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Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
Female Genitourinary SystemFemale Genitourinary System
Chapter 26Chapter 26
Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
Chapter 26: Female Genitourinary SystemChapter 26: Female Genitourinary System
Slide 26-2
Structure and FunctionStructure and Function
Subjective Data—Health Subjective Data—Health History QuestionsHistory Questions
Objective Data—Objective Data—Physical ExamPhysical Exam
Abnormal FindingsAbnormal Findings
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Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
Chapter 26: Female Genitourinary SystemChapter 26: Female Genitourinary System
Slide 26-3
Structure and FunctionStructure and Function External Genitalia or Vulva External Genitalia or Vulva
Mons pubisMons pubis Labia majoraLabia majora Labia minoraLabia minora FrenulumFrenulum ClitorisClitoris Urethral meatusUrethral meatus Paraurethral (Skene’s) Paraurethral (Skene’s)
glandsglands Vaginal orificeVaginal orifice HymenHymen Vestibular (Bartholin’s) glandsVestibular (Bartholin’s) glands
Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
Chapter 26: Female Genitourinary SystemChapter 26: Female Genitourinary System
Slide 26-4
Structure and Function Structure and Function (cont.)(cont.)
Internal Genitalia Internal Genitalia VaginaVagina CervixCervix Squamocolumnar Squamocolumnar
junctionjunction Anterior fornix and Anterior fornix and
posterior fornixposterior fornix Rectouterine pouch or Rectouterine pouch or
cul-de-sac of Douglascul-de-sac of Douglas UterusUterus Fallopian tubes Fallopian tubes
Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
Chapter 26: Female Genitourinary SystemChapter 26: Female Genitourinary System
Slide 26-5
Structure and Function Structure and Function (cont.)(cont.)
Developmental careDevelopmental care
Infants and adolescentsInfants and adolescents
Pregnant femalePregnant female
Aging femaleAging female
Cross-cultural careCross-cultural care
Exposure of genitaliaExposure of genitalia
Infibulation (female genital mutilation)Infibulation (female genital mutilation)
Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
Chapter 26: Female Genitourinary SystemChapter 26: Female Genitourinary System
Slide 26-6
Subjective Data—Subjective Data—Health History QuestionsHealth History Questions
Menstrual historyMenstrual history
Obstetric historyObstetric history
MenopauseMenopause
Self-care behaviorsSelf-care behaviors
Urinary symptomsUrinary symptoms
Vaginal discharge Vaginal discharge
Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
Chapter 26: Female Genitourinary SystemChapter 26: Female Genitourinary System
Slide 26-7
Subjective Data—Subjective Data—Health History Questions Health History Questions
(cont.)(cont.) HistoryHistory
Sexual activitySexual activity
Contraceptive useContraceptive use
Sexually transmitted disease (STD) contactSexually transmitted disease (STD) contact
STD risk reduction STD risk reduction
Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
Chapter 26: Female Genitourinary SystemChapter 26: Female Genitourinary System
Slide 26-8
Subjective Data—Subjective Data—Health History Questions Health History Questions
(cont.)(cont.)
Additional history for infants and childrenAdditional history for infants and children UrinationUrination
Perineal hygienePerineal hygiene
Sexual abuseSexual abuse
Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
Chapter 26: Female Genitourinary SystemChapter 26: Female Genitourinary System
Slide 26-9
Subjective Data—Subjective Data—Health History Questions Health History Questions
(cont.)(cont.)
Additional history for preadolescents and Additional history for preadolescents and adolescentsadolescents
Start of periodStart of period
SexSex
Sexually transmitted diseaseSexually transmitted disease
Sexual abuseSexual abuse
Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
Chapter 26: Female Genitourinary SystemChapter 26: Female Genitourinary System
Slide 26-10
Subjective Data—Subjective Data—Health History Questions Health History Questions
(cont.)(cont.)
Additional history for the aging adultAdditional history for the aging adult Postmenopausal bleedingPostmenopausal bleeding
Atrophic vaginitisAtrophic vaginitis
Uterine prolapseUterine prolapse
Sexual satisfactionSexual satisfaction
Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
Chapter 26: Female Genitourinary SystemChapter 26: Female Genitourinary System
Slide 26-11
Objective Data—Objective Data—Physical ExamPhysical Exam
PreparationPreparation
Lithotomy position and Lithotomy position and drapingdraping
Measures to enhance Measures to enhance comfort during examcomfort during exam
Mirror pelvic Mirror pelvic examination examination
Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
Chapter 26: Female Genitourinary SystemChapter 26: Female Genitourinary System
Slide 26-12
Objective Data—Objective Data—Physical Exam Physical Exam
(cont.)(cont.)EquipmentEquipment
GlovesGloves
Protective clothing for examinerProtective clothing for examiner
Goose-necked lamp with a strong lightGoose-necked lamp with a strong light
Vaginal speculum of appropriate sizeVaginal speculum of appropriate size
Large cotton-tipped applicators (rectal swabs)Large cotton-tipped applicators (rectal swabs)
Materials for cytologic studyMaterials for cytologic study
LubricantLubricant
Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
Chapter 26: Female Genitourinary SystemChapter 26: Female Genitourinary System
Slide 26-13
Objective Data—Objective Data—Physical Exam Physical Exam
(cont.)(cont.)
External genitalia—External genitalia—InspectionInspection Skin colorSkin color Hair distributionHair distribution Labia majoraLabia majora Any lesionsAny lesions ClitorisClitoris Labia minoraLabia minora Urethral openingUrethral opening Vaginal opening Vaginal opening PerineumPerineum AnusAnus
Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
Chapter 26: Female Genitourinary SystemChapter 26: Female Genitourinary System
Slide 26-14
Objective Data—Objective Data—Physical Exam Physical Exam
(cont.)(cont.)
External genitalia—External genitalia—PalpationPalpation
Skene’s glandsSkene’s glands
Bartholin’s glands Bartholin’s glands
Support of pelvic musculature Support of pelvic musculature
Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
Chapter 26: Female Genitourinary SystemChapter 26: Female Genitourinary System
Slide 26-15
Objective Data—Objective Data—Physical Exam Physical Exam
(cont.)(cont.)
Internal genitalia—Internal genitalia—Speculum examinationSpeculum examination
Insertion technique Insertion technique Cervix and os Cervix and os
ColorColor PositionPosition SizeSize OsOs SurfaceSurface Any Nabothian cystsAny Nabothian cysts Cervical secretionsCervical secretions
Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
Chapter 26: Female Genitourinary SystemChapter 26: Female Genitourinary System
Slide 26-16
Objective Data—Objective Data—Physical Exam Physical Exam
(cont.)(cont.)
Obtain cervical smears and culturesObtain cervical smears and cultures Vaginal poolVaginal pool
Cervical scrapeCervical scrape
Endocervical specimenEndocervical specimen
Data to include for the Data to include for the laboratorylaboratory
Inspect vaginal wallInspect vaginal wall
Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
Chapter 26: Female Genitourinary SystemChapter 26: Female Genitourinary System
Slide 26-17
Objective Data—Objective Data—Physical Exam Physical Exam
(cont.)(cont.)
Internal genitalia—Internal genitalia—BimanualBimanual ExaminationExamination Palpation techniquePalpation technique
Cervix Cervix ConsistencyConsistency
ContourContour
Mobility Mobility
UterusUterus
AdnexaAdnexa
Rectovaginal Rectovaginal examination examination Rectovaginal septumRectovaginal septum
Posterior uterine wallPosterior uterine wall
Cul-de-sacCul-de-sac
RectumRectum
Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
Chapter 26: Female Genitourinary SystemChapter 26: Female Genitourinary System
Slide 26-18
Objective Data—Objective Data—Physical Exam Physical Exam
(cont.)(cont.)
Developmental careDevelopmental care Infants and childrenInfants and children
AdolescentAdolescent
Pregnant femalePregnant female
Aging adultAging adult
Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
Chapter 26: Female Genitourinary SystemChapter 26: Female Genitourinary System
Slide 26-19
Sample ChartingSample Charting
Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
Chapter 26: Female Genitourinary SystemChapter 26: Female Genitourinary System
Slide 26-20
Sample Charting Sample Charting (cont.)(cont.)
Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
Chapter 26: Female Genitourinary SystemChapter 26: Female Genitourinary System
Slide 26-21
Sample Charting Sample Charting (cont.)(cont.)
Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
Chapter 26: Female Genitourinary SystemChapter 26: Female Genitourinary System
Slide 26-22
Abnormal FindingsAbnormal FindingsAbnormalities of theAbnormalities of theExternal GenitaliaExternal Genitalia
Pediculosis pubis (crab lice)Pediculosis pubis (crab lice) Syphilitic chancreSyphilitic chancre Herpes simplex virus—type 2 (herpes genitalis)Herpes simplex virus—type 2 (herpes genitalis) Red rash—contact dermatitisRed rash—contact dermatitis Human papillomavirus (HPV) wartsHuman papillomavirus (HPV) warts UrethritisUrethritis Abscess of Bartholin’s glandAbscess of Bartholin’s gland Urethral caruncleUrethral caruncle
Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
Chapter 26: Female Genitourinary SystemChapter 26: Female Genitourinary System
Slide 26-23
Abnormal Findings Abnormal Findings (cont.)(cont.)
Abnormalities of the Pelvic MusculatureAbnormalities of the Pelvic Musculature
CystoceleCystocele
Uterine prolapseUterine prolapse
RectoceleRectocele
Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
Chapter 26: Female Genitourinary SystemChapter 26: Female Genitourinary System
Slide 26-24
Abnormal Findings Abnormal Findings (cont.)(cont.)
Abnormalities of the CervixAbnormalities of the Cervix
Bluish cervix—cyanosisBluish cervix—cyanosis
Human papillomavirus (HPV, condylomata)Human papillomavirus (HPV, condylomata)
Diethylstilbestrol (DES) syndrome ErosionDiethylstilbestrol (DES) syndrome Erosion
ErosionErosion
PolypPolyp
CarcinomaCarcinoma
Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
Chapter 26: Female Genitourinary SystemChapter 26: Female Genitourinary System
Slide 26-25
Abnormal Findings Abnormal Findings (cont.)(cont.)
Vulvovaginal InflammationVulvovaginal Inflammation
Atrophic vaginitisAtrophic vaginitis
Candidiasis (moniliasis)Candidiasis (moniliasis)
TrichomoniasisTrichomoniasis
ChlamydiaChlamydia
Bacterial vaginosis Bacterial vaginosis
GonorrheaGonorrhea
Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
Chapter 26: Female Genitourinary SystemChapter 26: Female Genitourinary System
Slide 26-26
Abnormal Findings Abnormal Findings (cont.)(cont.)
Conditions of Uterine EnlargementConditions of Uterine Enlargement
PregnancyPregnancy
Myomas (leiomyomas, uterine fibroids)Myomas (leiomyomas, uterine fibroids)
Carcinoma of endometriumCarcinoma of endometrium
EndometriosisEndometriosis
Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
Chapter 26: Female Genitourinary SystemChapter 26: Female Genitourinary System
Slide 26-27
Abnormal Findings Abnormal Findings (cont.)(cont.)
Adnexal EnlargementAdnexal Enlargement
Fallopian tube mass—acute salpingitis Fallopian tube mass—acute salpingitis (pelvic inflammatory disease or PID)(pelvic inflammatory disease or PID)
Fallopian tube mass—ectopic pregnancyFallopian tube mass—ectopic pregnancy
Fluctuant ovarian mass—ovarian cystFluctuant ovarian mass—ovarian cyst
Solid ovarian mass—ovarian cancerSolid ovarian mass—ovarian cancer
Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
Chapter 26: Female Genitourinary SystemChapter 26: Female Genitourinary System
Slide 26-28
Abnormal Findings Abnormal Findings (cont.)(cont.)
Abnormalities in the Pediatric GenitaliaAbnormalities in the Pediatric Genitalia
Ambiguous genitaliaAmbiguous genitalia
Vulvovaginitis in childVulvovaginitis in child
Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
Chapter 26: Female Genitourinary SystemChapter 26: Female Genitourinary System
Slide 26-29
Which subject is most appropriate for Which subject is most appropriate for the start of the health history?the start of the health history?
A.A. Menstrual historyMenstrual history
B.B. Self-care behaviors Self-care behaviors
C.C. Sexual activity Sexual activity
D.D. Obstetric history Obstetric history
Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
Chapter 26: Female Genitourinary SystemChapter 26: Female Genitourinary System
Slide 26-30
Which would be the most appropriate way Which would be the most appropriate way to start asking about sexual activity?to start asking about sexual activity?
A.A. Ask open-ended questions.Ask open-ended questions.
B.B. Ask straightforward questions to elicit basic Ask straightforward questions to elicit basic facts.facts.
C.C. Ask whether the patient feels comfortable Ask whether the patient feels comfortable talking about sex.talking about sex.
D.D. Ask the patient whether she is currently in a Ask the patient whether she is currently in a sexual relationship.sexual relationship.