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Communication
April 2026
Gynaecological History
Patient
Miss Aisha Kone
Age / Sex
26F
Setting
Gynaecology Outpatients
Year Group
Y2 / Y3
Duration
10 minutes
Clinical Scenario
Candidate Briefing
Miss Aisha Kone is a 26-year-old woman referred by her GP to the gynaecology outpatient clinic with a 6-month history of worsening lower abdominal pain. She has no significant past medical history and is not currently on any medications.
Please take a focused gynaecological history from Miss Kone. You have 10 minutes. The examiner will ask questions in the final 2 minutes.
Note
This station tests both your ability to take a comprehensive, structured gynaecological history and your communication skills — particularly sensitivity when asking about sexual history, menstrual symptoms and pain. Marks are awarded for both content and manner.
Actor Script
Actor / Examiner Information — Do not show to candidate
Opening
Appear mildly anxious but polite. If asked how you are: "I'm okay, a bit worried to be honest. I've been getting this pain for months and it keeps getting worse."
Pain (if asked)
Site: Left lower abdomen / pelvis
Onset: About 6 months ago, gradual
Character: Dull, cramping ache
Radiation: Sometimes into the lower back and left thigh
Severity: 6/10 normally, up to 9/10 during period
Timing: Constant background ache, much worse in the few days before and during period
Aggravating: During sex (deep penetration), during period
Relieving: Ibuprofen helps a little, heat pad
Onset: About 6 months ago, gradual
Character: Dull, cramping ache
Radiation: Sometimes into the lower back and left thigh
Severity: 6/10 normally, up to 9/10 during period
Timing: Constant background ache, much worse in the few days before and during period
Aggravating: During sex (deep penetration), during period
Relieving: Ibuprofen helps a little, heat pad
Menstrual history
LMP: 2 weeks ago
Cycle: Regular, every 28 days, lasts 6–7 days
Flow: Heavy — soaks through a pad every 2 hours on worst days, passes clots
Dysmenorrhoea: Yes, severely painful periods — worse over the past year, takes days off work
IMB: No spotting between periods
PCB: No bleeding after sex
PMB: N/A (pre-menopausal)
Cycle: Regular, every 28 days, lasts 6–7 days
Flow: Heavy — soaks through a pad every 2 hours on worst days, passes clots
Dysmenorrhoea: Yes, severely painful periods — worse over the past year, takes days off work
IMB: No spotting between periods
PCB: No bleeding after sex
PMB: N/A (pre-menopausal)
Discharge
Mild clear/white discharge, no unusual smell, no itching — feels normal to you
Sexual history
Sexually active — one male partner, relationship of 2 years. Sex has become painful recently (deep dyspareunia). Only disclose dyspareunia if directly asked about pain during sex.
If asked sensitively about contraception: "We use condoms." If asked about STIs: "No, never had one — should I be worried?" Reassure her this is routine to ask.
Obstetric history
Never been pregnant. Would like children in the future — becomes slightly emotional if asked about this given the pain.
Smear history
Last smear 18 months ago — normal result. Up to date with invitations.
PMH / Medications
No past medical history. Takes ibuprofen PRN for the pain. No regular medications. No known drug allergies.
Family history
Mother had "women's problems" but you're not sure exactly what. Maternal aunt had ovarian cysts.
Social history
Works as a primary school teacher. Non-smoker. Drinks socially (4–5 units/week). Lives with partner.
ICE
Ideas: "I looked it up online and I'm worried it might be endometriosis — my aunt had something like that."
Concerns: "I'm scared it might affect my ability to have children."
Expectations: "I'd just like to know what's causing this and whether something can be done."
Concerns: "I'm scared it might affect my ability to have children."
Expectations: "I'd just like to know what's causing this and whether something can be done."
History Checklist
Presenting Complaint & HPC
- Site, onset, character, radiation
- Severity (VAS score)
- Timing — cyclical vs constant
- Aggravating & relieving factors
- Associated symptoms (discharge, bleeding)
Menstrual History
- LMP (date)
- Cycle regularity & length
- Duration & heaviness of flow
- Dysmenorrhoea
- Intermenstrual bleeding (IMB)
- Post-coital bleeding (PCB)
Sexual & Contraception History
- Sexually active (asked sensitively)
- Dyspareunia (superficial or deep)
- Contraception used
- STI history (sensitively)
Obstetric History
- Gravidity & parity (G/P)
- Previous pregnancies, deliveries, miscarriages
- Future fertility wishes
Cervical Smear History
- Date of last smear
- Result of last smear
- Any previous abnormal smears / colposcopy
PMH / Meds / FH / SH
- Past medical & surgical history
- Medications & allergies
- Family history (ovarian, endometrial cancer)
- Smoking, alcohol, occupation
ICE & Closing
- Ideas (what does she think it is?)
- Concerns (what worries her most?)
- Expectations (what does she hope for today?)
- Brief summary back to patient
- Explains next steps
Mark Scheme
| Competency | Marks | Awarded |
|---|---|---|
| Introduction | ||
| Introduces self (name and role); confirms patient name; establishes rapport and puts patient at ease | 1 | |
| Pain History (SOCRATES) | ||
| Elicits site and radiation of pain correctly (left iliac fossa / pelvis, radiating to back and thigh) | 1 | |
| Establishes onset, duration and progression (6 months, gradual, worsening) | 1 | |
| Asks about character, severity and timing — specifically asks if pain is cyclical / related to periods | 1 | |
| Asks about aggravating and relieving factors; specifically asks about dyspareunia (pain during sex) | 1 | |
| Menstrual History | ||
| Asks date of LMP | 1 | |
| Establishes cycle regularity, length and duration of flow | 1 | |
| Asks about heaviness of flow (number of pads, clots) and dysmenorrhoea | 1 | |
| Asks about intermenstrual bleeding (IMB) and post-coital bleeding (PCB) | 1 | |
| Asks about vaginal discharge (colour, consistency, odour, itching) | 1 | |
| Sexual & Contraception History | ||
| Asks sensitively whether the patient is sexually active; uses appropriate language
e.g. "Is it okay if I ask — are you currently sexually active?"
|
1 | |
| Asks about contraception currently used | 1 | |
| Asks sensitively about previous STIs | 1 | |
| Obstetric History & Smear | ||
| Establishes gravidity and parity; asks about future fertility wishes sensitively | 1 | |
| Asks date and result of last cervical smear; asks about any previous abnormal smears | 1 | |
| PMH / Medications / Family & Social History | ||
| Asks about past medical and surgical history; current medications and allergies | 1 | |
| Asks about family history relevant to gynaecological conditions (ovarian/endometrial cancer, endometriosis) | 1 | |
| Asks about smoking, alcohol, occupation | 1 | |
| ICE & Closing | ||
| Elicits ideas, concerns and expectations; acknowledges patient's concerns (particularly fertility) with empathy | 2 | |
| Provides a brief summary; explains that an examination and further investigations will be needed; thanks patient | 1 | |
Total
20 marks
Examiner Questions
What is the most likely diagnosis based on this history, and what are the classic features that support it?
Endometriosis — the presence of endometrial-like tissue outside the uterus. Classic features in this history:
- Cyclical pelvic pain, worse before and during menstruation (dysmenorrhoea)
- Deep dyspareunia (pain with deep penetration — suggests pouch of Douglas or uterosacral ligament involvement)
- Heavy, painful periods (menorrhagia + secondary dysmenorrhoea)
- Progressive worsening over months/years
- Family history (mother/aunt with "women's problems"/ovarian cysts — endometriosis has a familial component)
- Nulliparous woman of reproductive age
What investigations would you arrange next?
- Pelvic examination — may reveal uterosacral nodularity, fixed retroverted uterus or adnexal tenderness. However, normal examination does not exclude endometriosis.
- Transvaginal ultrasound (TVUS) — first-line imaging; can detect endometriomas (ovarian "chocolate cysts"), but cannot reliably identify peritoneal deposits
- MRI pelvis — better characterisation of deep infiltrating endometriosis
- Laparoscopy — gold standard for diagnosis; allows direct visualisation and biopsy of deposits, and can be therapeutic (diathermy, excision)
- CA-125 — may be mildly elevated in endometriosis but is non-specific; not diagnostic
- High vaginal and endocervical swabs to exclude PID (differential)
Miss Kone asks whether she will be able to have children. How do you respond?
Acknowledge her concern with empathy first: "I completely understand why you're worried about that — it's clearly very important to you." Explain honestly but sensitively: endometriosis is associated with subfertility in some women, but many with endometriosis do conceive naturally. The degree of impact on fertility depends on the severity and location of disease. This hasn't been fully assessed yet. Surgical treatment (laparoscopy) can improve fertility outcomes. Refer to a specialist early. Avoid making promises or predictions — but don't dismiss the concern either.
What is the differential diagnosis for chronic pelvic pain in a woman of reproductive age?
- Gynaecological: Endometriosis · Adenomyosis · Pelvic inflammatory disease (PID) · Ovarian cysts/torsion · Fibroids · Ectopic pregnancy (acute)
- Gastrointestinal: Irritable bowel syndrome (very common; often co-exists with endometriosis) · Inflammatory bowel disease · Constipation
- Urological: Interstitial cystitis · Recurrent UTI
- Musculoskeletal: Pelvic floor dysfunction · Pudendal neuralgia
- Psychological: Chronic pain syndrome; history of trauma