1. Female & Male Genitalia
Health Assessment

2. Female Health History Menstrual History Obstetric History
Age at menarche, frequency & duration of menstrual cycle, character or flow (amount and presence of clots), presence of dysmenorrhea (painful menstruation), dates of last two menstrual periods and premenstrual symptoms.
Bleeding outside of period or during menopause
Ie. Endometriosis, endometrial cancer
Obstetric History
Number of pregnancies, miscarriages or abortions, or complications

3. Female Health History Received human papillomavirus (HPV) vaccine
Prevent against cervical cancer & genital warts
Symptoms of infection/STIs
Vaginal discharge, pelvic pain, swollen perianal tissues or genital lesions
Symptoms of genitourinary problems
Burning during urination (dysuria), frequency, urgency, nocturia, hematuria, incontinence, stress incontenence
Symptoms of Perimenopause
Hot flash, drenching sweats, mood swings, vaginal dryness, itching, numbness and tingling, headache, or palpitations.

4. Female Health History Risk factors for ovarian cancer
>40 y/o, obese, history of ovarian dysfunction, breast or endometrial cancer, irradiation of pelvic organs, endometriosis, infertility or nulliparity, use of estrogen only hormone replacement
family history of ovarian, breast, or endometrial cancer
Risk factors for endometrial cancer
Postmenopausal, obese, infertile, early menarche, late menopause, HTN, DM, gallbladder disease, PCOS, estrogen-related exposure (HRT or tamoxifen use)
Family history of endometrial, breast, or colon cancer

5. Both Genders- Health History
Sexual history and current/past contraceptive practices
Oral contraceptives- Ask about tobacco use, history of blood clots due to increased risk for blood clots.
Previous illness or surgery involving reproductive organs, including STIs

6. Male Health History Urinary symptoms
Frequency, nocturia, urgency, decreased urinary output, difficulty starting stream, hematuria
Penile pain or swelling, genital lesions or urethral discharge
Heaviness or painless enlargement of testis or irregular lumps
Performance of self testicular exam?
Presence of inguinal hernia
Difficulty achieving erection or ejaculation

7. Examination Tips Explain each step of the examination in advance
Offer a chaperone
Keep patient draped for privacy
Avoid unexpected or sudden movements
Watch patient’s face to monitor comfort
Wear gloves

8. Female Exam

9. Inspection Skin color Hair distribution
No suspicious pigmented lesions noted.
Hair distribution
Inverted triangle. No nits or lice.
Tanner staging for adolescence
Note: The nurse will often examine external genitalia while performing routine hygiene measures or preparing to insert a urinary catheter

10. Inspection Labia majora Perineum
Symmetrical, no excoriation, nodules, rash, lesions or edema
Perineum
Smooth
Well healed episiotomy scar

11. Female Abnormalities

12. Inspection With gloved hand separate labia major and inspect: Clitoris
Labia minora
Dark pink and moist
Urethral opening
Slitlike and midline
Vaginal opening
No discharge or foul odor
No excoriation, nodules, rash, lesions, or edema.

13. Discharge Candidiasis- thick, white curdy
BV- thin, creamy gray-white; foul smelling
Trichomoniasis- frothy yellow-green; foul smelling
Chlamydia- White mucopurulent
Gonorrhea- yellowish

14. Female Abnormalities

15. Female Abnormalities
Rectocele
Cystocele
Uterine prolapse

16. Speculum Examination For routine pelvic exams patient should not
be on menses
Patient should avoid intercourse, douching, vaginal suppositories and tampons 24 hours prior to exam
Have patient empty bladder before examination
Patient lies supine, with head and shoulders elevated
Have patient place heels in stir-ups, slide all the way down examination table until buttocks extend slightly beyond the edge
Thighs should be flexed, abducted and externally rotated at the hips
Have light source available and supplies accessible

17. Speculum Examination/Bimanual Palpation
Obtain cervical smears and cultures
Pap Smears for cervical cancer
Inspect vaginal wall and cervix
Palpate cervix, uterus & ovaries

18. Charting

19. Charting

20. Male Genitalia

21. Male Anatomy

22. Inspection- Tanner Stage

23. Inspection of Penis Skin
Winkled, hairless, without lesions or inflammation
Dorsal vein may be apparent

24. Inspection of Penis Glans Smooth, without lesions
May need to retract foreskin
Phimosis- unable to retract foreskin
Paraphimosis- Unable to return foreskin to original position
Smegma- Cheesy substance under foreskin

25. Inspection/Palpation of Penis
Urethral meatus
Positioned centrally
Hypospastic- ventral location
Epispadias- dorsal location
Compress glans anteroposteriorly between thumb and forefinger to assess for dc
Meatus pink, smooth, without discharge
Profuse yellow = gonococcal
Scanty white = possible Chlamydia

26. Palpation of Penis Palpate shaft between thumb and first 2 finger.
Assess for nodules, induration, or tenderness
Smooth, semifirm, and nontender
If man gets erection during the exam, explain that it is a normal response and finish the exam

27. Inspection of Scrotum Hold scrotum out of way with back of hand
Mild asymmetry normal
Left often lower than right
Assess for edema and lesions

28. Palpation of Scrotum
Palpate scrotum, epididymis & spermatic cord between thumb and first two fingers
Testes- freely movable, oval, firm, rubbery, smooth and equal bilaterally.

29. Palpation of Scrotum Epididymis- discrete, smooth, and nontender
Spermatic cord- smooth and nontender

30. Inspect for Hernia
Inspect inguinal region for bulge as person stands and strains down.
No bulge noted

31. Palpation for Hernia
Gently insert finger into canal and ask patient to bear down.
No inguinal hernia noted.
Palpate femoral areas for bulge
No femoral hernia noted.

32. Palpate Inguinal Lymph Nodes
Palpate inferior to inguinal ligament and along upper inner thigh
Normal to palpate isolated node on occasion
Nonpalpable or small (<1cm), soft, discrete, and movable.

33. Testicular Cancer Incidence is low, 4 per 100,000 Peak age 15-35
If found early, excellent prognosis
The best time to examine testicles is during or after a shower or bath. The warm water allows the scrotum to relax and the testicles to drop down. The left testicle normally hangs a bit lower than the right. It is common for one testicle to be larger than the other one.
Young men should examine themselves once a month. More frequent exams actually may result in missing a slowly changing lump.

34. Testicular Self Exam
Support each testicle with one hand and examine it with the other.
Gently roll each testicle between the thumb and fingers. Testicles should feel firm and smooth, about the consistency of a hard-boiled egg without the shell.
The epididymis is a ropelike structure attached to the back of the testis. This structure is not an abnormal lump
Feel for firm masses, lumps, or nodules in the testicle. In cancer, these lumps often are painless.
Become familiar with normal size, shape, and weight of each testicle and epididymis. This will help you recognize a change from one self-examination to another, if a change should occur.

35. Charting