Why Gynaecology Histories Are High-Yield
Gynaecology and obstetric stations regularly appear in OSCEs and are often done poorly — not because the clinical content is difficult, but because students rush, forget systematic components, or feel uncomfortable asking sensitive questions. Done well, this station is highly score-able and one where thoroughness directly translates into marks.
💡 Tip
At the start of every gynaecology station, briefly acknowledge that some questions may feel personal: "Some of these questions may seem a little personal — please know everything you share is completely confidential and helps me understand your situation better." This scores an empathy mark and builds rapport from the outset.
The Gynaecology History Framework
A complete gynaecological history has six components:
- 1Presenting complaint (SOCRATES if pain)
- 2Menstrual history
- 3Obstetric history
- 4Gynaecological history (previous conditions, smears, STIs)
- 5Sexual history (sensitively)
- 6Systemic review and ICE
1. Presenting Complaint
Pelvic Pain
Apply SOCRATES fully. The discriminating questions are:
| Feature | Suggests |
|---|---|
| Cyclical, crampy, onset day 1–2 of period | Primary dysmenorrhoea |
| Progressively worsening cyclical pain, deep dyspareunia | Endometriosis |
| Unilateral, sudden-onset, severe — with risk factors | Ectopic pregnancy (until ruled out) |
| Constant lower abdominal pain with fever and discharge | PID |
| Unilateral loin-to-groin pain | Renal colic (differential) |
| Sudden, severe, with vomiting | Ovarian torsion |
⚠️ Red Flag
Always screen for ectopic pregnancy in any woman of reproductive age with pelvic pain. Ask: "Is there any chance you could be pregnant?" and "When was your last period — was it normal?" A missed or unusually light period in this context is an ectopic until proven otherwise.
Vaginal Discharge
Ask systematically:
- "Can you describe the discharge — the colour, consistency, and amount?"
- "Any unusual smell?"
- "Any associated itching or soreness?"
- "When did it start?"
| Discharge | Classic association |
|---|---|
| White, thick, cottage-cheese, no odour, itching | Candidiasis |
| Grey-white, thin, fishy odour (worse after sex) | Bacterial vaginosis |
| Yellow-green, frothy | Trichomonas |
| Purulent, may be minimal | Gonorrhoea / Chlamydia (often asymptomatic) |
| Post-menopausal bleeding or discharge | Endometrial pathology — red flag |
Abnormal Uterine Bleeding
- "Is the bleeding between periods, after sex, or after the menopause?"
- Intermenstrual bleeding → cervical pathology, polyps, chlamydia
- Postcoital bleeding → cervical ectropion, cervical cancer (red flag)
- Postmenopausal bleeding → always a red flag for endometrial carcinoma
2. Menstrual History
This is the most commonly forgotten section. Cover every component:
| Question | What to ask |
|---|---|
| LMP | "When was the first day of your last period?" |
| Cycle length | "How many days between the start of one period and the next?" (Normal: 21–35 days) |
| Duration | "How many days does your period last?" (Normal: 3–8 days) |
| Flow | "How heavy is your flow? How many pads or tampons per day on your heaviest day?" |
| Flooding/clots | "Do you ever flood through or pass clots?" |
| Dysmenorrhoea | "Do you get period pain? Does it stop you doing normal activities?" |
| Regularity | "Are your periods regular or do they vary?" |
💎 Clinical Pearl
Quantifying heavy periods: Clinically, ask: "Do you need to change every hour on your worst day?" Soaking through a pad or tampon hourly is the threshold for menorrhagia. Patients understand this better than asking "is it heavy?"
🧠 Mnemonic
PALM-COEIN — the FIGO classification of abnormal uterine bleeding:
- Polyp, Adenomyosis, Leiomyoma, Malignancy (structural)
- Coagulopathy, Ovulatory dysfunction, Endometrial, Iatrogenic, Not yet classified (non-structural)
3. Obstetric History
Ask about all pregnancies, not just live births:
"Have you ever been pregnant? Can you tell me about each pregnancy — including any that didn't result in a live birth?"
For each pregnancy:
- Gravidity (total pregnancies) and Parity (deliveries ≥24 weeks)
- Outcome: live birth, miscarriage, termination, ectopic
- Mode of delivery: SVD, instrumental, caesarean
- Complications: pre-eclampsia, gestational diabetes, PPH
💡 Tip
G and P notation: A woman with 3 pregnancies — one miscarriage, one CS, one SVD — is G3P2. Gravidity = total pregnancies; parity = deliveries ≥24 weeks. Writing this clearly in your presentation will impress examiners.
If currently pregnant, also ask:
- Gestational age ("How many weeks are you?")
- Singleton or multiple
- Antenatal care and scans
- Any complications this pregnancy
4. Gynaecological History
- Cervical smears: "Are you up to date with smear tests? Have you ever had an abnormal result?"
- STI screening: "Have you ever been tested for sexually transmitted infections?"
- Previous conditions: fibroids, PCOS, endometriosis, ovarian cysts
- Previous surgery: hysterectomy, oophorectomy, laparoscopy, LLETZ
5. Sexual History — Asking Sensitively
💡 Tip
Signpost before asking: "I'm going to ask a few questions about your sexual health — these are routine questions I ask everyone and help me give you the best care."
Key questions:
- "Are you currently sexually active?"
- "Do you have one partner or more than one?"
- "Do you have sex with men, women, or both?"
- "Are you using any contraception?"
- "Is there any chance you could be pregnant?"
6. ICE and Social History
ICE often contains the mark that separates a pass from a distinction:
- "What do you think might be causing this?"
- "Is there anything in particular you're worried about?"
- "What were you hoping we might do today?"
Social history: occupation, relationship status, smoking, alcohol, and safeguarding if domestic violence is suggested.
Common OSCE Gynaecology Scenarios
Scenario 1: Intermenstrual Bleeding, 28F
Likely: cervical ectropion, polyp, or STI. Ask about: sexual history, STI screen, smear history, postcoital bleeding, associated discharge.
Scenario 2: Pelvic Pain and Infertility, 32F
Likely: endometriosis. Ask about: progressive dysmenorrhoea, deep dyspareunia, cyclical bowel symptoms (tenesmus, rectal bleeding during menstruation), previous laparoscopy.
Scenario 3: Heavy Periods, 42F
Differentials: fibroids, adenomyosis, hypothyroidism (always screen), coagulopathy, endometrial polyp. Ask about: flooding, clots, dysmenorrhoea, urinary frequency (fibroid pressure), family history of bleeding.
Scenario 4: Postmenopausal Bleeding
⚠️ Red Flag
Postmenopausal bleeding is an endometrial carcinoma until proven otherwise. Any woman >12 months post-LMP presenting with bleeding must be referred on a 2-week wait pathway.
Common Examiner Follow-Up Questions
"What investigations would you request for suspected PID?"
"High vaginal swab and endocervical swabs for gonorrhoea and chlamydia, urine pregnancy test to exclude ectopic, FBC for raised WCC, CRP, and pelvic USS if tubo-ovarian abscess is suspected."
"How would you manage a patient with suspected ectopic pregnancy?"
"This is an emergency. I would call for senior help immediately, establish IV access, take bloods including serum βhCG, FBC and G&S. I'd request a transvaginal ultrasound and keep the patient nil by mouth in preparation for possible theatre."
"What are the risk factors for ectopic pregnancy?"
"Previous ectopic, PID or STI history, previous tubal surgery, IUD in situ, assisted conception, and smoking."