1. Genitourinary Assessment
NURS 347
Towson University

2. Ladies First

3. Anatomy & Physiology External Genitalia Vulva Mons pubis
Labia majora & minora
Frenulum
Clitoris
Vestibule
Urethral meatus
Vaginal orifice
Hymen
Bartholin’s & Skene’s glands

4. Anatomy & Physiology Internal Genitalia Vagina Cervix
Squamocolumnar junction
Rectouterine pouch
Uterus
Anterior & Posterior fornix
Fallopian tubes

5. Subjective Assessment
Menstrual history
Obstetric history
Menopause
Self-care behaviors
Urinary symptoms
Vaginal discharge
Past history
Sexual activity
Contraceptive uses
Sexually transmitted infections (STIs, formerly STDs)
STI risk reduction

6. Female Assessment Preparation of client Lithotomy position
Empty bladder
Maintain privacy

7. Objective Assessment Inspection: External Genitalia Palpation:
Skin: Even pigment, free from nodules or lesions
Pubic hair: Inverted triangle
Labia:
Majora: Symmetric, pink, plump, and well formed in nulliparous females
Minora: Dark pink and moist, symmetrical
Clitoris:
Urethral meatus: Stellate and slit-like, midline positioning
Vaginal opening: Narrow, vertical slit
Perineum: Smooth, even pigment
Anus: Coarse skin, increased pigmentation
Palpation:
Tenderness
Masses

8. Age & Situational Variations
Newborn
Edematous labia
Vaginal discharge

9. Tanner’s Staging
Stage I: Preadolescent: No pubic hair; mons and labia covered with fine vellus hair
Stage II: Growth sparse and mostly on labia, Long, downy hair, slight pigmentation, straight or slightly curly
Stage III: Growth sparse and spreading over mons pubis. Hair is darker, coarser, curlier.
Stage IV: Hair is adult in type, over smaller area; none on medial thigh
Stage V: Adult in type and pattern; inverse triangle. Also on medial thigh

10. Older Adult Decreased estrogen Sparse pubic hair
Mons pubis smaller, labia flatter
Decreased natural lubrication
Pale and thin vaginal walls

11. Health Promotion Vulvar self exam PAP smear
Annually after beginning sexual intercourse
2006 developed to prevent cervical cancer
FDA licensed vaccine for females ages 9-26
Targets HPV strands responsible for most cases of cervical cancer

12. Documentation

13. Documentation

14. Male Assessment

15. Anatomy & Physiology External Internal Glandular Structures Penis
Scrotum
Internal
Testis
Epididymis
Vas deferens
Glandular Structures
Prostate
Seminal vesicle
Bulbourethral glands

16. Subjective Assessment
Frequency, urgency, and nocturia
Dysuria
Hesitancy and straining
Urine color
Past genitourinary history
Penis- pain, lesions, discharge
Scrotum- self-care behaviors, lump
Sexual activity and contraceptive use
STI contact

17. Objective Assessment Inspection of external genitalia:
Penis: Skin is usually wrinkled, hairless, and without lesions
Glans: Smooth, without lesions. In an uncircumcised male, retract foreskin for inspection, then return to original position
Urethral meatus: Positioned centrally on the glans

18. Objective Assessment Inspect the Scrotum: Palpation Scrotum:
Asymmetry is a common finding; left generally lower than the right
Inspect all surfaces of scrotum; should be wrinkles and lesion free
Palpation
Scrotum:
Using thumb and two fingers, palpate half of the scrotum
Testes are oval, firm, rubbery, and smooth bilaterally; freely moveable and tender to moderate palpation
Epididymis:feels discrete, softer than the testes, smooth, and non-tender
Spermatic cord:
Palpate between thumb and forefinger along its length
Should feel smooth and non-tender
Masses:
Tenderness? Distal or proximal to testes?
Can you place fingers over it? Reduce while patient is supine?
Auscultate bowel sounds over it?

19. Objective Assessment Inspect and Palpate for Hernia:
When standing, inspect the inguinal region for a bulge
Palpate the inguinal canal, length of the spermatic cord up to the external inguinal ring
If able to insert your finger into the inguinal ring, ask pt to bear down
Inguinal ring feels like a triangular, slit-like opening

20. Age & Situational Variations
Newborn/infant/child
Palpate the testes:
Equal size bilaterally
Once palpated, consider testes “distended”
Older adult
Thinner, graying pubic hair
Decreased penis, testes size
Scrotal sac more pendulous, less rugae
Circumcision
Do not attempt to retract foreskin until after three months of age in the uncircumcised patient

21. Sex Maturity Ratings (SMR)
1. No pubic hair, penis and scrotum maintain the size the same as in childhood
2. Straight, slightly darker hairs; penis with little enlargement; scrotal enlargement, reddens, changes in texture
3. Hair darker, coarser, and curly; penis begins to enlarge; scrotum further enlarged
4. Thick hair growth, coarse and curly; penis grows in length and diameter, glans development; testes larger, scrotum darker
5. Hair growth spreads over medial thighs; penis and scrotum adult size and shape

22. Health Promotion Testicular Self-Examination
13-14 years through adulthood
T- Timing: Once a month
S- Shower: Warm water relaxes scrotal sac
E- Examine: Check for changes, report immediately

23. Documentation