Female & Male Genitalia Female & Male Genitalia

Health AssessmentHealth Assessment

Female Health HistoryFemale Health HistoryMenstrual HistoryMenstrual History Age at menarche, frequency & duration of Age at menarche, frequency & duration of

menstrual cycle, character or flow (amount and menstrual cycle, character or flow (amount and presence of clots), presence of dysmenorrhea presence of clots), presence of dysmenorrhea (painful menstruation), dates of last two (painful menstruation), dates of last two menstrual periods and premenstrual symptoms.menstrual periods and premenstrual symptoms.

Bleeding outside of period or during menopauseBleeding outside of period or during menopauseIe. Endometriosis, endometrial cancerIe. Endometriosis, endometrial cancer

Obstetric HistoryObstetric History Number of pregnancies, miscarriages or Number of pregnancies, miscarriages or

abortions, or complicationsabortions, or complications

Female Health HistoryFemale Health HistoryReceived human papillomavirus (HPV) vaccineReceived human papillomavirus (HPV) vaccine Prevent against cervical cancer & genital wartsPrevent against cervical cancer & genital warts

Symptoms of infection/STIsSymptoms of infection/STIs Vaginal discharge, pelvic pain, swollen perianal Vaginal discharge, pelvic pain, swollen perianal

tissues or genital lesionstissues or genital lesions

Symptoms of genitourinary problemsSymptoms of genitourinary problems Burning during urination (dysuria), frequency, Burning during urination (dysuria), frequency,

urgency, nocturia, hematuria, incontinence, stress urgency, nocturia, hematuria, incontinence, stress incontenence incontenence

Symptoms of PerimenopauseSymptoms of PerimenopauseHot flash, drenching sweats, mood swings, vaginal Hot flash, drenching sweats, mood swings, vaginal dryness, itching, numbness and tingling, headache, or dryness, itching, numbness and tingling, headache, or palpitations.palpitations.

Female Health HistoryFemale Health History

Risk factors for ovarian cancerRisk factors for ovarian cancer >40 y/o, obese, history of ovarian dysfunction, breast or >40 y/o, obese, history of ovarian dysfunction, breast or

endometrial cancer, irradiation of pelvic organs, endometrial cancer, irradiation of pelvic organs, endometriosis, infertility or nulliparity, use of estrogen endometriosis, infertility or nulliparity, use of estrogen only hormone replacementonly hormone replacement

family history of ovarian, breast, or endometrial cancerfamily history of ovarian, breast, or endometrial cancer

Risk factors for endometrial cancerRisk factors for endometrial cancer Postmenopausal, obese, infertile, early menarche, late Postmenopausal, obese, infertile, early menarche, late

menopause, HTN, DM, gallbladder disease, PCOS, menopause, HTN, DM, gallbladder disease, PCOS, estrogen-related exposure (HRT or tamoxifen use)estrogen-related exposure (HRT or tamoxifen use)

Family history of endometrial, breast, or colon cancerFamily history of endometrial, breast, or colon cancer

Both Genders- Health HistoryBoth Genders- Health History

Sexual history and Sexual history and current/past contraceptive current/past contraceptive practicespractices Oral contraceptives- Ask Oral contraceptives- Ask

about tobacco use, history of about tobacco use, history of blood clots due to increased blood clots due to increased risk for blood clots.risk for blood clots.

Previous illness or surgery Previous illness or surgery involving reproductive involving reproductive organs, including STIsorgans, including STIs

Male Health HistoryMale Health History

Urinary symptomsUrinary symptoms Frequency, nocturia, urgency, decreased urinary Frequency, nocturia, urgency, decreased urinary

output, difficulty starting stream, hematuria output, difficulty starting stream, hematuria

Penile pain or swelling, genital lesions or urethral Penile pain or swelling, genital lesions or urethral dischargedischarge

Heaviness or painless enlargement of testis or Heaviness or painless enlargement of testis or irregular lumpsirregular lumps Performance of self testicular exam?Performance of self testicular exam?

Presence of inguinal herniaPresence of inguinal hernia

Difficulty achieving erection or ejaculationDifficulty achieving erection or ejaculation

Examination TipsExamination Tips

Explain each step of the examination in advanceExplain each step of the examination in advanceOffer a chaperone Offer a chaperone Keep patient draped for privacyKeep patient draped for privacyAvoid unexpected or sudden movementsAvoid unexpected or sudden movementsWatch patient’s face to monitor comfortWatch patient’s face to monitor comfortWear glovesWear gloves

Female Exam

InspectionInspection

Skin colorSkin color No suspicious pigmented No suspicious pigmented

lesions noted.lesions noted.

Hair distributionHair distribution Inverted triangle. No nits or Inverted triangle. No nits or

lice.lice. Tanner staging for Tanner staging for

adolescenceadolescence

Note: The nurse will often examine external Note: The nurse will often examine external genitalia while performing routine hygiene genitalia while performing routine hygiene measures or preparing to insert a urinary measures or preparing to insert a urinary cathetercatheter

InspectionInspectionLabia majoraLabia majora Symmetrical, Symmetrical,

no no excoriation, excoriation, nodules, rash, nodules, rash, lesions or lesions or edemaedema

PerineumPerineum SmoothSmooth Well healed Well healed

episiotomy episiotomy scarscar

Female Abnormalities

InspectionInspectionWith gloved hand With gloved hand separate labia major separate labia major and inspect:and inspect: ClitorisClitoris Labia minoraLabia minora

Dark pink and moistDark pink and moist Urethral openingUrethral opening

Slitlike and midlineSlitlike and midline Vaginal openingVaginal opening

No discharge or foul No discharge or foul odorodor

No excoriation, nodules, No excoriation, nodules, rash, lesions, or rash, lesions, or edema.edema.

DischargeDischarge

Candidiasis- thick, white Candidiasis- thick, white curdycurdy

BV- thin, creamy gray-BV- thin, creamy gray-white; foul smellingwhite; foul smelling

Trichomoniasis- frothy Trichomoniasis- frothy yellow-green; foul yellow-green; foul smellingsmelling

Chlamydia- White Chlamydia- White mucopurulentmucopurulent

Gonorrhea- yellowishGonorrhea- yellowish

Female Abnormalities

Female AbnormalitiesFemale Abnormalities

RectoceleRectocele

CystoceleCystocele

Uterine prolapseUterine prolapse

Speculum ExaminationSpeculum ExaminationFor routine pelvic exams patient should not For routine pelvic exams patient should not

be on mensesbe on menses

Patient should avoid intercourse, douching, vaginal Patient should avoid intercourse, douching, vaginal suppositories and tampons 24 hours prior to examsuppositories and tampons 24 hours prior to exam

Have patient empty bladder before examinationHave patient empty bladder before examination

Patient lies supine, with head and shoulders elevatedPatient lies supine, with head and shoulders elevated

Have patient place heels in stir-ups, slide all the way Have patient place heels in stir-ups, slide all the way down examination table until buttocks extend slightly down examination table until buttocks extend slightly beyond the edgebeyond the edge

Thighs should be flexed, abducted and externally rotated Thighs should be flexed, abducted and externally rotated at the hipsat the hips

Have light source available and supplies accessibleHave light source available and supplies accessible

Speculum Examination/Bimanual Speculum Examination/Bimanual PalpationPalpation

Obtain cervical smears and culturesObtain cervical smears and cultures Pap Smears for cervical cancerPap Smears for cervical cancer

Inspect vaginal wall and cervixInspect vaginal wall and cervix

Palpate cervix, uterus & ovariesPalpate cervix, uterus & ovaries

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ChartingCharting

Male Genitalia

Male Anatomy

Inspection- Tanner Stage

Inspection of PenisSkin

Winkled, hairless, without lesions or inflammation

Dorsal vein may be apparent

Inspection of Penis

Glans Smooth, without

lesions May need to retract

foreskinPhimosis- unable to retract foreskinParaphimosis- Unable to return foreskin to original positionSmegma- Cheesy substance under foreskin

Inspection/Palpation of Penis

Urethral meatus Positioned centrally

Hypospastic- ventral location

Epispadias- dorsal location

Compress glans anteroposteriorly between thumb and forefinger to assess for dc

Meatus pink, smooth, without dischargeProfuse yellow = gonococcal

Scanty white = possible Chlamydia

Palpation of Penis

Palpate shaft between thumb and first 2 finger.

Assess for nodules, induration, or tenderness

Smooth, semifirm, and nontender

If man gets erection during the exam, explain that it is a normal response and finish the exam

Inspection of ScrotumHold scrotum out of way with back of hand

Mild asymmetry normal Left often lower than right

Assess for edema and lesions

Palpation of Scrotum

Palpate scrotum, epididymis & spermatic cord between thumb and first two fingers

Testes- freely movable, oval, firm, rubbery, smooth and equal bilaterally.

Palpation of Scrotum

Epididymis- discrete, smooth, and nontender

Spermatic cord- smooth and nontender

Inspect for Hernia

Inspect inguinal region for bulge as person stands and strains down.

No bulge noted

Palpation for Hernia

Gently insert finger into canal and ask patient to bear down.

No inguinal hernia noted.

Palpate femoral areas for bulge

No femoral hernia noted.

Palpate Inguinal Lymph Nodes

Palpate inferior to inguinal ligament and along upper inner thighNormal to palpate isolated node on occasion

Nonpalpable or small (<1cm), soft, discrete, and movable.

Testicular Cancer

Incidence is low, 4 per 100,000Peak age 15-35If found early, excellent prognosisThe best time to examine testicles is during or after a shower or bath. The warm water allows the scrotum to relax and the testicles to drop down. The left testicle normally hangs a bit lower than the right. It is common for one testicle to be larger than the other one. Young men should examine themselves once a month. More frequent exams actually may result in missing a slowly changing lump.

Testicular Self Exam

Support each testicle with one hand and examine it with the other. Gently roll each testicle between the thumb and fingers. Testicles should feel firm and smooth, about the consistency of a hard-boiled egg without the shell. The epididymis is a ropelike structure attached to the back of the testis. This structure is not an abnormal lump Feel for firm masses, lumps, or nodules in the testicle. In cancer, these lumps often are painless. Become familiar with normal size, shape, and weight of each testicle and epididymis. This will help you recognize a change from one self-examination to another, if a change should occur.

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