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Female Genitalia

Female Genitalia. Structure and Function N1037. External Genitalia. Mons pubis Labia majora Labia minora Frenulum Clitoris Vestibule = urethral meatus, opening of Skene’s glands (multiple), hymen, opening of Bartholin’s gland (x2) Perineum Anus.

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Female Genitalia

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  1. Female Genitalia Structure and Function N1037

  2. External Genitalia • Mons pubis • Labia majora • Labia minora • Frenulum • Clitoris • Vestibule = urethral meatus, opening of Skene’s glands (multiple), hymen, opening of Bartholin’s gland (x2) • Perineum • Anus • Skene’s Gland openings not visible but open posterior to the urethra at the 5 and 7 o’clock positions • Bartholin’s glands secrete a clear lubricating mucus

  3. Internal Genitalia • Vagina • Is a tubular canal extending from the orifice up and backward into the pelvis • 9 cm long and sits between the rectum posteriorly and the bladder/urethra anteriorly • Walls are in thick transverse folds (rugae) which enable expansion during childbirth. • Cervix projects into the vagina • Uterine cervix lies in front of the anterior rectal wall and may be palpated through it • Rectovaginal palpation allows for assessment of the rectovaginal septum, posterior uterine wall, cul-de-sac and rectum (repeat bimanual examination steps)

  4. OS-is the opening in the cervix. OS changes shape following Childbirth. Included in your handout. GOODELL’S SIGN 4-6 weeks: cervix softens, Mucus plug, vag secret white HEGAR’S SIGN 6-8 WKS: uterus softens CHADWICK’S SIGN 8-12 wk: cyanosis of vaginal Mucosa and cervix.

  5. Internal Genitalia • Rectouterine pouch • (cul-de-sac of Douglas) lies behind (separate from) the posterior fornix. • Uterus • pear-shaped, thick-walled, muscular organ • Top of the uteris is the Fundus • Body of uterus is the Corpus • Freely movable, not fixed and usually tilts forward and superior to the bladder (anteverted or anteflexed) • See p.701 to view other positions

  6. Internal Genitalia • Vagina • Uterus • Positions of the Uterus • Anteverted(most common) • Anteflexed • Midposition • Retroverted • Retroflexed • Fallopian tubes • trumpet shaped, 10 cm in length • Fimbriae direct ova into tube • Ovaries • oval shaped, are located one on each side of the uterus at the level of the superior iliac spine. • Serve to develop ova (eggs) as well as female hormones = oogenesis

  7. Developmental Considerations • See Table-20-1 page 703, Sex Maturity Ratings in girls • The first signs of puberty are breast and pubic hair development around the ages of 8 ½ and 13 years. • They take about 3 years to complete • Menarche = the onset of menstruation • occurs during the latter half of this sequence, just after the peak of growth velocity. • Menopause occurs between the ages of 48 and 51 (35 to 60) • Irregular menses x 1 – 2 years • Ovaries stop producing progesterone and estrogen which brings dramatic physical changes. • Decrease vaginal secretions leave the vagina dry and at risk fro irritation and pain with intercourse. • Increased risk for vaginitis • Sexual desire and the need for full sexual expression continues.

  8. Female Reproductive Cycle • Follicular phase • FSH • LH • Ovulation • Luteal phase • LH • Corpus luteum

  9. Health History • Age • Adolescent to young adult • Middle to late adulthood • Race • African American

  10. Chief Complaint • Common chief complaints • Uterine bleeding • Vaginal discharge • Urinary symptoms • Pelvic pain • Characteristics of Chief Complaints • Quality • Quantity • Associated manifestations • Aggravating factors • Alleviating factors • Setting • Timing

  11. Past Health History • Medical history • Surgical history • Medications • Communicable diseases • Allergies • Injuries and accidents • Special needs • Childhood illnesses

  12. Health History • Family history • Social history • Alcohol and tobacco use • Sexual practices • Home environment • Hobbies and leisure activities • Stress

  13. Health Maintenance Activities • Sleep • Diet • Exercise • Use of safety devices • Health check-ups

  14. Key Questions to Ask • Menstrual, obstetric, and menopause hxy • PMS • Vaginal discharge • Uterine bleeding • Sexual functioning • Reproductive medical history • Method of birth control

  15. Physical Assessment General equipment Examination table, lamp Stool, preferably with wheels Gloves Linens for draping Special equipment Vaginal specula Cytological materials

  16. Physical Assessment • General approach • Before • Preparation for patient • Show instruments and explain • Prepare room, ensure comfort • During • Keep patient informed • After • Support and discuss

  17. Subjective Data • menstrual history • obstetric history • menopause • self-care behaviours • urinary symptoms • vaginal discharge, itching • past history • sexual activity • contraceptive use • STD contact

  18. Inspection:External Genitalia • Pubic hair distribution • Skin color and condition • Mons pubis and vulva • Clitoris • Urethral meatus • Vaginal introitus • Perineum and anus

  19. External Genitalia • Normal Findings: • Pubic hair distribution shaped like an inverted 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 • Vaginal mucosa is pink and moist • Normal vaginal discharge is clear to white, free of odor • Perineum is smooth, slightly darkened • Anus is dark pink to brown and puckered

  20. Inspection:External Genitalia • Abnormal Findings: • Pubic Hair • Pediculosis pubis (Lice) • alopecia • Vaginal Discharges • Pale color, dryness = aging, estrogen changes • Foul-smelling discharge, color changes • See Table 20-3, pg 715 • Cystocele, cystourethrocele, rectocele • Genital warts • Genital Herpes Simplex • Figures on pg 713 • Urethral Meatus • Discharge = UTI • Perineum & anus • Fissure/ tear • Venous prominences = hemorrhoids

  21. Palpation of External Genitalia • Labia • Urethral meatus and Skene’s glands • Vaginal introitus • Perineum

  22. Normal Findings: Palpation • 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

  23. Palpation of External Genitalia • Abnormal Findings: • Labia • Swelling, reddness, pain or purulent discharge + Bartholin’s Gland Infection • Urethral Meatus • Pain on contact & Discharge from urethra = UTI or Skene Gland Infection • Vaginal • Bulging of vaginal or pelvic contents = uterine prolapse, cystocele, retrocele • Perineum • Tears or fissures

  24. Collecting Specimens- • Pap smear – 3 specimens collected – tests for Ca • Endocervical • Cervical • Vaginal • Chlamydia culture • Gonococcal culture- Z pattern • Saline mount – tests for WBC & protoza • KOH prep – tests for Candida albincans • Five percent acetic acid wash – tests for humanpapillomavirus = genital warts • Anal culture- tests for presence of gonorrheoae in Anal tissues

  25. Normal Findings: Specimens • Pap smear within normal limits • Cervicovaginal tissues free of Neisseria gonorrhoeae, Candida albicans • < 10 WBCs in the saline mount specimen • Negative acetic acid wash test

  26. Gerontological Variations • Menopause-related changes • Low estrogen levels • Cessation of menses • Generalized atrophy of external and internal female organs

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