Assessment of the Female

Genitourinary system
 Structures
• Mons pubis • Labia majora &
• Clitoris minora
• Perineum • Urinary meatus
• Anus • Bartholin’s glands
• Uterus • Cervix
• Ovaries • Fallopian tubes
• Urethra • Kidneys
• Vagina • Bladder
 Functions
What are the functions of…

• Mons pubis: subcutaneous pad over

symphysis pubis for protection
• Labia majora/minora: folds of adipose
and connective tissue that protect and
lubricate external genitalia
 Functions
What are the functions of…
• Clitoris: erectile tissue for sexual
stimulation
• Urinary meatus: opening to urethra
• Skene’s glands: lubricate and protect
 Functions
What are the functions of…
• Vaginal introitus: opening of the vagina
• Vagina: muscular tube for copulation, birth
canal, and menses
• Bartholin’s glands: secretes alkaline
mucus that improves viability & motility of
sperm
 Functions
What are the functions of…
• Cervix: end of the uterus into vagina
• Uterus: hollow, muscular organ; site for
fertilized egg implantation; protects fetus
 Functions
What are the functions of…
• Tubes: passage for ovum to uterus, site of
fertilization
• Ovaries: produce ova, estrogen, and
progesterone
• Kidneys: filter and excrete wastes
 Functions

What are the functions of…

• Ureter: connects kidneys to bladder
• Bladder: hollow muscular structure; holds
urine
• Urethra: connects bladder to urinary
meatus opening
 Development Variations

What developmental variations of the female

genitourinary system might be seen with:
• Children
• Pregnant patients
• Older adults
 History
What can the history tell you about the female
genitourinary system?
• Biographical data
• Current health status
• Past health history
• Family history
• Review of systems
• Psychosocial history
 Symptoms
What symptoms would signal a problem with
the female genitourinary system?
• Vaginal discharge
• Lesions
• Vaginal bleeding, pain
• Amenorrhea
• Urinary symptoms
 Physical Assessment
• Anatomical landmarks: external—note position
of structures; internal—visualize underlying
structures
• Approach: inspection, palpation
• Position: lithotomy
• Tools: gloves, speculum, lubricant, light, slides
and swabs for specimen collection
• General survey and head-to-toe scan
 Inspection

• External genitalia: color, hair

distribution, condition of skin, lesions,
discharge, odor, pubic pediculosis,
prolapse

• Rectal area: condition of skin, lesions,

discharge, bleeding, hemorrhoids, fissures
Abnormal Findings
 1. Cystocele

• Bladder herniate into the vagina

as a result of pregnancy
2. Rectocele
• Results from a tear in the
rectovaginal septum (Rectal
tissue bulges through this tear,
into the vagina, as a hernia .
3. Hemorrhoids
 Inspection

• Pelvic exam: color, lesions of

vaginal walls; color, lesions,
discharge, position, size, shape,
and patency of cervical os (obtain
specimens)
 Palpation
• Skene’s and Bartholin’s glands: masses,
swelling, discharge, tenderness
• Vaginal wall: texture, swelling, lesions,
tenderness
• Cervix: size, shape, consistency, position,
mobility, tenderness
• Uterus: size, shape, symmetry, position,
masses, tenderness
 Palpation
• Ovaries: size, shape, symmetry,
tenderness
• Anus and rectum: sphincter tone,
tenderness, lesions, masses,
hemorrhoids, polyps; test any stool for
occult blood
 Sequence of a Pelvic
Examination

• Mons pubis--note quantity and distribution of

hair growth
• Labia--usually plump and well-formed in adult
female
• Perineum--slightly darker than the skin of the
rest of the body. Mucous membranes appear
dark pink and moist
 Sequence of a Pelvic Examination
• Separate the labia and inspect the labia
minora:
– Labia minora
– Clitoris
– Urethral orifice
– Hymen
– Vaginal orifice
 Sequence of a Pelvic Examination

• Note the following:

– Discharge
– Inflammation
– Edema
– Ulceration
– Lesions
 Findings

• Note abnormalities
such as:
– Bulges and swelling
of vulva and vagina
– Enlarged clitoris
– Syphilitic chancres
– Sebaceous cyst
Primary Syphilis
Speculum examination of internal
genitalia
Speculum Examination of Internal
Genitalia

• Select a speculum of appropriate

size, lubricate and warm with warm
water (Commercially prepared
lubricants interfere with pap smear
studies)
 – Small--not sexually active female
– Medium--sexually active
– Large--women who have had children
• Medium to large speculum may be used
if female has had children.
Examination/Collection Specimen of
the Cervix
• Inspect the cervix
– Discharge:
• Endocervical vs. from vaginal vault
• Physiological discharge--odorless, colorless
• Culture any discharge.
Examination/Collection Specimen of
the Cervix
• Inspect the cervix
– Os:
• Nulliparous--small,
round, oval
• Parous/
multiparous--linear,
irregular, stellate
 Inspection of the Vagina
• Withdraw the speculum slowly while
observing the vaginal wall
• Close blades as the speculum emerges
from the introitus
• Inspect vaginal mucosa as the
speculum is withdrawn
 Pap Smear
• Papanicolaou test (also called Pap
smear, Pap test, cervical smear, or
smear test) is a screening test used in
gynecology to detect premalignant and
malignant (cancerous) processes in the
ectocervix.
 Pertinent Physical Findings
• External genitalia pink, moist, intact; small
amount of white, ordorless discharge; no lesions
• Vaginal walls and cervix pink, moist, intact; no
lesions
• Uterus anteverted, no masses, non-tender
• Ovaries and tubes non-palpable
• No rectal masses; hematest negative
Normal Findings: Inspection

• Pubic hair distribution shaped like

an inverse triangle
• No parasites present
• Labia majora and minora are
symmetrical, skin is slightly
pigmented, intact
• Urethral opening is midline; free
from discharge, swelling, or
redness
 Normal Findings: Inspection
• Vaginal mucosa is pink and moist
• Normal vaginal discharge is clear to white,
free from odor
• Perineum is smooth, slightly darkened
• Anus is dark pink to brown and puckered
 Normal Findings: Palpation
• Labia are soft, free from swelling, pain,
induration, or purulent discharge
• Vaginal muscle tone is strong in
nulliparous; diminished in multiparous
• Perineum is smooth and firm
• Urethral meatus is free from pain or
discharge
 Normal Findings:
Internal Genitalia

• Cervix is pink, pale (menopause),

or blue (pregnancy)
• Cervix is midline
• Glistening pink cervical epithelium
• Cervical os is round in nulliparous;
or a horizontal slit in multiparous
 Normal Findings
• Vaginal wall is nontender, free from
lesions, masses, or cysts
• Cervix is mobile, nontender, symmetrical,
rounded, and midline
• Uterus is pear-shaped in nongravid;
rounded in parous
• Ovaries are almond-shaped, firm, smooth,
and mobile without tenderness
 Assessing the Male
Genitourinary System
 Structures
• Scrotum • Testes
• Spermatic cord • Seminal vesicle
• Vas deferens • Prostate
• Epididymis • Kidney
• Ureter • Bladder
• Penis & glans • Inguinal area
• Bulbourethral • Urethra & meatus gland
 Functions

What are the functions of…

• Scrotum: sac that contains testes
• Testes: produces sperm and testosterone
• Vas deferens: duct from epididymis to
ejaculatory duct
 Functions

What are the functions of…

• Spermatic cord: protective sheath around the
vas deferens
• Seminal vesicles: produce 80% of semen
• Bulbourethral gland: secretes alkaline
substance to neutralize vaginal secretions
 Functions

What are the functions of…

• Prostate: produces 20% of semen
• Epididymis: stores sperm until it is mature
• Kidney: filters blood and removes wastes
 Functions

What are the functions of…

• Ureter: tube connecting kidney to bladder
• Bladder: hollow, muscular structure, holds urine
• Urethra: passageway for urine
 Functions

What are the functions of…

• Penis: male sex organ and urine elimination
• Glans penis: important for sexual arousal
 Functions

What are the functions of…

• Inguinal area: canal for vas deferens from
scrotum through the abdominal muscles, inguinal
lymph nodes
 Developmental Variations

What developmental variations of the male

genitourinary system might be seen with:
• Children
• Pregnant patients
• Older adults
 History
What can the history tell you about the male
genitourinary system?
• Biographical data
• Current health status
• Past health history
• Family history
• Review of systems
• Psychosocial history
 Symptoms
What symptoms would signal a problem with
the
male genitourinary system?
• Genital pain
• Lesions
• Genital swelling
• Penile discharge
• Urinary symptoms
 Pertinent History Findings
• Dysuria for past 3 days
• Clear urethral discharge after urination
• + History of chlamydia
• + Family history of CV disease
• Can’t remember last physical exam, doesn’t perform TSE
• Smokes 15-pack-years; alcohol 3x/week
• Lives alone in single home
 Pertinent History Findings

• Heterosexual
• 2 sex partners in past 6 months
• Uses condoms “sometimes”
• Satisfied with sexual performance
• No problems with erection or ejaculation
 Physical Assessment
• Anatomical landmarks: external—note position
of structures; internal—visualize underlying
structures
• Approach: inspection, palpation
• Position: standing or supine, leaning over table
or Sim’s position
 Physical Assessment

• Tools: gloves, lubricant, pen light, slides &

swabs for specimen collection, and stethoscope
• General survey and head-to-toe scan
 Inspection
• Penis: condition of skin, color, lesions, discharge,
size, position of urinary meatus, foreskin
• Scrotum: size and position, color, hair distribution,
lesions, swelling, pediculosis
• Inguinal area: condition of skin, bulges
• Rectal area: condition of skin, lesions, hemorrhoids,
polyps, fissures, bleeding
Abnormal Findings
 1. Genital warts
• highly contagious sexually transmitted
infection caused by some sub-types of
human papillomavirus (HPV).
 2. Tinea Cruris
• a fungal infection of the groin region in
either sex, though more often seen in
males.
 3. Phimosis
• the male foreskin cannot be fully retracted
from the head of the penis.
 4. Priapism

• potentially harmful and painful medical

condition in which the erect penis does not
return to its flaccid state, despite the
absence of both physical and
psychological stimulation, within four hours
 5. Scrotal swelling
• abnormal enlargement of the scrotum, the
sac surrounding the testicles.
 6. Chordee

• Head of the penis curves downward or

upward, at the junction of the head and
shaft of the penis
 7. Hydrocele
• Accumulation of clear fluid in the tunica
vaginalis, the most internal of membranes
containing a testicle.
 Palpation
• Penis: consistency, tenderness, masses,
discharge
• Scrotum & testes: size, shape, symmetry,
mobility, tenderness, masses
• Epididymis: swelling, tenderness, nodules
 Palpation
• Inguinal area: hernias, lymph nodes, tenderness
• Anus & rectum: sphincter tone, tenderness,
lesions, masses, hemorrhoids, polyps, test any
stool for occult blood
• Prostate: size, shape, symmetry, mobility,
consistency, nodules, tenderness, grade size
Musculoskeletal Assessment
 Pertinent Physical Findings
• Erythema at urethral meatus
• Clear to white thin discharge expressed from
urethral meatus
• Right inguinal lymph nodes enlarged and tender
 Structures
• Bones • Muscles
• Joints • Tendons
• Ligaments • Cartilage
• Bursae
 Functions
What are the functions of…
• Bones (206): structure; protection; act as levers;
produce blood cells; store calcium
• Muscles (650): allow for movement and position;
produce heat
 Functions

What are the functions of…

• Joints: point of articulation of two bones; provide
ROM
• Tendons: connect muscle to bone
• Ligament: connects bone to bone
 Functions

What are the functions of…

• Cartilage: supports and shapes; acts as a shock
absorber
• Bursae: sacs filled with synovial fluid; cushion
and reduce friction between joints
 Types of Joints
• Pivot • Hinge
• Condyloid • Plane/gliding
• Ball and socket • Saddle
 Movements
• Extension • Protraction
• Flexion • Retraction
• Hyperextension • Depression
• Abduction • Elevation
• Adduction • Opposition
• Circumduction • Reposition
• Internal rotation • Inversion
• External rotation • Eversion
• Pronation • Ulnar deviation
• Supination • Radial deviation
 Relationship to Other Systems

What is the relationship of the musculoskeletal system

to other systems?
• Integumentary • Respiratory
• HEENT • Genitourinary
• Lymphatic • Neurological
• Cardiovascular • Endocrine
• Hematological • Gastrointestinal
 History
What can the history tell you about the
musculoskeletal system?
• Biographical data
• Current health status
• Past health history
• Family history
• Review of systems
• Psychosocial history
 Symptoms

What symptoms would signal a problem

with the musculoskeletal system?
• Pain
• Weakness
• Stiffness
• Balance and coordination problems
• Other related symptoms
 Inspection
• Posture: head position, alignment
• Normal spinal curves: cervical, thoracic,
lumbar, sacral,
• Spinal deformities: kyphosis, scoliosis, lordosis
• Gait: phase, cadence, arm swing, toeing, base of
support, stride length
 Cerebellar Function

Balance:
• Gait
• Tandem walk (heel to toe)
• Toe and heel walking
• Deep knee bend
• Hop on one foot
• Romberg Test
 Cerebellar Function

Coordination:
• Rapid alternating movements
• Finger thumb opposition
• Toe tapping
• Heel down shin
Accuracy of movements:
• Finger to nose
• Point to point localization
 Inspection

Measurements:
• Arm lengths
• Leg lengths
• Arm circumferences
• Leg circumference