Gynecologic Health History
The reaction of gynecologic health history is necessary to provide or enhance the healthcare of the gynecologic patient. The information for history can be obtained through a series of questions regarding the various aspects of the patient’s gynecologic health. According to Tillman & Likis (2017), the complete gynecologic health history can consist of the following components:
- Menstrual history;
- Pregnancy history;
- History of vaginal and sexually transmitted infections;
- Genital hygiene;
- Sexual health;
- Contraceptive use;
In addition, gynecological health may include extra elements, such as various procedures related to disease screenings. Screening results allow the medical personnel to access detailed information about the gynecologic patient and adjust the possible treatment plan accordingly. The screenings described in the sections below present an important addition to gynecologic health background. Therefore, they require special coverage within the framework of gynecologic health history.
Breast Cancer Screening
The primary goal of breast cancer screening lies in the detection of early disease symptoms in seemingly healthy women. Screening tests improve the chances of patient survival and help avoid more intensive treatment, which can potentially cause side effects. American College of Obstetricians and Gynecologists (ACOG) developed particular guidelines for breast cancer screening. According to it, women aged 25-39 years may be offered to pass clinical breasts examination (American College of Obstetricians and Gynecologists [ACOG], 2017). Starting from the age of 40, women should undergo it annually. Women at 40-49 years may start passing mammography annually or biennially; the procedure becomes strongly recommended from the age of 50 until the patient reaches 75 (ACOG, 2017). These procedures serve as an addition to self-examination, which any woman can regularly conduct.
Cervical Cancer Screening
The number of deaths caused by cervical cancer has declined since the implementation of widespread screenings. According to U.S. Preventive Services Task Force (USPSTF), mortality contributed to cervical cancer decreased from 2,8 deaths per 100,000 women in 2000 to 2,3 per 100,000 in 2015 (U.S. Preventive Services Task Force [USPSTF], 2018). As a result of that effectiveness, USPSTF recommends cervical cancer screenings for women aged 21 to 65. Women aged 21 to 29 are recommended to pass only cervical cytology once in 3 years (USPSTF, 2018). Women aged 30-65 years are additionally suggested to undergo high-risk human papillomavirus (hrHPV) testing every five years, alone or in combination with cervical cytology (USPSTF, 2018). For that age group, the benefits of cervical cancer screening procedures outweigh the potential harms.
Colorectal Cancer Screening
By 2018 colorectal cancer (CRC) has become one of the most commonly diagnosed cancer types among U.S. adults. According to Siegel et al. (2018), CRC was diagnosed in more than 140 000 cases, and over 65 000 of them were females. As a result, the American Cancer Society developed screening guidelines that recommend the adults aged 45 years and older undergo stool-based tests or visual examinations (Wolf et al., 2018). In addition to regular screenings, the adults can undergo optional procedures, such as full colonoscopy or fecal immunochemical test.
HIV Testing (CDC)
With the advancements in contemporary medicine, HIV-positive patients aware of their condition can receive HIV treatment and stay healthy for many years. Testing plays a crucial role in the early detection of HIV and the avoidance of its transition into AIDS. Moreover, early detection of HIV allows stopping its transmission to other people. Centers for Disease Control and Prevention (CDC) provide screening guidelines for the U.S. population. According to them, every American aged between 13 and 64 is recommended to get tested for HIV at least once (Centers for Disease Control and Prevention [CDC], 2020). Furthermore, USPSTF deems necessary the HIV testing of all pregnant women, younger adolescents, and adults at increased risk of infection (as cited in Osborne, 2017, p. 145). A timely HIV testing can allow to quell the fears or provide timely medical intervention.
Health Maintenance Guidelines
Depending on the history section, several health maintenance guidelines can be used for the initial or follow-up assessment of the gynecologic patient. These guidelines include various tests and procedures necessary for the completion of medical history. In the case of gynecologic history, the following maintenance guidelines can be considered:
- Cervical cancer: pap smear, human papillomavirus (HPV), Gardasil vaccination;
- Breast cancer: physician breast examination, mammography;
- Colorectal cancer: colonoscopy, fecal occult blood test;
- Sexually transmitted diseases: routine chlamydia screening;
However, it should be noted that these guidelines are the most useful for the initial assessment of women in the general population. Each patient’s case should be treated individually after the initial assessment. Furthermore, certain groups of the population, such as LGBTQ+, require a special approach during the interview. That situation creates a necessity of building a health script based on questions related to the patient’s gynecologic, social, and general medical history.
Considerations for LGBTQ+ Patients
Gay and transgender men can feel inconvenience while receiving health care; however, in the context of gynecology, the focus is primarily shifted to considerations for LBQ women. Ellis (2017) claims that LBQ women feel most comfortable and safe in healthcare environments when their sexuality and gender are not an issue. Therefore, medical personnel should educate themselves about the needs and concerns of the LGBTQ+ population group to create a welcoming atmosphere for all patients, regardless of their gender and sexual orientation (Ellis, 2017). For instance, gynecologist clinicians should remember to use gender-neutral vocabulary instead of implying that their patient is a heterosexual female, as it used to be for a long time.
Potential Questions for Assessment
Assessment allows eliciting valuable information from the patient, which can be crucial for understanding individual cases. The questions might relate to such topics as social and general medical history:
- Could you explain the reasons for seeking care?
- Please, could you tell if you have any present health concerns?
- Did you undergo any hospitalizations or operations?
- Did you have any concerns related to mental health, such as suicidal or homicidal thoughts?
- Do you use any substances? If you do — with what purpose?
- Please, could you tell if you experienced intimate partner violence?
- Please, could you tell me about your current occupation?
- What are your plans for the future?
A clinician should bear in mind that the patient must feel comfortable even when answering difficult personal questions. Therefore, such questions must be asked in a comforting tone, polite form and allow the patient to speak as much as they want. The patient must be assured that all information will be used strictly for medical purposes, and their privacy will not be compromised in any way.
Gynecologic Health History Script
Complete health history combines the information regarding the patient’s general, mental, and gynecologic health. This section addresses specific questions related to the patient’s gynecologic background:
- Please, could you tell me about your menstrual history?
- How many times have you been pregnant?
- How did you give birth? How many abortions did you have?
- How many sexual partners did you have? Could you describe them?
- Do you have a history of sexually transmitted infections?
- How do you perform genital hygiene?
- Did you undergo any genital surgeries?
- Did you undergo gynecological health screenings? What types, and how often?
Combining the answers to these questions with the general and mental health history information would allow completing the patient’s health history. Since gynecology-related questions are even more intimate than general and mental health questions, a healthcare provider must strictly adhere to suggestions from the previous section. The patient must know that their comfort and privacy will not be harmed.
Reflection
During the gynecologic health history script development, I have become fascinated with the complexity of women’s health subject. Previously I supposed, that gynecologists only conduct physical examinations of female genitals and breasts. In reality, they have to be sophisticated psychologists since the creation of gynecologic health history requires asking difficult questions of intimate nature. To my surprise, a complete gynecologic history needs to include the parts related to the patient’s general and mental health and even address their social status. That element of gynecology was novel to me, but now I can see the logic behind it.
Personally, I found no problems in formulating and asking gynecology-related questions. I reckon that the majority of patients who come to seek gynecologic care would be expecting them. However, it could be challenging to explain why the patients have to answer the questions about their family, personality, or occupation when they visited a gynecologist’s office. The patients might not understand why the seemingly unrelated information is interesting to the clinician. Therefore, the main goal would be convincing them that those questions are not intended to violate their privacy.
Regarding the script elements, I found the question related to gynecologic health screenings to be the most insightful. While the other questions are important, the information about HIV testing or breast, cervical, and colorectal cancer can be crucial for providing healthcare recommendations to the patient. If the patient did not undergo the screenings, their gynecologic health condition might be worse than they think. As for the changes to the script, I would work on my straightforwardness in question stating, since a gynecologist needs to be a doctor and a diplomat as well.
References
Centers for Disease Control and Prevention. (2020). HIV testing. Web.
Ellis, S. A. (2017). Lesbian, bisexual, queer, and transgender health. In K. D. Schuiling & F. E. Likis (Eds.), Women’s gynecologic health 3rd edition (pp. 161–184). Jones & Bartlett Learning.
Osborne, K. (2017). Periodic screening and health maintenance. In K. D. Schuiling & F. E. Likis (Eds.), Women’s gynecologic health 3rd edition (pp. 95–133). Jones & Bartlett Learning.
Siegel, R. L., Miller, K. D., & Ahmedin J. (2018). Cancer statistics, 2018. CA: A Cancer Journal for Clinicians, 68(1), 7–30. Web.
The American College of Obstetricians and Gynecologists. (2017). Breast cancer risk assessment and screening in average-risk women. Web.
Tillman S., & Likis F. E. (2017). Gynecologic history and physical examination. In K. D. Schuiling & F. E. Likis (Eds.), Women’s gynecologic health 3rd edition (pp. 95–133). Jones & Bartlett Learning.
U.S. Preventive Services Task Force. (2018). Cervical cancer: Screening. Web.
Wolf, M. D. A., Fontham, T. H. E., Church, R. T., Flowers, C. R., Guerra, C. E, LaMonte, S. J., Etzioni, R., McKenna, M. T., Oeffinger, K. C., Tina Shih, Y-C., Walter, L. C., Andrews., K. S., Brawley, O. W., Brooks, D., Fedewa, S. A., Manassaram-Baptiste, D., Siegel, R. L., Wender, R. C., & Smith, R.A. (2018). Colorectal cancer screening for average-risk adults: 2018 guideline update from the American Cancer Society. CA: A Cancer Journal for Clinicians, 68(4), 250–281. Web.