Week 6: Female GU

Question 1

FEMALE GU QUESTIONS

Answer 1

Urination
Painful urination: Dysuria
Incontinence: stress vs urge
Characteristics

External Genitalia
Lesions, redness, warmth
Mass?
Rash, itching?

Internal Genitalia
Vaginal discharge: quality characteristics, odor
Dyspareunia (painful intercourse)
Health Promotion
HPV, Hep B, Pap smear

Menses: 
regular vs irregular
# days between cycles
# days cycle lasts
Amenorrhea (no period)
Menorrhagia (prolonged, heavy bleeding)
LMP (last menstrual period)
PMS
Pelvic pain
OLDCART

Sexual Contacts/STI: 5 Ps
Practices, protection, past hx, pregnancy prevention, plus

Question 2

OTHER HX QUESTIONS

Answer 2

Gynecologic history
History of breast disease, breastfeeding, mammogram, pelvic exam, Pap smear, STIs
Obstetric history: Story of every pregnancy that a woman has had
Year, duration, method of delivery, complications, and details about each child
Sexual history
Should provide an opportunity to further the patient–clinician relationship and support behaviors that encourage sexual health across the life span
Five Ps: Practices, protection from STIs, past history of STIs, and pregnancy prevention, Plus (safety, forced, under influence)

Question 3

COMMON CONCERNS & EXAMPLE

Answer 3

Vaginal Discharge
Pelvic pain/cramps
Amenorrhea:is the absence of menstruation
Menorrhagia
Dysuria/frequency
Urinary incontinence
Family Planning
STI testing
WWE
Onset: Recent, intermittent, or chronic
Location: Vulvovaginal
Duration: Persistent symptoms, increasing amount of discharge or worsening associated symptoms versus lingering, improving, or intermittent symptoms
Character: Odor (none, fishy [amine], putrid), color (gray, yellow, green, white), consistency (frothy, thin, clumped), amount
Associated symptoms—local: Pruritus (internal, external, or both), painful skin lesions, dyspareunia, dysuria, frequent urination
Associated symptoms—systemic: Fever, nausea, vomiting; any prior history of similar symptoms
Aggravating factors: Intercourse, urination, antibiotics, douching, soaking in a bathtub or hot tub
Relieving symptoms: Over-the-counter (OTC) antifungal cream, cool compresses, sitz bath, or other treatments
Temporal factors: Timing in relation to menstrual cycle, recent antibiotics, symptoms after presence of foreign objects, or latex in vagina; recent sexual activity, new partner, or history of infection in current partner.

Question 4

APPROACH TO FEMALE GU EXAM

Answer 4

Obtains permission and seeks/selects a chaperone
Explains each step of exam in Advance
Drapes the patient from mid abdomen to knees; may press drape down to maintain eye contact w/pt
Avoids unexpected or sudden movements
Chooses correct size speculum
May warm speculum w/tap water (not necessary if using plastic)
Monitors comfort of pt and provides pt w/permission to stop exam at any time
Uses excellent but gentle technique- letting pt know what is coming before each step of exam

Question 5

FEMALE EXAM: INSPECT & PALPATE

Answer 5

Inspection: Lithotomy Position: scoot pt to end of table, feet in stirups
External Genitalia: mons pubis, clitoris, urethra, labia, vaginal introitus, hair distribution, skin
Perineum
Anus

Question 6

FEMALE EXTERNAL GU: PALPATION

Answer 6

Palpation : three fingers
Inguinal lymph nodes
Labia Majora- including Bartholin’s glands
Other cysts or lesions? Moles (melanoma?)
Tenderness?

Question 7

STEPS TO SPECULUM EXAM

Answer 7

Suggest warming speculum w/warm tap water (not be necessary for non-metal speculum)
May apply lubricant to top and bottom- avoid end of speculum
Insert the light into the speculum
Warn pt that she is going to feel you touching her with your fingers
Gently spread the labia with your non-dominant hand
Let pt know that she will feel pressure
Using your dominant hand, gently insert speculum tilting slightly downward
Continue to advance slowly