1. Copyright © 2015 by Mosby, an imprint of Elsevier Inc. . Chapter 18 Female Genitalia

2. Copyright © 2015 by Mosby, an imprint of Elsevier Inc.  " Unless someone like you cares a whole awful lot. Nothing is going to get better; It's not”  --Dr Seuss

3. Copyright © 2015 by Mosby, an imprint of Elsevier Inc. External Genitalia  Patient is in the lithotomy position.  Inspect the pubic hair characteristics and distribution.  Inspect and palpate the labia  Inspect the urethral meatus and vaginal opening  Palpate the Bartholin glands  Inspect and palpate the perineum 3

4. Copyright © 2015 by Mosby, an imprint of Elsevier Inc. Internal Genitalia Speculum Examination  Collect necessary specimens.  Inspect the cervix  Inspect and palpate vaginal walls  Adnexa  Fallopian tubes  Ovaries 4

5. Copyright © 2015 by Mosby, an imprint of Elsevier Inc. Bimanual Examination  Palpate the uterus  Palpate the ovaries  Palpate the adnexal areas for masses and tenderness  Ovaries  Fallopian tubes 5

6. Copyright © 2015 by Mosby, an imprint of Elsevier Inc. Rectovaginal Examination  Palpate the posterior aspect of the uterus.  Palpate the anterior and posterior rectal wall 6

7. Copyright © 2015 by Mosby, an imprint of Elsevier Inc. Adolescents  Puberty  functional maturation of reproductive organs is seen. 7

8. Copyright © 2015 by Mosby, an imprint of Elsevier Inc. Pregnant Women  Softened pelvic cartilage and cervix  Symphysis of pelvic joint separates  Chadwick sign  Bluish color to cervix 8

9. Copyright © 2015 by Mosby, an imprint of Elsevier Inc. Older Adults  Menopause 9

10. Copyright © 2015 by Mosby, an imprint of Elsevier Inc. History  Abnormal bleeding  Pain  Vaginal discharge  Premenstrual complaints  Menopause symptoms complaints  Infertility  Urinary symptoms 10

11. Copyright © 2015 by Mosby, an imprint of Elsevier Inc. History (Cont.)  Menstrual history  Pregnancy history  Menopausal history  Gynecological history 11

12. Copyright © 2015 by Mosby, an imprint of Elsevier Inc. Family/ Personal History  Diabetes  Cancer of reproductive organs  Multiple pregnancies  Congenital anomalies  Contraceptive history  Date of last pelvic exam and Pap smear  Sexual history 12

13. Copyright © 2015 by Mosby, an imprint of Elsevier Inc. Adolescents  Talk with teen in private  Should not assume that youthful age precludes sexual activity or any of the related concerns  Questions should be posed in a gentle, matter- of-fact, and nonjudgmental manner 13

14. Copyright © 2015 by Mosby, an imprint of Elsevier Inc. Older Adults  Menopausal history  History associated with age  Urinary problems 14

15. Copyright © 2015 by Mosby, an imprint of Elsevier Inc. Equipment  Drapes  Speculum  Specimen collection supplies  Slides  Cytologic fixation  Culture plates/ media  Gloves  Water-soluble lubricant  Lamp 15

16. Copyright © 2015 by Mosby, an imprint of Elsevier Inc. Preparation  Assist the patient into the lithotomy position on the examining table. 16

17. Copyright © 2015 by Mosby, an imprint of Elsevier Inc. External Examination  Labia majora  Labia minora  Clitoris  Urethral orifice  Vaginal introitus 17

18. Copyright © 2015 by Mosby, an imprint of Elsevier Inc. External Examination (Cont.)  Skene glands  Bartholin glands  Perineum  Anus 18

19. Copyright © 2015 by Mosby, an imprint of Elsevier Inc. Internal Examination  Cervix  Pap smear  Cytologic smear  DNA probe  Chlamydia and gohhorrea  Wet mount  Bacterial vaginosis 19

20. Copyright © 2015 by Mosby, an imprint of Elsevier Inc. Bimanual Examination  Cervix  Uterus  Ovaries  Adnexa 20

21. Copyright © 2015 by Mosby, an imprint of Elsevier Inc. Rectovaginal Examination  Uterus: confirm bimanual examination findings  Location and position  Size, shape, and contour  Consistency  Tenderness 21

22. Copyright © 2015 by Mosby, an imprint of Elsevier Inc. Infants  Inspect and palpate external genitalia only.  Expected swelling of labia minora 22

23. Copyright © 2015 by Mosby, an imprint of Elsevier Inc. Children  Internal examination only if evidence of:  Bleeding  Discharge  Trauma or abuse  Behavioral changes 23

24. Copyright © 2015 by Mosby, an imprint of Elsevier Inc. Adolescents  All adolescent females should have a pelvic examination within 3 years of initiating sexual intercourse.  Young women who are not sexually active should have their first examination by age 21 years. 24

25. Copyright © 2015 by Mosby, an imprint of Elsevier Inc. Older Adults  Age-related changes  Vaginal introitus may be constricted.  Vagina is narrower and shorter. 25

26. Copyright © 2015 by Mosby, an imprint of Elsevier Inc. Abnormalities  Premenstrual syndrome (PMS)  Collection of physical, psychological, and mood symptoms related to a woman’s menstrual cycle  Infertility  Inability to conceive over a period of 1 year of unprotected sexual intercourse 26

27. Copyright © 2015 by Mosby, an imprint of Elsevier Inc. Abnormalities (Cont.)  Menopause  Cessation of menstrual cycle  1 year with no menses  Endometriosis  Presence and growth of endometrial tissue outside the uterus 27

28. Copyright © 2015 by Mosby, an imprint of Elsevier Inc. Abnormalities (Sexually Transmitted Infections)  Condyloma acuminatum (genital warts)  Warty lesions due to sexually transmitted infection with human papillomavirus (HPV)  Genital herpes  From herpes simplex  HSV-2 is most common 28

29. Copyright © 2015 by Mosby, an imprint of Elsevier Inc. Abnormalities (STI’s)  Inflammation of Bartholin gland  Commonly, but not always, caused by Neisseria gonorrhoeae  Vaginal infections  Bacterial vaginosis (Gardnerella vaginalis)  Candida vulvovaginitis (Candida albicans)  Trichomoniasis (Trichomonas vaginalis)  Gonorrhea  Chlamydia 29

30. Copyright © 2015 by Mosby, an imprint of Elsevier Inc. Abnormalities (Cervix)  Cervical polyp  Bright red soft protrusion from endocervical canal  Cervical cancer  Two main types of cervical cancer, named for the cell type from which the cancer arises:  Squamous cell carcinoma  Adenocarcinoma 30

31. Copyright © 2015 by Mosby, an imprint of Elsevier Inc. Abnormalities (Uterus)  Endometrial cancer  Cancers of the glandular cells found in the lining of the uterus 31

32. Copyright © 2015 by Mosby, an imprint of Elsevier Inc. Abnormalites (Adnexa)  Ovarian cysts  Fluid-filled sac in an ovary  Ovarian cancer  Classified by the cells from which the cancer arises  Epithelial  Stromal  Germ cell  Tubal (ectopic) pregnancy  Pregnancy occurring outside the uterus 32

33. Copyright © 2015 by Mosby, an imprint of Elsevier Inc. Abnormalities (Adnexa)  Pelvic inflammatory disease (PID)  Infection of the uterus, fallopian tubes, and other reproductive organs  Common and serious complication of some sexually transmitted infections 33

34. Copyright © 2015 by Mosby, an imprint of Elsevier Inc. Abnormalities (Older Adults)  Urinary incontinence  Stress  Urge  Overflow  Functional 34