Normal Genito-Anal Findings Flashcards
Introduction:
- There are a number of ___-_____ genital features that may be present in a survivor
- Some are more _____ in children while others occur in all age groups
non-specific
common
Why is it important to do an anal examination before the genital examination?
Doing an anal examination before the genital examination helps to avoid cross-contamination.
What specimens should be collected first during the examination?
Specimens from the anal area should be collected first before moving to the genital examination.
Is a rectal examination routinely necessary during a sexual assault examination?
No, a rectal examination is not routinely necessary during a sexual assault examination.
Is a speculum examination routinely necessary during a sexual assault examination?
No, a speculum examination is not routinely necessary. It should not be done if the patient is a child, virgin, or if there are other contraindications. However, a deep vaginal specimen can still be collected if it does not cause pain or discomfort to the survivor.
What is the first step before conducting any examination?
Always do an anal examination first to prevent fluid from the vagina from leaking down and causing cross-contamination.
- Clitoris
Normal:
The inner lips are labia minora and outside of the are labia majora, the opening at the bottom is the
vaginal opening and they all different but they are all normal
- Urethra:
- This is seen when the patient is lying on their back, it is the opening of the bladder which is seen as the first orifice, then the vaginal opening and then the rectal opening
- The urethra can have large red swelling which may be due to just an infection or inflammation
from and UTI
- Fourth picture: (2)
o A covering over the vaginal orifice which may be due to a prolapsed urethra or a tumour covering the vaginal opening
o Can be reversed if treat with estrogen cream or can be surgically removed
Vestibule: (3)
- Is the ‘room’ - the space with the vaginal opening, urethra and the
glands - In the circle is the sulcus or the groove between the hymen and the edge of the labia minora
- If the whole area is red and inflamed and it is bilateral it can be sexual abuse or can be poor hygiene and inflammation
Vestibular Bands:
- Can see the bands in the circles, the bands are from the urethra outwards and most girls have them until puberty and then they disappear
Labia Majora:
- Labia majora are fleshy outer lips that cover the whole _____, in a child are small and they grow
vestibule
Labia Majora:
- First and Second picture -
o Congenital haemangioma, the bruises are not from trauma, have variations in each patient
Labia Majora:
- Third picture -
o Contact dermatitis or “nappy rash” from the combination of the bacteria in the nappy and the sensitive skin
Labia Majora:
- Fourth picture =
o Lichens sclerosis - autoimmune disease and is very itchy, scratch marks may be present (not from abuse)
Labia Minora
* Are the inner lips - in young girls are small and may have thin bands, but as get older and more ______ is present, they grow a lot
* The two sides are join at the bottom at the posterior _____
Oestrogen
Facet
Labia Minora
* First picture:
o Normal hymen
Labia Minora
* Second picture: (2)
o Labia minora are fused – often in young girls
o Treat with Estrogen cream
How does the genital tract change during growth and development? (3)
The genital tract undergoes changes in three phases:
- Infancy: High estrogen levels due to maternal hormones, low pH.
- Childhood: Genital size shrinks and pH becomes higher (alkaline).
- Adolescence: pH decreases and becomes acidic.
What are the implications of these changes in growth and development?
These changes affect the size, function, and environment of the genital tract.
What are the effects of estrogen on growth and development? (2)
Estrogen has various effects, including:
- Growth spurt in childhood and adolescence.
- Thelarche, which is the development of breast tissue.
Oestrogen effects:
External genitalia = (2)
Oestrogen effects:
Hymen = (3)
Oestrogen effects:
Vagina = (3)
Oestrogen effects:
Cervix =
Hymenal configuration
* First picture: (2)
o Membrane at the opening of the
vagina, neat opening
o Annual hymen as go all the way round
the vagina and typical of a baby
Hymenal configuration
- Second picture = (2)
o Concentric hymen - not a neat round hole as get older gets bigger
o Top part is missing but is normal and no irregularity of the rim around the vagina and looks like a half moon
Hymenal configuration
- Third picture =
o Fimbriated hymen in 70% of adult women as get older and gets thick and closes - normal
Hymenal configuration
- Fourth picture = (5)
o Imperforated hymen and covered vagina opening
o Not common and does not allow bleeding to occur
o Very painful and has to be opened and cut so menstruation can occur instead of the blood going back up into the tubes
o Needs surgical intervention.
o Urethra is at the top and is open to urinate
Hymenal configuration
- Fifth and sixth =
o Fimbriated hymen multiple notches and lumps on the hymen but is intact
Hymenal septum: (4)
- Bands of tissues passing from one side of the opening to the other – normal
- Notches are normal
- Can also get a lump on either side opposite each other
- However if defect is on one side may be abuse
Hymenal bump/ mound:
- Normal but may not be if only on one side or not opposite each other
Hymen variants:
* Second picture = (3)
o Normal cause scar at 12 o’clock
o Congenital birth defect
o If then scar is at 6 o’clock more like abuse like in the first picture
Hymenal membrane:
- Thick and fold outwards and ____
evert
Diameter of the hymenal opening:
Intra-vaginal ridges: (2)
- Part of the tissue associated with “bumps and lumps” on the vagina
- Not part of the hymen, behind the hymen and is part of the vaginal wall
Vaginal Coloumn: (2)
- Rigid tissue extends into the vaginal opening
- Occurs at 12 and at 6 o’clock anterior and posteriorly
Anal anatomy:
* Cross section = (3)
o Internal and external sphincters which are NB when looking for chronic abuse
o On the side is the venous plexus with varicose veins
o The outer bottom - sweat glands
Anal anatomy:
- On the anal canal surface have pecinate/dentate lines or ridges
What happens when the anus dilates?
o When the anus dilates - external sphincter can be seen - the colour changes and can see the dentate lines
Perianal Skin: (2)
- Puckering of the skin, the external sphincter is pinched tightly and there is no discoloration of the skin
- A natural reflex when examination the anus
Perianal Skin:
- Second picture =
o Normal skin tags or lacerations
Anal findings:
- First picture =
o Skin tag which can be both normal and abnormal or it can be from healing of lacerations, tears or fissures
Anal findings:
- Second picture = (2)
o “Saw tooth” appearance of the skin which affects the function of the sphincters
o The pectinate line shows the different colors of the skin going into the anal canal but all are normal findings
Anal findings:
- Third picture =
o A tear and a fissure at the top
Anal findings:
- Fourth picture = (2)
o A tear on the anal skin which may be from constipation as they might struggle to pass stool and leave cuts and blisters - can be painful and inflamed
o May also be anal abuse
