Copyright © 2015 by Mosby, an imprint of Elsevier Inc. . Chapter 18 Female Genitalia
Copyright © 2015 by Mosby, an imprint of Elsevier Inc. " Unless someone like you cares a whole awful lot. Nothing is going to get better; It's not” --Dr Seuss
Copyright © 2015 by Mosby, an imprint of Elsevier Inc. External Genitalia Patient is in the lithotomy position. Inspect the pubic hair characteristics and distribution. Inspect and palpate the labia Inspect the urethral meatus and vaginal opening Palpate the Bartholin glands Inspect and palpate the perineum 3
Copyright © 2015 by Mosby, an imprint of Elsevier Inc. Internal Genitalia Speculum Examination Collect necessary specimens. Inspect the cervix Inspect and palpate vaginal walls Adnexa Fallopian tubes Ovaries 4
Copyright © 2015 by Mosby, an imprint of Elsevier Inc. Bimanual Examination Palpate the uterus Palpate the ovaries Palpate the adnexal areas for masses and tenderness Ovaries Fallopian tubes 5
Copyright © 2015 by Mosby, an imprint of Elsevier Inc. Rectovaginal Examination Palpate the posterior aspect of the uterus. Palpate the anterior and posterior rectal wall 6
Copyright © 2015 by Mosby, an imprint of Elsevier Inc. Adolescents Puberty functional maturation of reproductive organs is seen. 7
Copyright © 2015 by Mosby, an imprint of Elsevier Inc. Pregnant Women Softened pelvic cartilage and cervix Symphysis of pelvic joint separates Chadwick sign Bluish color to cervix 8
Copyright © 2015 by Mosby, an imprint of Elsevier Inc. Older Adults Menopause 9
Copyright © 2015 by Mosby, an imprint of Elsevier Inc. History Abnormal bleeding Pain Vaginal discharge Premenstrual complaints Menopause symptoms complaints Infertility Urinary symptoms 10
Copyright © 2015 by Mosby, an imprint of Elsevier Inc. History (Cont.) Menstrual history Pregnancy history Menopausal history Gynecological history 11
Copyright © 2015 by Mosby, an imprint of Elsevier Inc. Family/ Personal History Diabetes Cancer of reproductive organs Multiple pregnancies Congenital anomalies Contraceptive history Date of last pelvic exam and Pap smear Sexual history 12
Copyright © 2015 by Mosby, an imprint of Elsevier Inc. Adolescents Talk with teen in private Should not assume that youthful age precludes sexual activity or any of the related concerns Questions should be posed in a gentle, matter- of-fact, and nonjudgmental manner 13
Copyright © 2015 by Mosby, an imprint of Elsevier Inc. Older Adults Menopausal history History associated with age Urinary problems 14
Copyright © 2015 by Mosby, an imprint of Elsevier Inc. Equipment Drapes Speculum Specimen collection supplies Slides Cytologic fixation Culture plates/ media Gloves Water-soluble lubricant Lamp 15
Copyright © 2015 by Mosby, an imprint of Elsevier Inc. Preparation Assist the patient into the lithotomy position on the examining table. 16
Copyright © 2015 by Mosby, an imprint of Elsevier Inc. External Examination Labia majora Labia minora Clitoris Urethral orifice Vaginal introitus 17
Copyright © 2015 by Mosby, an imprint of Elsevier Inc. External Examination (Cont.) Skene glands Bartholin glands Perineum Anus 18
Copyright © 2015 by Mosby, an imprint of Elsevier Inc. Internal Examination Cervix Pap smear Cytologic smear DNA probe Chlamydia and gohhorrea Wet mount Bacterial vaginosis 19
Copyright © 2015 by Mosby, an imprint of Elsevier Inc. Bimanual Examination Cervix Uterus Ovaries Adnexa 20
Copyright © 2015 by Mosby, an imprint of Elsevier Inc. Rectovaginal Examination Uterus: confirm bimanual examination findings Location and position Size, shape, and contour Consistency Tenderness 21
Copyright © 2015 by Mosby, an imprint of Elsevier Inc. Infants Inspect and palpate external genitalia only. Expected swelling of labia minora 22
Copyright © 2015 by Mosby, an imprint of Elsevier Inc. Children Internal examination only if evidence of: Bleeding Discharge Trauma or abuse Behavioral changes 23
Copyright © 2015 by Mosby, an imprint of Elsevier Inc. Adolescents All adolescent females should have a pelvic examination within 3 years of initiating sexual intercourse. Young women who are not sexually active should have their first examination by age 21 years. 24
Copyright © 2015 by Mosby, an imprint of Elsevier Inc. Older Adults Age-related changes Vaginal introitus may be constricted. Vagina is narrower and shorter. 25
Copyright © 2015 by Mosby, an imprint of Elsevier Inc. Abnormalities Premenstrual syndrome (PMS) Collection of physical, psychological, and mood symptoms related to a woman’s menstrual cycle Infertility Inability to conceive over a period of 1 year of unprotected sexual intercourse 26
Copyright © 2015 by Mosby, an imprint of Elsevier Inc. Abnormalities (Cont.) Menopause Cessation of menstrual cycle 1 year with no menses Endometriosis Presence and growth of endometrial tissue outside the uterus 27
Copyright © 2015 by Mosby, an imprint of Elsevier Inc. Abnormalities (Sexually Transmitted Infections) Condyloma acuminatum (genital warts) Warty lesions due to sexually transmitted infection with human papillomavirus (HPV) Genital herpes From herpes simplex HSV-2 is most common 28
Copyright © 2015 by Mosby, an imprint of Elsevier Inc. Abnormalities (STI’s) Inflammation of Bartholin gland Commonly, but not always, caused by Neisseria gonorrhoeae Vaginal infections Bacterial vaginosis (Gardnerella vaginalis) Candida vulvovaginitis (Candida albicans) Trichomoniasis (Trichomonas vaginalis) Gonorrhea Chlamydia 29
Copyright © 2015 by Mosby, an imprint of Elsevier Inc. Abnormalities (Cervix) Cervical polyp Bright red soft protrusion from endocervical canal Cervical cancer Two main types of cervical cancer, named for the cell type from which the cancer arises: Squamous cell carcinoma Adenocarcinoma 30
Copyright © 2015 by Mosby, an imprint of Elsevier Inc. Abnormalities (Uterus) Endometrial cancer Cancers of the glandular cells found in the lining of the uterus 31
Copyright © 2015 by Mosby, an imprint of Elsevier Inc. Abnormalites (Adnexa) Ovarian cysts Fluid-filled sac in an ovary Ovarian cancer Classified by the cells from which the cancer arises Epithelial Stromal Germ cell Tubal (ectopic) pregnancy Pregnancy occurring outside the uterus 32
Copyright © 2015 by Mosby, an imprint of Elsevier Inc. Abnormalities (Adnexa) Pelvic inflammatory disease (PID) Infection of the uterus, fallopian tubes, and other reproductive organs Common and serious complication of some sexually transmitted infections 33
Copyright © 2015 by Mosby, an imprint of Elsevier Inc. Abnormalities (Older Adults) Urinary incontinence Stress Urge Overflow Functional 34