Examination of Male & Female Genitalia, Breast, Prostate & Rectum Janet M. Galiczewski RN, CCRN, MSN, ANP

Breast A& P Breast overlies pectoralis major. Breast is a hormonally sensitive tissue. Upper Outer Quadrant-site of most breast cancers. Breast composed of glandular tissue, fibrous tissue including suspensory ligaments, adipose tissue. Proportion varies with age, cycle, pregnancy, lactation, & general nutrition. Suspensory ligaments (Cooper’s Ligaments) support breast tissue, contract in CA breast-produce pits or dimples in overlying skin.

Breast Lymphatics Central Pectoral (Anterior) Subscapular (Posterior) Lateral

Breast Cancer Risk Factors Family History Menstrual History Pregnancy Age Sex Education & Income Location Caucasian Women A Good History is imperative

Techniques of Breast Exam. Inspection: Pt sitting, disrobed to the waist,arms at sides. Inspect breasts, note appearance of skin; color, redness from infection or inflammatory CA. Size & symmetry of breasts Contour

Technique of Breast Exam. Inspect nipples; note size & shape, direction in which they point, rashes or ulceration, discharge. Assess breast development according to Tanner. Check for dimpling or retraction.

Exam (Cont). Palpation: Ask pt. to lie down Bring pts arm overhead, use pads of first three fingers, compress tissue gently. Use a pattern: concentric circles (or other method). Note: Consistency of tissues, tenderness, nodules.

If you find a nodule: Location Size Shape Consistency Movable Distinctness Nipple Lymphadenopathy

Exam (cont) Palpate each nipple. Compress the areola with your index finger & thumb, watch for discharge. Male Breast: Monthly exam (self), clinical exam every 1-3 years. Inspect nipple & areola for nodules, swelling, ulceration. Palpate the areola for nodules.

Breast Cancer Screening Encourage bilateral self - breast exams monthly. 5-7 days after onset of menses. They should continue after menopause. Age 20-39 CBE every three years. =/> 40 CBE yearly along with mammography. For women at increased risk mammography should be initiated at 30 years of age. After 70 the benefits of mammography is less well defined.

Save a Life 1 in 7 Choose to be proactive!! Choose to Live!! Cumulative lifetime risk factor for developing BREAST CANCER is : 1 in 7 Choose to be proactive!! Choose to Live!!

Female Genitalia A&P Labia Majora Labia Minora Vestibule Introitus Perineum Urethral Meatus Skene’s Glands Bartholin’s Glands

Female Genitalia (Internal) Vagina Uterus Cervix External Os Fallopian Tubes Ovaries; Adnexa

Internal Female Genitalia

Examination Empty Bladder Position & Drape Appropriately Inspect external genitalia; separate labia majora & inspect Labia minora Clitoris Urethral meatus Introitus Note:inflamm.,ulceration, discharge,swelling,nodules,palpate any lesions.

If you suspect urethritis or inflammation of the paraurethral glands (Skene’s): Insert index finger into vagina, milk urethra gently from inside outward. May be R/T chlamydia or gonorrhea, get culture.

Internal Exam. Locate the cervix Assess support of the vaginal wall Cystocele Uterine Prolapse Rectocele Insert Speculum Inspect Cervix & Os Pap Smear

Exam (cont). Perform a Bimanual exam. Palpate the cervix Palpate the uterus Retroversion of the uterus Palpate Each Ovary Rectovaginal Exam

Male Genitalia A & P Shaft of the penis Glans Prepuce/foreskin Urethra Urethral meatus Scrotum Testes

Male Genitalia

Inguinal canal External Inguinal ring Inguinal Hernias Femoral Hernias Prostate

Prostate

Examination of Male Genitalia Penis Inspection Foreskin,smegma, phimosis, paraphimosis. Glans; hypospadias Palaption palpate shaft between thumb & 1st 2 fingers; feel for induration along ventral surface. Scrotum Palpation Testicular Cancer (See Handout)

Examination of Male Genitalia Transillumination of the scrotum Hydrocele Hernias: Inguinal & Femoral Inspection Palpation

Prostate Examination Note: Size:2.5cm x 4 cm wide Shape:heart with palpable central groove Consistency: elastic, rubbery Nodules Tenderness: nontender to palpation Mobility: slightly mobile Should not protrude more than 1 cm into rectum

Anus & Rectum Anal canal surrounded by 2 layers of muscle called sphincters Internal sphincter is under involuntary control. External sphincter is under voluntary control.

Examination of the Anus & Rectum Inspect saccrococcygeal & perianal areas for: Lumps Ulcers Inflammation Rashes Excoriation Hemorrhoids Venereal warts Herpes

Hemorrhoid

Examination of the Anus & Rectum Examine sphincter tone of the anus; Note: Tenderness Induration Irregularities Insert finger clockwise & counterclockwise Note; nodules, irregularities, induration Stool for occult blood (Guiac)