Male Female Genitalia and Rectum Assessment

Assessing Male Genitalia and
Rectum
Dexter Jayson F. Caminar, RN
Anatomy and Physiology
Prepared by: Dexter Jayson F. Caminar, RN

Anatomy and Physiology

External Genitalia
 Penis
• is the male reproductive organ
• acts as a conduit for urine to leave the body
 Scrotum
• is a loosely hanging, pliable, pear-shaped pouch of darkly pigmented skin that located behind the
penis.
• it houses the testes, which produce sperm

Internal Genitalia
 Spermatic Cord (blood vessels, lymphatic vessels, nerves and the vas deferens or ductus deferens)
• a bundle of nerves, ducts, and blood vessels connecting the testicles to the abdominal cavity.
• vas deferens – transports spermatozoa away from the testis.
 Epididymis
• stores sperm cells that are created in the testes.
• bring the sperm to maturity (12 - 20 days to mature)
• 18 – 20 ft in length
 Prostate gland
• a walnut-sized structure that’s located below the urinary bladder in front of the rectum.
• contributes additional fluid to the ejaculate.
• Prostate fluids also help to nourish the sperm.

Internal Genitalia
 Seminal vesicles
• are sac-like pouches that attach to the vas deferens near the base of the bladder.
• make a sugar-rich fluid (fructose) that provides sperm with a source of energy and
helps with the sperms’ ability to move (motility).
 Urethra
• is the tube that carries urine from the bladder to outside of your body.
• In males, it has the additional function of expelling (ejaculating) semen when you
reach orgasm. When the penis is erect during sex, the flow of urine is blocked from the
urethra, allowing only semen to be ejaculated at orgasm.

Internal Genitalia
 Bulbourethral glands (Cowper’s glands)

• are pea-sized structures located on the sides of the urethra, just below the
prostate gland.
• produce a clear, slippery fluid that empties directly into the urethra. This fluid
serves to lubricate the urethra and to neutralize any acidity that may be
present due to residual drops of urine in the urethra.

Inguinal Area
 Are located laterally to the pubic region over the iliac region or the upper part of
the hip bone.
 When assessing the male genitalia, the nurse needs to be familiar with structures
of the inguinal or groin area because hernias are common in this location.

What is Hernia?
 A hernia occurs when an internal organ or other body part protrudes

through the wall of muscle or tissue that normally contains it.

Anus and Rectum

Anus and Rectum
 Anus
• The anus is the opening at the lower end of the intestines. It's where the end
of the intestines connect to the outside of the body.
• Within the anus are the two sphincters that normally hold the anal closed
except when passing gas and feces.
 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.

Anus and Rectum
 Rectum
• The last several inches of the large intestine closest to the anus.
• It is where the body stores stool before a person is ready to have
a bowel movement.

Nursing Assessment
Collecting Subjective Data: The Nursing Health History

• When interviewing a male client for information regarding his genitalia, anus, rectum, and
prostate, keep in mind that this may be a very sensitive topic and can prove to be
embarrassing for both the client and the examiner.
• Feeling regarding body image, fear of cancer, and sexuality.
• Ease the client’s anxiety
• Ask the questions in a straightforward manner, and let the client voice any concerns.
• Trusting relationship is a key to a successful interview.

History of Present Health Concern
Questions:
 Pain
• May indicate hernia or an inflammatory process
• May include STDs, prostitis, muscle strain, UTI or malignancy
 Itching
• Pediculosis pubis – crab lice
 Lesions
• Sign of STI or cancer
 Discharge
• infection
 Lumps, Swelling, Masses
• May indicate infection, hernia or cancer
• Testicular tumor pr scrotal hernia

Questions:
 Urination
• Difficulty urinating may indicate infection or blockage, including prostatic enlargement
• How many times do you urinate during night? – prostate abnormalities
• (started taking any new medication?) can cause frequent urination or nocturia
• Color, odor or amount – change in color or odor may indicate infection
o Hematuria – blood in the urine may indicate infection, kidney stones or cancer
o Decrease in amount of voided urine may indicate prostate enlargement or kidney problems.
• Pain or burning sensation – may be sign of UTI, prostitis or STI

• Incontinence or dribbling – may be sign of overflow incontinence, prostate tumor, enlarge
prostate or neurologic disease.

Questions:
 Sexual Dysfunction
• Change in pattern of sexual activity or sexual desire (libido)
• Difficulty attaining or maintaining an erection (erectile dysfunction may be attributed to various
factors or disorders like alcohol use, diabetes, depression and HPN meds)
• Problem with fertility

Questions:
 Bowel Patterns
• What is your usual bowel patter? Any recent change in the pattern? Any pain while passing a bowel
movement?
o Associated with many disorders
o Early warning signs of cancer
• Constipation
o Bowel obstruction
o Colon cancer
o Irritable bowel syndrome
• Diarrhea with nausea or vomiting
o Gastroenteritis, colitis or medication side effect
• Trouble controlling you bowels
Prepared by: Dextero Neurologic

Jayson F. Caminar, RNdisorder or some gastrointestinal infection
Questions:
 Stool
• Color of your stool? Hard or Soft? Presence of blood in your stool?
o Black stools may indicate GI bleeding or iron supplements
o Red blood in the stool may indicate hemorrhoids, polyps, cancer, or colitis.
o Clay-colored stools result from lack of bile pigment.
• Mucus in your stool? Have you noticed that your stools are oily, greasy, or bulky, or that they
float?
o Mucus may indicate some intestinal infection.
o Bloody mucus in stool or mucus with abdominal pain may indicate Crohn disease (a type of
inflammatory bowel disease IBD), ulcerative colitis, and even cancer.
o Steatorrhea (fats in the stool), causes the stool to float

Questions:
 Itching and Pain

• Do you experience any itching or pain in the rectal area?
o STIs, Hemorrhoids, pinworms, or anal trauma may cause itching and
pain.

Past Health History
Questions:
 Describe any prior medical problems you have had, how they were treated, and the results.
 When was the last time you had a testicular examination by your primary health care
provider? What was the result?
 Have you ever been tested for human immunodeficiency virus (HIV), and other STDs?
Why were you tested?

Past Health History
Questions:
 Have you ever had anal or rectal trauma or surgery? Were you born with any congenital
deformities of the anus or rectum? Have you had prostate surgery? Have you had
hemorrhoids or surgery for hemorrhoids?
 When was the last time you had a stool test to detect blood?
 Have you ever had a sigmoidoscopy? Colonoscopy?
 When was the last time you had a digital rectal examination (DRE)? What was the result?

Past Health History
Questions:
 Have you ever had blood taken for a prostate screening which measures the level of
prostate-specific antigen (PSA) in your blood? When was the test performed and what was
the result?

Family History
 Is there a history of polyps or colon, rectal, or prostate cancer in

your family?

Lifestyle and Health Practices
 How many sexual partners do you have?
 What kind of birth control method do you use, if any?
 Are you satisfied with your current level of physical and sexual activity and sexual
functioning
 Do you have concerns about fertility? If you experience fertility troubles, how has this
affected your relationship?

 Do you have an intimate partner or someone you consider to be a significant other? Are
you comfortable with expression of your sexuality? Are you satisfied with your sexual
relationship? If no, would you like to explain further?
 Do you have any fears related to sex? Can you identify any stress in your current
relationship that relates to sex?
 Do you feel comfortable communicating with your partner about your sexual likes and
dislikes?

 What do you know about STIs and their prevention?
 Are you currently exposed to chemicals or radiation? Have you been exposed in the past?
 Describe the activity you perform in a typical day. Do you do any heavy lifting?
 Do you perform testicular self-examinations? When was the last time you performed this
examination?

 Do you use any laxatives, stool softeners, enemas, or other bowel movement-enhancing
medications?
 Do you engage in anal sex?
 Do you take any medications for your prostate?
 How much high-fiber food and roughage (part of the food that is not digested by the body)
do you consume every day? Do you eat foods high in saturated fats?

 Do you engage in regular exercise?
 Have any anal or rectal problems affected your normal activities of daily living?

Self-Assessment: Testicular Self-Examination

Assessing Female Genitalia
and Rectum
Dexter Jayson F. Caminar, RN
Female External Genitalia

 Mons Pubis
• Fat pad located over the symphysis pubis
o Symphysis pubis is a joint sandwiched between your left pelvic bone and your
right pelvic bone. It helps your pelvis absorb some of the weight from your upper
body before it travels to your lower body. It also helps separate your pelvic bones
to prepare for vaginal childbirth.
• Normal adult mons pubis is covered with pubic hair in a triangular pattern
• Absorb force and protect the symphysis pubis during coitus

 Clitoris
• Is the pleasure center of your reproductive anatomy
• Located at the anterior end of the labia minora.
• Small, cylindrical mass of erectile tissue and nerves
 Labia Majora
• Are relatively large, fleshy folds of tissue that enclose and protect the other external
genital organs.
• Contain sweat and sebaceous glands, which produce lubricating secretions.
• During puberty, hair appears on the labia majora.

 Labia Minora
• the two inner folds of skin that surround the opening of the vagina.
 Perineum
• tiny patch of sensitive skin between your genitals (vaginal opening or
scrotum) and anus, and it's also the bottom region of your pelvic cavity.

 Vaginal Opening
• where your baby exits your body during childbirth and where period blood flows during
menstruation. It's also the hole where a penis, finger, sex toy, tampon or menstrual cup can be
inserted.
• A thin membrane called a hymen usually surrounds or partially covers your vaginal opening.
 Urethral Meatus / Opening

• The transport tube that leads from the bladder to discharge urine outside the body.
• The female urethral meatus is above the vaginal opening.

Female Internal Genitalia

 Vagina
• the muscular tube leading from the external genitals to
the cervix of the uterus in women and most female mammals.
 Cervix
• The lower, narrow end of the uterus that forms a canal between
the uterus and vagina.

 Uterus
• The hollow, pear-shaped organ in a woman's pelvis. The uterus is where a
fetus (unborn baby) develops and grows. Also called womb.
• 2 components: Corpus (the body) and the cervix
• Corpus: Fundus (upper portion), body (central portion) and isthmus (narrow
lower portion)
• 3 layers of the uterine wall: endometrium (inner), myometrium (middle) and
peritoneum (outer)

 Ovaries
• One of a pair of female glands in which the eggs form and the
female hormones estrogen and progesterone are made.
• These hormones play an important role in female traits, such as
breast development, body shape, and body hair.
• They are also involved in the menstrual cycle, fertility, and
pregnancy.

 Fallopian Tube
• a pair of tubes along which eggs travel from the ovaries to the uterus.

Nursing Assessment
Collecting Subjective Data: The Nursing Health History

• When interviewing the client about genital, reproductive, anal, and rectal health, keep in
mind that this may be a very sensitive topic and can prove to be embarrassing for both the
client and the examiner.
• Feeling regarding body image, fear of cancer, and sexuality.
• Ease the client’s anxiety
• Ask the questions in a straightforward manner, and let the client voice any concerns.
• Trusting relationship is a key to a successful interview.

History of Present Health Concern:
Menstrual Cycle
 What was the date of your last menstrual period? Do your menstrual cycles occur on a
regular schedule? How long do they last? Describe the typical amount of blood flow you
have with your periods, Any clotting?
• Normal menstrual cycle usually occurs approx. every 18-45 days.
• Average length is 3-7 days.
• Absence, excessive or changes in menstrual pattern indicates a need to collect more information.

 What other symptoms do you experience before or during your period (cramps, bloating,
moodiness, breast tenderness)?
• Headache, weight gain, mood swings, abdominal cramping, and bloating are common complaints
before or during the menstrual period.
• Some women experience premenstrual syndrome (PMS)

 How old were you when you started your period?
• Menarche range from 10.5 to 15.5 years of age
 Have you stopped menstruating or have your periods become irregular? Are you currently
taking any contraceptives containing estrogen or progesterone? Do you have any spotting
between periods? What symptoms have you experience?
• Irregularities or amenorrhea may due to pregnancy, depression, ovarian tumors, ovarian cysts,
autoimmune disease nutritional and hormonal imbalances, and medications.

Menopause
 Are you still having periods? Have your periods changed?

• Menopause – (absence of menses for 12 months) normal physiologic process that occurs in
women between the ages of 40 to 58 years, usually at the age of 50.
• Premature menopause – before 30
• Early menopause – between 31 and 40
• Delayed menopause – older than 58
• *ovaries removed surgically

 Are you experiencing any symptoms of menopause?
• Hot flashes and night sweats
• Mood swings, irritability, decreased appetite, vaginal dryness, spotting, and
irregular vaginal bleeding may also occur (old age – low estrogen -
inflammation and thinning of the vaginal lining (atrophic vaginitis) or womb
lining – spotting)

 What are your concerns about going through menopause?
• A normal stage in a woman’s life.
• Grieve their loss of child-bearing capabilities
• New phase of life, as they feel relieved no longer having to be concerned
about pregnancy

Vaginal Discharge, Pain, Masses
 Are you experiencing vaginal discharge that is unusual in terms of

color, amount, or odor?
• Discharge may be normal or from an infection

 Do you experience pain or itching in your genital or groin area?
• Pain in the area of vulva, vagina, uterus, cervix or ovaries may indicate
infection.
• Itching may indicate infection or infestation

 Do you have any lumps, swelling, or masses in your genital area?
• May indicate infection, lymphedema, or cancer

Sexual Dysfunction
 Do you have any problems with your sexual performance?

• A broad opening question about sex allows the client to focus the interview to areas where she has
concerns. Some women have difficulty achieving orgasm and may believe there is something
wrong with them.
• As women age, their estrogen production decreases, causing atrophy of the vaginal mucosa.
These women may experience dyspareunia (painful intercourse) and may need to use lubrication
to increase comfort during intercourse.

 Have you recently had a change in your sexual activity pattern or libido?
• A change in sexual activity or libido needs to be investigated for the cause. A woman who is
dissatisfied with her sexual performance may experience a decreased libido.
 Do you experience (or have you experienced) problems with fertility?

• Infertility is the failure to conceive (regardless of cause) after 1 year of unprotected intercourse.
• Approx 35% of infertility cases are related to female fertility factors from a variety of causes.

Urination
 Do you have any difficulty urinating? Do you have any burning or pain with urination?
Has your urine changed color or developed an odor? Have you noticed any blood in your
urine?
• Urinary frequency, burning, or pain are signs of infection (UTI or STI)
• Change in color and odor may indicate infection or renal insufficiency/failure
 Do you have difficulty controlling your urine?

Bowel Patterns
 What is your usual bowel pattern? Have you noticed any recent change in the pattern? Any
pain while passing a bowel movement?
• May indicate early warning signs of cancer

 Do you experience constipation?
• May indicate a bowel obstruction or the need for dietary counseling
 Do you experience diarrhea? Is diarrhea associated with any nausea and vomiting?
• Diarrhea may signal impaction or indicate the need for dietary counseling.

 Do you have trouble controlling your bowels?
• Fecal incontinence occurs with your logic disorders and some intestinal
infections

Stool
 What is the color of your stool? Hard or soft? Have you noticed any blood on or in your
stool? If so, how much?
• Black stool may indicate gastrointestinal bleeding or the use of iron suppliments.
• Red blood in the stool is found with hemorrhoids, polyps, cancer, or colitis.
• Clay-colored stools result from a lack of bile pigment.

 Have you noticed any mucus in your stool?
• May indicate excessive fat in the stool.
• Excessive mucus may be a manifestation of irritable bowel syndrome or irritable bowel disorder.

Itching and Pain
 Do you experience any itching or pain in the rectal area?

• STI, hemorrhoids, pinworms, candida (fungal infection) or anal trauma may cause itching
• STI, hemorrhoids, fissure (small tear in the tissue), or trauma may cause pain

Personal Health History:
 Describe any prior gynecologic problems you have had and the results of any treatment.
• Some problems, such as bacterial vaginosis or cancer, may recur.

 When was your last pelvic or rectovaginal examination by health care provider? Was a Pap
test performed? What was the result?
• Pelvic and rectal examinations are used to detect masses, ovarian tenderness, or organ
enlargement.
• Pap smear test is a screening test for cervical cancer. (age 21, not before)

 Have you ever been diagnosed with an STI? If so, what? How was it treated?
• STIs can increase the clients risk of pelvic inflammatory disease (PID), which leads to scarring in
adhesions on the fallopian tubes.
• Scarred fallopian tubes increase the risk of infertility in ectopic pregnancy

 Have you ever been pregnant? How many times? How many children do you have? Is
there any chance that you might be pregnant now? Any miscarriages or abortions?
• The female client’s ability to become impregnated and carry a fetus to term is important baseline
information
• It is important to know if the client is pregnant in case medications or x-ray tests need to be
prescribed

 Have you ever been diagnosed with diabetes?
• Diabetes predisposes women to vaginal yeast infection

 Have you had a colonoscopy? When was the last time?
• Recommended screening for colorectal cancer starting at the age of 50 and continuing until age
75.
• Colonoscopies recommended only every 10 years due to small gains versus risks from this
invasive test

 Do you smoke?
• The risk for cervical cancer increases in clients who smoke and who are infected with human
papillomavirus (HPV, a type of STI)

 How many sexual partners and have you had in your lifetime? In the last six months?
Currently?
• A client who has multiple sexual partners increases her risk of contracting STIs

 Do you use contraceptives? What kind? How often? If you take oral contraceptives, do you
experience side effects?
• Failure to use any type of contraceptive increases the risk of becoming pregnant
• Failure to use a barrier type of contraceptive (male or female condom) may increase the risk of
STIs and human immunodeficiency virus (HIV) infection
• Minor side effects of oral contraceptives (e.g., Weight gain, breast tenderness, headaches, nausea)
might develop, which usually subside after the third cycle. Oral contraceptives increase the
glycogen content of vaginal secretions, which increases the risk of vaginal yeast infection
• Major side effects and contraceptives include thromboembolic disorders, cerebrovascular accident
(CVA), and myocardial infarct (MI)

 What do you call your intimate partner or someone you consider to be significant other?
 What is your sexual preference?
 Are you sexually active with males, females, or both?
 Do you have questions or concerns about your sexual orientation, sexual desires, or
sexuality?

• Inform client of the confidentiality of the sexual history.
• Some of our clients identify themselves as LGBT (lesbian, gay, bisexual, or transgender)
• Use gender-neutral terms for sexual orientation until the client reveals the terms to use.
• Once identified, the nurse should use the same terms as the client such as “lesbian”, “gay”,
or “homosexual”
• If the client is homosexual, she may not have the same concerns as heterosexual woman. If
she engages in oral sex, she will need to take precautions to prevent orovaginal
transmission of infection

 Do you engage in anal sex?
• Anal sex increases the risk of STIs, infection by HIV, HPV, fissures, rectal prolapse (rectum
becomes stretched out and protrudes from the anus), and hemorrhoid formation

 Do you feel comfortable communicating with your partner about your sexual likes and
dislikes?
 Do you have any fears related to sex? Can you identify any stress in your current
relationship that relates to sex?
 Do you have any concerns about fertility? If you have trouble with fertility, how has this
affected your relationship with your partner or extended family?

 Do you perform monthly genital self-examination?
 How do you anticipate going through menopause? Or How do you feel about going
through menopause if currently experiencing it?
 Have you ever been tested for HIV? What was the result? Why were you tested?
 What do you know about STIs and their prevention?

 Do you wear cotton underwear and avoid tight jeans?
 After a bowel movement or urination, do you wipe from front to back?
 Do you douche frequently?
 Do you use any laxatives, stool softeners, enemas, or other bowel movement-enhancing
medications?

 How much high-fiber food and roughage do you consume everyday? Do you eat food high
in saturated fat?
 Do you engage in regular exercise?
 Do you use calcium supplements?

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Assessing Male Genitalia and

Prepared by: Dexter Jayson F. Caminar, RN

Prepared by: Dexter Jayson F. Caminar, RN

Prepared by: Dexter Jayson F. Caminar, RN

Prepared by: Dexter Jayson F. Caminar, RN

Prepared by: Dexter Jayson F. Caminar, RN

 Bulbourethral glands (Cowper’s glands)

Prepared by: Dexter Jayson F. Caminar, RN

Prepared by: Dexter Jayson F. Caminar, RN

 A hernia occurs when an internal organ or other body part protrudes

Prepared by: Dexter Jayson F. Caminar, RN

Prepared by: Dexter Jayson F. Caminar, RN

Prepared by: Dexter Jayson F. Caminar, RN

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Collecting Subjective Data: The Nursing Health History

Prepared by: Dexter Jayson F. Caminar, RN

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• Pain or burning sensation – may be sign of UTI, prostitis or STI

Prepared by: Dexter Jayson F. Caminar, RN

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Prepared by: Dexter Jayson F. Caminar, RN

 Itching and Pain

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 Have you ever had a sigmoidoscopy? Colonoscopy?

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 Is there a history of polyps or colon, rectal, or prostate cancer in

Prepared by: Dexter Jayson F. Caminar, RN

 How many sexual partners do you have?

 What kind of birth control method do you use, if any?

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Prepared by: Dexter Jayson F. Caminar, RN

 What do you know about STIs and their prevention?

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 Do you engage in anal sex?

 Do you take any medications for your prostate?

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 Do you engage in regular exercise?

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 Urethral Meatus / Opening

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Collecting Subjective Data: The Nursing Health History

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 Are you still having periods? Have your periods changed?

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 Are you experiencing vaginal discharge that is unusual in terms of