What questions should I ask during a female genitalia examination?

Essential Questions During Female Genitalia Examination

History Questions Before Physical Examination

Ask about the patient's last Pap smear result and whether she understands its purpose, as many women believe they have had a Pap smear when they actually have not, and many do not understand the difference between a pelvic examination and cervical cancer screening 1.

Menstrual and Reproductive History

• Date of last menstrual period and menstrual pattern (cycle length, duration, flow characteristics) to assess for dysmenorrhea, amenorrhea, oligomenorrhea, or abnormal uterine bleeding 1.
• Age at menarche to evaluate pubertal development and identify delayed or precocious puberty 1.
• Pregnancy history including number of pregnancies, deliveries, and outcomes 2.
• Contraceptive use and plans for pregnancy prevention 1.

Sexual Health and STI Risk Assessment

• Sexual activity status and age at first intercourse, as approximately half of high school adolescents have been sexually active 1.
• Number of sexual partners (lifetime and recent) to assess STI and cervical cancer risk 1.
• Condom use consistency to evaluate protection against STIs 1.
• History of sexually transmitted infections in the patient or partners, as women with STD history have five times higher risk of cervical precursor lesions 1.
• New or multiple partners to assess current transmission risk 1.

Symptom-Specific Questions

For any woman with gynecologic complaints, ask about:

• Vulvar symptoms including itching, burning, or lesions 2.
• Vaginal discharge characteristics (color, odor, consistency, timing) to differentiate bacterial vaginosis, candidiasis, and other causes 3, 4.
• Pelvic pain location, quality, duration, and timing relative to menstrual cycle 2, 5.
• Dyspareunia (painful intercourse) and its timing (entry vs. deep) 2.
• Urinary symptoms including urgency, frequency, nocturia, and dysuria, as bladder conditions like interstitial cystitis frequently masquerade as gynecologic pain 5.
• Gastrointestinal symptoms including abdominal pain, bloating, early satiety, or constipation, which may indicate ovarian pathology 2.

Critical Safety Questions

Always ask about history of sexual abuse or assault, as this affects the patient's comfort with examination, preference for examiner gender, and differential diagnosis 1, 3.

• Trauma history including any genital injury or foreign body insertion 3, 6.
• Bleeding in prepubertal girls or postmenopausal women, which is always abnormal and requires investigation 7.

Questions During Physical Examination

Patient Comfort and Consent

• Explain each step before performing it to reduce anxiety, as anxiety causes muscle tension that makes examination more difficult 3, 4.
• Ask about pain or discomfort during the examination and stop if resistance is encountered 3, 4.
• Offer choice of examiner gender when possible, particularly for patients with abuse history 1.

Findings to Communicate and Clarify

• Describe visible findings in simple terms to educate the patient about normal anatomy versus pathology 1.
• Confirm whether a Pap smear was obtained during this visit, as patients frequently believe they received one when they did not 1.
• Explain the need for annual Pap smears for women with STD history, even though general population guidelines allow longer intervals 1.

Post-Examination Discussion Questions

Follow-Up and Results

• Provide information about when and how results will be communicated, ideally giving the patient a written statement that a Pap smear was obtained 1.
• Explain what abnormal results would mean and next steps for follow-up 1.
• Identify local providers for follow-up if the current setting cannot provide comprehensive gynecologic care 1.

HPV-Specific Counseling (When Relevant)

• Explain HPV transmission and natural history, as women frequently overestimate cancer risk and are confused about normal Pap results with HPV presence 1.
• Clarify that most sexually active people acquire HPV and that infection usually regresses without treatment 1.
• Discuss partner notification, noting that most partners are already infected subclinically and no practical screening exists for them 1.
• Address condom use for new partners, though the period of communicability is unknown 1.

Patient Education Priorities

• Differentiate between Pap tests, pelvic exams, pregnancy tests, and STD tests, as adolescents and many women confuse these procedures 1.
• Explain that HPV itself is never treated, only its manifestations (warts, cervical abnormalities) 1.
• Clarify screening intervals based on age and risk factors, as new guidelines create confusion 1.

Common Pitfalls to Avoid

Never assume the patient understands medical terminology or the purpose of procedures performed 1.

• Do not force examination when the patient is not cooperative, as this creates trauma and should never be done 3, 4.
• Do not assume an intact hymen prevents speculum examination, as the hymen typically has a natural opening allowing careful insertion with appropriate technique 4.
• Do not skip external genital inspection in adolescents, as this should be part of every comprehensive physical examination and normalizes the experience 1, 3.
• Do not diagnose conditions without appropriate testing, particularly avoiding self-diagnosis of candidiasis without microscopic confirmation 6.