NCM 103A: FUNDAMENTALS OF NURSING (RLE)

Topic: Perineal Care (Female and Male)

Activate Prior Knowledge

Review of the anatomy of female and male genitalia
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Female Genitalia Male Genitalia

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Acquire New Knowledge

Learning Objectives:
At the end of lecture-discussion and demonstration, the students will be able to:
1. Assess the patient needing assistance with perineal care.
2. Choose the appropriate procedure and equipment needed during perineal care.
3. Demonstrate the proper techniques of perineal care.

Perineum
 The area between the thighs
 This area is dark, warm, and moist and it favors the growth of bacteria
 It extends from the anterior pelvis to the anus

Perineal Care “peri-care” or “perineal-genital” care

 Perineal care consists of washing the perineum and external genitalia to prevent
bacterial growth
 Perineal care is routinely performed when bathing the client and it is required to
prevent skin irritation or infection to clients who are vulnerable
 Performed a minimum of once daily, usually as part of a complete or partial bed
bath.

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  The nurse should maintain a professional and dignified attitude when performing
perineal care.
 Performed as often as necessary because of incontinence of urine or feces,
profuse diaphoresis, or urethral, vaginal, or rectal discharge.
 Requires use of a firm but gentle touch to minimize stimulation.
 Can be delegated to nursing assistive personnel.

Purpose
1. To improve self-image and promote the feeling of well-being
2. To decrease bacterial growth.
3. To promote healing after perineal or anal surgery and vaginal deliveries.
4. To remove excessive secretions. (e.g., Smegma – a thick, cheesy substance found
under the labia minora and around the clitoris in the femalw and under the foreskin
in the male client. When smegma is allowed to collect, it irritates these areas and
emits foul odor).
5. To stimulate circulation

Patients who need frequent perineal care:

a. Who are unable to do self-care
b. Patients with genito-urinary tract infections
c. With fecal & urinary incontinence
d. With An Indwelling Foley catheter
e. Who are recovering from rectal or genital surgery or childbirth
f. Patients with excessive vaginal drainage
g. Patients with injury and ulcers
h. Uncircumcised males
i. Morbid obesity

Nursing Diagnosis Self-Care Deficit (Hygiene) related to

a. Decreased or lack of motivation
b. Weakness or tiredness
c. Pain or discomfort
d. Perceptual or cognitive impairment
e. Inability to perceive body part or spatial relationship
f. Neuromuscular or musculoskeletal impairment
g. Medically imposed restriction
h. Therapeutic procedure restraining mobility (e.g., intravenous infusion, cast)

Equipment:
Bath blanket or sheet Disposable gloves
2 bath towels Forceps
Wash cloth Cotton balls
Protective pad Bedpan
Soap Cornocupia
Pitcher of warm water or prescribed solution (antifungal/antibacterial)

Procedure and Rationale:

PROCEDURE RATIONALE
1 Assess the presence of irritation, excoriation, Provides you with information
inflammation, swelling, excessive discharge, to direct physical assessment
odor, pain or discomfort; urinary or fecal of genitalia.
incontinence; presence of indwelling catheter;

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 recent rectal or perineal surgery. Determines extent of perineal
care required by client.
2 Determine self-care abilities or whether the client If patient is able to maneuver
is experiencing any discomfort in the perineal- and handle washcloth, allow
genital area. them to clean perineum on
their own.

Maintain patient’s dignity and

self- care ability
3 Assemble equipment and supplies then bring to To prevent having to interrupt
client’s unit. the procedure later to gather
additional equipment.

4 Explain to the client what you are going to do, Doing so provides
why it is necessary, and how she can cooperate. information and reduces level
of anxiety during procedure
that is often embarrassing to
nurse and client.
5 Wash hands and observe other appropriate To prevent contamination
infection control procedures.
6 Provide for privacy by pulling curtains around Helps patient feel more
clients bed or close room door. comfortable
7 Raise bed to comfortable working position. Fold Provides full exposure of
the top bed linen to the foot of the bed and fold female genitalia
the gown up to expose the genital area.
8 Position and drape the client and clean the upper Position the patient for the
inner thighs. procedure to access the site
For females: Position client in a back-lying that requires hygiene care.
position with knees flexed and spread well apart.
Cover her body and legs with the bath blanket.
For males: Position client in a supine position Provides full exposure of
with knees slightly flexed and hips slightly male genitalia
externally rotated. Drape the legs by tucking the
bottom corners of the bath blanket under the
inner sides of the legs. Bring the middle portion
of the base of the blanket up over the pubic area.
9 Don clean gloves. Wash and dry the upper inner Eliminates transmission of
thighs. microorganisms
10 Inspect the perineal area. Note particular areas Determines extent of perineal
of inflammation, excoriation, or swelling, care required by client.
especially between the labia in females or the
scrotal folds in males. Also note excessive
discharge or secretions from the orifices, and the
presence of odors.
11 Wash and dry the perineal-genital area:
Skinfolds may contain body
secretions that harbor
microorganisms. Wiping from
front to back reduces chance
of transmitting fecal
organisms to urinary meatus

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 For females: Clean the labia majora. Then
spread the labia to wash the folds between the
labia majora and labia minora. Use separate

quarters of the washcloth for each stroke, and

wipe from the pubis to the rectum. For
menstruating women and clients with indwelling
catheter, use clean wipes, cotton balls or gauze.
Take a clean ball for each stroke. Rinse and dry
the area well.
For males: Wash and dry the penis, using Return the foreskin to its
firm strokes. If client is uncircumcised, retract natural position over the
the prepuce to expose the glans penis for glans penis if the patient is
cleaning. Replace the foreskin after cleaning. uncircumcised to prevent
Wash and dry the scrotum. constriction of blood flow that
may precipitate edema, pain,
and even necrosis of the
glans penis. Vigorous
massage can lead to erection
which is embarrassing to
nurses and clients.

12 Clean between the buttocks. Assist the client to Skin folds may contain body
turn onto the side facing away from you. Pay secretions that harbor
particular attention to the anal area and posterior microorganisms. Wiping from
folds of the scrotum in males. Clean the anus front to back reduces chance
with toilet tissue before washing it, if necessary. of transmitting fecal
Dry the area well. organisms to urinary meatus
13 Ensure client comfort. Remove bath blanket. Promotes comfort
Ensure that the client’s clothing is dry. Position
to a comfortable position and keep patient warm
with top sheet and blanket in place.
14 Dispose soiled articles and/or clean equipment Prevents transmission of

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 and return to supply room. Perform microorganisms. Protects
handwashing. patient from injury.
15 Document pertinent data. To promote continuity of
care. Giving signature
maintains professional
accountability.

Assessment:
1. Graded Recitation
2. Return Demonstration

3. Pre-test
1. It is found in between thighs and it extends from the anterior pelvis to the anus.
The area is normally dark, warm and moist and it is a favorable place for bacterial
growth.
a. Perineum
b. Vagina
c. Penis
d. Anus

2. Perineal care consists of washing the perineum and external genitalia to

prevent bacterial growth and it is routinely performed when bathing the client but
may be required to prevent skin irritation or infection to clients who are
vulnerable.
a. The statement is false
b. The statement is true
c. The statement is neither true or false
d. The statement is either true or false

3. It is defined as thick, cheesy substance found under the labia minora and
around the clitoris in the female and under the foreskin in the male client.
a. Mucus
b. Semen
c. Smegma
d. None of the options

4. Perineal care is routinely performed when bathing the client. While performing
perineal care, your patient asked why you’re doing the procedure. What is the
most appropriate response of a nurse?
a. Perineal care is being performed to promote bacterial growth
b. Perineal care is performed to promote healing and increase patient
comfort
c. Perineal care is performed to remove excessive secretions and maintaining
self-image of the nurse
d. All of the options
Rationale: Purposes of perineal care are: To improve self-image and promote the feeling of
well-being, To decrease bacterial growth, To promote healing after perineal or anal surgery and
vaginal deliveries, To remove excessive secretions and To stimulate circulation

5. Assessment is an essential nursing role in order to determine the extent of

care to be given to our patients. All except one is to be assessed before
performing perineal care?
a. Presence of inflammation and swelling on the genitalia
b. Urinary or fecal incontinence

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 c. Presence of indwelling catheter
d. Mental status of the patient
e. All of the options

Rationale: Assess the presence of irritation, excoriation, inflammation, swelling, excessive

discharge, odor, pain or discomfort; urinary or fecal incontinence; presence of indwelling
catheter; recent rectal or perineal surgery.

6. Perineal care is essential in order to promote comfort to all patient who cannot
perform self-care. Which among the following patients’ needs to have perineal care to
prevent bacterial growth?
a. Patients with an indwelling Foley catheter
b. Patients who are admitted in the intensive care unit who just undergone major
surgery
c. Morbid obese patients
d. All of the options

Rationale: Patients who need frequent perineal care are the following: Who are unable
to do self-care, Patients with genito-urinary tract infections, with fecal & urinary
incontinence, with an Indwelling Foley catheter, who are recovering from rectal or
genital surgery or childbirth, patients with excessive vaginal drainage, patients with
injury and ulcers, uncircumcised males and Morbid obese patients

7. Nurse is daisy is performing perineal to a female patient. She is correct if she

does which of the following steps?
a. She cleanse first the labia majora then extends up to the anus
b. She spreads the labia to wash the folds of between labia major and labia
minora by using separate quarters of the washcloth for each stroke
c. She spreads the labia to wash the folds of between labia major and labia
minora by using the same quarter of the washcloth for each stroke
d. She cleanse the labia minora then the labia majora and wipes the rectum to
the pubis
Rationale: Proper technique includes cleaning the labia majora first. Then spread the
labia to wash the folds between the labia majora and labia minora. Use separate
quarters of the washcloth for each stroke, and wipe from the pubis to the rectum.

8. In performing perineal care to a male patient, which among the following is the
reason why caregiver should wash and dry the penis, using firm strokes?
a. To prevent erection
b. To promote circulation
c. To properly remove the secretions
d. To prevent skin tears
Rationale: Washing and drying the penis using firm strokes prevents erection.

9. Properly positioning our client prevents unnecessary exposure of the body

parts. In performing perineal care what is the most appropriate position for male
clients?
a. Client is in supine position with hips slightly externally rotated
b. Client is on side lying position with his knees slightly flexed
c. Client is in supine position with knees slightly flexed and hips are slightly
internally rotated
d. Client is in supine position with knees slightly flexed and hips are
slightly externally rotated
Rationale: Male patients are positioned in a supine position with knees slightly flexed and hips
slightly externally rotated. Drape the legs by tucking the bottom corners of the bath blanket

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under the inner sides of the legs. Bring the middle portion of the base of the blanket up over the
pubic area.
10. Perineal care is a nursing skill that cannot be delegated to nursing assistive
personnel.
a. The statement is false
b. The statement is true
c. The statement is neither true or false
d. The statement is either true or false

References:

Perineal Care retrieved from https://www.youtube.com/watch?v=8JdtbrVqg4g

Perineal Care retrieved from https://www.slideshare.net/kayeconstantino/perineal-care
Nuggent, P & Vitale, B.(2014). Fundamentals of Nursing. Philadelphia: PA
Potter & Perry (2001).Fundamentals of Nursing 5th Edition. Elsevier Science: Singapore
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