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Female & Male Genitalia. Health Assessment. Female Health History. Menstrual History
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Female & Male Genitalia Health Assessment
Female Health History • Menstrual History • Age at menarche, frequency & duration of menstrual cycle, character or flow (amount and presence of clots), presence of dysmenorrhea (painful menstruation), dates of last two menstrual periods and premenstrual symptoms. • Bleeding outside of period or during menopause • Ie. Endometriosis, endometrial cancer • Obstetric History • Number of pregnancies, miscarriages or abortions, or complications
Female Health History • Received human papillomavirus (HPV) vaccine • Prevent against cervical cancer & genital warts • Symptoms of infection/STIs • Vaginal discharge, pelvic pain, swollen perianal tissues or genital lesions • Symptoms of genitourinary problems • Burning during urination (dysuria), frequency, urgency, nocturia, hematuria, incontinence, stress incontenence • Symptoms of Perimenopause • Hot flash, drenching sweats, mood swings, vaginal dryness, itching, numbness and tingling, headache, or palpitations.
Female Health History • Risk factors for ovarian cancer • >40 y/o, obese, history of ovarian dysfunction, breast or endometrial cancer, irradiation of pelvic organs, endometriosis, infertility or nulliparity, use of estrogen only hormone replacement • family history of ovarian, breast, or endometrial cancer • Risk factors for endometrial cancer • Postmenopausal, obese, infertile, early menarche, late menopause, HTN, DM, gallbladder disease, PCOS, estrogen-related exposure (HRT or tamoxifen use) • Family history of endometrial, breast, or colon cancer
Both Genders- Health History • Sexual history and current/past contraceptive practices • Oral contraceptives- Ask about tobacco use, history of blood clots due to increased risk for blood clots. • Previous illness or surgery involving reproductive organs, including STIs
Male Health History • Urinary symptoms • Frequency, nocturia, urgency, decreased urinary output, difficulty starting stream, hematuria • Penile pain or swelling, genital lesions or urethral discharge • Heaviness or painless enlargement of testis or irregular lumps • Performance of self testicular exam? • Presence of inguinal hernia • Difficulty achieving erection or ejaculation
Examination Tips • Explain each step of the examination in advance • Offer a chaperone • Keep patient draped for privacy • Avoid unexpected or sudden movements • Watch patient’s face to monitor comfort • Wear gloves
Inspection • Skin color • No suspicious pigmented lesions noted. • Hair distribution • Inverted triangle. No nits or lice. • Tanner staging for adolescence Note: The nurse will often examine external genitalia while performing routine hygiene measures or preparing to insert a urinary catheter
Inspection • Labia majora • Symmetrical, no excoriation, nodules, rash, lesions or edema • Perineum • Smooth • Well healed episiotomy scar
Inspection • With gloved hand separate labia major and inspect: • Clitoris • Labia minora • Dark pink and moist • Urethral opening • Slitlike and midline • Vaginal opening • No discharge or foul odor No excoriation, nodules, rash, lesions, or edema.
Discharge • Candidiasis- thick, white curdy • BV- thin, creamy gray-white; foul smelling • Trichomoniasis- frothy yellow-green; foul smelling • Chlamydia- White mucopurulent • Gonorrhea- yellowish
Female Abnormalities • Rectocele • Cystocele • Uterine prolapse
Speculum Examination • For routine pelvic exams patient should not be on menses • Patient should avoid intercourse, douching, vaginal suppositories and tampons 24 hours prior to exam • Have patient empty bladder before examination • Patient lies supine, with head and shoulders elevated • Have patient place heels in stir-ups, slide all the way down examination table until buttocks extend slightly beyond the edge • Thighs should be flexed, abducted and externally rotated at the hips • Have light source available and supplies accessible
Speculum Examination/Bimanual Palpation • Obtain cervical smears and cultures • Pap Smears for cervical cancer • Inspect vaginal wall and cervix • Palpate cervix, uterus & ovaries
Inspection of Penis • Skin • Winkled, hairless, without lesions or inflammation • Dorsal vein may be apparent
Inspection of Penis • Glans • Smooth, without lesions • May need to retract foreskin • Phimosis- unable to retract foreskin • Paraphimosis- Unable to return foreskin to original position • Smegma- 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 discharge • Profuse 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 Scrotum • Hold 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 thigh • Normal to palpate isolated node on occasion • Nonpalpable or small (<1cm), soft, discrete, and movable.
Testicular Cancer • Incidence is low, 4 per 100,000 • Peak age 15-35 • If found early, excellent prognosis • The 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.