SUMMARY NOTES

Introduction to the Female Genitalia and Rectum

I. External Genitalia

Mons Pubis ✓ The mons pubis is the fat pad located over the
symphysis pubis.
✓ The normal adult mons pubis is covered with pubic
hair in a triangular pattern.
✓ It functions to absorb force and to protect the
symphysis pubis during coitus (sexual intercourse).

Labia Majora ✓ The labia majora are two folds of skin that extend
posteriorly and inferiorly from the mons pubis to the
perineum.
✓ The skin folds are composed of adipose tissue,
sebaceous glands, and sweat glands.
✓ The outer surface of the labia majora is covered with
pubic hair in the adult, whereas the inner surface is
pink, smooth, and moist.

Labia Minora ✓ Inside the labia majora are the thinner skin folds of
the labia minora.
✓ These folds join anteriorly at the clitoris and form a
prepuce or hood; posteriorly the two folds join to form
the frenulum.
✓ Compared with the labia majora, the labia minora are
hairless and usually darker pink.
✓ They contain numerous sebaceous glands that
promote lubrication and maintain a moist environment
in the vaginal area.

Clitoris ✓ The clitoris is located at the anterior end of the labia

minora.
✓ It is a small, cylindrical mass of erectile tissue and
nerves with three parts:
1. Glans - the visible rounded portion of the clitoris
2. Corpus - the body
3. Crura - two bands of fibrous tissue that attach the
clitoris to the pelvic bone
✓ The clitoris is similar to the male penis and contains
many blood vessels that become engorged during
sexual arousal.
Vestibule ✓ The skin folds of the labia majora and labia minora
form a boat-shaped area (or fossa) called the
vestibule.
✓ The vestibule contains several openings.

NCM 101: Health Assessment

Topic: Assessment of the Female Genitalia and Rectum
Prepared By: K. Abuan
 Urethral Meatus ✓ Located between the clitoris and the vaginal orifice is
the urethral meatus.

Skene’s Gland ✓ The openings of Skene’s glands are located on either

side of the urethral opening and are usually not
visible.
✓ Skene’s glands secrete mucus that lubricates and
maintains a moist vaginal environment.
✓ These small glands are often referred to as the lesser
vestibular glands.

Vaginal Orifice ✓ Below the urethral meatus is the vaginal orifice.

✓ This is the external opening of the vagina and has
either a slit-like or irregular circular structure,
depending on the configuration of a hymen.

Hymen ✓ The hymen is a fold of membranous tissue that covers

part of the vagina.

Bartholin’s Glands ✓ These glands secrete mucus, which lubricates the area
during sexual intercourse.
✓ These small glands, which are not visible to the naked
eye, are often referred to as the greater vestibular
glands.

NCM 101: Health Assessment

Topic: Assessment of the Female Genitalia and Rectum
Prepared By: K. Abuan
II. Internal Genitalia

Vagina ✓ The vagina, a muscular, tubular organ, extends up and slightly back toward
the rectum from the vaginal orifice (external opening) to the cervix.
✓ It lies between the rectum posteriorly and the urethra and bladder anteriorly,
and is approximately 10 cm long.
✓ The normal vaginal environment is acidic (pH of 3.8–4.2).
✓ The environment of the vagina is maintained because of the vaginal flora
✓ The vaginal Flora composed of Döderlein’s bacilli, and the bacilli act on
glycogen to produce lactic acid. This acidic environment helps to prevent
vaginal infection.
✓ Functions:
1. Passage for menstrual flow
2. Receives penis during sexual intercourse
3. Lower portion of birth canal during delivery
✓ The vaginal wall comprises four layers.
1. Outer Layer
- Composed of pink squamous epithelium and connective tissue
- It is under the direct influence of the hormone estrogen and contains
many mucus-producing cells.
- This outer layer of epithelium lies in transverse folds called rugae.
- These transverse folds allow the vagina to expand during intercourse;
they also facilitate vaginal delivery of a fetus.
2. Submucosal Layer
- Second layer
- It contains the blood vessels, nerves, and lymphatic channels
3. Third Layer
- Composed of smooth muscle
4. Fourth Layer
- Consists of connective tissue and the vascular network.
Cervix ✓ The cervix (or neck of the uterus) separates the upper end of the vagina from
the isthmus of the uterus.
✓ The junction of the isthmus and the cervix forms the internal os; the junction
of the cervix and the vagina forms the external os or ectocervix.
✓ The “os” refers to the opening in the center of the cervix.
✓ The cervix is composed of smooth muscle, muscle fibers, and connective
tissue.
✓ Two types of epithelium that cover the external os:
1. Squamous epithelium
- Lines the vaginal wall
2. Columnar epithelium
- Lines the endocervical canal
✓ Squamocolumnar Junction
- Where the two epitheliums meet
- Migrates towards the cervical os with maturation or with increased
estrogen levels
✓ The transformational zone is important:
1. 90% of the neoplasms of the lower genital track originate in this area.
2. This is the area from which cells are obtained for cervical cytology or
the Papanicolaou smear (Pap test).
✓ The cervix functions to allow the entrance of sperm into the uterus and to
allow the passage of menstrual flow.
NCM 101: Health Assessment
Topic: Assessment of the Female Genitalia and Rectum
Prepared By: K. Abuan
 ✓ It also secretes mucus and prevents the entrance of vaginal bacteria.
✓ During childbirth, the cervix stretches (dilates) to allow the passage of the
fetus.
Uterus ✓ The uterus is a pear-shaped muscular organ
✓ The uterus is usually situated in a forward position above the bladder at
approximately a 45-degree angle to the vagina when standing (anteverted
and anteflexed position).
✓ The normal-sized uterus is approximately 7.5 cm long, 5 cm wide, and 2.5
cm thick.
✓ The uterus is movable.
✓ Has two components:
1. Corpus – body
2. Cervix – neck
✓ The corpus of the uterus is divided into:
1. Fundus – upper portion
2. Body – central portion
3. Isthmus – narrow lower portion
✓ Three layers of the uterine wall:
1. Endometrium
- Inner mucosal layer
- Composed of epithelium, connective tissue, vascular network
- Estrogen and progesterone influence the thickness of this tissue.
- Uterine glands contained secrete an alkaline substance that keep uterine
cavity moist
- A portion of the endometrium sheds during menses and childbirth.
2. Myometrium
- Middle Layer
- Composed of 3 layers of smooth muscle fibers
- Functions to expel the products of conception
3. Peritoneum
- Outer uterine layer
- Covers the uterus and separated it from the abdominal cavity
- Forms anterior and posterior pouches around the uterus.
- The posterior pouch is called the recto-uterine pouch or the cul-de-sac of
Douglas.
Ovaries ✓ The ovaries are a pair of small, oval-shaped organs, each of which is situated
on a lateral aspect of the pelvic cavity.
✓ Each is approximately 3 cm long, 2 cm wide, and 1 cm deep. The ovaries are
connected to the uterus by the ovarian ligament.
✓ The ovary functions to develop and release ova and to produce hormones
such as estrogen, progesterone, and testosterone.
✓ The ovum travels from the ovary to the uterus through the fallopian tubes.
✓ These 8- to 12-cm long tubes begin near the ovaries and enter the uterus just
beneath the fundus.
✓ The end of the tube near the ovary has fringe-like extensions called fimbriae.
✓ The ovaries, fallopian tubes, and supporting ovarian ligaments are referred to
as the adnexa (Latin for appendages).

III. Anus and Rectum

✓ Anal canal
- The final segment of the digestive system.
- It begins at the anal sphincter and ends at the anorectal junction (also known as the pectinate line, mucocutaneous
junction, or dentate line).
- It measures from 2.5 cm to 4 cm long.
- It is lined with skin that contains no hair or sebaceous glands but does contain many somatic sensory nerves,
making it susceptible to painful stimuli.
- The anal canal proceeds upward toward the umbilicus.
✓ Anal opening/ Anal verge
- Can be distinguished from the perianal skin by its hairless, moist appearance.
- Extends interiorly, overlying the external anal sphincter
✓ External Sphincter
- Composed of skeletal muscle and is under voluntary control.
✓ Internal Sphincter
- Composed of smooth muscle and is under involuntary control by the autonomic nervous system.
NCM 101: Health Assessment
Topic: Assessment of the Female Genitalia and Rectum
Prepared By: K. Abuan
✓ Intersphincteric Groove
- Dividing the two sphincters.
✓ Anorectal Junction
- Located just above the internal sphincter, not palpable, but may be visualized during internal examination.
- The dividing point of the anal canal and the rectum
✓ Rectum
- The rectum is lined with folds of mucosa (columns of Morgagni)
- The lowest portion of the large intestine and is approximately 12 cm long, extending from the end of the sigmoid
colon to the anorectal junction.
- The anal canal and rectum are at approximately right angles to each other.
✓ Anal Crypts
- There are 8 to 12 anal crypts and 5 to 8 papillae.
✓ Valves of Houston
- Three inward foldings inside the rectum
- The function of the valves of Houston is unclear.
- The lowest valve may be felt, usually on the client’s left side.

NCM 101: Health Assessment

Topic: Assessment of the Female Genitalia and Rectum
Prepared By: K. Abuan