and Paula Briggs2
(1)
Department of Obstetrics and Gynaecology, Monash University, Clayton, Victoria, Australia
(2)
Sexual and Reproductive Health, Southport and Ormskirk Hospital, Southport, UK
Learning about gynaecology and obstetrics (and most of medicine) is about understanding and organising thoughts, and not just about memorizing. To understand any condition, we need a framework on which to build. In order to do this logically, we have devised a series of headings to describe certain conditions.
Let us use endometriosis as an example
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Definition – This defines the condition. Endometriosis is when the endometrial tissue grows outside the uterine cavity.
Incidence – Endometriosis most commonly presents in the third decade. It can be associated with subfertility. In comparison, if we were talking about endometrial cancer we would say that the incidence in the UK is 1 in 4,000 because all cases of cancer are recorded.
Aetiology and pathogenesis – This explains the cause of the condition, and how the disease develops. In the case of endometriosis, theories include, retrograde menstruation and spread of endometrial cells, lymphatic dissemination of endometrial cells, spread through blood vessels, or local metaplasia. An immunological abnormality is necessary to allow the ectopic endometrium to proliferate. Pain may be caused by the endometriotic lesions “menstruating” into themselves, causing pressure or adhesions. Subfertility may be caused by adhesions or the release of prostaglandins interfering with gamete transport, fertilisation or implantation.
Clinical Assessment
History – The golden rule is always to take a thorough history first.
Examination –
Remember: Inspection/palpation/percussion/auscultation. It is important to examine the patient thoroughly.
Inspection: There is little one would see on inspection – very rarely there can be endometriosis on the cervix or vagina.
Palpation: In endometriosis, it is unlikely that anything can be felt on abdominal examination. On vaginal examination, one may feel nodules in the pouch of Douglas, a fixed retroverted uterus, or an ovarian cyst if there is an endometrioma.
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