Chapter 27

Assessing Female Genitalia,

Anus, and Rectum
Structure and Function
 External genitalia:
o Include structures that can be readily identified
through inspection
 Internal genitalia:
o Include the female reproductive organs

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Question #1
Is the following statement true or false?
The female reproductive system falls under internal
genitalia.

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Answer to Question #1
True.
The female reproductive system falls under internal
genitalia.

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Cervical Cancer: Risk Factors #1
 Human papilloma virus (HPV) infection
 Smoking
 Immunosuppression
 Chlamydia infection
 Diet low in fruits and vegetables
 Being overweight
 Intrauterine device use

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Cervical Cancer: Risk Factors #2
 Having multiple full-term pregnancies
 Being younger than 17 at first full-term pregnancy
 Poverty
 Having a mother who took diethylstilbestrol (DES) while
pregnant
 Family history of cervical cancer

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Cervical Cancer: Risk Reduction #1

 Avoid risky sexual practices: do not have sex at an early

age; do not have multiple partners; avoid high-risk
sexual activities and partners who participate in these.
 Consult with a health care professional about having an
HPV vaccination for boys and girls as early as 9 years old
and up to 26 years old, but especially between 10 and
11 years of age (ACOG, 2015).
 Follow the USPSTF guidelines for routine Pap smears.

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Cervical Cancer: Risk Reduction #2

 If your mother took DES to prevent miscarriage,

maintain a careful preventive screening schedule.
 Eat nutritious food and have routine care for illnesses
that weaken your immune system.
 Talk to your partner about your expectations of sexual
health before becoming intimate.

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Cervical Cancer: Incidence
 The lowest cervical cancer rates are found in Eastern
Mediterranean countries.
 An unusually high rate of cervical cancer was found in
the African region where income levels tend to be low.

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Teaching Opportunity: Risk Reduction
 Introduce discussion of ways to reduce risks of cervical
cancer during examination:
o Establish trusting relationship with client during
exam.
o Teach self-examination.
o Explain that self-examination helps detect
abnormalities early.

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History of Current Health Problem #1
 Menstrual cycles
 Age at time of first menstrual period
 Menopause
 Vaginal discharge
 Pain or itching in genitalia or groin

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History of Current Health Problem #2
 Lumps, swelling, or masses in genitalia or groin
 Urinating difficulty, changes in urine color, or developed
an odor
 Difficulty controlling urine
 Sexual performance
 Sexual activity pattern
 Fertility problems

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Past and Family History
 Previous gynecologic problems and results of any
treatment
 Date of last pelvic exam by a physician
 Date of last Pap smear and results
 Fever diagnosed with STD
 Pregnancies
 Reproductive or genital cancer

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Lifestyle and Health Practices #1
 Smoking
 Sexual partners
 Contraceptives
 Genitalia problems
 Sexual preference
 Comfort level in communication about sexuality
 Fears and stress with sex

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Lifestyle and Health Practices #2
Fertility concerns
Menopause concerns
Genital self-exam
HIV results
Estrogen replacement
Toxic shock syndrome
Sexually transmitted diseases

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Question #2
Which is covered under the external genitalia?
A. Inspecting vaginal opening
B. Inspecting vaginal musculature
C. Inspecting labia minora
D. Inspecting the vagina

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Answer to Question #2
C. Inspecting labia minora.
The labia minora are thinner skin folds located inside the
labia majora. Vaginal opening extends from the vaginal
orifice to the cervix and falls under internal genitalia, as do
the vagina and its musculature.

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Equipment #1
 Stool
 Light
 Vaginal speculum
 Water-soluble lubricant
 Large swabs for vaginal examination
 Nonsterile gloves

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Equipment #2

 Bifid spatula
 Endocervical broom
 pH paper
 Feminine napkins
 Hand-held mirror

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Physical Assessment: External Genitalia
#1
 Inspection:
o Mons pubis
o Labia majora and perineum
o Labia minora, clitoris, urethral meatus, and vaginal
opening

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Physical Assessment: External Genitalia
#2

 Palpation:
o Bartholin glands
o Urethra

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Physical Assessment: Internal Genitalia
#1

 Inspection:
o Vaginal opening
o Vaginal musculature
o Cervix
o Vagina

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Physical Assessment: Internal Genitalia
#2

 Bimanual examination
o Palpation
 The cervix
 The uterus
 The ovaries

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Physical Assessment: Internal Genitalia
#3

 Rectovaginal examination

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Findings
 External genitalia and vaginal opening
 Cervix
 Vaginitis
 Uterine enlargement
 Adnexal masses

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Older Client Findings
 Vaginal infection because of atrophy of the vaginal
mucosa
 Gray, thinning pubic hair
 Cervix appears pale after menopause
 Urinary incontinence from muscle weakness or loss
of urethral elasticity

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Data Analysis
 Nursing diagnoses
 Collaborative problems
 Referrals

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