Note the appearance of the female external genitalia.

1. Inspect the mons pubis and labia for color, size, symmetry, bruises, lesions, and rashes.

Next, separate the labia and using traction pull toward the examiner to reveal the clitoris, labia minor,
posterior fourchette, urethral meatus, hymen, and vaginal orifice. A pen light or otoscope light can be
used to provide illumination.

Note any bruises, lesions, rashes, discharge, swelling, or other irregularities and document any inability
to visualize structures within the vestibule due to labial adhesions.

2. Inspect the posterior rim of the hymen from 3 to 9 o’clock with anunderstanding of normal anatomic
variations of the prepubertal hymen: crescentic (hymenal tissue absent for 11 to 1 o’clock); annular
(hymenal tissue present from 12 to 12 o’clock); and redundant or fimbriated (hymenal tissue that folds
onto self, opening may be difficult to visualize) (Heger et al, 2002).

The hymen may be smooth and delicate or have shallow notches and/or bumps, which are variations of
normal.

3. Characteristics of any vaginal/urethral discharge or bleeding should be noted. Tanner stage of female
sexual development should be observed.

Initially, no pubic hair is present.

4. Inspect the urethra of patient for the presence of prolapse, the protrusion of the urethral mucosa
beyond the meatus.

5. Visualize the inguinal area and note any change in contour and symmetry.

6. Palpate the inguinal area in for lymph nodes and other masses.