Chapter 26 Female Genitalia

Structure and Function Subjective Data—Health History Questions Chapter 26 Female Genitalia Structure and Function Subjective Data—Health History Questions Objective Data—The Physical Exam Abnormal Findings

Structure and Function Developmental care Infants and adolescents Pregnant female Aging female Cross-cultural care Exposure of genitalia Infibulation (female genital mutilation)

Structure and Function Chapter 26 Structure and Function Female Genitalia External Genitalia or Vulva Mons pubis Labia majora Labia minora Frenulum Clitoris Urethral meatus Paraurethral (Skene’s) glands Vaginal orifice Hymen Vestibular (Bartholin’s) glands

Structure and Function, cont. Chapter 26 Structure and Function, cont. Female Genitalia Internal Genitalia Vagina Cervix Squamocolumnar junction Anterior fornix and posterior fornix Rectouterine pouch or cul-de-sac of Douglas Uterus Fallopian tubes

Developmental Competence Infancy – Adolescence Tanner’s Mature Asian women normally have fine sparse pubic hair African-American and Mexican-American girls had pubic hair and had achieved menarche at younger ages than white

Pregnant Female Goodell’s Sign Chadwick’s Sign Hagar’s sign Uterus

Aging Female Menopause Hormonal changes Ovaries and uterus involute Vagina shorter, narrower, drier Less pubic hair

Subjective Data— Health History Questions Chapter 26 Female Genitalia Subjective Data— Health History Questions Menstrual history Obstetric history Menopause Self-care behaviors Urinary symptoms Vaginal discharge Past history Sexual activity Contraceptive use Sexually transmitted disease (STD) contact STD risk reduction

Subjective Data— Health History Questions (cont.) Additional history for infants and children Urination Perineal hygiene Sexual abuse

Subjective Data— Health History Questions Additional history for preadolescents and adolescents Start of period Sex Sexually transmitted disease Sexual abuse

Subjective Data— Health History Questions Additional history for the aging adult Postmenopausal bleeding Atrophic vaginitis Uterine prolapse Sexual satisfaction

Objective Data— The Physical Exam Chapter 26 Female Genitalia Objective Data— The Physical Exam Preparation Lithotomy position and draping Measures to enhance comfort during exam Mirror pelvic examination Equipment needed Gloves Protective clothing for examiner Goose-necked lamp with a strong light Vaginal speculum of appropriate size Large cotton-tipped applicators (rectal swabs) Materials for cytologic study Lubricant

Objective Data— The Physical Exam, cont. Chapter 26 Female Genitalia Objective Data— The Physical Exam, cont. External Genitalia—Inspection Skin color Hair distribution Labia majora Any lesions Clitoris Labia minora Urethral opening Vaginal opening Perineum Anus

External Genitalia—Palpation Skene’s glands Bartholin’s glands Support of pelvic musculature

Objective Data— The Physical Exam, cont. Chapter 26 Female Genitalia Objective Data— The Physical Exam, cont. Internal Genitalia—Speculum Examination Technique of insertion Cervix and os—Inspect Color Position Size Os Surface Any Nabothian cysts Cervical secretions Obtain cervical smears and cultures Vaginal pool Ectocervical scrape Endocervical specimen Data to include for the laboratory Inspect vaginal wall

Objective Data— The Physical Exam, cont. Chapter 26 Female Genitalia Objective Data— The Physical Exam, cont. Internal Genitalia—Bimanual Examination Palpation technique Cervix Consistency Contour Mobility Uterus Adnexa Rectovaginal examination Rectovaginal septum Posterior uterine wall Cul-de-sac Rectum

Abnormal Findings Abnormalities of the External Genitalia Chapter 26 Abnormal Findings Abnormalities of the External Genitalia Female Genitalia Pediculosis pubis (crab lice) Herpes simplex virus—type 2 (herpes genitalis) Red rash—contact dermatitis Syphilitic chancre Genital human papillomavirus (HPV, condylomata acuminata, genital warts) Abscess of Bartholin’s gland Urethritis Urethral caruncle

Abnormal Findings Abnormalities of the Pelvic Musculature Chapter 26 Female Genitalia Abnormal Findings Abnormalities of the Pelvic Musculature Cystocele Rectocele Uterine prolapse Enterocele

Abnormal Findings Abnormalities of the Cervix Chapter 26 Abnormal Findings Abnormalities of the Cervix Female Genitalia Bluish cervix—cyanosis Erosion Human papillomavirus (HPV, condylomata) Polyp Carcinoma Diethylstilbestrol (DES) syndrome

Abnormal Findings Vulvovaginal Inflammations Conditions of Uterine Chapter 26 Abnormal Findings Female Genitalia Vulvovaginal Inflammations Atrophic vaginitis Candidiasis (moniliasis) Trichomoniasis Bacterial vaginosis Chlamydia Gonorrhea Conditions of Uterine Enlargement Pregnancy Myomas (leiomyomas, uterine fibroids) Carcinoma of endometrium Endometriosis

Abnormal Findings Adnexal Enlargement Chapter 26 Female Genitalia Abnormal Findings Adnexal Enlargement Fallopian tube mass—acute salpingitis (pelvic inflammatory disease or PID) Fallopian tube mass—ectopic pregnancy Fluctuant ovarian mass—ovarian cyst Solid ovarian mass—ovarian cancer

Abnormal Findings Abnormalities in the Pediatric Genitalia Chapter 26 Female Genitalia Abnormal Findings Abnormalities in the Pediatric Genitalia Ambiguous genitalia Vulvovaginitis in child