PHYSICAL EXAMINATION OF THE FEMALE GENITALIA Flashcards by Senpai Sama

what does amenorrhea mean?

Absent menstrual cycle

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what is defined as prolonged menses

more than 7 days

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History of Present Illness for Female Genitalia issues

Abnormal bleeding.
Pain
Vaginal discharge
Premenstrual symptoms complaint
Menopausal symptoms complaint
Infertility
Urinary symptoms

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True/False
Ask the adolescent patient the same questions you would ask an adult woman. Talk to the adolescent without parents present.

True

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What are some contributing factors for infertility

Abnormalities of the vagina, cervix, uterus, fallopian tubes, an ovaries.
Stress
Nutrition
Chemical substances
Diseases
Sexual and immunological responses

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Family History questions to ask

family history of diabetes
cancer of reproductive organs
DES (diethylstilbestrol) ingestion by mother during pregnancy
multiple pregnancies
congenital anomalies

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What glands secrete lubrication during sexual excitement.

Bartholin glands

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What glands are for draining urethral glands

Skene glands

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The anterior wall of the vagina is separated from the bladder and urethra by the ______________
The posterior wall is separated from the rectum by the
_____________.

vesicovaginal septum

- rectovaginal septum

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Pelvic organs may be palpated through pockets around the cervix called what?

Fornices

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The internal genitalia are supported by what ligaments?

cardinal,
uterosacral,
round,
broad

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The ______ of the uterus are composed of the fallopian tubes and ovaries

adnexa

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shallow upper section of the Pelvis which consists mainly of the flared-out iliac bones is considered the _________

false pelvis

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Pelvis

__________is the lower curved bony canal, including the inlet, cavity, and outlet.

true pelvis

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the onset of menstruation (menarche), occurs

between the ages of_______ in the US

11 and 14 years

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During pregnancy the uterus rises out of pelvis into the abdominal cavity by _____ weeks of gestation

12 weeks

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Uterine weight at term, excluding the fetus and placenta, is about what?

1000g

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During pregnancy the pelvic joints separate slightly, resulting in what type of gait

“waddle gait.”

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During pregnancy
The papillae of the mucosa have a hobnailed appearance.
Is this Normal?

Yes

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Older adults

Ovarian function diminishes around age_____, and menopause occurs between _______ years of age

40 and 55

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Menopause is conventionally defined as what?

1 year with no menses

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True/False

Most women express lack of enthusiasm in anticipation of a pelvic examination, most do not experience anxiety

True

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Marked anxiety before an examination may be a sign of what?

that something is not quite right

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What is the patient position for a pelvic exam?

lithotomy position

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If the woman is disabled what are some alternate positions

- Diamond-shaped position - Obstetric stirrups position - M-Shaped position - V-Shaped

Inspect labia majora for what?

-redness, -tenderness, -excoriation, -rashes, -lesions. Observe for: -discoloration, -varicosities, -stretching, -signs of trauma or scarring

Inspect labia minora for:

- inflammation, - irritation, - excoriation, - caking of discharge in the tissue folds, - discoloration or tenderness, - ulcers or vesicles

Palpate Skene and Bartholin glands. Milk the skene glands and look for discharge and note any tenderness. If discharge occurs, note what? Does this indicate infection?

- color, consistency and odor | - yes

An abscess of the Bartholin gland is usually ______ in origin and pus filled.

gonococcal or staphylococcal

a Bartholin gland that hot to the touch and fluctuant indicates what?

Abcess

if the woman has borne children or has told you about signs of weak muscle tone what do you have them do? What are you looking for?

Ask the patient to bear down as you watch for bulging and urinary incontinence

When testing the muscle tone Bulging of the anterior wall and urinary incontinence indicate the presence of a what?

cystocele

When testing the muscle tone bulging of the posterior wall indicates what?

Rectocele

When testing the muscle tone Bulging of the posterior wall indicates a what?

rectocele

_____________ marked by protrusion of the cervix or uterus on straining.

Uterine prolapse

These findings are considered what? 1) Skin is smooth. 2) Hair is in triangular pattern. 3) Majora are symmetric, soft, and homogenous. 4) Minora are moist and dark pink. 5) Clitoris is 2 cm in length and 0.5 cm in diameter. 6) No swelling, mass, or pain is present

Normal

These findings are considered what? 1) After hymen tears, hymenal tags may be visible. 2) Uterus is usually flattened and anteroposterior at a 45-degree angle, but it may also be anteverted, anteflexed, retroverted, or retroflexed. 3) Episiotomy scar may be evident. 4) Perineum is thinner and more rigid in multiparous women and more thick and smooth in nulliparous women. 5) Pale cervix suggests anemia 6) Squamous epithelium on cervical canal may be visible. 7) Nabothian cysts may be seen around cervix. 8) Os of nulliparous women may be small, round, or oval; os of multiparous women may be more horizontal, irregular, or stellate.

Typical variations

External labia swelling, pain, warmth, and redness may mean what?

Bartholin gland abscess

Young women who are not sexually active should have their first examination by what age?

21 years old

By menarche, vaginal opening should be at least ___ cm wide

1 cm

Urethral inflammation or dilation suggests what

repeated urinary tract infections

Vaginal discharge (yellow, green, or gray) with odor suggests what?

infection

Labia minora irritation may be caused by ____

vaginal infection

Ulcers or vesicles may be from what type of infection?

sexually transmitted infection.

What issue? usually begins in a woman’s late 20s and increases in incidence and severity as menopause approaches. -Characterized by edema, headache, weight gain and behavioral disturbances such as irritability, nervousness, dysphoria, and lack of coordination. Symptoms occur 5 to 7 days

Premenstrual syndrome – PMS

What is presence and growth of endometrial tissue outside the uterus causes pelvic pain, dysmenorrhea, and heavy or prolonged menstrual flow

Endometriosis

What issue - Warty lesions on the labia, within the vestibule or in the perianal region as a result of human papillomavirus(HPV) infection. - Veneral warts are sexually transmitted and are flesh-colored, whitish pink to reddish brown, discrete, soft growths and may form cauliflower-like masses

Condyloma Acuminatum (Genital warts)

What issue Benign skin infection caused by poxvirus, may be transmitted by sexual contact. Incubation period is from 2 to 7 weeks. The lesions are white or flesh-colored, dome-shaped papules that are round or oval. Surface characteristic is central umbilication from a thick creamy core can be expressed.

Molluscum Contagiosum

What issue Lesions of secondary syphilis appear about 6 to 12 weeks after infection. Flat, round, or oval papules covered by a gray exudates

Condyloma latum

What issue? | A firm, painless ulcer. In women develop internally

Syphilitic chancre (Primary syphilis)

What issues? STI that produces small red vesicles. The lesions may itch and are painful and usually confined to a small localized patch on the vulva, perineum, vagina or cervix.

Herpes lesions

Caused by gonococcal infection. Acute inflammation produces a hot, red, tender, fluctuant swelling that may drain pus. -Chronic inflammation results in a nontender cyst on the labium.

Inflammation of Bartholin gland

A hernail protrusion of the urinary bladder through the anterior wall of the vagina. Bulging can be seen as the woman bears down.

Cystocele

Hernial protrusion of part of the rectum through the posterior wall of the vagina.

Rectocele

Finding include vaginal discharge, lesions, and masses. This appears as ulcerated or raised red lesions on the vulva.

Cancer of the vulva

A bright red polypoid growth that protrudes from the urethral meatus

Urethral carbuncle

Vaginal infections | Watery discharge; usually not foul smelling; dysuria, profuse frothy, greenish discharge.

Trichomoniasis

Vaginal infections | Purulent discharge from cervix; skene/bartholin inflammation.

Gonorrhea

Vaginal infections | Homogenous thin, white or gray discharge; positive KOH with clue cells.

Bacterial vaginosis

Vaginal issue | Bright red, soft and fragile arise from the endocervical canal

Cervical polyps

what appears as shiny red tissue around the os that may bleed easily.

Columnar epithelium

Result of weakening of the supporting structures of the pelvic floor, often occurring with a cystocele or rectocele.

Uterine prolapsed

What issue? Are common, benign, uterine tumors that appear as firm, irregular nodules in the contour of the uterus.

Myomas

Growths that can occur unilaterally or bilaterally affecting the ovaries. The cysts are smooth.

Ovarian cysts

What issue Causes marked pelvic tenderness, with tenderness and rigidity of the lower abdomen. A tender, unilateral adnexal mass may indicate the site of pregnancy. This is a surgical emergency

Ruptured tubal pregnancy

What issue? | Often caused by gonococcal and chlamydial infection that may be acute or chronic.

Pelvic inflammatory disease

Inflammation or infection of the fallopian tube and associated with PID.

Salpingitis

Infants and children What issue? Vaginal secretions that collect behind an imperforate hymen and manifested by a small midline lower abdominal mass or small cyst between the labia.

Hydrocolpos

What issue? | Vaginal discharge accompanied by warm, erythematous, and swollen vulvar tissue.

Vulvovaginitis

Caused by lack of estrogen in older adults. Vaginal mucosa is dry and pale. The accompanying vaginal discharge may be white, gray, yellow, green or blood-tinged.

Atrophic vaginitis