Female & Male Genitalia Health Assessment

Female Health History Menstrual History Obstetric History Age at menarche, frequency & duration of menstrual cycle, character or flow (amount and presence of clots), presence of dysmenorrhea (painful menstruation), dates of last two menstrual periods and premenstrual symptoms. Bleeding outside of period or during menopause Ie. Endometriosis, endometrial cancer Obstetric History Number of pregnancies, miscarriages or abortions, or complications

Female Health History Received human papillomavirus (HPV) vaccine Prevent against cervical cancer & genital warts Symptoms of infection/STIs Vaginal discharge, pelvic pain, swollen perianal tissues or genital lesions Symptoms of genitourinary problems Burning during urination (dysuria), frequency, urgency, nocturia, hematuria, incontinence, stress incontenence Symptoms of Perimenopause Hot flash, drenching sweats, mood swings, vaginal dryness, itching, numbness and tingling, headache, or palpitations.

Female Health History Risk factors for ovarian cancer >40 y/o, obese, history of ovarian dysfunction, breast or endometrial cancer, irradiation of pelvic organs, endometriosis, infertility or nulliparity, use of estrogen only hormone replacement family history of ovarian, breast, or endometrial cancer Risk factors for endometrial cancer Postmenopausal, obese, infertile, early menarche, late menopause, HTN, DM, gallbladder disease, PCOS, estrogen-related exposure (HRT or tamoxifen use) Family history of endometrial, breast, or colon cancer

Both Genders- Health History Sexual history and current/past contraceptive practices Oral contraceptives- Ask about tobacco use, history of blood clots due to increased risk for blood clots. Previous illness or surgery involving reproductive organs, including STIs

Male Health History Urinary symptoms Frequency, nocturia, urgency, decreased urinary output, difficulty starting stream, hematuria Penile pain or swelling, genital lesions or urethral discharge Heaviness or painless enlargement of testis or irregular lumps Performance of self testicular exam? Presence of inguinal hernia Difficulty achieving erection or ejaculation

Examination Tips Explain each step of the examination in advance Offer a chaperone Keep patient draped for privacy Avoid unexpected or sudden movements Watch patient’s face to monitor comfort Wear gloves

Female Exam

Inspection Skin color Hair distribution No suspicious pigmented lesions noted. Hair distribution Inverted triangle. No nits or lice. Tanner staging for adolescence Note: The nurse will often examine external genitalia while performing routine hygiene measures or preparing to insert a urinary catheter

Inspection Labia majora Perineum Symmetrical, no excoriation, nodules, rash, lesions or edema Perineum Smooth Well healed episiotomy scar

Female Abnormalities

Inspection With gloved hand separate labia major and inspect: Clitoris Labia minora Dark pink and moist Urethral opening Slitlike and midline Vaginal opening No discharge or foul odor No excoriation, nodules, rash, lesions, or edema.

Discharge Candidiasis- thick, white curdy BV- thin, creamy gray-white; foul smelling Trichomoniasis- frothy yellow-green; foul smelling Chlamydia- White mucopurulent Gonorrhea- yellowish

Female Abnormalities

Female Abnormalities Rectocele Cystocele Uterine prolapse

Speculum Examination For routine pelvic exams patient should not be on menses Patient should avoid intercourse, douching, vaginal suppositories and tampons 24 hours prior to exam Have patient empty bladder before examination Patient lies supine, with head and shoulders elevated Have patient place heels in stir-ups, slide all the way down examination table until buttocks extend slightly beyond the edge Thighs should be flexed, abducted and externally rotated at the hips Have light source available and supplies accessible

Speculum Examination/Bimanual Palpation Obtain cervical smears and cultures Pap Smears for cervical cancer Inspect vaginal wall and cervix Palpate cervix, uterus & ovaries

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Male Genitalia

Male Anatomy

Inspection- Tanner Stage

Inspection of Penis Skin Winkled, hairless, without lesions or inflammation Dorsal vein may be apparent

Inspection of Penis Glans Smooth, without lesions May need to retract foreskin Phimosis- unable to retract foreskin Paraphimosis- Unable to return foreskin to original position Smegma- Cheesy substance under foreskin

Inspection/Palpation of Penis Urethral meatus Positioned centrally Hypospastic- ventral location Epispadias- dorsal location Compress glans anteroposteriorly between thumb and forefinger to assess for dc Meatus pink, smooth, without discharge Profuse yellow = gonococcal Scanty white = possible Chlamydia

Palpation of Penis Palpate shaft between thumb and first 2 finger. Assess for nodules, induration, or tenderness Smooth, semifirm, and nontender If man gets erection during the exam, explain that it is a normal response and finish the exam

Inspection of Scrotum Hold scrotum out of way with back of hand Mild asymmetry normal Left often lower than right Assess for edema and lesions

Palpation of Scrotum Palpate scrotum, epididymis & spermatic cord between thumb and first two fingers Testes- freely movable, oval, firm, rubbery, smooth and equal bilaterally.

Palpation of Scrotum Epididymis- discrete, smooth, and nontender Spermatic cord- smooth and nontender

Inspect for Hernia Inspect inguinal region for bulge as person stands and strains down. No bulge noted

Palpation for Hernia Gently insert finger into canal and ask patient to bear down. No inguinal hernia noted. Palpate femoral areas for bulge No femoral hernia noted.

Palpate Inguinal Lymph Nodes Palpate inferior to inguinal ligament and along upper inner thigh Normal to palpate isolated node on occasion Nonpalpable or small (<1cm), soft, discrete, and movable.

Testicular Cancer Incidence is low, 4 per 100,000 Peak age 15-35 If found early, excellent prognosis The best time to examine testicles is during or after a shower or bath. The warm water allows the scrotum to relax and the testicles to drop down. The left testicle normally hangs a bit lower than the right. It is common for one testicle to be larger than the other one. Young men should examine themselves once a month. More frequent exams actually may result in missing a slowly changing lump.

Testicular Self Exam Support each testicle with one hand and examine it with the other. Gently roll each testicle between the thumb and fingers. Testicles should feel firm and smooth, about the consistency of a hard-boiled egg without the shell. The epididymis is a ropelike structure attached to the back of the testis. This structure is not an abnormal lump Feel for firm masses, lumps, or nodules in the testicle. In cancer, these lumps often are painless. Become familiar with normal size, shape, and weight of each testicle and epididymis. This will help you recognize a change from one self-examination to another, if a change should occur.

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