Female/Male Genetalia Flashcards
What is the onset of menarche for women? and what are some characteristics of the first few years?
9-16 y/o, blacks start earlier. irregular pattern for 1-2years.
What is the frequency, duration, and character or flow of menarche?
frequency is the interval between periods 24-32 days. (abnormal is on the outskirts of these numbers) Anemia is too little flow, abnormal 5tbps. inc. flow abnormal.
Dysmenorrhea
painful menstruation, immediately following ovulation, release of prostaglandins, cause uterus to contract, results in temporary O2 deprivation inc. uterine activity.
Endometriosis
tissue found elsewhere in the body, heavy period and irregular. Pain during intercouse.
Bleeding outside of period or during menopause
Endometriosis or endometrial cancer
HPV Vaccine
2006 FDA approved Gardasil to protect both cancer(70%) % genital warts(90%) for adolescents 11-12 and 13-26 for females. For males 9-26 to prevent genital warts.
symptoms of STI’s
- Vaginal discharge=chlamydia=white/yellow
- Curdy white=yeast infection
- pelvic pain, swollen perianal tissues or genital lesions(cancers).
- STI’s= PID-infertility infection of fallopian tubes.
Symptoms of genitourinary problems
-Burning during urination(dysuria), frequency, urgency, nocturia, hematuria, incontinence(inability to hold urine), stress incontinence(weak pelvic floor muscles cough, sneeze can’t hold urine, inc. pressure leaking of urine)
Symptoms of perimenopause
-Hot flashes, drenching sweats, mood swings, vaginal dryness, itching, numbness and tingling, headache or palpitations.
Menopause
40-55 y/o cells in reproductive track dec. in size in sex muscles. Epithelium becomes itchy & dry. cease to have a period for 12 months usually around age 48-51. Estrogen dependent parts decrease in size
Risk factors for ovarian cancer
Risk factors for ovarian cancer
>40 y/o, obese, history of ovarian dysfunction, breast or endometrial cancer, irradiation of pelvic organs, endometriosis, infertility or nulliparity, use of estrogen only hormone replacement
family history of ovarian, breast, or endometrial cancer
Risk factors for endometrial cancer
Postmenopausal, obese, infertile, early menarche, late menopause, HTN, DM, gallbladder disease, PCOS(polycystic ovarian syndrome), estrogen-related exposure (HRT or tamoxifen use)
Family history of endometrial, breast, or colon cancer
Both Genders Health History
-Sexual history and current/past contraceptive practices
Oral contraceptives- Ask about tobacco use, history of blood clots due to increased risk for blood clots.
-Previous illness or surgery involving reproductive organs, including STIs
-Casual multiple partners?
-monogamous?
-condoms?
Male Health History, urinary symptoms
Frequency, nocturia, urgency, decreased urinary output, difficulty starting stream, hematuria
Male Health History, genitals
Penile pain or swelling, genital lesions or urethral discharge
-Heaviness or painless enlargement of testis or irregular lumps(Testicular cancer)
-Performance of self testicular exam?
-Presence of inguinal hernia-Strain, lift, cough.
-Difficulty achieving erection or ejaculation. Make sure they aren’t using dieuretics, sedatives, tranqulizers, SSRI’s( prozac)
Examination Tips
Explain each step of the examination in advance Offer a chaperone Keep patient draped for privacy Avoid unexpected or sudden movements Watch patient’s face to monitor comfort Wear gloves
Female Inspection
Skin color
No suspicious pigmented lesions noted.
Hair distribution
Inverted triangle. No nits or lice.
Tanner staging for adolescence
stage1-pre-adolescence fine velos hair
Stage 2- sparse hair on labia
Stage 3- sparse hair moves over mons pubis
stage 4- more over mons pubis begins to get more curly
stage 5- Adult inverse triangle & on medial thigh
Note: The nurse will often examine external genitalia while performing routine hygiene measures or preparing to insert a urinary catheter
Inspection of Labia majora and perineum
-Symmetrical, no excoriation, nodules, rash, lesions or edema
-Perineum
Smooth
Well healed episiotomy scar
Epidermoid cyst
yellowish in color
HPV
Veneral warts
Herpes
painful ulcers w/ red base
syphilitic chancre
painless ulcer, firm
secondary syphilis
slightly raised papules w/grey exudate
carcinoma of the vulva
raised red lesion
Inspection, of female genitalia
With gloved hand separate labia major and inspect: Clitoris Labia minora Dark pink and moist Urethral opening Slitlike and midline Vaginal opening No discharge or foul odor No excoriation, nodules, rash, lesions, or edema.
Discharge: Candidiasis, BV, Trichomoniasis,Chlamydia, Gonorrhea
Candidiasis- thick, white curdy, cottage cheese like, pruritis
BV- thin, creamy gray-white; foul smelling, pain, itching, burning, overgrowth of natural flora, notice after intercourse.
Trichomoniasis- frothy yellow-green; foul smelling
Chlamydia- White mucopurulent
Gonorrhea- yellowish
-Chlamydia and Gonorrhea may not see discharge in females or males, may see discharge in males if seen at all.
Bartholins gland infection
Bartholins gland secretes mucous during sex, infection during ghonorrhea or chlamydia. Tense, hot, tender put around opening.
Urethral caruncle
post menopausal women. small, red, benign tumors.
Prolapse of urethral mucosa
decrease estrogen levels weaken muscles, women get this, swollen red ring around meatus.
Cystocele
bladder has herniated pushing against vagina wall weakening of tissue, upper 2/3 involved, frequency, urgency, dysuria.
cystourethrocele
bladder and urethra herniated
Rectocele
rectum bulging into vaginal wall herniated rectum
Uterine Prolapse graded by straining-
-Grade 0 Normal
-Grade 1 decent into vagina not reaching introitus
-Grade 2 decent up to the introitus
-Grade 3 decent outside the introitus
this is the decent out the uterus
Speculum Examination
For routine pelvic exams patient should not
be on menses
Patient should avoid intercourse, douching, vaginal suppositories and tampons 24 hours prior to exam
Have patient empty bladder before examination
Patient lies supine, with head and shoulders elevated
Have patient place heels in stir-ups, slide all the way down examination table until buttocks extend slightly beyond the edge
Thighs should be flexed, abducted and externally rotated at the hips
Have light source available and supplies accessible
-Pap check for STD’s, BV, yeast infection
Speculum Examination/Bimanual Palpation
Obtain cervical smears and cultures Pap Smears for cervical cancer Inspect vaginal wall and cervix Palpate cervix, uterus & ovaries -Bimanual palp. check for shape of uterus & ovaries & feeling the cervix. Pain in cervical motion tenderness cause for BID
Chadwick sign
cyanotic cervix 8-12 weeks pregnancy
gladwell sign
4-6 weeks pregnant soft cervix like the tip of the nose
Male anatomy
scrotum–>testes—>epididymus(where sperm mature)—>vas deferens–>ejaculatory duct—>60%seminal vesicals=semen production, prostate 1/3 semen prodution
Tanner Staging Males
1-pre adolescence, velos hair on parts and abdomen
2- little bit of pubic hair little or no enlargement to penis
3- hair darkens penis enlargens and scrotum does too
4- hair spreads penis and scrotum grow, glands
5- hair spread to thighs penis and scrotum grow
pubic hair continues to spread and grow till age 20
Inspection of penis skin
Skin
Winkled, hairless, without lesions or inflammation
Dorsal vein may be apparent
Inspection of penis glans phimosis and paraphimosis and smegma
Glans Smooth, without lesions May need to retract foreskin Phimosis- unable to retract foreskin Paraphimosis- Unable to return foreskin to original position Smegma- Cheesy substance under foreskin
Inspection/Palpation of Penis
Urethral meatus,
Hypospastic and
Epispades
Urethral meatus Positioned centrally Hypospastic- ventral location Epispadias- dorsal location last two can be surgically corrected
Inspection/Palpation of penis
Compress glans anteroposteriorly between thumb and forefinger to assess for dc, make sure no discharge, if there is possible infection.
Meatus pink, smooth, without discharge
Profuse yellow = gonococcal
Scanty white = possible Chlamydia
Palpation of Penis
Palpate shaft between thumb and first 2 finger.
Assess for nodules, induration, or tenderness
Smooth, semifirm, and nontender
If man gets erection during the exam, explain that it is a normal response and finish the exam
Inspection of Scrotum
Hold penis out of way with back of hand
Mild asymmetry normal
Left often lower than right
Assess for edema and lesions
scrotal edema
more likely to be both sides, CHF, renal failure, portal vein obstruction. 1 sided edema: epididymytus, tortion of spermatic chord.
Palpation of scrotum
Palpate scrotum, epididymis & spermatic cord between thumb and first two fingers
Testes- freely movable, oval, firm, rubbery, smooth and equal bilaterally
-testes feel like a hard boiled egg w/the shell off
Early testicular tumor
15-35 y/o nodular usually malignant. whites most common
hydraseal
serous fluid: epididymous painless swelling, tumor of the testes, trauma, newborns.
Epididymis
Discrete, smooth, and nontender
Epididymidous
prostitus, chlamydia,ghonorrha, severe pain. edemal pain
Testicular tortion
sudden twistion of spertatic chord, faulty anchoring of testes. emergency. Late childhood, early adolescence. Lower abdominal pain 1 teste higher than the other. ischemia/engorgement. N.V. painful, no fever, testers can become gangrenous.
Spermatic chord vericelles
bag of worms. dilated vericose veins in spermatic chord. Bluish color shows through. Incompetent veins, dull pain.
Inspection for Hernia
Inspect inguinal region for bulge as person stands and strains down
Palpation for Hernia
Gently insert finger into canal and ask patient to bear down. Ask pt. to cough this increase interabdominal pressure, hernia would come down and touch finger.
No inguinal hernia noted.
Palpate femoral areas for bulge
No femoral hernia noted.
Palpate Inguinal Lymph Nodes
Palpate inferior to inguinal ligament and along upper inner thigh
Normal to palpate isolated node on occasion
Nonpalpable or small (1cm
Testicular Cancer
Incidence is low, 4 per 100,000
Peak age 15-35
If found early, excellent prognosis
The best time to examine testicles is during or after a shower or bath. The warm water allows the scrotum to relax and the testicles to drop down. The left testicle normally hangs a bit lower than the right. It is common for one testicle to be larger than the other one.
Young men should examine themselves once a month. More frequent exams actually may result in missing a slowly changing lump.
Testicular Self Exam
Support each testicle with one hand and examine it with the other.
Gently roll each testicle between the thumb and fingers. Testicles should feel firm and smooth, about the consistency of a hard-boiled egg without the shell.
The epididymis is a ropelike structure attached to the back of the testis. This structure is not an abnormal lump
Feel for firm masses, lumps, or nodules in the testicle. In cancer, these lumps often are painless.
Become familiar with normal size, shape, and weight of each testicle and epididymis. This will help you recognize a change from one self-examination to another, if a change should occur.
