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INTRODUCTION

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Serving as both specialist and primary care provider, a gynecologist has an opportunity to diagnose and treat a wide variety of diseases. Once problems are identified, clinicians, in consultation with the patient, determine how best to manage chronic medical issues based on their experience, practice patterns, and professional interests. Although some conditions may require referral, gynecologists play an essential role in patient screening, in emphasizing ideal health behaviors, and in facilitating appropriate consultation for care beyond their scope of practice.

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Various organizations provide preventive care recommendations and update these regularly. Commonly accessed guidelines are those from the American College of Obstetricians and Gynecologists (ACOG), Centers for Disease Control and Prevention (CDC), U.S. Preventive Services Task Force (USPSTF), and American Cancer Society.

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MEDICAL HISTORY

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During a comprehensive well-woman visit, patients are first queried regarding new or ongoing illness. To assist with evaluation, complete medical, social, and surgical histories are obtained and include obstetric and gynecologic events. Gynecologic topics usually cover current and prior contraceptives; results from prior sexually transmitted disease (STD) testing, cervical cancer screening, or other gynecologic tests; sexual history, described in Chapter 3; and menstrual history, outlined in Chapter 8. Obstetric questions chronicle circumstances around deliveries, losses, or complications. Current medication lists include both prescription and over-the-counter drugs and herbal agents. Also, prior surgeries, their indications, and complications are sought. A social history covers smoking and drug or alcohol abuse. Screening for intimate partner violence or depression can be completed, as outlined on page 18 and more fully in Chapter 13. Discussion might also assess the patient’s support system and any cultural or spiritual beliefs that might affect her general health care. A family history helps identify women at risk for familial or multifactorial disease such as diabetes or heart disease. In families with prominent breast, ovarian, or colon cancer, genetic evaluation may be indicated, and criteria are outlined in Chapters 33 and 35. Moreover, a significant family clustering of thromboembolic events may warrant testing, as describe in Chapter 39, especially prior to surgery or hormone initiation. Last, a review of systems, whether performed by the clinician or office staff, may add clarity to new patient problems.

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For adults, following historical inventory, a complete physical examination is completed. Many women present to their gynecologist with complaints specific to the breast or pelvis. Accordingly, these are often areas of increased focus, and their evaluation is described next.

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PHYSICAL EXAMINATION

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Breast Examination
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Clinical Evidence
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Self breast examination (SBE) is an examination performed by the patient herself to detect abnormalities. However, studies have shown that SBE increases diagnostic testing rates for ultimately benign breast disease and is ineffective in lowering breast cancer mortality rates (Kösters, 2008; Thomas, 2002). Accordingly, several organizations have removed SBE from their recommended screening ...

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