Transcript Chapter 20

Chapter 20
Female Genitalia
Copyright 2002, Delmar, A division of Thomson Learning
Competencies
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Describe the anatomy and
physiology of the female genitalia,
including age-relevant
transformations.
Demonstrate the techniques
necessary for assessment of the
female genitalia, including patient
positioning, external and internal
inspection, speculum procedures,
and palpation methods.
(continues)
Copyright 2002, Delmar, A division of Thomson Learning
Competencies
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Identify anatomic landmarks during
bimanual vaginal, uterine, and
rectovaginal examinations.
Identify normal findings as well as
atypical findings of the vulva,
vagina, and cervix.
Describe procedures for genital and
anal smears and cultures.
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Anatomy and
Physiology
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External female genitalia
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Labia majora
Labia minora
Clitoris
Vaginal introitus
Urethral meatus
(continues)
Copyright 2002, Delmar, A division of Thomson Learning
Anatomy and
Physiology
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Internal female genitalia
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Vagina
Uterus
Cervix
Fundus
Ovaries
Fallopian tubes
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Female Reproductive
Cycle
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Follicular phase
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FSH
LH
Ovulation
Luteal phase
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LH
Corpus luteum
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Health History
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Age
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Adolescent to young adult
Middle to late adult
Race
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Ethnic minorities
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Chief Complaint
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Common chief complaints
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Uterine bleeding
Vaginal discharge
Urinary symptoms
Pelvic pain
Characteristics to assess
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Past Health History
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Medical history
Surgical history
Medications
Communicable diseases
Allergies
Injuries
Special needs
Childhood illnesses
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Health History
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Family history
Social history
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Substance use
Sexual practices
Hobbies
Stress
Health maintenance
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Key Questions to Ask
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Menstrual, obstetric, and
menopause histories
PMS
Vaginal discharge
Uterine bleeding
Sexual functioning
Reproductive medical history
Method of birth control
Copyright 2002, Delmar, A division of Thomson Learning
Physical Assessment
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Special equipment
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Vaginal specula
Cytological materials
General approach
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Prior
During
After
Copyright 2002, Delmar, A division of Thomson Learning
Inspection: External
Genitalia
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Pubic hair distribution
Skin color and condition
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Mons pubis and vulva
Urethral meatus
Vaginal introitus
Perineum and anus
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Palpation of External
Genitalia
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Labia
Urethral meatus and Skene’s glands
Vaginal introitus
Perineum
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Speculum Examination
of the Cervix
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Use of speculum
Characteristics of assessment
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Color
Position
Size
Surface characteristics
Discharge
Shape of cervical os
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Collecting Specimens
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Pap smear
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Endocervical
Cervical
Vaginal
Gonococcal culture
Saline mount
KOH prep
Five percent acetic acid wash
Anal culture
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Inspection
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Vaginal wall
Bimanual examination
Vagina
Cervix
Fornices
Uterus
Adnexa
Rectovaginal examination
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Gerontological
Variations
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Menopause-related changes
Low estrogen levels
Cessation of menses
Generalized atrophy of external and
internal female organs
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Normal Findings:
Inspection
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Pubic hair distribution shaped like an
inverse 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
(continues)
Copyright 2002, Delmar, A division of Thomson Learning
Normal Findings:
Inspection
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Vaginal mucosa is pink and moist
Normal vaginal discharge is clear to
white, free from odor
Perineum is smooth, slightly
darkened
Anus is dark pink to brown and
puckered
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Normal Findings:
Palpation
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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
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Normal Findings:
Internal Genitalia
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Cervix is pink, pale (menopause), or
blue (pregnancy)
Cervix is midline
Glistening pink cervical epithelium
Cervical os is round in nulliparous;
or a horizontal slit in multiparous
Copyright 2002, Delmar, A division of Thomson Learning
Normal Findings:
Cytological Smears and
Cultures
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Pap smear within normal limits
Cervicovaginal tissues free from
Neisseria gonorrheae, Candida albicans
< 10 WBC’s in the saline mount
specimen
Negative acetic acid wash test
Vaginal wall is pink, moist, deeply
rugated
Copyright 2002, Delmar, A division of Thomson Learning
Normal Findings
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Vaginal wall is nontender, free from
lesions, masses, or cysts
Cervix is mobile, nontender,
symmetrical, rounded, and midline
Uterus is pear-shaped in nongravid;
rounded in parous
Ovaries are almond-shaped, firm,
smooth, and mobile without
tenderness
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