Audio_Gynec_Hp_24

OFFICE VISIT

HISTORY: This 61-year-old multiparous white female and breast cancer survivor presents today reporting a one-day episode of staining noted on her mini-pad. The patient is uncertain as to the etiology of this blood spot given her severe hemorrhoidal state. The patient reports that no further bleeding was noted aside from that event with a single mini-pad on Thursday, April 6, 2006.

PHYSICAL EXAMINATION: Today is limited to the abdomen and pelvis. Abdomen is benign. Vulvar inspection revealed atrophic changes without lesions, blood or discharge. Some minor erythema attributable to atrophic changes was noted. No bleeding was encountered, however. Speculum examination failed to identify any vaginal erosions, abnormal discharge of blood of any type. Cervix was smooth and without lesions or evidence of bleeding. Single digit Bimanual examination revealed no organomegaly, no cervical motion tenderness, and no adnexal fullness or tenderness. Rectal exam was negative. Guaiac testing also was negative.

PLAN: The patient was advised when a future event such as this that mini-tampon would be advisable to further delineate the etiology of the source of spotting. Endometrial biopsy was declined. However, the patient was issued a referral for pelvic sonography to further evaluate the endometrial lining in this postmenopausal female taking no hormonal replacement therapy. Please note that this patient did undergo colposcopically directed biopsies with LEEP procedure of the cervix in August 2005. Pathology revealed only atrophic squamous mucosa with atypia. She was noted to have a positive high-risk HPV DNA presence. Finally, the patient also suffers from osteoporosis and is taking Fosamax. Colonoscopy was performed within the past three years.