Sexual dysfunction and dyspareunia — structured oral station (12 minutes)

FRANZCOG oral-format station on dyspareunia: candidate takes a permission-based biopsychosocial sexual history, plans examination with consent, classifies the symptom, defends a multimodal plan using PLISSIT and explores a trauma disclosure with appropriate language. Scored against the eight published RANZCOG oral domains.

Prompt

You are the on-call gynaecology registrar in a teaching clinic. A 32-year-old woman, Maria, is booked for a 30-minute consultation because of persistent dyspareunia for four years. The letter from her GP says her swabs and pelvic ultrasound have been normal. The examiner will ask you to take a focused biopsychosocial sexual history, defend an examination plan, propose an initial multimodal plan and handle the moment when she becomes distressed about a past abusive relationship. Four minutes reading time is provided; the oral lasts twelve minutes.

Reading the stem (4 minutes)

What does this stem really test?

^[1]

Reasoning through a sensitive consultation, not a procedure.
A complete biopsychosocial sexual history in the patient's words, not a checklist.
Consent-led examination planning and explanation.
A multimodal plan: pelvic-floor physiotherapy, CBT/psychosexual therapy, lubrication and moisturiser, and only justified medication.
Trauma-informed communication when the patient discloses something difficult.

^[2]

Plan your opener, your history structure, your examination approach, your plan structure and your communication response.

^[1]

References4Show

[1]Basson R Human sexual response Handb Clin Neurol, 2015.PMID 26003236
[2]Portman DJ, Gass MLS Genitourinary syndrome of menopause: new terminology for vulvovaginal atrophy from the International Society for the Study of Women's Sexual Health and the North American Menopause Society Menopause, 2014.PMID 25179577
[3]Bornstein J, Goldstein AT, Stockdale CK, et al. 2015 ISSVD, ISSWSH, and IPPS Consensus Terminology and Classification of Persistent Vulvar Pain and Vulvodynia J Sex Med, 2016.PMID 27045260
[4]The 2020 genitourinary syndrome of menopause position statement of The North American Menopause Society The 2020 genitourinary syndrome of menopause position statement of The North American Menopause Society Menopause, 2020.PMID 32852449

Sexual dysfunction and dyspareunia — structured oral station (12 minutes)

Reading the stem (4 minutes)

What does this stem really test?

Reasoning through a sensitive consultation, not a procedure.

A complete biopsychosocial sexual history in the patient's words, not a checklist.

Consent-led examination planning and explanation.

A multimodal plan: pelvic-floor physiotherapy, CBT/psychosexual therapy, lubrication and moisturiser, and only justified medication.

Trauma-informed communication when the patient discloses something difficult.

Plan your opener, your history structure, your examination approach, your plan structure and your communication response.

References4Show

[1]Basson R Human sexual response Handb Clin Neurol, 2015.PMID 26003236
[2]Portman DJ, Gass MLS Genitourinary syndrome of menopause: new terminology for vulvovaginal atrophy from the International Society for the Study of Women's Sexual Health and the North American Menopause Society Menopause, 2014.PMID 25179577
[3]Bornstein J, Goldstein AT, Stockdale CK, et al. 2015 ISSVD, ISSWSH, and IPPS Consensus Terminology and Classification of Persistent Vulvar Pain and Vulvodynia J Sex Med, 2016.PMID 27045260
[4]The 2020 genitourinary syndrome of menopause position statement of The North American Menopause Society The 2020 genitourinary syndrome of menopause position statement of The North American Menopause Society Menopause, 2020.PMID 32852449