ASSESSING FEMALE GENITOURINARY SYSTEM  Increased risk for vaginitis

 Impaired female sexual response

EXTERNAL GENITALIA:
1. Mons Pubis CROSS-CULTURAL CARE:
2. Prepuce of the Clitoris  Mexican-Americans (Women do not show their body to
3. Clitoris men)
4. Labia Minora  Chinese-Americans (Examination of the genitalia is
5. Labia Majora offensive)
6. Perineum  Muslim women (Female modesty)
7. Anus  Infibulation (invasive procedure to remove the clitoris to
8. Vaginal Orifice inhibit sexual pleasure) or female genitalia mutilation is
common in Africa
DEVELOPMENTAL CARE:
A. INFANTS AND ADOLESCENTS SUBJECTIVE DATA COLLECTION
 At birth, the external genitalia are engorged 1. Menstrual History
 The ovaries are located in the abdomen during childhood 2. Obstetric History
 The uterus is small with a straight axis an no anteflexion 3. Menopause
 At puberty, development of secondary sex characteristics 4. Self-Care Behaviors
occur 5. Urinary Symptoms
 The first signs of puberty are breast and pubic hair 6. Vaginal History
development 7. Past History
 Ovaries are now at pelvic cavity 8. Sexual Activity
9. Contraceptive Use
TANNER’S 5 STAGES OF PUBIC HAIR 10. STD
DEVELOPMENT/SMR:
Stage I – No pubic hair, mons and labia covered with fine vellus SUBJECTIVE DATA: ASSESSMENT
hair as on abdomen 1. Menstrual History
Stage II – Growth sparse and mostly on labia. Long downy hair, a. Date of last menstrual period
slightly pigmented. Straight or only slightly curly. Occurs at 11 b. Age at first period
and 12. c. How often the periods occur
Stage III – Growth sparse and spreading over mons pubis. Hair d. Hoe many days does the period last
is darker, coarser, curlier. Occurs at 12 and 13. e. Usual amount of flow: light, medium, heavy
Stage IV – Hair is adult in type but over smaller area; none on f. Amount of pads or tampons being used each day or
medial thigh. Occurs at 13 and 14. hour
Stage V – Adult in type and pattern; inverse triangle. Hair is 2. Obstetric History
present on medial thigh surface. a. How many times
b. How many babies have you had
B. PREGNANT FEMALE (tikang la po ini ha notes kay wa c. Any miscarriages or abortion
hiya han pics) d. Do you think you may be pregnant now? What
3 Signs: symptoms have you noticed?
Presumptive – signs felt by the pregnant woman only
Nausea GTPALM
Vomiting  A 20 years old female is currently 8 weeks pregnant. She
Early morning sickness had a miscarriage at 12 weeks gestation 2 years ago. She
Probable – felt by the examiner has no living children
 Chadwick – normal in pregnant women (bluish) G – 2 (currently pregnant at 8 weeks; had a miscarriage 2 years
 Hegar – influenced by hormones (estrogen) ago
Positive – confirmation tests that confirms the pregnancy T–0
P–0
Mucus Plug – protects fetus from pathogens A – 1 (miscarriage 12 weeks)
Bloody Show – true sign of labor M–0

C. THE AGING FEMALE 3. Menopause

 Menopause – cessation of the menses, usually occurs a. Have you periods slowed down or stopped?
around 48 to 51 years old. o Perimenopause
 Uterus shrinks in size. o Menopause
 Ovaries atrophy to 1 to 2 cm and are not palpable o Postmenopause
 The sacral ligaments relax and pelvic musculature weakens Associated Symptoms:
 Cervix shrinks and looks paler with a thick glistening  Hot flashes (vasomotor symptom)
epithelium  Headache
 The vaginal epithelium is atrophies  Mood Swings
 Decreased vaginal secretion  Vaginal Dryness
 Itching INSPECTION OF THE CERVIX AND OS:
NOTE:
4. Self-care Behaviors Color – cervical mucosa is pink and even
a) How often do you have gynecologic check-up? (+) Chadwick’s sign
b) Last Papanicolau smear? Pale
5. Urinary Symptoms Position – midline, either anterior or posterior (Projects 1-3cm
a) Any burning or pain in urinating into the vagina)
b) Awaken during night to urinate Size – diameter is 1 inch
c) Blood in the urine OS – small and round
d) Any difficulty in controlling urine Horizontal and irregular slit
e) Urinate with a sneeze, laugh, cough, bearing down
6. Vaginal History NORMAL VARIATIONS OF THE CERVIX:
a) Any unusual vaginal discharge? Note the character,  Round
smell and color  Horizontal Parous (after childbirth)
7. Past History
a) Any problems in the genital area? Sores or lesions LACERATIONS:
b) Any abdominal pain  Unilateral Transverse
c) Any past surgery on uterus, ovaries, vagina?  Bilateral Transverse
 Stellate
OBJECTIVE DATA ASSESSMENT:  Cervical Eversion
Preparation  Nabothian cysts (benign)
1. No douching for 48 hours
2. Urinate before examination CERVICAL SMEARS AND CULTURES:
3. Dorsal lithotomy position 1. Vaginal Pool (SORRY HAHA WA HA PIC AND KINUHA
4. No hands over the head KO LANG SIYA KAY BROSEL HAHA)
5. Elevate client’s head and shoulders 2. Cervical Scrape
Equipment a. SCJ
1. Stool b. Cervix
2. Light 3. Endocervical Specimen
3. Vaginal speculum
a. Grave’s Speculum NECESSARY DATA FOR LABORATORY REQUEST:
b. Pederson Speculum  Name
4. Water soluble lubricant
 Age and Date of birth
5. Large swabs for vaginal examination
 Date of specimen
6. Specimen container
 Date of LMP (first day of menstrual cycle- ask the patient
7. Gloves (non-sterile)
the first day of her menstrual period)
8. Ayre spatula
9. Endocervical broom  Any hormone medication
10. pH paper  If pregnant, EDD/EDC (Expected Date of Delivery)
11. Mirror  Known Infections
 Abnº findings on physical examination
INSPECTION:
1. Skin color SCREENING FOR STD
2. Hair distribution  Gonorrhea & Chlamydia GC Culture
3. Labia Majora
4. Clitoris ABNORMALITIES OF THE EXTERNAL GENITALIA:
5. Labia Minora 1. Pediculosis Pubis (Crab Lice)
6. Labia Majora (an nakadto ppt kay minora la ghap idk S: Severe perineal itching
HAHA) O: Exoriations and erythematous areas
7. Urethral opening  Visible little dark spots and adherent to pubis hair
8. Introitus 2. Syphilitic Chancre (Trepoutoma Pallidum)
9. Perineum O: Begins as a small, solitary silvery papule that erodes to a red,
round or oval, superficial ulcer with a yellowish serous discharge
PALPATION: Tx: Penicillin G
1. Skene’s gland 3. Herpes Genitals
2. Bartholin’s gland S: Episodes of local pain, dysuria (painful urination), fever
3. Posterios part of the labia majora O: Clusters of small, shallow vesicles with surrounding
4. Palpate the perineum erythema
 Erupt on genital areas and inner thigh
SPECULUM EXAMINATION:  (+) inguinal adenopathy, edema
1. Select the proper-sized speculum  Vesicles on labia rupture in 1 to 3 days, leaving painful
2. Do not use lubricant GEL ulcers
 Initial infection lasts 7 to 10 days
 Virus remains dormant indefinitely
 Recurrent infections last 3 to 10 days with milder symptoms
Tx: Antiviral
4. Genital Warts (Condyloma Acuminatum)
CA: Human Papilloma Virus
S: Painless wart growths, may be unnoticed by woman
O: Pink or flesh colored, soft, pointed, moist, warts papules
 Single or multiple in cauliflower-like patch. Occur around
vulva, introitus, anus, vagina, cervix
Tx: Prophylactic (Gardasil Vaccine)
5. Abscess of Bartholin’s Gland
S: Severe, local pain
O: Overlying skin & hot
 Posterior part of labia swollen; palpable fluctuant mass and
tenderness
 Mucosa shows red spot at site of duct opening
 Secondary to gonococcal infection
6. Urethral Caruncle
S: Tender, painful with urination, urinary frequency, hematuria,
dyspareunia
O: Small, deep red meatus; usually secondary to urethritis or
skenitis; lesion may bleed on contact
7. Urethritis
S: Dysuria
O: Palpation of anterior vaginal wall shows erythema,
tenderness, induration along urethra, purulent discharge from
meatus. Caused by N. Gonorrea, Chlamydia, Staphylococcus
infection
ABNORMALITIES OF THE PELVIC MUSCULATURE:
1. Cystocele
S: Feeling of pressure in vagina, stress incontinence
O: Introitus widening and the presence of soft, round anterior
bulge (bladder)
2. Rectocele
S: Feeling of pressure in vagina, possibly constipation
O: Introitus widening and presence of a soft, round bulge from
posterior (part of the rectum covered by vaginal mucosa,
prolapses into vagina)
3. Uterine Prolapse
O: Uterus protrudes into vagina
First degree – cervix appears at introitus with straining
Second Degree – cervix bulges outside introitus with straining
Third Degree – whole uterus protrudes into vagina even without
straining
VULVOVAGINAL INFLAMMATIONS:
1. Atrophic Vaginitis
S: Postmenopausal vaginal itching, dryness, burning sensation,
dyspareunia, mucoid discharge
O: Pale mucosa with abraded areas that bleed easily; may have
bloody discharge
2. Candidiasis (Moniliasis)
S: Intense pruritus, thick whitish discharge
O: Vulva and vagina are erythematous and edematous.
Discharge is usually thick, white, curdy, “like cottage cheese”
Predisposing Factors:
 Use of oral contraceptives
 Use of antibiotics
 Alkaline vaginal pH
 Diabetes
 Pregnancy
3. Trichomoniasis (Trich)
S: Pruritus, watery and often malodorous vaginal discharge,
urinary frequency, terminal dysuria
o Symptoms are worse during menstruation
O: Vulva may be erythematous. Vagina diffusely red, granular,
with red raised papules and petechiae (strawberry appearance)
 Frothy, yellow-green, foul-smelling discharge
 Microscopic examination of saline wet mount specimen
shows characteristics flagellated cells
4. Bacterial Vaginosis (Gardnerella Vaginalis/
Haemophilus Vaginalis, Nonspecific Vaginitis)
S: Profuse discharge, “constant wetness” with foul-fishy rotten
odor
O: Thin, creamy, gray-white, malodorous discharge. No
inflammation on vaginal wall or cervix
 Microscopic view of saline wet amount of specimen shows
typical “clue cells”
5. Chlamydia
S: Urinary frequency, dysuria or vaginal discharge
O: May have yellow or green mucopurulent discharge, friable
cervix, cervical motion tenderness
6. Gonorrhea
S: Variable: Vaginal discharge, dysuria, abnormal uterine
bleeding, abscess in Bartholin’s or Skene’s glands;
O: Purulent vaginal discharge. Diagnose by positive culture of
organism. It may progress to acute salpingitis, PID
EXTRA FROM MY NOTES:
Pheromones – stimulates sexual desire
Vaginitis – due to decreased acidity of the vagina
G- gravida (total number of pregnancy, dead or alive)
T- term (number of pregnancy that reached 37-40 weeks AOG)
P- preterm (number of pregnancy that reached 20-36 weeks
AOG)
A- abortion (number of delivery less than 20 weeks AOG)
L- living (number of babies that are alive)
M- multiple gystation (number of babies e.g. twins)
Age of viability – 24 weeks (age should be of the baby to be
alive inside a pregnant woman’s womb
Hematuria – presence of blood in urine
F- functional (urinary tract is functional but the individual
prevents himself form staying dry)
O- overflow (incomplete bladder emptying; there is blockage)
R- reflex (bladder muscle contracts and urine leaks without
warning or urge)
U- urge (feeling of strong urge to urinate)
M- mix (combination of overflow and….. AMBOT MGA MANA
HAHAHA)
S- stress (leaks when you jump, cough and laugh)
ASSESSING MALE GENITOURINARY SYSTEM: Rationale: These signs are early warning sign for testicular
Cancer.
THE MALE GENITALIA: 6. If patient report an enlargement in inguinal area, asses if it
(PS. WA AK MAKAHABOL HINI SORRY HAHAHA TAGAE is intermittent or constant, associated with straining or lifting
NALA AKO NOTES FRIENDS HUHU) and painful whether pain is affected by coughing, lifting or
straining at stool.
DEVELOPMENTAL CARE: Rationale: These signs and symptoms reflect potential inguinal
A. INFANTS hernia
 Prenatally, the testes develop in the abdominal cavity near 7. Ask if patient has difficulty of achieving erection or
the kidneys ejaculation, review whether the patient is taking diuretics,
 Before birth, testes descend along the inguinal canal into sedatives, antihypertensives or tranquilizers
the scrotum before birth Rationale: These medications influence sexual performance
B. ADOLESCENTS
 Puberty begins between ages 9.5 to 13.5 OBJECTIVE DATA ASSESSMENT:
 The first sign is enlargement of the testes Preparation:
1. Have the patient void. Position the male standing,
SMR IN BOYS: (PS DI INI COMPLETE FROM MY NOTES) undershorts down
Stage I – pre-pubertal genitalia 2. Do not discuss genitourinary history or sexual practices
Stage II – no enlargement of penis but enlargement of the while performing the examination
scrotum 3. Use a firm deliberate touch, not a soft, stroking one
Stage III – pubic hair 4. If an erection does occur
Enlarged penis in length
Stage IV – penis increase in diameter Pubic Hair:
Stage V – adult size and shape of penis  Inspect the distribution, amount and characteristics of pubic
hair
C. ADULTS AND AGING ADULTS Penis:
1. Sexual development remains constant  Inspect the penile shaft and glans penis for lesions,
2. Aging changes are due to: nodules, swellings of inflammation
a. Decreased muscle tone o Inspect the urethral meatus for swelling, inflammation
b. Decreased subcutaneous fat and discharge
c. Decreased cellular metabolism  Compare the glans slightly to open the urethral
3. Amount of pubic hair decreases and hair turns gray meatus
4. Penis size decreases  Palpate the penis for tenderness, thickening and nodules
5. Slower and less intense sexual response Scrotum:
6. Erection takes longer to develop  Inspect the scrotum for appearance, general size and
7. Ejaculation is shorter and less forceful symmetry
8. Rapid detumescence  Palpate the scrotum to asses status of underlying testes,
9. Refractory state lasts longer epididymis and spermatic cord
 Palpate both testes simultaneously for comparative
CROSS-CULTURAL CARE purposes
Circumcision Inguinal Area:
Indication:  Inspect both inguinal areas for bulges while the client is
 Cultural reasons standing and is straining down
 Prevention of phimosis
 Inflammation of glans penis TESTICULAR SELF EXAMINATION (TSE):
 Prevent UTI during infancy  Check your testicles at least once a month
 Perform the test in the shower
SUBJECTIVE DATA COLLECTION  Soap yourself up
1. Review normal urinary elimination pattern  Check one testicle at the time
Rationale: Urinary problems are associated with GU problems  Gently roll it between the fingers
2. Assess patient’s sexual history and use of safe sex habits  Feel up the spermatic cord on the back side of testicles
Rationale: Sexual history reveals risk for and understand of  Look for hard lumps, smooth or rounded bumps
STD and HIV  Changes in size, shape or consistency
3. Determine if patient has had previous surgery or illness
 Or any painful areas
involving urinary of reproductive organs including STI
Rationale: Alterations resulting from disease or surgery are
MALE GENITAL LESIONS:
sometimes responsible for symptoms or changes in organ
1. Syphilitic Chancre
structure or function
 Begins within 2-4 weeks of infection
4. Ask if patient has noticed penile pain or swelling, genital
 Small, solitary, silvery papule that erodes to a red, round or
lesions or urethral discharge
oval, superficial ulcer with a yellowish serous discharge
Rationale: These signs and symptoms may indicate STI
2. Condyloma Acuminatum (Genital Warts)
5. Determine if patient has noticed heaviness or painless
enlargement of testis or irregular lumps
 Soft, pointed, moist, fleshy, painless paules may be single 6. Orchitis
or multiple in a cauliflower-like patch S: Acute or moderate pain of sudden onset
 Correlated with early onset of sexual activity, infrequent use Swollen testis, feeling of weight, fever
of contraception and multiple sexual partners O: Inspection – enlarged, edematous, reddened; does not
3. Genital Herpes transilluminate
 Clusters of small vesicles with surrounding erythema, which Palpation – swollen, congested, tense, and tender testis
are often painful, erupt on the glans or foreskin 7. Scrotal Edema
S: Tenderness
ABNORMALITIES OF THE PENIS: O: Inspection – enlarged, may be reddened (with local
1. Phimosis irritation)
 Foreskin is advance and fixed so tight it is impossible to Palpation – taut with pitting, probably unable to feel scrotal
retract over glans contents
 May be congenital or acquired from adhesions
 Poor hygiene leads to retained dirt and smegma. Which HERNIAS:
increases risk of inflammation or calculus formation A. INDIRECT INGUINAL HERNIA
2. Hypospadias  Most common form of hernia
 Congenital defect  Sac herniates through internal inguinal ring. Can remain in
 Urethral meatus opens on the ventral side of the glans, canal or pass into scrotum
shaft, or at the penoscrotal junction Signs and Symptoms (S/S):
3. Epispadias  Pain with training; soft swelling that increases
 Meatus opens on the dorsal side of the glans or shaft above intraabdominal pressure: may decrease when lying down
a broad, spade-like penis B. DIRECT INGUINAL HERNIA
4. Priapism  Brought on by heavy lifting, muscle atrophy, obesity,
 Prolonged painful erection without sexual desire chronic cough or ascites
5. Peyronie’s Disease  Directly behind and through external inguinal ring, above
 Hard, nontender, subcutaneous plaques palpated on dorsal inguinal ligament: rarely entersscrotum
or lateral surface of the penis S/S:
 Associated with painful bending of the penis during  Painless
erections  Round swelling close to the pubis in area of internal inguinal
ring
ABNORMALITIES OF THE SCROTUM:  Easily reduced when supine
1. Absent Testis Cryptorchidism C. FEMORAL HERNIA
S: Empty scrotal half  Through femoral ring and canal below inguinal ligament
O: Inspection – in true maldescent, atrophic scrotum on often on the right side
affected side  Due to increased abdominal pressure muscle weakness or
Palpation – no testis frequent stooping
2. Testicular Torsion S/S:
S: Sudden onset of excruciating pain in testicle  Severe pain
o Lower abdominal pain  May become strangulated
o Nausea and vomiting
o No fever EXTRA FROM MY NOTES:
O: Inspection – red, swollen scrotum Older People – decrease orgasm (12-24 hours)
Palpation – cord feels thick, swollen and tender; cremasteric
reflex is absent on side of torsion T - time (once a month)
3. Epididymitis S – shower
S: Sudden onset of severe pain in scrotum, relieved by elevation E – examine and check for changes
o Rapid swelling
o Fever Phren’s Sign – when elevated, there is no pain
O: Inspection – enlarged, reddened scrotum
Palpation – exquisitely tender, epididymis enlarged, Strangulated – an intestine kuno nalusad ha may inguinal
indurated HAHAHA ambot pashnea
 Overlying scrotal skin may be thick and edematous
4. Hydrocele
S: Painless swelling, weight and bulk in scrotum
O: Inspection – enlarged, mass does transilluminate with a pink
or red glow
Palpation – non tender mass
5. Scrotal Hernia
S: Swelling may have pain with straining
O: Inspection – enlarge and may reduce when supping does not
transilluminate
Palpation – soft mushy mass
P.S. HELLO HUHU JAEBAL
MAYDA ADA NAMAN
IBA NA WA HAN FRIENDS
PICS KAYA THANK YOU IN
NAG BASE AKO ADVANCE
HAN NOTES SO HAHAHA
PLEASE REFER
GHAP KAMO
IYO NOTES
AND…..

TAGAE GYUD
KO NOTES
GHAP HUHUHU P.P.S.
LABI NAN STAN NALU
FUNCTIONS HAHAHA –
HAN PARTS DYOSA SHE ;)