Copyright 2002, Delmar, A division of Thomson Learning Chapter 20 Female Genitalia Copyright 2002, Delmar, A division of Thomson Learning

Copyright 2002, Delmar, A division of Thomson Learning Competencies Describe the anatomy and physiology of the female genitalia, including age-relevant transformations. Demonstrate the techniques necessary for assessment of the female genitalia, including patient positioning, external and internal inspection, speculum procedures, and palpation methods. (continues) Copyright 2002, Delmar, A division of Thomson Learning

Copyright 2002, Delmar, A division of Thomson Learning Competencies Identify anatomic landmarks during bimanual vaginal, uterine, and rectovaginal examinations. Identify normal findings as well as atypical findings of the vulva, vagina, and cervix. Describe procedures for genital and anal smears and cultures. Copyright 2002, Delmar, A division of Thomson Learning

Anatomy and Physiology External female genitalia Labia majora Labia minora Clitoris Vaginal introitus Urethral meatus (continues) Copyright 2002, Delmar, A division of Thomson Learning

Anatomy and Physiology Internal female genitalia Vagina Uterus Cervix Fundus Ovaries Fallopian tubes Copyright 2002, Delmar, A division of Thomson Learning

Female Reproductive Cycle Follicular phase FSH LH Ovulation Luteal phase Corpus luteum Copyright 2002, Delmar, A division of Thomson Learning

Copyright 2002, Delmar, A division of Thomson Learning Health History Age Adolescent to young adult Middle to late adult Race Ethnic minorities Copyright 2002, Delmar, A division of Thomson Learning

Copyright 2002, Delmar, A division of Thomson Learning Chief Complaint Common chief complaints Uterine bleeding Vaginal discharge Urinary symptoms Pelvic pain Characteristics to assess Copyright 2002, Delmar, A division of Thomson Learning

Copyright 2002, Delmar, A division of Thomson Learning Past Health History Medical history Surgical history Medications Communicable diseases Allergies Injuries Special needs Childhood illnesses Copyright 2002, Delmar, A division of Thomson Learning

Copyright 2002, Delmar, A division of Thomson Learning Health History Family history Social history Substance use Sexual practices Hobbies Stress Health maintenance Copyright 2002, Delmar, A division of Thomson Learning

Copyright 2002, Delmar, A division of Thomson Learning Key Questions to Ask Menstrual, obstetric, and menopause histories PMS Vaginal discharge Uterine bleeding Sexual functioning Reproductive medical history Method of birth control Copyright 2002, Delmar, A division of Thomson Learning

Copyright 2002, Delmar, A division of Thomson Learning Physical Assessment Special equipment Vaginal specula Cytological materials General approach Prior During After Copyright 2002, Delmar, A division of Thomson Learning

Inspection: External Genitalia Pubic hair distribution Skin color and condition Mons pubis and vulva Urethral meatus Vaginal introitus Perineum and anus Copyright 2002, Delmar, A division of Thomson Learning

Palpation of External Genitalia Labia Urethral meatus and Skene’s glands Vaginal introitus Perineum Copyright 2002, Delmar, A division of Thomson Learning

Speculum Examination of the Cervix Use of speculum Characteristics of assessment Color Position Size Surface characteristics Discharge Shape of cervical os Copyright 2002, Delmar, A division of Thomson Learning

Copyright 2002, Delmar, A division of Thomson Learning Collecting Specimens Pap smear Endocervical Cervical Vaginal Gonococcal culture Saline mount KOH prep Five percent acetic acid wash Anal culture Copyright 2002, Delmar, A division of Thomson Learning

Copyright 2002, Delmar, A division of Thomson Learning Inspection Vaginal wall Bimanual examination Vagina Cervix Fornices Uterus Adnexa Rectovaginal examination Copyright 2002, Delmar, A division of Thomson Learning

Gerontological Variations Menopause-related changes Low estrogen levels Cessation of menses Generalized atrophy of external and internal female organs Copyright 2002, Delmar, A division of Thomson Learning

Normal Findings: Inspection Pubic hair distribution shaped like an inverse triangle No parasites present Labia majora and minora are symmetrical, skin is slightly pigmented, intact Urethral opening is midline; free from discharge, swelling, or redness (continues) Copyright 2002, Delmar, A division of Thomson Learning

Normal Findings: Inspection Vaginal mucosa is pink and moist Normal vaginal discharge is clear to white, free from odor Perineum is smooth, slightly darkened Anus is dark pink to brown and puckered Copyright 2002, Delmar, A division of Thomson Learning

Normal Findings: Palpation Labia are soft, free from swelling, pain, induration, or purulent discharge Vaginal muscle tone is strong in nulliparous; diminished in multiparous Perineum is smooth and firm Urethral meatus is free from pain or discharge Copyright 2002, Delmar, A division of Thomson Learning

Normal Findings: Internal Genitalia Cervix is pink, pale (menopause), or blue (pregnancy) Cervix is midline Glistening pink cervical epithelium Cervical os is round in nulliparous; or a horizontal slit in multiparous Copyright 2002, Delmar, A division of Thomson Learning

Normal Findings: Cytological Smears and Cultures Pap smear within normal limits Cervicovaginal tissues free from Neisseria gonorrheae, Candida albicans < 10 WBC’s in the saline mount specimen Negative acetic acid wash test Vaginal wall is pink, moist, deeply rugated Copyright 2002, Delmar, A division of Thomson Learning

Copyright 2002, Delmar, A division of Thomson Learning Normal Findings Vaginal wall is nontender, free from lesions, masses, or cysts Cervix is mobile, nontender, symmetrical, rounded, and midline Uterus is pear-shaped in nongravid; rounded in parous Ovaries are almond-shaped, firm, smooth, and mobile without tenderness Copyright 2002, Delmar, A division of Thomson Learning