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Question 2
What is the name of the individual who needs doctor consultation? | |
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Question 3
What is the date of birth of the individual who needs doctor consultation? | |
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Question 4
Address What is your mailing address? | |
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Question 5
What was your mailing address from birth until now? | |
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Question 6
Where is the patient now? | |
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Question 7
Where do you live now? How long have you lived at this address? | |
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Question 8
How long do you plan to live at this address? | |
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Question 9
What is your contact information including current mailing address, telephone, e-mail, and any other details, and person to contact in case of emergency? | |
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Question 10
How old were you when you had your first period? | |
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Question 11
Are your cycles regular/monthly? Yes No | |
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Question 12
How many days does your period last? | |
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Question 13
If in menopause, at what age did it occur? | |
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Question 14
Years of hormone replacement therapy? | |
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Question 15
Are you currently sexually active? Yes No | |
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Question 16
If not, have you ever been sexually active? Yes No | |
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Question 17
Do you currently have a partner? Yes No Partner’s gender | |
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Question 18
How long have you been in this relationship? | |
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Question 19
How many lifetime sexual partners have you had? | |
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Question 20
At what age was your first intercourse? | |
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Question 21
Have you ever been sexually abused, threatened or hurt by anyone? | |
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Question 22
Are you experiencing any sexual problems? | |
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Question 23
When was your last pap smear? | |
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Question 24
Have you had any abnormal pap smears? Yes No when? | |
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Question 25
Have you been told you have HPV? Yes No when? | |
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Question 26
Have you had any treatments for abnormal pap smears? Yes No repeat pap colposcopy biopsy | |
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Question 27
Have you received HPV vaccine? Yes No date | |
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Question 28
Have you ever had ovarian cysts? Yes No | |
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Question 29
Have you been told you have fibroids of the uterus? Yes No | |
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Question 30
Have you ever been treated for any sexually transmitted infections? Yes No Gonorrhea Chlamydia Syphilis Herpes Condyloma PID | |
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Question 31
Current birth control None Timing Condoms Diaphragm Birth control pills Patch Implants Depo Provera IUD Tubal ligation Vasectomy Ring Past birth control None Timing Condoms Diaphragm Birth control pills Patch Implants Depo Provera IUD Tubal ligation Vasectomy Ring | |
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Question 32
Have you ever had a yeast infection? Yes No Chronic? Yes No | |
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Question 33
Have you ever been treated for a vaginal bacterial infection (bacterial vaginosis)? Yes No Chronic? Yes No | |
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Question 34
Do you ever have problems with urinating such as infections, frequency, loss of urine, blood in your urine? Yes No If yes, please explain__________________________________________________________________________________ | |
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Question 35
When was your last mammogram? | |
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Question 36
Have you had any abnormal mammograms? Yes No | |
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Question 37
Have you had any breast biopsies? Yes No If yes, result | |
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Question 38
Do you do breast self examination? | |
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Question 19
Have you ever had a sexually-transmitted disease? | |
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Question 20
Would you use a condom when having sex with a partner you ---------? | |
| I have read and agree to the Terms & Conditions. | |
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What is Gynecology? Gynecology is the branch of medicine that deals with diseases and disorders of the female reproductive system. Most gynecologists are obstetricians as well, but the specialty of obstetrics is limited to the care of pregnant women and the delivery of infants. The organs and structures studied by the gynecologist are the ovaries, oviducts, uterus, cervix, vagina, vulva, and breasts. Among the various diseases and disorders that affect these structures are congenital defects, infections, inflammations, benign and malignant tumors, disturbances of the sex hormones, and injuries, particularly those that occur during childbirth. In addition to these disorders, the gynecologist is concerned with functional (nonpathological) disturbances of the reproductive system, including sterility and certain menstrual disorders. He may also instruct his patients on the proper use of contraceptives and prescribe contraceptive drugs or devices. | |