1. FEMALE GENITAL SYSTEM
PREMED H&P

2. External Female Genitalia
Vulva – Includes the (Folds) labia structures, clitoris, urethral openings and vagina
Labia Majora – Round, folds of adipose tissue
Labia Minora – Thin, pinkish, red folds of skin that extend to form the prepuce and the clitoris
Clitoris – Contains nerve endings for sexual pleasure
Prepuce - Fold of skin covering the clitoris
Vestibule – Fossa between the labia minora

4. Urethral Meatus – Found between the clitoris and vagina
Bartholin Glands – Located on either side of the vagina
Perineum – Tissue between the vaginal opening and the anus

6. Uterus – Body (corpus), Isthmus, Fundus (upper portion),cervix
Vagina – Hollow tube that extends upward from the vulva externally to the uterus internally (uterine cervix)
Uterus – Body (corpus), Isthmus, Fundus (upper portion),cervix
Ectocervix – Vagina opening into the cervix, also called the “external os”
Viewed through a speculum

7. Fallopian Tube – Extends from each side of the uterus toward the ovary
Adnexa: Ovaries, Fallopian tubes
Ovaries: Production of ova (egg) and secretion of hormones (progesterone, estrogen, testosterone)

9. Hormone secretions during puberty stimulate the growth of the uterus and its lining
Also stimulate secondary sex characteristics – breasts and pubic hair
Lymphatics from vulva and lower vagina drains into the inguinal nodes
Lymphatics from upper vagina and internal genitalia drains into the pelvic and abdominal lymph nodes

10. Leukorrhea – Vaginal secretions and produced during sexual arousal
Before menarche or menstruation, there is an increase in vaginal secretions
Leukorrhea – Vaginal secretions and produced during sexual arousal
*Must be differentiated with discharge during infection

11. Aging With age, ovarian function diminishes during a woman’s 40’s
Menstrual period stops at an age between 45 and 52
Pubic hair becomes less and gray
With a decline in estrogen, labia and clitoris becomes smaller, vagina narrows and shortens
Uterus and ovaries diminish in size as well

12. History
What are the common concerning complaints in a female?

13. Menstruation (Flow of blood between 3 to 7days)
Menopause (Absence of menses for 12 months)
Pregnancy
Vulva/Vaginal symptoms
Sexual activity
Example – Date of first period (“age at menarche”) – Possible pregnancy or menstrual irregularities

14. Amenorrhea – Absence of periods
Amenorrhea with heavy bleeding may be an abortion
Oligomenorrhea – Infrequent periods, irregular
Dysmenorrhea – Pain with menses, “cramping pain” in the lower abdomen
Premenstrual syndrome (PMS) – Complex symptoms that occur 4 to 10 days before periods
Includes tension, nervousness, irritability, depression, mood swings, weight gain, bloating, edema and tenderness of breasts, and headache

15. Vulva/Vaginal symptoms: - Vaginal discharge, itching
Menopausal Symptoms – Hot flashes, flushing, sweating, and sleep disturbances
*Post-menopausal bleeding can indicate endometrial cancer
Vulva/Vaginal symptoms: - Vaginal discharge, itching
Dyspareunia – Pain during intercourse
Vaginismus – Involuntary spasm of muscle around vagina making penetration hard

16. PHYSICAL EXAMINATION 1. Assess patient’s sexual maturity
*Delayed puberty may be familial or chronic illness. Also medical abnormalities with the hypothalamus, pituitary gland, ovary
2. Inspect Patient’s external genitalia
Labia minora, clitoris, urethral meatus, vaginal opening
Note for inflammation, ulceration, discharge, swelling

18. INTERNAL EXAMINATION Inserting Speculum Inspect the cervix
Color of cervix, position, characteristic, ulceration, nodules, mass, bleeding, discharge
Obtain specimen for Pap Smear
Perform a bimanual examination
Using the index and middle fingers
Palpate cervix and uterus