Chapter 20 Female Genitalia Copyright 2002 Delmar A

Chapter 20 Female Genitalia Copyright 2002, Delmar, A division of Thomson Learning

Competencies l l Describe the anatomy and physiology of the female genitalia, including age-relevant transformations. Demonstrate the techniques necessary for assessment of the female genitalia, including patient positioning, external and internal inspection, speculum procedures, and palpation methods. Copyright 2002, Delmar, A division of Thomson Learning (continues)

Competencies l l l Identify anatomic landmarks during bimanual vaginal, uterine, and rectovaginal examinations. Identify normal findings as well as atypical findings of the vulva, vagina, and cervix. Describe procedures for genital and anal smears and cultures. Copyright 2002, Delmar, A division of Thomson Learning

Anatomy and Physiology l External female genitalia Labia majora £ Labia minora £ Clitoris £ Vaginal introitus £ Urethral meatus £ (continues) Copyright 2002, Delmar, A division of Thomson Learning

Anatomy and Physiology l Internal female genitalia Vagina £ Uterus £ Cervix £ Fundus £ Ovaries £ Fallopian tubes £ Copyright 2002, Delmar, A division of Thomson Learning

Female Reproductive Cycle l Follicular phase FSH £ LH £ Ovulation £ l Luteal phase LH £ Corpus luteum £ Copyright 2002, Delmar, A division of Thomson Learning

Health History l Age Adolescent to young adult £ Middle to late adult £ l Race £ Ethnic minorities Copyright 2002, Delmar, A division of Thomson Learning

Chief Complaint l Common chief complaints Uterine bleeding £ Vaginal discharge £ Urinary symptoms £ Pelvic pain £ l Characteristics to assess Copyright 2002, Delmar, A division of Thomson Learning

Past Health History l l l l Medical history Surgical history Medications Communicable diseases Allergies Injuries Special needs Childhood illnesses Copyright 2002, Delmar, A division of Thomson Learning

Health History l l Family history Social history Substance use £ Sexual practices £ Hobbies £ Stress £ l Health maintenance Copyright 2002, Delmar, A division of Thomson Learning

Key Questions to Ask l l l l Menstrual, obstetric, and menopause histories PMS Vaginal discharge Uterine bleeding Sexual functioning Reproductive medical history Method of birth control Copyright 2002, Delmar, A division of Thomson Learning

Physical Assessment l Special equipment Vaginal specula £ Cytological materials £ l General approach Prior £ During £ After £ Copyright 2002, Delmar, A division of Thomson Learning

Inspection: External Genitalia l l Pubic hair distribution Skin color and condition Mons pubis and vulva £ Urethral meatus £ Vaginal introitus £ Perineum and anus £ Copyright 2002, Delmar, A division of Thomson Learning

Palpation of External Genitalia l l Labia Urethral meatus and Skene’s glands Vaginal introitus Perineum Copyright 2002, Delmar, A division of Thomson Learning

Speculum Examination of the Cervix l l Use of speculum Characteristics of assessment Color £ Position £ Size £ Surface characteristics £ Discharge £ Shape of cervical os £ Copyright 2002, Delmar, A division of Thomson Learning

Collecting Specimens l Pap smear Endocervical £ Cervical £ Vaginal £ l l l Gonococcal culture Saline mount KOH prep Five percent acetic acid wash Anal culture Copyright 2002, Delmar, A division of Thomson Learning

Inspection l l l l Vaginal wall Bimanual examination Vagina Cervix Fornices Uterus Adnexa Rectovaginal examination Copyright 2002, Delmar, A division of Thomson Learning

Gerontological Variations l l Menopause-related changes Low estrogen levels Cessation of menses Generalized atrophy of external and internal female organs Copyright 2002, Delmar, A division of Thomson Learning

Normal Findings: Inspection l l Pubic hair distribution shaped like an inverse 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 (continues) Copyright 2002, Delmar, A division of Thomson Learning

Normal Findings: Inspection l l Vaginal mucosa is pink and moist Normal vaginal discharge is clear to white, free from odor Perineum is smooth, slightly darkened Anus is dark pink to brown and puckered Copyright 2002, Delmar, A division of Thomson Learning

Normal Findings: Palpation l l 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 Copyright 2002, Delmar, A division of Thomson Learning

Normal Findings: Internal Genitalia l l Cervix is pink, pale (menopause), or blue (pregnancy) Cervix is midline Glistening pink cervical epithelium Cervical os is round in nulliparous; or a horizontal slit in multiparous Copyright 2002, Delmar, A division of Thomson Learning

Normal Findings: Cytological Smears and Cultures l l l Pap smear within normal limits Cervicovaginal tissues free from Neisseria gonorrheae, Candida albicans < 10 WBC’s in the saline mount specimen Negative acetic acid wash test Vaginal wall is pink, moist, deeply rugated Copyright 2002, Delmar, A division of Thomson Learning

Normal Findings l l Vaginal wall is nontender, free from lesions, masses, or cysts Cervix is mobile, nontender, symmetrical, rounded, and midline Uterus is pear-shaped in nongravid; rounded in parous Ovaries are almond-shaped, firm, smooth, and mobile without tenderness Copyright 2002, Delmar, A division of Thomson Learning