Female Genitourinary System

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Female Genitourinary SystemFemale Genitourinary System

Chapter 26Chapter 26


Chapter 26: Female Genitourinary SystemChapter 26: Female Genitourinary System

Slide 26-2

Structure and FunctionStructure and Function

Subjective Data—Health Subjective Data—Health History QuestionsHistory Questions

Objective Data—Objective Data—Physical ExamPhysical Exam

Abnormal FindingsAbnormal Findings

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Slide 26-3

Structure and FunctionStructure and Function External Genitalia or Vulva External Genitalia or Vulva

Mons pubisMons pubis Labia majoraLabia majora Labia minoraLabia minora FrenulumFrenulum ClitorisClitoris Urethral meatusUrethral meatus Paraurethral (Skene’s) Paraurethral (Skene’s)

glandsglands Vaginal orificeVaginal orifice HymenHymen Vestibular (Bartholin’s) glandsVestibular (Bartholin’s) glands



Slide 26-4

Structure and Function Structure and Function (cont.)(cont.)

Internal Genitalia Internal Genitalia VaginaVagina CervixCervix Squamocolumnar Squamocolumnar

junctionjunction Anterior fornix and Anterior fornix and

posterior fornixposterior fornix Rectouterine pouch or Rectouterine pouch or

cul-de-sac of Douglascul-de-sac of Douglas UterusUterus Fallopian tubes Fallopian tubes



Slide 26-5

Structure and Function Structure and Function (cont.)(cont.)

Developmental careDevelopmental care

Infants and adolescentsInfants and adolescents

Pregnant femalePregnant female

Aging femaleAging female

Cross-cultural careCross-cultural care

Exposure of genitaliaExposure of genitalia

Infibulation (female genital mutilation)Infibulation (female genital mutilation)



Slide 26-6

Subjective Data—Subjective Data—Health History QuestionsHealth History Questions

Menstrual historyMenstrual history

Obstetric historyObstetric history

MenopauseMenopause

Self-care behaviorsSelf-care behaviors

Urinary symptomsUrinary symptoms

Vaginal discharge Vaginal discharge



Slide 26-7

Subjective Data—Subjective Data—Health History Questions Health History Questions

(cont.)(cont.) HistoryHistory

Sexual activitySexual activity

Contraceptive useContraceptive use

Sexually transmitted disease (STD) contactSexually transmitted disease (STD) contact

STD risk reduction STD risk reduction



Slide 26-8


(cont.)(cont.)

Additional history for infants and childrenAdditional history for infants and children UrinationUrination

Perineal hygienePerineal hygiene

Sexual abuseSexual abuse



Slide 26-9


(cont.)(cont.)

Additional history for preadolescents and Additional history for preadolescents and adolescentsadolescents

Start of periodStart of period

SexSex

Sexually transmitted diseaseSexually transmitted disease

Sexual abuseSexual abuse



Slide 26-10


(cont.)(cont.)

Additional history for the aging adultAdditional history for the aging adult Postmenopausal bleedingPostmenopausal bleeding

Atrophic vaginitisAtrophic vaginitis

Uterine prolapseUterine prolapse

Sexual satisfactionSexual satisfaction



Slide 26-11

Objective Data—Objective Data—Physical ExamPhysical Exam

PreparationPreparation

Lithotomy position and Lithotomy position and drapingdraping

Measures to enhance Measures to enhance comfort during examcomfort during exam

Mirror pelvic Mirror pelvic examination examination



Slide 26-12

Objective Data—Objective Data—Physical Exam Physical Exam

(cont.)(cont.)EquipmentEquipment

GlovesGloves

Protective clothing for examinerProtective clothing for examiner

Goose-necked lamp with a strong lightGoose-necked lamp with a strong light

Vaginal speculum of appropriate sizeVaginal speculum of appropriate size

Large cotton-tipped applicators (rectal swabs)Large cotton-tipped applicators (rectal swabs)

Materials for cytologic studyMaterials for cytologic study

LubricantLubricant



Slide 26-13


(cont.)(cont.)

External genitalia—External genitalia—InspectionInspection Skin colorSkin color Hair distributionHair distribution Labia majoraLabia majora Any lesionsAny lesions ClitorisClitoris Labia minoraLabia minora Urethral openingUrethral opening Vaginal opening Vaginal opening PerineumPerineum AnusAnus



Slide 26-14


(cont.)(cont.)

External genitalia—External genitalia—PalpationPalpation

Skene’s glandsSkene’s glands

Bartholin’s glands Bartholin’s glands

Support of pelvic musculature Support of pelvic musculature



Slide 26-15


(cont.)(cont.)

Internal genitalia—Internal genitalia—Speculum examinationSpeculum examination

Insertion technique Insertion technique Cervix and os Cervix and os

ColorColor PositionPosition SizeSize OsOs SurfaceSurface Any Nabothian cystsAny Nabothian cysts Cervical secretionsCervical secretions



Slide 26-16


(cont.)(cont.)

Obtain cervical smears and culturesObtain cervical smears and cultures Vaginal poolVaginal pool

Cervical scrapeCervical scrape

Endocervical specimenEndocervical specimen

Data to include for the Data to include for the laboratorylaboratory

Inspect vaginal wallInspect vaginal wall



Slide 26-17


(cont.)(cont.)

Internal genitalia—Internal genitalia—BimanualBimanual ExaminationExamination Palpation techniquePalpation technique

Cervix Cervix ConsistencyConsistency

ContourContour

Mobility Mobility

UterusUterus

AdnexaAdnexa

Rectovaginal Rectovaginal examination examination Rectovaginal septumRectovaginal septum

Posterior uterine wallPosterior uterine wall

Cul-de-sacCul-de-sac

RectumRectum



Slide 26-18


(cont.)(cont.)

Developmental careDevelopmental care Infants and childrenInfants and children

AdolescentAdolescent

Pregnant femalePregnant female

Aging adultAging adult



Slide 26-19

Sample ChartingSample Charting



Slide 26-20

Sample Charting Sample Charting (cont.)(cont.)



Slide 26-21

Sample Charting Sample Charting (cont.)(cont.)



Slide 26-22

Abnormal FindingsAbnormal FindingsAbnormalities of theAbnormalities of theExternal GenitaliaExternal Genitalia

Pediculosis pubis (crab lice)Pediculosis pubis (crab lice) Syphilitic chancreSyphilitic chancre Herpes simplex virus—type 2 (herpes genitalis)Herpes simplex virus—type 2 (herpes genitalis) Red rash—contact dermatitisRed rash—contact dermatitis Human papillomavirus (HPV) wartsHuman papillomavirus (HPV) warts UrethritisUrethritis Abscess of Bartholin’s glandAbscess of Bartholin’s gland Urethral caruncleUrethral caruncle



Slide 26-23

Abnormal Findings Abnormal Findings (cont.)(cont.)

Abnormalities of the Pelvic MusculatureAbnormalities of the Pelvic Musculature

CystoceleCystocele

Uterine prolapseUterine prolapse

RectoceleRectocele



Slide 26-24


Abnormalities of the CervixAbnormalities of the Cervix

Bluish cervix—cyanosisBluish cervix—cyanosis

Human papillomavirus (HPV, condylomata)Human papillomavirus (HPV, condylomata)

Diethylstilbestrol (DES) syndrome ErosionDiethylstilbestrol (DES) syndrome Erosion

ErosionErosion

PolypPolyp

CarcinomaCarcinoma



Slide 26-25


Vulvovaginal InflammationVulvovaginal Inflammation

Atrophic vaginitisAtrophic vaginitis

Candidiasis (moniliasis)Candidiasis (moniliasis)

TrichomoniasisTrichomoniasis

ChlamydiaChlamydia

Bacterial vaginosis Bacterial vaginosis

GonorrheaGonorrhea



Slide 26-26


Conditions of Uterine EnlargementConditions of Uterine Enlargement

PregnancyPregnancy

Myomas (leiomyomas, uterine fibroids)Myomas (leiomyomas, uterine fibroids)

Carcinoma of endometriumCarcinoma of endometrium

EndometriosisEndometriosis



Slide 26-27


Adnexal EnlargementAdnexal Enlargement

Fallopian tube mass—acute salpingitis Fallopian tube mass—acute salpingitis (pelvic inflammatory disease or PID)(pelvic inflammatory disease or PID)

Fallopian tube mass—ectopic pregnancyFallopian tube mass—ectopic pregnancy

Fluctuant ovarian mass—ovarian cystFluctuant ovarian mass—ovarian cyst

Solid ovarian mass—ovarian cancerSolid ovarian mass—ovarian cancer



Slide 26-28


Abnormalities in the Pediatric GenitaliaAbnormalities in the Pediatric Genitalia

Ambiguous genitaliaAmbiguous genitalia

Vulvovaginitis in childVulvovaginitis in child



Slide 26-29

Which subject is most appropriate for Which subject is most appropriate for the start of the health history?the start of the health history?

A.A. Menstrual historyMenstrual history

B.B. Self-care behaviors Self-care behaviors

C.C. Sexual activity Sexual activity

D.D. Obstetric history Obstetric history



Slide 26-30

Which would be the most appropriate way Which would be the most appropriate way to start asking about sexual activity?to start asking about sexual activity?

A.A. Ask open-ended questions.Ask open-ended questions.

B.B. Ask straightforward questions to elicit basic Ask straightforward questions to elicit basic facts.facts.

C.C. Ask whether the patient feels comfortable Ask whether the patient feels comfortable talking about sex.talking about sex.

D.D. Ask the patient whether she is currently in a Ask the patient whether she is currently in a sexual relationship.sexual relationship.

Female Genitourinary System

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