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By David Jenkins MD, FRCOG (auth.)

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Ask her to point to where the pain is with one finger. If she can't put her finger on the source of the pain, you may have similar difficulty. Question 3. Again, are the words used here by the patient 'moderate' or otherwise? Question 4. g. tenderness in an episiotomy scar or possibly secondary atrophic vaginitis and oestrogen deficiency. Question 5. Pain may be referred from bladder or urethral pathology. Question 6. If 'yes' then pathology is likely in the vulva, vagina or cervix. The Problem Vaginal pain and pelvic pain are considered together here.

How long is it since you stopped having periods? How long is it since the abnormal bleeding was first noticed? Is it heavy or only a stain? Have you had any discharge from the front passage apart from the blood? 5. Do you bleed after intercourse? 6. )? 7. Have you been on any other drugs? 8. Have you been jaundiced recently? 9. Is your urine blood-stained? 10. Do you have any bleeding from the back passage? Category A Menstrual Problems and Abnormal Bleeding 35 Key to Questions Question 1. The longer interval between the menopause and the bleeding, the more sinister the diagnosis is likely to be.

Category A Menstrual Problems and Abnormal Bleeding 39 12. Have you had any pain in your shoulders? 13. Have you fainted recently? 14. Have you had pain in your back passage when you sit down or your bowels move? Key to Questions Questions 1-6. Assess whether the patient is pregnant and the gestation. Question 3. Recent ultrasound evidence or urinary pregnancy test results would be helpful regarding pregnancy, site of pregnancy and gestation. Questions 8, 9. Passing clots suggests inevitable abortion and passing tissue reinforces this.

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