Week 13: Assessing the Vagina Flashcards
Structure and function
External genitalia:
- CLITORIS – Contains erectile tissue and nerves; becomes engorged during sexual arousal
- PREPUCE – Inner folds of the labia minora surrounding the clitoris
- RUGAE – Transverse folds located in the vagina that allow for expansion
Internal genitalia:
1. CERVIX – Tested frequently (Pap smear) because 90% of neoplasms occur in this lower genital tract
Chief complaints
Common CCs:
1. Menstrual irregularities – amenorrhea, dysmenorrhea
- Vaginal discharge/odor
- Vulva/vaginal area lesions
- Vaginal bleeding (with/without sex)
- Pain/itching/spasms in genitalia or groin – vaginismus (spasms of the muscles of the vagina)
- Urinary symptoms/difficulties – dysuria, incontinence, difficulty controlling urine, changes in urine color/odor
- Lumps/swelling/masses in genitalia or groin
- Sexual performance/activity pattern – dyspareunia (painful sex)
- Fertility problems
- Rectum (GI) – abnormal stools (D/, constipation, IBS), changes in stool (color/mucus/blood), hemorrhoids (BRBPR)
Common peri & menopause CC
Peri/menopause CCs:
1. Metrorrhagia: Spotting/irregular menses (especially during perimenopause)
- Fatigue and trouble sleeping
- Hot flashes and night sweats (common, 60%)
- Mood swings
- Decreased appetite
- Vaginal dryness (due to lack of estrogen)
- Urinary urgency or leakage (stress incontinence)
**Inquire about hormone replacement therapy (ET and EPT) and natural herbal therapies
PHMX and FHX
Normal menses = q 24-32 days; Length = 3-7 days
Inquire about heaviness (# of pads/tampons used)
Transgender pts
- Communication – establish rapport
- Physical changes
- Gender-affirming surgeries – vaginoplasty
Menses vocabulary
Terms:
1. MENARCHE: Beginning of menstruation
- PERIMENOPAUSAL: Transition before menopause
- MENOPAUSE: Normal physiologic process (secondary amenorrhea)
- AMENORRHEA: Absence of menses; Primary (failure to initiate menarche) vs. Secondary (cessation of menses after they previously existed)
- DYSMENORRHEA: Painful periods
- MENORRHAGIA: Increased amounts of bleeding or duration
- METRORRHAGIA: Abnormal bleeding/spotting that occurs between periods
- PREMENSTRUAL SYNDROME (PMS) – Complex psychological and physical symptoms occurring 4-10 days before the onset of menses
- DYSURIA: Painful urination (independent of menses)
Pap smear
Pelvic examination should begin by age 21, every 3 (initially) to every 5 yrs.; Earlier if high risk (immunocompromised or exposed to DES in utero)
Equipment – Endocervical broom
Older clients & cultural considerations
Older pts:
1. Always a concern if any vaginal bleeding (indicative of cervical CA, polyps)
- Estrogen production decreases, causing atrophy of the vaginal mucosa (and increased risk for vaginal infection)
- Gray, thinning pubic hair
- Sensitivity towards sexual health
CULTURE – History of cultural pubertal rites (i.e. Female circumcision)
Cervical CA
Associated with a high mortality rate; high cure rate if discovered early
Most important risk factor = HPV infection (vaccine)
Cervical CA risk factors:
1. Females (mid-30s)
- Multiple sexual partners, early unprotected sex, or sex with uncircumcised male
- Failure to have regular Pap tests
- Chlamydia or HIV infection
- Cigarette smoking
Colorectal CA
Affects the LI or rectum, beginning in the lining of the colon/rectum
RISK FACTORS: >50 yrs. old, African American or Eastern European decent, CA elsewhere (i.e. Breast CA), colon polyps, IBS (Crohn’s or ulcerative colitis), HPV (causes 95% of colorectal CAs)
MODIFIABLE risk factors: Diet (limit fat, and red/processed meats), smoking, alcohol, reduced physical activity/sedentary lifestyle
Patient education:
1. Preventative screening (50-75 yrs. of age) – FOBT (yearly), sigmoidoscopy (every 5 yrs.), and colonoscopy (every 10 yrs.)
- Notify PCP if black/tarry stools, blood during BM, change in bowl habits, unexplained weight loss
Abnormal findings
CYSTOCELE: Herniation of the bladder into the vagina
RECTOCELE: Herniation of the rectum into the vagina
