter occurred with their consent:

• "Was this sexual encounter consensual?"

Human relationship

Enquire if this was a regular sexual partner or a one-off casual sexual come across:

• "Was this a regular sexual partner, or a casual sexual encounter?"

Partner demographics

Analyze the sex activity and land of origin of the partner:

• "What sexual practice was the partner in question?"
• "What state was the partner from?"

Types of sex involved

You should clarify what type of sex was involved in the encounter:

• "What type of sex was involved in this sexual encounter?"
• "Did you requite or receive oral sex?"
• "Did you lot accept vaginal sex?"
• "Did you give or receive anal sex?"
• "Did you take drugs just before or during sex?"
• "Did the sex involve more than two people?"

Contraception

Clarify the blazon of contraception used and the consistency of usage:

• "Did you use any grade of contraception for the sexual encounter?"
• "Was any barrier contraception used during sex?"
• "Was there any problems with the contraception used?" (e.g. rubber splitting)
• "Was at that place whatsoever signal at which contraception was non used during the sex?"
• "Did you utilize contraception for every sexual meet with this individual?"

Other sexual partners

Ask about other sexual partners in the final three months:

• "Have you had any other partners inside the last 3 months?" – if so, repeat the above questions for each

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HIV adventure cess

Ask specifically nigh HIV run a risk factors to determine the patient'due south take a chance profile:

• "Accept you lot e'er had a partner who is known to be HIV positive?"
• "Accept you ever had sex with a bisexual human being/engaged in male homosexual activeness?"
• "Have y'all ever had sexual practice with someone abroad, or who was born in a dissimilar land?"
• "Have y'all e'er injected drugs?"
• "Are you aware of whatever of your previous partners having ever injected drugs?"
• "Have you ever paid someone for sex, or been paid for sexual practice?"

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Past medical and surgical history

It is important to enquire about the patient's medical history, as these conditions may bear upon the sexual health effect and may themselves be impacted past or prevent the utilize of specific treatments.

Ask if the patient has whatevermedicalweather condition:

• "Do yous accept any medical weather condition?"
• "Are you currently seeing a md or specialist regularly?"

If the patient does have a medical condition, you should assemble more details to assesshowwellcontrolled the disease is and whattreatment(s) the patient is receiving. Information technology is besides important to ask about anycomplications associated with the status includinginfirmaryadmissions.

Enquire if the patient or any of their sexual partners have previously been diagnosed with a sexually transmitted infection.

Explore which immunisations the patient has previously received:

• Hepatitis A/B and HPV vaccinations are particularly relevant to men who have sex with men.

Allergies

It'due south essential to clarify anyallergies the patient may have and to certificate these conspicuously in the notes, including thetype of allergic reaction the patient experienced.

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Drug history

Ask if the patient is currently taking whateverprescribedmedications orover-the-counterremedies:

• "Are y'all currently taking whatever prescribed medications or over-the-counter treatments?"

If the patient is taking prescribed or over the counter medications,document themedicationname,dose,frequency,form androute.

Enquire the patient if they're currently experiencing whateversidefurnishings from their medication:

• "Have you noticed whatsoever side furnishings from the medication y'all currently have?"

Some medications may causesexual wellnessissues orinterfere withmedications:

• St John's Wart increases the metabolism of the COCP reducing its effectiveness.
• Antibiotics may crusade secondary vaginal thrush.

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Social history

Understanding the social context of a patient is admittedly key to edifice a complete picture of their health.

General social context

Explore the patient'southgeneral social context including:

• who else the patient lives with and their personal support network
•  the historic period of partner(south): exist enlightened of safeguarding issues, especially surrounding the social factors related to sexual encounters

Smoking

Record the patient'southsmokinghistory, including the type and corporeality of tobacco used.

Consider if medications such as the COCP arecontraindicated because of the patients smoking status:

• If smoking more than 40 cigarettes a day, the COCP would exist contraindicated.
• If over 35-years-onetime and smoking more xv cigarettes a day, the COCP would be contraindicated.

Booze

Record thefrequency,type andvolume ofalcohol consumed on a weekly basis (meet our alcohol history taking guide for more information).

The use of alcohol may impair a patient's ability to remember of import details of sexual encounters (e.m. employ of contraception).

Recreational drug apply

Inquire the patient if they utilizerecreationaldrugs and if and then make up one's mind the type of drugs used and their frequency of utilise.

4 drug administration and sharing of the equipment used to snort cocaine increases the risk of acquiring claret-borne viruses such as hepatitis C and HIV.

The utilize of recreational drugs may impair a patient's ability to recall important details of sexual encounters (eastward.m. employ of contraception).

Diet and weight

Ask if the patient what theirdiet looks similar on anaverageday.

Ask about the patient'southwardelectric currentweight:

• Anorexia can result in oligomenorrhoea (infrequent periods) or amenorrhoea (absence of catamenia).
• A raised BMI may be a contraindication to some treatments, including combined oral contraceptives.

Occupation

Ask near the patient'south currentoccupation and if they are managing ok at piece of work with their current symptoms.

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Closing the consultation

Summarise thefundamentalpoints dorsum to the patient.

Ask the patient if they have anyquestions orconcerns that take not been addressed.

Re-affirm confidentiality, or hash out if any breaches are felt to be advisable.

Thank the patient for their time.

Dispose of PPE accordingly and launder your hands.

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Source: https://geekymedics.com/sexual-history-taking/

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