1. ASSESSING THE FEMALE GENITOURINARY SYSTEM

2. Outcomes Identify pertinent genitourinary history questions.
Obtain a female genitourinary history.
Perform a female genitourinary physical assessment.
(Continued)

3. Outcomes Document pertinent genitourinary assessment findings.
Identify actual/potential health problems stated as nursing diagnosis.
Differentiate between normal and abnormal findings.

4. Structures Mons pubis  Labia majora & minora
Clitoris  Urinary meatus
Perineum  Bartholin’s glands
Anus  Cervix
Uterus  Fallopian tubes
Ovaries  Kidneys
Urethra  Bladder
Vagina  Skene’s gland

5. Anatomy and Physiology Review

6. Functions What are the functions of…
Mons pubis:
Subcutaneous pad over symphysis pubis for protection
Labia majora/minora:
Folds of adipose and connective tissue that protect and lubricate external genitalia
(Continued)

7. Functions What are the functions of…
Clitoris:
Erectile tissue for sexual stimulation
Urinary meatus:
Opening to urethra
Skene’s glands:
Lubricate and protect
(Continued)

8. Functions What are the functions of…
Vaginal introitus:
Opening of the vagina
Vagina:
Muscular tube for copulation, birth canal, and menses
Bartholin’s glands:
Secretes alkaline mucus that improves viability & motility of sperm
(Continued)

9. Functions What are the functions of…
Cervix:
End of the uterus into vagina
Uterus:
Hollow, muscular organ; site for fertilized egg implantation; protects fetus
(Continued)

10. Functions What are the functions of…
Tubes:
Passage for ovum to uterus, site of fertilization
Ovaries:
Produce ova, estrogen and progesterone
Kidneys:
Filter and excrete wastes (Continued)

11. Functions What are the functions of…
Ureter:
Connects kidneys to bladder
Bladder:
Hollow muscular structure; holds urine
Urethra:
Connects bladder to urinary meatus opening

12. Relationship to Other Systems
What is the relationship of the female genitourinary system to other systems?
Integumentary
Gastrointestinal
Lymphatic
Musculoskeletal
Cardiovascular
Respiratory
Endocrine
Neurological

14. Developmental Variations
Children—next quarter
Pregnant clients—next quarter
Older Women
Reproductive ability peaks in late 20’s
Estrogen levels begin to decline, and between 46 & 55 menstrual periods become shorter, less frequent, & cease
Increased risk of infection (decreased vaginal secretions)

15. Cultural Variations page 618
African Americans
Asians
Jews
Native Americans
Whites

16. Case Study
Mrs. James, 29-year- old, married, mother of 4-year-old daughter, housewife
C/O scant midcycle vaginal bleeding for past 2 months
Annual PAP test and gynecologic exam

17. Symptoms What symptoms would signal a problem with the female genitourinary system?
Vaginal discharge
Lesions
Vaginal bleeding, pain
Amenorrhea
Urinary symptoms

18. Pertinent History Findings
Midcycle vaginal bleeding
Taking BCP, occasional ASA
+ History of rheumatic fever
Gravida 1/para 1; menarche 12; LMP 21 days ago, cycle every days, menses 5 days, moderate-to-light flow.
Sexually active in monogamous, heterosexual relationship, satisfied with sexual performance

19. Physical Assessment
Anatomical landmarks: external--note position of structures; internal--visualize underlying structures
Approach: inspection, palpation
Position: lithotomy
Tools: gloves, speculum, lubricant, light, slides and swabs for specimen collection
General survey and head-to-toe scan

20. Inspection
External genitalia: color, hair distribution, condition of skin, lesions, discharge, odor, pubic pediculosis, prolapse
Rectal area: condition of skin, lesions, discharge, bleeding, hemorrhoids, fissures
(Continued)

21. Inspection
Pelvic exam: color, lesions of vaginal walls; color, lesions, discharge, position, size, shape, and patency of cervical os (obtain specimens)

22. Palpation
Skene’s and Bartholin’s glands: masses, swelling, discharge, tenderness
Vaginal wall: texture, swelling, lesions, tenderness
Cervix: size, shape, consistency, position, mobility, tenderness
Uterus: size, shape, symmetry, position, masses, tenderness

23. Palpation Ovaries: size, shape, symmetry, tenderness
Anus and Rectum: sphincter tone, tenderness, lesions, masses, hemorrhoids, polyps; test any stool for occult blood

26. Pertinent Physical Findings
External genitalia pink, moist, intact; small amount of white, ordorless discharge; no lesions
Vaginal walls and cervix pink, moist, intact; no lesions
Uterus anteverted, no masses, non-tender
Ovaries and tubes non-palpable
No rectal masses; hematest negative

27. Nursing Diagnosis
What actual or potential problems can you identify for Mrs.James?