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Structure and Function N1037.  Mons pubis  Labia majora  Labia minora  Frenulum  Clitoris  Vestibule = urethral meatus, opening of Skene’s glands.

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Presentation on theme: "Structure and Function N1037.  Mons pubis  Labia majora  Labia minora  Frenulum  Clitoris  Vestibule = urethral meatus, opening of Skene’s glands."— Presentation transcript:

1 Structure and Function N1037

2  Mons pubis  Labia majora  Labia minora  Frenulum  Clitoris  Vestibule = urethral meatus, opening of Skene’s glands (multiple), hymen, opening of Bartholin’s gland (x2)  Perineum  Anus  Skene’s Gland openings not visible but open posterior to the urethra at the 5 and 7 o’clock positions  Bartholin’s glands secrete a clear lubricating mucus

3  Vagina ◦ Is a tubular canal extending from the orifice up and backward into the pelvis ◦ 9 cm long and sits between the rectum posteriorly and the bladder/urethra anteriorly ◦ Walls are in thick transverse folds (rugae) which enable expansion during childbirth.  Cervix projects into the vagina ◦ Uterine cervix lies in front of the anterior rectal wall and may be palpated through it ◦ Rectovaginal palpation allows for assessment of the rectovaginal septum, posterior uterine wall, cul-de-sac and rectum (repeat bimanual examination steps)

4 20 – 4 OS-is the opening in the cervix. OS changes shape following Childbirth. Included in your handout. GOODELL’S SIGN 4-6 weeks: cervix softens, Mucus plug, vag secret white HEGAR’S SIGN 6-8 WKS: uterus softens CHADWICK’S SIGN 8-12 wk: cyanosis of vaginal Mucosa and cervix.

5  Rectouterine pouch  (cul-de-sac of Douglas) lies behind (separate from) the posterior fornix.  Uterus  pear-shaped, thick-walled, muscular organ  Top of the uteris is the Fundus  Body of uterus is the Corpus  Freely movable, not fixed and usually tilts forward and superior to the bladder (anteverted or anteflexed)  See p.701 to view other positions

6 ◦ Vagina ◦ Uterus  Positions of the Uterus  Anteverted (most common)  Anteflexed  Midposition  Retroverted  Retroflexed ◦ Fallopian tubes  trumpet shaped, 10 cm in length  Fimbriae direct ova into tube ◦ Ovaries  oval shaped, are located one on each side of the uterus at the level of the superior iliac spine.  Serve to develop ova (eggs) as well as female hormones = oogenesis

7 20 – 7  See Table-20-1 page 703, Sex Maturity Ratings in girls  The first signs of puberty are breast and pubic hair development around the ages of 8 ½ and 13 years.  They take about 3 years to complete  Menarche = the onset of menstruation  occurs during the latter half of this sequence, just after the peak of growth velocity.  Menopause occurs between the ages of 48 and 51 (35 to 60) ◦ Irregular menses x 1 – 2 years ◦ Ovaries stop producing progesterone and estrogen which brings dramatic physical changes. ◦ Decrease vaginal secretions leave the vagina dry and at risk fro irritation and pain with intercourse. ◦ Increased risk for vaginitis ◦ Sexual desire and the need for full sexual expression continues.

8 20 – 8  Follicular phase ◦ FSH ◦ LH ◦ Ovulation  Luteal phase ◦ LH ◦ Corpus luteum

9 20 – 9

10 20 – 10  Age ◦ Adolescent to young adult ◦ Middle to late adulthood  Race ◦ African American

11 20 – 11  Common chief complaints ◦ Uterine bleeding ◦ Vaginal discharge ◦ Urinary symptoms ◦ Pelvic pain  Characteristics of Chief Complaints ◦ Quality ◦ Quantity ◦ Associated manifestations ◦ Aggravating factors ◦ Alleviating factors ◦ Setting ◦ Timing

12 20 – 12  Medical history  Surgical history  Medications  Communicable diseases  Allergies  Injuries and accidents  Special needs  Childhood illnesses

13 20 – 13  Family history  Social history ◦ Alcohol and tobacco use ◦ Sexual practices ◦ Home environment ◦ Hobbies and leisure activities ◦ Stress

14 20 – 14  Sleep  Diet  Exercise  Use of safety devices  Health check-ups

15 20 – 15  Menstrual, obstetric, and menopause hxy  PMS  Vaginal discharge  Uterine bleeding  Sexual functioning  Reproductive medical history  Method of birth control

16 General equipment Examination table, lamp Stool, preferably with wheels Gloves Linens for draping Special equipment Vaginal specula Cytological materials

17 20 – 17  General approach ◦ Before  Preparation for patient  Show instruments and explain  Prepare room, ensure comfort ◦ During  Keep patient informed ◦ After  Support and discuss

18 20 – 18  menstrual history  obstetric history  menopause  self-care behaviours  urinary symptoms  vaginal discharge, itching  past history  sexual activity  contraceptive use  STD contact

19 20 – 19  Pubic hair distribution  Skin color and condition ◦ Mons pubis and vulva ◦ Clitoris ◦ Urethral meatus ◦ Vaginal introitus ◦ Perineum and anus

20 20 – 20  Normal Findings: ◦ Pubic hair distribution shaped like an inverted 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 ◦ Vaginal mucosa is pink and moist ◦ Normal vaginal discharge is clear to white, free of odor ◦ Perineum is smooth, slightly darkened ◦ Anus is dark pink to brown and puckered

21  Abnormal Findings: ◦ Pubic Hair  Pediculosis pubis (Lice)  alopecia ◦ Vaginal Discharges  Pale color, dryness = aging, estrogen changes  Foul-smelling discharge, color changes  See Table 20-3, pg 715  Cystocele, cystourethrocele, rectocele ◦ Genital warts ◦ Genital Herpes Simplex  Figures on pg 713 ◦ Urethral Meatus  Discharge = UTI ◦ Perineum & anus  Fissure/ tear  Venous prominences = hemorrhoids

22 20 – 22  Labia  Urethral meatus and Skene’s glands  Vaginal introitus  Perineum

23 20 – 23  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

24  Abnormal Findings: ◦ Labia  Swelling, reddness, pain or purulent discharge + Bartholin’s Gland Infection  Urethral Meatus ◦ Pain on contact & Discharge from urethra = UTI or Skene Gland Infection  Vaginal ◦ Bulging of vaginal or pelvic contents = uterine prolapse, cystocele, retrocele  Perineum ◦ Tears or fissures

25 20 – 25  Pap smear – 3 specimens collected – tests for Ca ◦ Endocervical ◦ Cervical ◦ Vaginal  Chlamydia culture  Gonococcal culture- Z pattern  Saline mount – tests for WBC & protoza  KOH prep – tests for Candida albincans  Five percent acetic acid wash – tests for humanpapillomavirus = genital warts  Anal culture- tests for presence of gonorrheoae in Anal tissues

26 20 – 26  Pap smear within normal limits  Cervicovaginal tissues free of Neisseria gonorrhoeae, Candida albicans  < 10 WBCs in the saline mount specimen  Negative acetic acid wash test

27 20 – 27  Menopause-related changes  Low estrogen levels  Cessation of menses  Generalized atrophy of external and internal female organs


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