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Assessment of the Female Genitourinary System

Assessment of the Female Genitourinary System. Health Assessment Across the Lifespan NRS 102. Structure and Function Subjective Data—Health History Questions Objective Data—Physical Exam Abnormal Findings. Structure and Function External Genitalia or Vulva. Mons pubis Labia majora

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Assessment of the Female Genitourinary System

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  1. Assessment of the Female Genitourinary System Health Assessment Across the Lifespan NRS 102

  2. Structure and Function • Subjective Data—Health History Questions • Objective Data—Physical Exam • Abnormal Findings

  3. Structure and Function External Genitalia or Vulva • Mons pubis • Labia majora • Labia minora • Frenulum • Clitoris • Urethral meatus • Paraurethral (Skene’s) glands • Vaginal orifice • Hymen • Vestibular (Bartholin’s) glands

  4. Structure and Function (cont.) Internal Genitalia • Vagina • Cervix • Squamocolumnar junction • Anterior fornix and posterior fornix • Rectouterine pouch or cul-de-sac of Douglas • Uterus • Fallopian tubes

  5. Structure and Function (cont.) Developmental care • Infants and adolescents • Pregnant female • Aging female Cross-cultural care • Exposure of genitalia • Infibulation (female genital mutilation)

  6. Subjective Data—Health History Questions • Menstrual history • Obstetric history • Menopause • Self-care behaviors • Urinary symptoms • Vaginal discharge

  7. Subjective Data—Health History Questions (cont.) • History • Sexual activity • Contraceptive use • Sexually transmitted disease (STD) contact • STD risk reduction

  8. Subjective Data—Health History Questions (cont.) Additional history for infants and children • Urination • Perineal hygiene • Sexual abuse

  9. Subjective Data—Health History Questions (cont.) Additional history for preadolescents and adolescents • Start of period • Sex • Sexually transmitted disease • Sexual abuse

  10. Subjective Data—Health History Questions (cont.) Additional history for the aging adult • Postmenopausal bleeding • Atrophic vaginitis • Uterine prolapse • Sexual satisfaction

  11. Objective Data—Physical Exam Preparation • Lithotomy position and draping • Measures to enhance comfort during exam • Mirror pelvic examination

  12. Objective Data—Physical Exam (cont.) Equipment • Gloves • Protective clothing for examiner • Goose-necked lamp with a strong light • Vaginal speculum of appropriate size • Large cotton-tipped applicators (rectal swabs) • Materials for cytologic study • Lubricant

  13. Objective Data—Physical Exam (cont.) External genitalia—Inspection • Skin color • Hair distribution • Labia majora • Any lesions • Clitoris • Labia minora • Urethral opening • Vaginal opening • Perineum • Anus

  14. Objective Data—Physical Exam (cont.) External genitalia—Palpation • Skene’s glands • Bartholin’s glands • Support of pelvic musculature

  15. Objective Data—Physical Exam (cont.) Internal genitalia—Speculum examination • Insertion technique • Cervix and os • Color • Position • Size • Os • Surface • Any Nabothian cysts • Cervical secretions

  16. Objective Data—Physical Exam (cont.) • Obtain cervical smears and cultures • Vaginal pool • Cervical scrape • Endocervical specimen • Data to include for the laboratory • Inspect vaginal wall

  17. Internal genitalia—BimanualExamination Palpation technique Cervix Consistency Contour Mobility Uterus Adnexa Rectovaginal examination Rectovaginal septum Posterior uterine wall Cul-de-sac Rectum Objective Data—Physical Exam (cont.)

  18. Objective Data—Physical Exam (cont.) Developmental care • Infants and children • Adolescent • Pregnant female • Aging adult

  19. Sample Charting

  20. Sample Charting (cont.)

  21. Sample Charting (cont.)

  22. Abnormal FindingsAbnormalities of theExternal Genitalia • Pediculosis pubis (crab lice) • Syphilitic chancre • Herpes simplex virus—type 2 (herpes genitalis) • Red rash—contact dermatitis • Human papillomavirus (HPV) warts • Urethritis • Abscess of Bartholin’s gland • Urethral caruncle

  23. Abnormal Findings (cont.)Abnormalities of the Pelvic Musculature • Cystocele • Uterine prolapse • Rectocele

  24. Abnormal Findings (cont.)Abnormalities of the Cervix • Bluish cervix—cyanosis • Human papillomavirus (HPV, condylomata) • Diethylstilbestrol (DES) syndrome Erosion • Erosion • Polyp • Carcinoma

  25. Abnormal Findings (cont.)Vulvovaginal Inflammation • Atrophic vaginitis • Candidiasis (moniliasis) • Trichomoniasis • Chlamydia • Bacterial vaginosis • Gonorrhea

  26. Abnormal Findings (cont.)Conditions of Uterine Enlargement • Pregnancy • Myomas (leiomyomas, uterine fibroids) • Carcinoma of endometrium • Endometriosis

  27. Abnormal Findings (cont.)Adnexal Enlargement • Fallopian tube mass—acute salpingitis (pelvic inflammatory disease or PID) • Fallopian tube mass—ectopic pregnancy • Fluctuant ovarian mass—ovarian cyst • Solid ovarian mass—ovarian cancer

  28. Abnormal Findings (cont.)Abnormalities in the Pediatric Genitalia • Ambiguous genitalia • Vulvovaginitis in child

  29. Which subject is most appropriate for the start of the health history? • Menstrual history • Self-care behaviors • Sexual activity • Obstetric history

  30. Which would be the most appropriate way to start asking about sexual activity? • Ask open-ended questions. • Ask straightforward questions to elicit basic facts. • Ask whether the patient feels comfortable talking about sex. • Ask the patient whether she is currently in a sexual relationship.

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