Health Assessment NUR 103

Physical Assessment of the Reproductive System

Terminology The External Female Genitalia

Mons pubis Labia majora Labia minora Frenulum Clitoris Vestible Urethral meatus

Terminology The Internal Female Genitalia

Vagina Rugae Cervix Anterior fornix Posterior fornix Rectouterine pouch, or cul-de-sac of Douglas Uterus Fallopian tubes Ovaries

Equipment For Female Examination

Gloves Protective clothing Vaginal Speculum Of appropriate size Large cotton-tipped applicators (rectal swabs) Materials for cytologic study: Glass slide with frosted end Sterile Cytobrush or cottontipped applicator Ayres spatula Spray fixative Specimen container for gonorrhea Cx/chlamidia Small bottle of normal saline, potassium hydroxide, and acetic acid (white vinagar) Lubricant

Pederson Speculum

Positioning for Female Examination

Assessment of the Female Genitalia

Normal Findings: Inspection: Note: Hair distribution- usual pattern Skin color, no lesions of inverted triangle. Labia Majora symmetric, plump, and well formed. Nulliparous woman, labia meet in midline; following vaginal delivery, labia are gaping and slightly shriveled. Abnormal Findings: Inspection: Note: Refer any suspicious lesion for biopsy Consider delayed puberty if no pubic hair or breast development has occurred by age of 13. Nits, or lice at base of pubic hair Swelling

Internal Genitalia
Speculum Examination: Select proper-sized speculum Graves Speculum

Pederson Speculum

Inspect the cervix and its os

 Surface: Smooth, Surface reddened, eversion, or ectropion, granular, asymmetric, past vaginal delivery; around os. Endocervial canal everted Friable, bleeds easily. or rolled out. Red, beefy Any lesions: white patch halo inside the pink on cervix, strawberry cervix surrounding os. spot. Refer any suspicious, red, white, or pigmented lesion for biopsy.

Inspect the Vaginal Wall

Bimanual Exam

 Bimanual Exam Inspection of Cervix Palpate Pelvic Organs

Abnormal Findings of External Genitalia

Pediculosis Pubis (Crab Lice): Severe perineal itching, excoriations, erythematous areas. May see little dark spots, nits (eggs) adherent to pubic hair near roots.

Syphilitic Chancre
Begins as small, solitary silvery papule, erodes to red, round or oval, superficial ulcer with yellowish serous discharge. Palpation- nontender indurated base; can be lifted like button between thumb and finger.

Herpes Simplex Virus- Type 2

Red Rash- Contact Dermatitis

History of skin contact with allergenic substance in environment, intense pruritus. Primary lesion- red, swollen, vesicles. May have weeping of lesions, crusts, scales, thickening of skin, excoriations from scratching. May result from reaction to feminine hygiene spray, synthetic underclothing.

Genital Human Papillomavirus (HPV, Condylomata Acuminata, Genital Warts

Painless warty growths, may Be unnoticed by woman. Pink or flesh-colored, soft, pointed, moist, warty papules. Single or multiple in cauliflowerlike patch. Occur around vulva, introitus, anus, vagina, cervix.

Terminology related to assessment of male reproductive systems

Examination Equipment Needed for Male Anatomy:

Gloves- Wear gloves during every male genitalia exam. Occasionally: glass slide for urethral specimen Materials for cytology Flashlight

Positioning for Male Examination:

1. Position male standing with undershorts down, with appropriate draping. 2. Examiner should be sitting. (Male may be supine for first part of exam, standing for hernia check. 3. Take time for pt. to discuss genitourinary history.

Inspection and palpation of male reproductive system

General Inspection of penis and glans Inspection & palpation of scrotum Hernia Inspection

Always encourage self care by:

Teaching every male from 13-14 years old through adulthood to perform testicular self-examination (TSE).