∙ menstrual history ∙ obstetric history: full term? early delivery? tubes tied? ∙ self-care behaviors: gyno check-ups ∙ urinary symptoms: odor, color, cloudy ∙ vaginal discharge: odor, color, how much ∙ sexual history: protection? how many partners? ∙ contraceptive use ∙ STI: have you ever had one? ∙ STI risk reduction
Describe beginning the assessment and the positions that the patient is in.
∙ initially the woman can be sitting ∙ for examination, place the woman in the lithotomy position with the examiner sitting on a stool ∙ provide privacy ∙ have the patient empty their bladder ∙ decrease anxiety ∙ assist the healthcare provider
What should be inspected?
∙ skin color: even color, labia minora are a darker pink ∙ hair distribution: usually a triangle and can go up the stomach ∙ labia majora: normally symmetric, plump, and well-formed ∙ lesions: no lesions should be present besides occasional sebaceous cysts ∙ clitoris ∙ labia minora: dark pink and moist, usually symmetric ∙ urethral opening: narrow vertical slit or large opening ∙ perineum: smooth ∙ anus: has coarse skin of increased pigmentation
Describe a pap smear.
∙ educate the patient on the importance of screening for cervical cancer ∙ no exam on period ∙ no intercourse, douche, or anything in vagina 24 hours prior ∙ the patient may have spotting afterward ∙ will not perform on a virgin ∙ will not do one if they have an infection
Describe the infant girl genitalia.
∙ newborn external genitalia enlarged ∙ ovaries are in the abdomen until puberty
Describe the adolescent female genitalia.
∙ first signs of puberty at age 8 1/2 - 13 years ∙ first signs of puberty: breast and pubic hair development ∙ sexual maturity ratings page 739
Describe female genitalia in a pregnant woman.
∙ perineum and vulva are increased vascularly ∙ varicose veins on labia ∙ anal hemorrhoids ∙ vaginal wall blue or violet, rugated and thick ∙ blue cervix
Describe female genitalia in an aging woman.
∙ decreased lubrication ∙ decreased pubic hair ∙ everything decreases in size ∙ vaginal wall and cervix pale in color ∙ cervix retracts ∙ may need a smaller speculum and more lubricate
∙ cervical cancer more common in Hispanic woman ∙ African Americans have 50% higher incidence than whites
How do you examine the penis?
∙ make the patient comfortable ∙ firm deliberate touch ∙ erections can occur
Describe what the penis looks like.
∙ skin is wrinkled, hairless, no lesions ∙ glans smooth, no lesions ∙ circumcised or not ∙ urethral meatus position
Describe what the scrotum looks like.
∙ asymmetry can occur ∙ size can vary ∙ no lesions, except sebaceous cysts ∙ assess for inguinal hernias and lymph nodes
How do you palpate the penis?
∙ palpate the shaft ∙ utilize thumb and first two fingers ∙ feels smooth, semi-firm, and non-tender
How do you palpate the scrotum?
∙ feel oval, firm. and rubbery ∙ smooth, equal, and bilaterally ∙ freely moveable ∙ tenter to moderate pressure ∙ assess any mass found
Describe infant and child male genitals.
∙ testes normally descended ∙ the penis is normally 2-3 cm before puberty
Describe the aging adults male genitals.
∙ thin, graying pubic hair ∙ decreased size fo the penis, testes, and they are less firm ∙ scrotal sac pendulous ∙ scrotal skin excoriated
Describe kidney disease.
∙ 47% higher in Hispanics, 230% higher for American Indians, 420% higher for blacks and whites
How would one perform a testicular self-exam?
∙ T: timing, once a month ∙ S: shower, warm water relaxes scrotal sac ∙ E: examine, check for changes, report changes immediately ** hold scrotum on one hand and use index finger and 1st two fingers, use light pressure
Look at the new powerpoint for health promotion in males.
Describe what the anus should look like.
∙ anus: moist, hairless, coarse, folded, pigmented ∙ anal opening is tight with no lesions ∙ valsalva maneuver to assess for hemorrhoids or fissures