1. Structure and Function N1037
Female Genitalia
Structure and Function
N1037

2. External Genitalia
Skene’s Gland openings not visible but open posterior to the urethra at the 5 and 7 o’clock positions
Bartholin’s glands secrete a clear lubricating mucus
Mons pubis
Labia majora
Labia minora
Frenulum
Clitoris
Vestibule = urethral meatus, opening of Skene’s glands (multiple), hymen, opening of Bartholin’s gland (x2)
Perineum
Anus

3. Internal Genitalia Vagina Cervix projects into the vagina
Is a tubular canal extending from the orifice up and backward into the pelvis
9 cm long and sits between the rectum posteriorly and the bladder/urethra anteriorly
Walls are in thick transverse folds (rugae) which enable expansion during childbirth.
Cervix projects into the vagina
Uterine cervix lies in front of the anterior rectal wall and may be palpated through it
Rectovaginal palpation allows for assessment of the rectovaginal septum, posterior uterine wall, cul-de-sac and rectum (repeat bimanual examination steps)

4. OS-is the opening in the
cervix.
OS changes shape following
Childbirth.
Included in your handout.
GOODELL’S SIGN
4-6 weeks: cervix softens,
Mucus plug, vag secret white
HEGAR’S SIGN
6-8 WKS: uterus softens
CHADWICK’S SIGN
8-12 wk: cyanosis of vaginal
Mucosa and cervix.

5. Internal Genitalia Rectouterine pouch Uterus
(cul-de-sac of Douglas) lies behind (separate from) the posterior fornix.
Uterus
pear-shaped, thick-walled, muscular organ
Top of the uteris is the Fundus
Body of uterus is the Corpus
Freely movable, not fixed and usually tilts forward and superior to the bladder (anteverted or anteflexed)
See p.701 to view other positions

6. Internal Genitalia Vagina Uterus Fallopian tubes Ovaries
Positions of the Uterus
Anteverted (most common)
Anteflexed
Midposition
Retroverted
Retroflexed
Fallopian tubes
trumpet shaped, 10 cm in length
Fimbriae direct ova into tube
Ovaries
oval shaped, are located one on each side of the uterus at the level of the superior iliac spine.
Serve to develop ova (eggs) as well as female hormones = oogenesis

7. Developmental Considerations
See Table-20-1 page 703, Sex Maturity Ratings in girls
The first signs of puberty are breast and pubic hair development around the ages of 8 ½ and 13 years.
They take about 3 years to complete
Menarche = the onset of menstruation
occurs during the latter half of this sequence, just after the peak of growth velocity.
Menopause occurs between the ages of 48 and 51 (35 to 60)
Irregular menses x 1 – 2 years
Ovaries stop producing progesterone and estrogen which brings dramatic physical changes.
Decrease vaginal secretions leave the vagina dry and at risk fro irritation and pain with intercourse.
Increased risk for vaginitis
Sexual desire and the need for full sexual expression continues.

8. Female Reproductive Cycle
Follicular phase
FSH LH
Ovulation
Luteal phase
Corpus luteum

10. Health History Age Race Adolescent to young adult
Middle to late adulthood
Race
African American

11. Chief Complaint Common chief complaints
Uterine bleeding
Vaginal discharge
Urinary symptoms
Pelvic pain
Characteristics of Chief Complaints
Quality
Quantity
Associated manifestations
Aggravating factors
Alleviating factors
Setting
Timing

12. Past Health History Medical history Surgical history Medications
Communicable diseases
Allergies
Injuries and accidents
Special needs
Childhood illnesses

13. Health History Family history Social history Alcohol and tobacco use
Sexual practices
Home environment
Hobbies and leisure activities
Stress

14. Health Maintenance Activities
Sleep
Diet
Exercise
Use of safety devices
Health check-ups

15. Key Questions to Ask Menstrual, obstetric, and menopause hxy PMS
Vaginal discharge
Uterine bleeding
Sexual functioning
Reproductive medical history
Method of birth control

16. Physical Assessment General equipment Special equipment
Examination table, lamp
Stool, preferably with wheels
Gloves
Linens for draping
Special equipment
Vaginal specula
Cytological materials

17. Physical Assessment General approach Before During After
Preparation for patient
Show instruments and explain
Prepare room, ensure comfort
During
Keep patient informed
After
Support and discuss

18. Subjective Data menstrual history obstetric history menopause
self-care behaviours
urinary symptoms
vaginal discharge, itching
past history
sexual activity
contraceptive use
STD contact

19. Inspection:External Genitalia
Pubic hair distribution
Skin color and condition
Mons pubis and vulva
Clitoris
Urethral meatus
Vaginal introitus
Perineum and anus

20. External Genitalia Normal Findings:
Pubic hair distribution shaped like an inverted 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
Vaginal mucosa is pink and moist
Normal vaginal discharge is clear to white, free of odor
Perineum is smooth, slightly darkened
Anus is dark pink to brown and puckered

21. Inspection:External Genitalia
Abnormal Findings:
Pubic Hair
Pediculosis pubis (Lice)
alopecia
Vaginal Discharges
Pale color, dryness = aging, estrogen changes
Foul-smelling discharge, color changes
See Table 20-3, pg 715
Cystocele, cystourethrocele, rectocele
Genital warts
Genital Herpes Simplex
Figures on pg 713
Urethral Meatus
Discharge = UTI
Perineum & anus
Fissure/ tear
Venous prominences = hemorrhoids

22. Palpation of External Genitalia
Labia
Urethral meatus and Skene’s glands
Vaginal introitus
Perineum

23. 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

24. Palpation of External Genitalia
Abnormal Findings:
Labia
Swelling, reddness, pain or purulent discharge + Bartholin’s Gland Infection
Urethral Meatus
Pain on contact & Discharge from urethra = UTI or Skene Gland Infection
Vaginal
Bulging of vaginal or pelvic contents = uterine prolapse, cystocele, retrocele
Perineum
Tears or fissures

25. Collecting Specimens-
Pap smear – 3 specimens collected – tests for Ca
Endocervical
Cervical
Vaginal
Chlamydia culture
Gonococcal culture- Z pattern
Saline mount – tests for WBC & protoza
KOH prep – tests for Candida albincans
Five percent acetic acid wash – tests for humanpapillomavirus = genital warts
Anal culture- tests for presence of gonorrheoae in Anal tissues

26. Normal Findings: Specimens
Pap smear within normal limits
Cervicovaginal tissues free of Neisseria gonorrhoeae, Candida albicans
< 10 WBCs in the saline mount specimen
Negative acetic acid wash test

27. Gerontological Variations
Menopause-related changes
Low estrogen levels
Cessation of menses
Generalized atrophy of external and internal female organs