Elsevier items and derived items © 2006 by Elsevier Inc. Assessment of the Reproductive System

Female Reproductive System External genitalia: vulva, labia majora, labia minora, clitoris, vestibule, perineum Internal genitalia: vagina, uterus, corpus, cervix, fallopian tubes, ovaries Breasts Menstruation and menopause External genitalia: vulva, labia majora, labia minora, clitoris, vestibule, perineum Internal genitalia: vagina, uterus, corpus, cervix, fallopian tubes, ovaries Breasts Menstruation and menopause

Male Reproductive System External genitalia: penis, scrotum Internal genitalia: testes and spermatic cord, epididymis, vas deferens, seminal vesicles and ejaculatory ducts, prostate gland Inguinal area External genitalia: penis, scrotum Internal genitalia: testes and spermatic cord, epididymis, vas deferens, seminal vesicles and ejaculatory ducts, prostate gland Inguinal area

Assessment Techniques: Female History: pain, bleeding, discharge, masses Physical assessment –Breast examination –Abdominal examination –Examination of the external genitalia –Pelvic examination –Bimanual examination –Rectovaginal examination History: pain, bleeding, discharge, masses Physical assessment –Breast examination –Abdominal examination –Examination of the external genitalia –Pelvic examination –Bimanual examination –Rectovaginal examination

Assessment techniques History The nurse uses data about client’s age, sex, and culture to assess the risk for certain diseases. The nurse considers the client’s age in evaluating the reproductive system. Personal history( the nurse assesses he client’s health habits, such as diet, sleep, and exercise patterns.)

Family history helps to determine the client’s risk for conditions that affects reproductive system functioning. Diet history is often critical for the correct interpretation of presenting symptoms of the reproductive system. Social history of the client provides insight into the whole person, including stressors, job history, education.

Obstetric History Number of pregnancies, live deliveries, stillbirths, abortions Difficulties with pregnancies, deliveries Birth weight of babies Problems with infertility

Use of Contraception Type used (past and present) Difficulties with method, suitability If discontinued, reasons for doing so

Sexual History Sexual orientation Regularity of intercourse Number of partners in the past 12 months Associated symptoms (e.g., pain, postcoital bleeding) Sexual dysfunction

Current health problem If a client seeks medical attention for a problem related to the reproductive system, the nurse asks additional questions to explore the chief complaint.

1.Onset (sudden or gradual) 2.Chronology 3.Current situation (improving or deteriorating) 4.Location 5.Radiation 6.Quality 7.Timing (frequency, duration) 8.Severity 9.Precipitating and aggravating factors 10.Relieving factors 11.Associated symptoms 12.Effects on daily activities 13.Previous diagnosis of similar episodes 14.Previous treatments 15.Efficacy of previous treatments

Most complaints concern pain, discharge, masses, and reproductive functioning

Pain Onset, location, radiation, character, severity Relation to menstruation Aggravating and relieving factors Use of analgesics and their effect Associated gastrointestinal, urinary or vaginal symptoms Are symptoms related to an encounter with a new sexual partner? The nurse should not assume that the initial medical diagnosis is conclusive

Vaginal Discharge The nurse asks about: Onset, color, odor, consistency, quantity Relation to menstrual period Associated symptoms (e.g., rectal or urethral discharge, vaginal itch or burning, urinary symptoms, malaise, abdominal pain, fever) Relation to medication use (e.g., antibiotics, steroids) History of previous vaginal or pelvic infections and their treatment

Masses any reported masses in the breast should be evaluated Soreness, tenderness and their relation to menstrual cycle Redness, swelling, nipple discharge Change in contour, presence of masses Is client breast-feeding?

Bleeding Heavy bleeding or lack of bleeding may concern the woman. The possibility of pregnancy is considered in any sexually active woman with amenorrhea. Any postmenopausal bleeding needs to be evaluated. The nurse asks when the bleeding occurs in relation to certain events, such as the menstrual cycle or menopause, intercourse, trauma. In additional, the nurse notes the presence of associated symptoms

Other Associated Symptoms Ulcerations Persistent lesions Sense of pelvic relaxation (pelvic organs feel as though they are falling down or out) Infertility Pelvic infection

Assessment Techniques: Male Examination of the external genitalia Examination for inguinal hernia Examination of the rectum and prostate Examination of the external genitalia Examination for inguinal hernia Examination of the rectum and prostate

Papanicolaou Test Client preparation for pap test Procedure Follow-up care Client preparation for pap test Procedure Follow-up care

Blood Studies Pituitary gonadotropin Steroid hormones Serologic tests Syphilis detection Prostate-specific antigen Pituitary gonadotropin Steroid hormones Serologic tests Syphilis detection Prostate-specific antigen

Other Studies Urinalysis for steroid hormones Wet preparation (smears) Cultures General x-rays CT scans for reproductive system disorders Hysterosalpingography: an x-ray of the cervix, uterus, and fallopian tubes (Continued) Urinalysis for steroid hormones Wet preparation (smears) Cultures General x-rays CT scans for reproductive system disorders Hysterosalpingography: an x-ray of the cervix, uterus, and fallopian tubes (Continued)

Other Studies (Continued) Mammography Ultrasonography Magnetic resonance imaging to scan for pelvic tumors Colposcopy Mammography Ultrasonography Magnetic resonance imaging to scan for pelvic tumors Colposcopy

Other Studies (Continued) Laparoscopy Hysteroscopy Laparoscopy Hysteroscopy

Other Studies (Continued) Cervical biopsy Endometrial biopsy and Aspiration CfWUiClg/Endometrial-Biopsy-of-the- Uterus.html Breast biopsy and aspiration biopsy of breast fluid or tissue /Breast-Tissue-Biopsy.html Cervical biopsy Endometrial biopsy and Aspiration CfWUiClg/Endometrial-Biopsy-of-the- Uterus.html Breast biopsy and aspiration biopsy of breast fluid or tissue /Breast-Tissue-Biopsy.html

Other Diagnostic Tests Needle biopsy of the prostate Semen analysis Needle biopsy of the prostate Semen analysis