PHYSICAL EXAMINATION OF THE FEMALE GENITALIA Flashcards
what does amenorrhea mean?
Absent menstrual cycle
what is defined as prolonged menses
more than 7 days
History of Present Illness for Female Genitalia issues
-Abnormal bleeding.
-Pain
-Vaginal discharge
-Premenstrual symptoms complaint
-Menopausal symptoms complaint
-Infertility
-Urinary symptoms
True/False
Ask the adolescent patient the same questions you would ask an adult woman. Talk to the adolescent without parents present.
True
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
Family History questions to ask
-family history of diabetes
-cancer of reproductive organs
-DES (diethylstilbestrol) ingestion by mother during pregnancy
-multiple pregnancies
-congenital anomalies
What glands secrete lubrication during sexual excitement.
Bartholin glands
What glands are for draining urethral glands
Skene glands
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
Pelvic organs may be palpated through pockets around the cervix called what?
Fornices
The internal genitalia are supported by what ligaments?
cardinal,
uterosacral,
round,
broad
The ______ of the uterus are composed of the fallopian tubes and ovaries
adnexa
shallow upper section of the Pelvis which consists mainly of the flared-out iliac bones is considered the _________
false pelvis
Pelvis
__________is the lower curved bony canal, including the inlet, cavity, and outlet.
true pelvis
the onset of menstruation (menarche), occurs
between the ages of_______ in the US
11 and 14 years
During pregnancy the uterus rises out of pelvis into the abdominal cavity by _____ weeks of gestation
12 weeks
Uterine weight at term, excluding the fetus and placenta, is about what?
1000g
During pregnancy the pelvic joints separate slightly, resulting in what type of gait
“waddle gait.”
During pregnancy
The papillae of the mucosa have a hobnailed appearance.
Is this Normal?
Yes
Older adults
Ovarian function diminishes around age_____, and menopause occurs between _______ years of age
40
40 and 55
Menopause is conventionally defined as what?
1 year with no menses
True/False
Most women express lack of enthusiasm in anticipation of a pelvic examination, most do not experience anxiety
True
Marked anxiety before an examination may be a sign of what?
that something is not quite right
What is the patient position for a pelvic exam?
lithotomy position
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
