Chapter 27
Assessing Female Genitalia,
Anus, and Rectum
Structure and Function
External genitalia:
o Include structures that can be readily identified
through inspection
Internal genitalia:
o Include the female reproductive organs
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Question #1
Is the following statement true or false?
The female reproductive system falls under internal
genitalia.
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Answer to Question #1
True.
The female reproductive system falls under internal
genitalia.
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Cervical Cancer: Risk Factors #1
Human papilloma virus (HPV) infection
Smoking
Immunosuppression
Chlamydia infection
Diet low in fruits and vegetables
Being overweight
Intrauterine device use
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Cervical Cancer: Risk Factors #2
Having multiple full-term pregnancies
Being younger than 17 at first full-term pregnancy
Poverty
Having a mother who took diethylstilbestrol (DES) while
pregnant
Family history of cervical cancer
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Cervical Cancer: Risk Reduction #1
Avoid risky sexual practices: do not have sex at an early
age; do not have multiple partners; avoid high-risk
sexual activities and partners who participate in these.
Consult with a health care professional about having an
HPV vaccination for boys and girls as early as 9 years old
and up to 26 years old, but especially between 10 and
11 years of age (ACOG, 2015).
Follow the USPSTF guidelines for routine Pap smears.
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Cervical Cancer: Risk Reduction #2
If your mother took DES to prevent miscarriage,
maintain a careful preventive screening schedule.
Eat nutritious food and have routine care for illnesses
that weaken your immune system.
Talk to your partner about your expectations of sexual
health before becoming intimate.
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Cervical Cancer: Incidence
The lowest cervical cancer rates are found in Eastern
Mediterranean countries.
An unusually high rate of cervical cancer was found in
the African region where income levels tend to be low.
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Teaching Opportunity: Risk Reduction
Introduce discussion of ways to reduce risks of cervical
cancer during examination:
o Establish trusting relationship with client during
exam.
o Teach self-examination.
o Explain that self-examination helps detect
abnormalities early.
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History of Current Health Problem #1
Menstrual cycles
Age at time of first menstrual period
Menopause
Vaginal discharge
Pain or itching in genitalia or groin
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History of Current Health Problem #2
Lumps, swelling, or masses in genitalia or groin
Urinating difficulty, changes in urine color, or developed
an odor
Difficulty controlling urine
Sexual performance
Sexual activity pattern
Fertility problems
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Past and Family History
Previous gynecologic problems and results of any
treatment
Date of last pelvic exam by a physician
Date of last Pap smear and results
Fever diagnosed with STD
Pregnancies
Reproductive or genital cancer
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Lifestyle and Health Practices #1
Smoking
Sexual partners
Contraceptives
Genitalia problems
Sexual preference
Comfort level in communication about sexuality
Fears and stress with sex
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Lifestyle and Health Practices #2
Fertility concerns
Menopause concerns
Genital self-exam
HIV results
Estrogen replacement
Toxic shock syndrome
Sexually transmitted diseases
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Question #2
Which is covered under the external genitalia?
A. Inspecting vaginal opening
B. Inspecting vaginal musculature
C. Inspecting labia minora
D. Inspecting the vagina
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Answer to Question #2
C. Inspecting labia minora.
The labia minora are thinner skin folds located inside the
labia majora. Vaginal opening extends from the vaginal
orifice to the cervix and falls under internal genitalia, as do
the vagina and its musculature.
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Equipment #1
Stool
Light
Vaginal speculum
Water-soluble lubricant
Large swabs for vaginal examination
Nonsterile gloves
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Equipment #2
Bifid spatula
Endocervical broom
pH paper
Feminine napkins
Hand-held mirror
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Physical Assessment: External Genitalia
#1
Inspection:
o Mons pubis
o Labia majora and perineum
o Labia minora, clitoris, urethral meatus, and vaginal
opening
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Physical Assessment: External Genitalia
#2
Palpation:
o Bartholin glands
o Urethra
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Physical Assessment: Internal Genitalia
#1
Inspection:
o Vaginal opening
o Vaginal musculature
o Cervix
o Vagina
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Physical Assessment: Internal Genitalia
#2
Bimanual examination
o Palpation
The cervix
The uterus
The ovaries
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Physical Assessment: Internal Genitalia
#3
Rectovaginal examination
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Findings
External genitalia and vaginal opening
Cervix
Vaginitis
Uterine enlargement
Adnexal masses
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Older Client Findings
Vaginal infection because of atrophy of the vaginal
mucosa
Gray, thinning pubic hair
Cervix appears pale after menopause
Urinary incontinence from muscle weakness or loss
of urethral elasticity
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Data Analysis
Nursing diagnoses
Collaborative problems
Referrals
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