Obstetrics & Gynecology · Model history
Painful periods and pelvic pain: a model gynecology history
- Setting
- Gynecology clinic
- Patient
- Ms. Yoon, 32, has worsening period pain and has been trying to conceive for one year.
- Listen
- 4 min
After listening
Say the next question
Read the patient’s answer, say your next question aloud, then reveal the model.
“Bowel movements are more painful during my period. I have IBS, but this pain feels more tied to my cycle.”
Ask one background question that connects cyclical pelvic pain with the fertility history.
Have you ever been pregnant, had pelvic surgery, or been treated for any gynecologic condition?
Model interview
Full transcript
- Doctor
Ms. Yoon, I'm Dr. Morgan. What would you like help with today?
- Patient
My periods have become very painful, and my husband and I have been trying to get pregnant for a year without success.
- Doctor
Tell me how the pain has changed over that time.
- Patient
It used to be manageable, but for the past year the cramps have become severe. I sometimes have to miss work.
- Doctor
Where do you feel the pain, and when does it begin in relation to your period?
- Patient
Deep in my pelvis and lower back. It starts the day before my period and is worst for the first two days.
- Doctor
How long are your cycles, and when did your last period start?
- Patient
They're regular, about twenty-eight days. My last period started twelve days ago.
- Doctor
How long do you bleed, and has the amount changed?
- Patient
About five days. It is a little heavier than it used to be, but I'm not soaking through a pad every hour.
- Doctor
Do you have bleeding between periods or after sex?
- Patient
No.
- Doctor
I ask everyone with pelvic pain about sex because it can help us understand the pain. Is it okay if I ask you a few questions?
- Patient
Yes, that's okay.
- Doctor
Do you have pain during sex? If so, does it feel near the entrance or deeper in the pelvis?
- Patient
It's a deep pain, especially with deeper penetration. That has also become worse this year.
- Doctor
Any unusual vaginal discharge, fever, or history of a sexually transmitted infection or pelvic infection?
- Patient
No discharge or fever, and I've never had an STI or pelvic infection.
- Doctor
Do bowel movements or urination become painful around your period?
- Patient
Bowel movements are more painful during my period. I have IBS, but this pain feels more tied to my cycle.
- Doctor
Have you ever been pregnant, had pelvic surgery, or been treated for any gynecologic condition?
- Patient
No pregnancies and no surgery. I haven't had any gynecologic treatment.
- Doctor
Are you and your husband having sex regularly without birth control, and has either of you had fertility testing?
- Patient
Yes, usually two or three times a week without birth control. Neither of us has had testing.
- Doctor
Are there any other partners or pregnancy possibilities that would change which tests we should discuss?
- Patient
No, just my husband.
- Doctor
What medicines, supplements, or pain relievers do you use? Any medicine allergies?
- Patient
I take ibuprofen during my period and a prenatal vitamin. I don't have any known allergies.
- Doctor
Does anyone in your family have endometriosis or difficulty becoming pregnant?
- Patient
My aunt had endometriosis. I don't know of fertility problems in anyone else.
- Doctor
What are you most concerned about, and what were you hoping would happen today?
- Patient
I'm worried the pain means I may never get pregnant. I've read about laparoscopy and want to know if I need it.
- Doctor
Let me make sure I have this right. Over the past year your period pain has become severe enough to disrupt work. You also have deep pain during sex and bowel pain around your period. Your cycles are regular, and you have been having regular sex without birth control for a year without becoming pregnant. Your main concern is future fertility. Is that accurate?
- Patient
Yes, exactly.
- Doctor
Thank you. We can now discuss an examination and a stepwise evaluation of both the pelvic pain and fertility. We will decide together which tests are useful and whether a procedure would add value.
- Patient
Thank you. I appreciate that.
Flow at a glance
The route through the history
- Open with both concerns
- Map pain to the menstrual cycle
- Characterize bleeding
- Ask permission before sexual history
- Separate bowel and bladder patterns
- Clarify pregnancy intention and fertility timeline
- Summarize the patient's priority
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Editorial record
Tied to one reviewed case
This model uses a fictional Bedside English case as its source. The page and pre-generated WAV audio are checked against the same transcript and source-case fingerprints.
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