Synopsis
Take a private, inclusive and clinically discriminating reproductive history that establishes immediate risk, respects the person’s language and autonomy, and guides proportionate examination, testing, safeguarding and follow-up.
- Begin by explaining why particular questions matter, what will be recorded, and the limits of confidentiality; ask the patient how they prefer body parts, gender, partners and pregnancies to be described.
- Offer part of the consultation alone as routine, use a professional interpreter rather than a partner, and check that later messages, letters and portal access are safe.
- For bleeding, define last normal period, cycle interval and regularity, duration, flooding, clots, products changed, night leakage, pain, intermenstrual or postcoital bleeding and anaemia symptoms.
- A sexual history is shaped by the clinical question: partners, practices, protection from infection, pregnancy prevention, previous infections, pain, bleeding, sexual function, consent and what the patient wants from care.
- Record each pregnancy chronologically, including intendedness, gestation and outcome, ectopic or molar pregnancy, mode of birth, haemorrhage, hypertension, diabetes, prematurity, loss and the health of parent and child.
- Ask about cervical screening, contraception, fertility goals, menopause symptoms, gynaecological procedures, medicines, anticoagulants and relevant family cancers without assuming anatomy or reproductive capacity.
- Use neutral questions before direct safeguarding enquiry, then assess immediate danger, children or dependants, sexual violence and coercive control; do not promise absolute secrecy.
- Summarise the timeline back to the patient, distinguish fact from uncertainty, agree examination and tests separately, and document declined elements without judgement or repeated pressure.
Key red flags
Syncope, shoulder-tip pain, unilateral pelvic pain or heavy bleeding with possible pregnancy raises ectopic pregnancy or haemorrhage and needs urgent location assessment.
Current threats, stalking, forced sex, contraception sabotage, restricted healthcare access or fear of a partner requires a private immediate-safety and safeguarding response.
Postmenopausal bleeding, persistent intermenstrual bleeding, a pelvic mass, unexplained weight loss or abnormal discharge requires cancer-pathway consideration rather than symptom treatment alone.
Fever, rigors, purulent discharge, severe tenderness, recent instrumentation or postpartum deterioration can indicate pelvic infection or sepsis and warrants urgent physiological assessment.
A child or young person describing exploitation, an adult at risk unable to protect themselves, or concern about forced marriage or FGM activates local safeguarding procedures.
A missed or atypical period with unilateral pain, syncope, shoulder-tip pain or bleeding requires pregnancy testing and urgent ectopic assessment even when contraception was reportedly used.
A partner answering, refusing privacy, monitoring communication, controlling medicines or sabotaging contraception can indicate coercive control and should prompt safe private enquiry.
Investigation priorities
Obtain an accurate history and enable disclosure without a companion shaping the account.
Management branches
Any consultation includes menstrual, sexual, obstetric or reproductive symptoms.
- Explain the purpose of sensitive questions, confirm communication preferences and confidentiality limits, and arrange professional interpretation where needed.
- Offer time alone, identify safe contact routes and establish physiology, bleeding severity, pain, pregnancy possibility and immediate safeguarding threats.
- Take a chronological symptom and reproductive history using neutral language, then summarise it back and correct misunderstandings before planning tests.