Transcript Chapter 20
Structure and Function N1037 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 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) 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. 20–4 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 ◦ 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 20–7 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. Follicular phase ◦ FSH ◦ LH ◦ Ovulation Luteal phase ◦ LH ◦ Corpus luteum 20–8 20–9 Age ◦ Adolescent to young adult ◦ Middle to late adulthood Race ◦ African American 20–10 Common chief complaints ◦ ◦ ◦ ◦ Uterine bleeding Vaginal discharge Urinary symptoms Pelvic pain Characteristics of Chief Complaints ◦ ◦ ◦ ◦ ◦ ◦ ◦ 20–11 Quality Quantity Associated manifestations Aggravating factors Alleviating factors Setting Timing Medical history Surgical history Medications Communicable diseases Allergies Injuries and accidents Special needs Childhood illnesses 20–12 Family history Social history ◦ ◦ ◦ ◦ ◦ 20–13 Alcohol and tobacco use Sexual practices Home environment Hobbies and leisure activities Stress 20–14 Sleep Diet Exercise Use of safety devices Health check-ups Menstrual, obstetric, and menopause hxy PMS Vaginal discharge Uterine bleeding Sexual functioning Reproductive medical history Method of birth control 20–15 General equipment Examination table, lamp Stool, preferably with wheels Gloves Linens for draping Special equipment Vaginal specula Cytological materials General approach ◦ Before Preparation for patient Show instruments and explain Prepare room, ensure comfort ◦ During Keep patient informed ◦ After Support and discuss 20–17 menstrual history obstetric history menopause self-care behaviours urinary symptoms vaginal discharge, itching past history sexual activity contraceptive use STD contact 20–18 Pubic hair distribution Skin color and condition ◦ ◦ ◦ ◦ ◦ Mons pubis and vulva Clitoris Urethral meatus Vaginal introitus Perineum and anus 20–19 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 20–20 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 Labia Urethral meatus and Skene’s glands Vaginal introitus Perineum 20–22 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 20–23 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 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- 20–25 tests for presence of gonorrheoae in Anal tissues Pap smear within normal limits Cervicovaginal tissues free of Neisseria gonorrhoeae, Candida albicans 20–26 < 10 WBCs in the saline mount specimen Negative acetic acid wash test Menopause-related changes Low estrogen levels Cessation of menses Generalized atrophy of external and internal female organs 20–27