Female Genitourinary System

Female Genitourinary System

1. external genitalia- vulva, mons pubis, labia majora, labia minora, clitoris, frenulum, vestibule, urethral meatus, paraurethral glands, vaginal orifice, hymen, vestibuar glands

2. internal genitalia- vagina, rugae, cervix, squamocolumnar junction, anterior fornix, posterior fornix, rectourine pouch, uterus, fallopian tubes, ovaries

3. subjective data

   • menstrual history- date of your last period, age at first period, how often, how many days does it last, usual amount of flow, any clotting, pain, cramps?
   • obstetric history- have you ever been pregnant, how many times, how many babies, miscarriage/abortion, pregnancy duration, complications
   • menopause- have your period slowed down or stopped, hot flashes, numbness, tingling, headache, hormone replacement therapy, how do you feel about going through menopause
   • patient centered care- how often do you have a gynecologic check up?
   • acute pelvic pain- any pain in the lower abdomen or pelvis, constant or come and go, associated with period
   • urinary symptoms- any problems urinating, amount, burning or pain, blood
   • vaginal discharge- character, color, when did it begin, any medications, family history of diabetes
   • past history- any other problems in the genital area, sores or lesions, past surgery
   • sexual activiy- sexual relationship, preference
   • contraceptive use, sti contact

4. objective data

   • inspection- skin color is even, labia minora are a darker pink, hair distribution, labia majora normally are symmetric, plump, well formed, perineum is smooth
   • palpation- assess the urethra and skene glands. dip gloved finger in warm water to lubricate, insert idex finger into vagina, any discharge appears at 11 oclock and 1 oclock, culture it. palpate the posterior parts of labia majora with index finger in the vagina and thumb outside at 5 and 7 oclock positions. normally the labia feel soft and homogenous. palpate perineum- feels thick, smooth and muscular in the nulliparous woman and thin and rgid in the multiparous woman. no bulging of vaginal walls or urinary incontinence
   • internal genitalia- pap test- inspect the cervix and its o's- color- pink an even, position- midline, either anterior or posterior, size- diameter is 2.5 cm (1 inch), Os= this is smal and round in the nulliparous woman, parous woman= it is a horizontal, irregular slit and may show healed lacerations on tehs sides, surface- smooth, endocervical canal is everted or rolled out.
   • pap test- screens for cervical cancer and not for endometrial or ovarian cancer.
   • inspect the vaginal wall, bimanual examination- consisitency- feels smooth and firm, contour- evenly rounded, mobility- palpate al around the fornices, the wall should feel smooth
   • rectovaginal examinatio- assess the rectovaginal septum, posterior uterine wall, cul-de-sac, and rectum