It’s All in the History

Takashi Murakami. 727. 1996

Takashi Murakami. 727. 1996



People go to see the doctor for many reasons.  Sometimes it is just a check up or medication refill or for not feeling well.  Sometimes it is because of pain.

Pain is tricky.  It can come on all of a sudden.  It can ebb and flow.  It can last seconds, minutes, hours, days, weeks, months or years.  It can start from excessive use or a strain.  It can show up after an accident.  It can start out very mild and grow.   It can start in one place and travel to another.  It can occur in the middle of the night or during the menstrual cycle.  It can cause vomiting or come with a fever.

As a gynecologist, the pain I see is mostly in the abdomen or belly.  More often than not, the pain is in the lower belly or pelvis.  Because the reproductive organs are in this region, many people come to see me.  It is my job to tease out the pain and try to define it.  How do I do this?

It is all in the history.  I ask you all about the pain.

How long has it been going on?  How did it start?  What does it feel like?  When does it occur?  Does it radiate from one place to another?  Did you try anything to make it better?

Have you seen anyone else for this pain, and if you did, what was done?  Does anything make it better?  Does anything make it worse?  Does anything else happen when you get this pain?

Is there any fever or vomiting?  Has your appetite changed?  Do you have trouble with constipation or diarrhea?  Any difficulty with urinating?  Discharge?  The list goes on and on….It may seem tedious to ask these questions, but the more information I have, the better to help you.

Additionally, I like to know about any medical problems you may have.  Past surgeries, past gynecological history, past obstetrical history, and social history also help me try to figure out the pain.   There have been occasions when family history has provided important clues to the source of pain.

The history of your pain helps to guide us in determining what the name of your pain is and how to treat it.  If you have been living with pain and are thinking about coming to be seen, here is what I have for you.

Take a moment to think about the pain.  When did it start?  What does it feel like?  Some people keep a pain diary, and write down when it occurs, for how long, what else occurs during the episode.  You may want to write down your concerns and questions about the pain.  Sometimes when we see the doctor we forget to ask the questions that form in our mind before we get there.  Believe it or not, I have forgotten my questions when I go to my doctor!  Lastly, we may send you out with a long list of things to do such as laboratory work and radiology requests.  If it is a long list, have your doctor write it down for you.

Pain can be from many different causes—some serious such as appendicitis and some not like menstrual cramps.  It is still pain and it is pain that is affecting your quality of life.  Our goal is to determine the cause and treat it.  The best place to start is with a good history.


Cynthia Wilkes MD

Stafford Women’s Health Associates

Stafford VA

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