SUMMARY OF IMPORTANT LESSONS LEARNED FROM

ASSESSMENT OF THE GENITALIAS AND ANUS AND RECTUM

The examination of the genitals and reproductive tract of women includes assessment of the inguinal
lymph nodes and inspection and palpation of the external genitals. For sexually active adolescent and
adult women, a Papanicolaou test (Pap test) is used to detect cancer of the cervix. Examination of the
genitals usually creates uncertainty and apprehension in women, and the lithotomy position can cause
embarrassment. The nurse must explain each part of the examination in advance. Collection of
subjective data from the patients, such as history of present health concern (menstrual cycle,
menopause, vaginal discharge, pain, masses, urination and sexual dysfunction), past health history,
family history, lifestyle and health practices

Collection of objective data or the physical examination of the patient. The equipment needed for
examining the female genitalia includes disposable gloves, speculums, slides and special solutions,
spatulas, endocervical broom and other devices.

Inspection of the external genitalia. Inspect the mons pubis, note the distribution of pubic hair. Observe
and palpate inguinal lymph nodes. Inspect the labia majora and perineum for lesions, swelling and
excoriation. Inspect the labia minora, clitoris, urethral meatus and vaginal opening for lesions,
excoriation, swelling and or discharge.

Palpate Bartholin’s gland for swelling, tenderness and discharge. Palpate the urethra for urethritis or
inflammation of Skene’s gland.

Inspection of the internal genitalia. Inspect the size of the vaginal opening, and the angle of the vagina.
Inspect the vaginal musculature. Inspect the cervix, note the color, size, position, discharge and lesions.
Inspect the vagina, note the color, surface, consistency and any discharge. Obtain a Pap smear.

Palpate the vaginal wall for texture and tenderness. Palpate the cervix for contour, consistency, mobility
and tenderness. Palpate the uterus, note the size, position, shape and consistency. Palpate the ovaries,
note the size, shape, consistency, mobility and tenderness.

In adult men, complete examination should include assessment of the external genitals, the presence of
any hernia, and the prostate gland. Collection of subjective data from the client. When interviewing a
male client, keep in mind the sensitivity of the topic. Anxiety, embarrassment, and fear may influence
the client’s ability to discuss problems. Determine the client’s history through, history of present health
concern (pain, lesions, discharge, lumps, swelling, masses, urination, sexual dysfunction), past health
history, family history, life and health practices.

Collection of objective data or the physical examination. The purpose of examining the male genitalia is
to detect abnormalities that may range from life-threatening diseases to painful conditions that
interfere with normal function.

Inspection and palpation of the penis. Inspect the base of the penis and pubic hair, note pubic hair
growth pattern and excoriation, erythema, or infestation at the base of the penis and within the pubic
hair. Inspect the skin of the shaft, note for rashes, lesion or lumps. Palpate the shaft. Inspect the foreskin
for color, location and integrity of the foreskin for uncircumcised men. Inspect the glans for size, shape
and lesion or redness. Palpate the urethral discharge. Inspect the scrotum for size, shape and position.
Inspect the scrotal skin. Palpate the scrotal contents; palpate each testis and epididymis, palpate each
spermatic cord and vas deferens. Auscultate for a scrotal mass.

Inspect the inguinal area for inguinal and femoral hernia. Palpate for inguinal hernia and inguinal nodes.
Palpate inguinal lymph nodes for size, consistency, mobility or tenderness. Palpate for femoral hernia.
Inspect and palpate for scrotal hernia.

Rectal examination, an essential part of every physical examination, involves inspection and palpation.
The extent of the assessment of the rectum and anus depends on the rectal problems stated by the
client in the nursing history. History of present health concern (bowel patterns, stool, itching and pain)
past health history, family history and lifestyle and health practices

The hands-on physical examination of the anus, rectum and prostate can cause most clients anxiety and
embarrassment. Proceed with the examination in a competent and effective manner. Position during
the examination; for females, dorsal recumbent with knees flexed or lithotomy; for males, standing
position while the client bends over the examination table.

Inspection of the anus and rectum. Inspect the perianal area for lumps, ulcers, lesions, rashes, redness,
fissures and thickening of the epithelium. Inspect the sacrococcygeal area for swelling, redness,
dimpling, or hair. Palpate the anus. Palpate the rectum for tenderness, irregularities, nodules, and
hardness. Palpate the peritoneal cavity, note for tenderness and nodules. Palpate the prostate gland,
note the size, shape, consistency, nodules and tenderness. Inspect the stool.

Reference :

Weber. J & Kelly. J. Health Assessment in Nursing 3 rd Edition. Lippincott Williams & Wilkins. Chapter 21 p 471- 491 ,
Chapter 22 p 507-517, Chapter 23 p531-541

Kozier.B et.al. Fundamentals of Nursing 7th Edition. Pearson Education. Chapter 28 p 615,618,622

Health Assessment Handout p 79-83