Female Genitourinary System

Chapter 26

Elsevier items and derived items 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.

Chapter 26: Female Genitourinary System

Structure and Function

Subjective DataHealth
History Questions

Objective Data
Physical Exam

Abnormal Findings

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Elsevier items and derived items 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.

Slide 26-2

Chapter 26: Female Genitourinary System

Structure and Function

External Genitalia or Vulva

Mons pubis
Labia majora
Labia minora
Frenulum
Clitoris
Urethral meatus
Paraurethral (Skenes)
glands
Vaginal orifice
Hymen
Vestibular (Bartholins) glands
Elsevier items and derived items 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.

Slide 26-3

Chapter 26: Female Genitourinary System

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
Elsevier items and derived items 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.

Slide 26-4

Chapter 26: Female Genitourinary System

Structure and Function

(cont.)

Developmental care

Infants and adolescents

Pregnant female

Aging female

Cross-cultural care

Exposure of genitalia

Infibulation (female genital mutilation)

Elsevier items and derived items 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.

Slide 26-5

Chapter 26: Female Genitourinary System

Subjective Data
Health History Questions

Menstrual history

Obstetric history

Menopause

Self-care behaviors

Urinary symptoms

Vaginal discharge

Elsevier items and derived items 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.

Slide 26-6

Chapter 26: Female Genitourinary System

Subjective Data
Health History Questions
(cont.)

History

Sexual activity

Contraceptive use

Sexually transmitted disease (STD) contact

STD risk reduction

Elsevier items and derived items 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.

Slide 26-7

Chapter 26: Female Genitourinary System

Subjective Data
Health History Questions
(cont.)

Additional history for infants and children

Urination

Perineal hygiene

Sexual abuse

Elsevier items and derived items 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.

Slide 26-8

Chapter 26: Female Genitourinary System

Subjective Data
Health History Questions
(cont.)

Additional history for preadolescents and

adolescents

Start of period

Sex

Sexually transmitted disease

Sexual abuse

Elsevier items and derived items 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.

Slide 26-9

Chapter 26: Female Genitourinary System

Subjective Data
Health History Questions
(cont.)

Additional history for the aging adult

Postmenopausal bleeding

Atrophic vaginitis

Uterine prolapse

Sexual satisfaction

Elsevier items and derived items 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.

Slide 26-10

Chapter 26: Female Genitourinary System

Objective Data
Physical Exam
Preparation

Lithotomy position and

draping

Measures to enhance
comfort during exam

Mirror pelvic
examination

Elsevier items and derived items 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.

Slide 26-11

Chapter 26: Female Genitourinary System

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
Elsevier items and derived items 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.

Slide 26-12

Chapter 26: Female Genitourinary System

Objective Data
Physical Exam
(cont.)

External genitaliaInspection
Skin color
Hair distribution
Labia majora
Any lesions
Clitoris
Labia minora
Urethral opening
Vaginal opening
Perineum
Anus
Elsevier items and derived items 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.

Slide 26-13

Chapter 26: Female Genitourinary System

Objective Data
Physical Exam
(cont.)

External genitaliaPalpation

Skenes glands

Bartholins glands

Support of pelvic musculature

Elsevier items and derived items 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.

Slide 26-14

Chapter 26: Female Genitourinary System

Objective Data
Physical Exam
(cont.)

Internal genitalia
Speculum examination

Insertion technique
Cervix and os

Color
Position
Size
Os
Surface
Any Nabothian cysts
Cervical secretions
Elsevier items and derived items 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.

Slide 26-15

Chapter 26: Female Genitourinary System

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

Elsevier items and derived items 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.

Slide 26-16

Chapter 26: Female Genitourinary System

Objective Data
Physical Exam
(cont.)

Internal genitaliaBimanual Examination

Palpation technique

Cervix

Consistency
Contour
Mobility

Uterus

Adnexa
Rectovaginal
examination

Rectovaginal septum

Posterior uterine wall

Cul-de-sac

Rectum

Elsevier items and derived items 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.

Slide 26-17

Chapter 26: Female Genitourinary System

Objective Data
Physical Exam
(cont.)

Developmental care

Infants and children

Adolescent

Pregnant female

Aging adult

Elsevier items and derived items 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.

Slide 26-18

Chapter 26: Female Genitourinary System

Sample Charting

Elsevier items and derived items 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.

Slide 26-19

Chapter 26: Female Genitourinary System

Sample Charting
(cont.)

Elsevier items and derived items 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.

Slide 26-20

Chapter 26: Female Genitourinary System

Sample Charting
(cont.)

Elsevier items and derived items 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.

Slide 26-21

Chapter 26: Female Genitourinary System

Abnormal Findings
Abnormalities of the
External Genitalia

Pediculosis pubis (crab lice)

Syphilitic chancre

Herpes simplex virustype 2 (herpes genitalis)

Red rashcontact dermatitis

Human papillomavirus (HPV) warts

Urethritis

Abscess of Bartholins gland

Urethral caruncle

Elsevier items and derived items 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.

Slide 26-22

Chapter 26: Female Genitourinary System

Abnormal Findings (cont.)

Abnormalities of the Pelvic Musculature

Cystocele

Uterine prolapse

Rectocele

Elsevier items and derived items 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.

Slide 26-23

Chapter 26: Female Genitourinary System

Abnormal Findings (cont.)

Abnormalities of the Cervix

Bluish cervixcyanosis

Human papillomavirus (HPV, condylomata)

Diethylstilbestrol (DES) syndrome Erosion

Erosion

Polyp

Carcinoma
Elsevier items and derived items 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.

Slide 26-24

Chapter 26: Female Genitourinary System

Abnormal Findings (cont.)

Vulvovaginal Inflammation

Atrophic vaginitis

Candidiasis (moniliasis)

Trichomoniasis

Chlamydia

Bacterial vaginosis

Gonorrhea
Elsevier items and derived items 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.

Slide 26-25

Chapter 26: Female Genitourinary System

Abnormal Findings (cont.)

Conditions of Uterine Enlargement

Pregnancy

Myomas (leiomyomas, uterine fibroids)

Carcinoma of endometrium

Endometriosis

Elsevier items and derived items 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.

Slide 26-26

Chapter 26: Female Genitourinary System

Abnormal Findings (cont.)

Adnexal Enlargement

Fallopian tube massacute salpingitis

(pelvic inflammatory disease or PID)

Fallopian tube massectopic pregnancy

Fluctuant ovarian massovarian cyst

Solid ovarian massovarian cancer

Elsevier items and derived items 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.

Slide 26-27

Chapter 26: Female Genitourinary System

Abnormal Findings (cont.)

Abnormalities in the Pediatric Genitalia

Ambiguous genitalia

Vulvovaginitis in child

Elsevier items and derived items 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.

Slide 26-28

Chapter 26: Female Genitourinary System

Which subject is most appropriate for

the start of the health history?
A.

Menstrual history

B.

Self-care behaviors

C.

Sexual activity

D.

Obstetric history

Elsevier items and derived items 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.

Slide 26-29

Chapter 26: Female Genitourinary System

Which would be the most appropriate way

to start asking about sexual activity?
A.
B.

C.

D.

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.

Elsevier items and derived items 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.

Slide 26-30