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Chapter 20
Female Genitalia
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2. Copyright 2002, Delmar, A division of Thomson Learning
Competencies
Describe the anatomy and physiology of the female genitalia, including age-relevant transformations.
Demonstrate the techniques necessary for assessment of the female genitalia, including patient positioning, external and internal inspection, speculum procedures, and palpation methods.
(continues)
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Competencies
Identify anatomic landmarks during bimanual vaginal, uterine, and rectovaginal examinations.
Identify normal findings as well as atypical findings of the vulva, vagina, and cervix.
Describe procedures for genital and anal smears and cultures.
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4. Anatomy and Physiology
External female genitalia
Labia majora
Labia minora
Clitoris
Vaginal introitus
Urethral meatus
(continues)
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5. Anatomy and Physiology
Internal female genitalia
Vagina
Uterus
Cervix
Fundus
Ovaries
Fallopian tubes
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6. Female Reproductive Cycle
Follicular phase
FSH LH
Ovulation
Luteal phase
Corpus luteum
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Health History
Age
Adolescent to young adult
Middle to late adult
Race
Ethnic minorities
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Chief Complaint
Common chief complaints
Uterine bleeding
Vaginal discharge
Urinary symptoms
Pelvic pain
Characteristics to assess
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Past Health History
Medical history
Surgical history
Medications
Communicable diseases
Allergies
Injuries
Special needs
Childhood illnesses
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Health History
Family history
Social history
Substance use
Sexual practices
Hobbies
Stress
Health maintenance
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Key Questions to Ask
Menstrual, obstetric, and menopause histories
PMS
Vaginal discharge
Uterine bleeding
Sexual functioning
Reproductive medical history
Method of birth control
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Physical Assessment
Special equipment
Vaginal specula
Cytological materials
General approach
Prior
During
After
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13. Inspection: External Genitalia
Pubic hair distribution
Skin color and condition
Mons pubis and vulva
Urethral meatus
Vaginal introitus
Perineum and anus
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14. Palpation of External Genitalia
Labia
Urethral meatus and Skene’s glands
Vaginal introitus
Perineum
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15. Speculum Examination of the Cervix
Use of speculum
Characteristics of assessment
Color
Position
Size
Surface characteristics
Discharge
Shape of cervical os
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Collecting Specimens
Pap smear
Endocervical
Cervical
Vaginal
Gonococcal culture
Saline mount
KOH prep
Five percent acetic acid wash
Anal culture
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Inspection
Vaginal wall
Bimanual examination
Vagina
Cervix
Fornices
Uterus
Adnexa
Rectovaginal examination
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18. Gerontological Variations
Menopause-related changes
Low estrogen levels
Cessation of menses
Generalized atrophy of external and internal female organs
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19. 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
(continues)
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20. 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
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21. 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
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22. 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
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23. Normal Findings: Cytological Smears and Cultures
Pap smear within normal limits
Cervicovaginal tissues free from Neisseria gonorrheae, Candida albicans
< 10 WBC’s in the saline mount specimen
Negative acetic acid wash test
Vaginal wall is pink, moist, deeply rugated
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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
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