1. Examination of Male & Female Genitalia, Breast, Prostate & Rectum
Janet M. Galiczewski
RN, CCRN, MSN, ANP

2. Breast A& P Breast overlies pectoralis major.
Breast is a hormonally sensitive tissue.
Upper Outer Quadrant-site of most breast cancers.
Breast composed of glandular tissue, fibrous tissue including suspensory ligaments, adipose tissue.
Proportion varies with age, cycle, pregnancy, lactation, & general nutrition.
Suspensory ligaments (Cooper’s Ligaments) support breast tissue, contract in CA breast-produce pits or dimples in overlying skin.

3. Breast Lymphatics Central Pectoral (Anterior) Subscapular (Posterior)
Lateral

5. Breast Cancer Risk Factors
Family History
Menstrual History
Pregnancy
Age
Sex
Education & Income
Location
Caucasian Women
A Good History is imperative

6. Techniques of Breast Exam.
Inspection:
Pt sitting, disrobed to the waist,arms at sides.
Inspect breasts, note appearance of skin; color, redness from infection or inflammatory CA.
Size & symmetry of breasts
Contour

7. Technique of Breast Exam.
Inspect nipples; note size & shape, direction in which they point, rashes or ulceration, discharge.
Assess breast development according to Tanner.
Check for dimpling or retraction.

8. Exam (Cont). Palpation: Ask pt. to lie down
Bring pts arm overhead, use pads of first three fingers, compress tissue gently.
Use a pattern: concentric circles (or other method).
Note: Consistency of tissues, tenderness, nodules.

9. If you find a nodule:
Location
Size
Shape
Consistency
Movable
Distinctness
Nipple
Lymphadenopathy

10. Exam (cont) Palpate each nipple.
Compress the areola with your index finger & thumb, watch for discharge.
Male Breast: Monthly exam (self), clinical exam every 1-3 years.
Inspect nipple & areola for nodules, swelling, ulceration.
Palpate the areola for nodules.

11. Breast Cancer Screening
Encourage bilateral self - breast exams monthly. 5-7 days after onset of menses. They should continue after menopause.
Age CBE every three years.
=/> 40 CBE yearly along with mammography.
For women at increased risk mammography should be initiated at 30 years of age.
After 70 the benefits of mammography is less well defined.

12. Save a Life 1 in 7 Choose to be proactive!! Choose to Live!!
Cumulative lifetime risk factor for developing BREAST CANCER is :
1 in 7
Choose to be proactive!!
Choose to Live!!

13. Female Genitalia A&P Labia Majora Labia Minora Vestibule Introitus
Perineum
Urethral Meatus
Skene’s Glands
Bartholin’s Glands

15. Female Genitalia (Internal)
Vagina
Uterus
Cervix
External Os
Fallopian Tubes
Ovaries; Adnexa

16. Internal Female Genitalia

17. Examination Empty Bladder Position & Drape Appropriately
Inspect external genitalia; separate labia majora & inspect
Labia minora
Clitoris
Urethral meatus
Introitus
Note:inflamm.,ulceration, discharge,swelling,nodules,palpate any lesions.

18. If you suspect urethritis or inflammation of the paraurethral glands (Skene’s): Insert index finger into vagina, milk urethra gently from inside outward.
May be R/T chlamydia or gonorrhea, get culture.

19. Internal Exam. Locate the cervix Assess support of the vaginal wall
Cystocele
Uterine Prolapse
Rectocele
Insert Speculum
Inspect Cervix & Os
Pap Smear

20. Exam (cont). Perform a Bimanual exam. Palpate the cervix
Palpate the uterus
Retroversion of the uterus
Palpate Each Ovary
Rectovaginal Exam

21. Male Genitalia A & P Shaft of the penis Glans Prepuce/foreskin Urethra
Urethral meatus
Scrotum
Testes

22. Male Genitalia

23. Inguinal canal
External Inguinal ring
Inguinal Hernias
Femoral Hernias
Prostate

25. Prostate

26. Examination of Male Genitalia
Penis
Inspection
Foreskin,smegma, phimosis, paraphimosis.
Glans; hypospadias
Palaption palpate shaft between thumb & 1st 2 fingers; feel for induration along ventral surface.
Scrotum
Palpation
Testicular Cancer (See Handout)

27. Examination of Male Genitalia
Transillumination of the scrotum
Hydrocele
Hernias: Inguinal & Femoral
Inspection
Palpation

28. Prostate Examination Note: Size:2.5cm x 4 cm wide
Shape:heart with palpable central groove
Consistency: elastic, rubbery
Nodules
Tenderness: nontender to palpation
Mobility: slightly mobile
Should not protrude more than 1 cm into rectum

29. Anus & Rectum
Anal canal surrounded by 2 layers of muscle called sphincters
Internal sphincter is under involuntary control.
External sphincter is under voluntary control.

30. Examination of the Anus & Rectum
Inspect saccrococcygeal & perianal areas for:
Lumps
Ulcers
Inflammation
Rashes
Excoriation
Hemorrhoids
Venereal warts
Herpes

31. Hemorrhoid

32. Examination of the Anus & Rectum
Examine sphincter tone of the anus; Note:
Tenderness
Induration
Irregularities
Insert finger clockwise & counterclockwise
Note; nodules, irregularities, induration
Stool for occult blood (Guiac)