Health Assessment

NUR 241

Physical Assessment of the

Reproductive System
 Define terminology.
 Describe anatomy and physiology.
 Identify equipment.
 Identify positioning.
 Identify techniques.
 Explain process of performing assessment
of male and female reproductive systems.
 Recognize normal and abnormal data.
 Differentiate between normal and
abnormal assessment data.
Terminology related to assessment of male
reproductive systems:
 Penis: External reproductive organ of the male through
which the urethra passes. Composed of three cylindrical
columns of erectile tissue: two corpora cavernosa on dorsal
side, one corpus spongiosum ventrally.
 Glans: (Corpus spongiosum) Cone of erectile tissue, found
at the distal end of shaft.
 Urethra: Tube leading from urinary bladder to outside of
body, transverses the corpus spong., and its meatus forms a
slit at the glans tip.
 Frenulum: A fold of forskin extending from urethral
meatus ventrally.
 Scrotum: A loose, protective sac, encloses testes.
 Epididymis: Highly coiled tubule that leads from the
seminiferous tubules of the testis to the vas deferens. Main
storage site of sperm.
 Vas Deferns: A muscular duct or tube that leads
from the epididymis to the urethra of the male
reproductive tract.
 Spermatic cord: Ascends along the posterior
border of the testes and runs through the tunnel
of the inguinal canal into the abdomen.
 Ejaculatory duct: A duct of the seminal vesicle
behind the bladder which empties into the
urethra.
 Lymphatics: Where the penis and scrotal
surface drain into the inguinal lymph nodes, those
of testes drain into the abdomen.
Examination Equipment Needed
for Male Anatomy:
1. Gloves- Wear gloves
during every male
genitalia exam.
2. Occasionally: glass
slide for urethral
specimen
3. Materials for
cytology
4. Flashlight
Positioning for Male Examination:
1) Position male standing with undershorts
down, with appropriate draping.
2) Examiner should be sitting. (Male may be
supine for first part of exam, standing for
hernia check.
3) Take time for pt. to discuss genitourinary
history.
Inspection and palpation of male
reproductive system:
Normal Findings:
• Penis: skin wrinkled, hairless,
no lesions.
• Glans: smooth, no lesions.
Retract uncircumcised for
skin. Cheesy smegma uncer
foreskin may be noted.
Always slide foreskin back to
original position.
• Abnormal Findings:
• Inflammation, solitary ulcer,
grouped vesicles, superficial ulcers,
wartlike papules.
• Inflammation, lesions on glans or
corona.
• Phimosis- unable to retract
foreskin.
• Paraphimosis- unable to return
forskin to original pos.
• Hypospadias- ventral location of
meatus.
• Epispadias- dorsal location of
meatus
• Pubic lice or nits- excoriated skin
• Stricture- narrowed opening
• Edges that are red, everted,
edematous, purulent discharge
(urethritis).
• Nodule, induration, tenderness
Abnormal finding in the male
reprodctive system:
 Urethritis:
 Infection of the urethra.
 Painful burning with urination
 Meatus edges are red and swollen
with discharge.
 Urine is cloudy.
 Renal Calculi:
 Renal stones
 Sudden, severe flank pain that
radiates
 Nausea and Vomiting
 Restlessness
 Acute Urinary Retention:
 Abrupt inability to pass urine.
 Bladder distension and lower
abdominal pain.
 Tinea Cruris:
 Fungal infection in the crural fold.
 Infection does not extend to the
scrotum.
 Jock itch.
 Genital Herpes:
 Clusters of small vesicles
 Vesicles rupture to form superficial
ulcers
 Initial manifestation lasts 7-10 days
 Recurrent episodes last 3-10 days
 Virus lays dormant indefinitely
 Syphilitic Chancre:
 Manifests 2-4 weeks after infection
 Small, solitary papule that erodes into
round superficial ulcer.
 Can be lifted like a button.
Inspection and palpation of
scrotum:
Normal Findings: Abnormal Findings:
1. Inspect scrotum as male holds 1. Scrotal swelling (edema)
penis. 2. taut and pitting. (Heart
2. Scrotal size varies with room failure, renal failure, local
temp. inflammation. Lesions
3. Should be asymmetrical with 3. Inflammation
left scrotal half lower than 4. Absent testes, temporary
right. migration, true
4. Spread rugae out between cryptorchidism
fingers, Inspect post. surface. 5. Atrophied testes-small, soft
5. Palpate gently ea. Half between 6. Fixed testes
thumb and first two fingers.
7. Nodules on testes or
Contents should easily slide.
epididymides
Testes palpable, oval, firm,
rubbery, smooth, equal bilat. 8. Marked tenderness
Freely movable. 9. Indurated, swollen, tender
6. Epididymis feels discrete, softer epididymis (epididymitis)
than testis, smooth, nontender
• Inspect each spermatic cord • Abnormal findings:
between thumb and • Thickened cord, soft, swollen,
forefinger, along its length tortuous.
from epidiymis to external
inguinal ring. Should feel
• Abnormalities in scrotum:
smooth, nontender cord.
hernia, tumor, orchitis,
• Any mass? Note tenderness, epididymitis, hydrocele,
distal or proximal to testes, spermaatocele, varicocele.
can you place finger over it?,
does it reduce when pt. lies
down, can you auscultate • Serous fluid does trasilluinate
bowel sounds over it. and shows red glow, e.g.,
hydrocele, or spermatocele.
• Transillumination: Perform
Solid tissue and blood do not
this maneuver if you note
transilluminate, e.g., hernia,
swelling or mass. Darken
epidiymitiis, or tumor.
room, shine flashlight from
behind scrotal contents,
normal scrotal contents do
not illuminate.
 Inspect for hernia
Normal Findings:
Technique: Abnormal Findings:
 Inspect inquinal region for bulge as pt.  Bulge at external inguinal ring or
stands and strains. femoral canal (hernia may be
 Normally, none is present. present but easily reduced and
 Palpate right side of inquinal canal by may appear only intermittently
asking pt. to shift wt. onto left leg. Place with increase in intraabdominal
right index finger low in the right scrotal
half. Palpate up length of spermatic cord, pressure.)
invaginating scrotal skin as you go, to  Palpable herniating mass bumps
external inguinal ring. Feels like triangular
slitlike opening, may go easier if you ask pt. your fingertip or pushes against
to bear down. the side of your finger.
 Normally, there is no change. Repeat
procedure to left side.
 Palpate inguinal lymph nodes by palpating
horizontal chain along groin inferior to  Enlarged, hard, matted, fixed
ligament and vertical chain along inner nodes.
thigh. Normal- feels small, soft, discrete,
and movable.
 Female reproductive system

The female reproductive system (or female genital

system) is made up of the internal and external sex
organs that function in reproduction of new
offspring . In the human the female reproductive
system is immature at birth and develops to
maturity at puberty to be able to produce gametes,
and to carry a fetus to full term. The internal sex
organs are the uterus and Fallopian tubes, and the
ovaries. The uterus or womb accommodates the
embryo which develops into the fetus. The uterus
also produces vaginal and uterine secretions which
help the transit of sperm to the Fallopian tubes.
The ovaries produce the ova (egg cells). The
external sex organs are also known as the genitals
and these are the organs of the vulva including the
labia, clitoris and vaginal opening. The vagina is
connected to the uterus at the cervix.
At certain intervals, the ovaries release an ovum,
which passes through the Fallopian tube into the
uterus. If, in this transit, it meets with sperm, a single
sperm can enter and merge with the egg, fertilizing
it. The corresponding equivalent among males is the
male reproductive system.
Fertilization usually occurs in the Fallopian
tubes and marks the beginning of
embryogenesis. The zygote will then divide
over enough generations of cells to form a
blastocyst, which implants itself in the wall of
the uterus.
This begins the period of gestation and the
embryo will continue to develop until full-
term. When the fetus has developed enough to
survive outside the uterus, the cervix dilates
and contractions of the uterus propel the
newborn through the birth canal (the vagina).
 Terminology
The External Female Genitalia
 Vulva- (or pudendum) The external genitalia.
 Mons pubis- A round, firm pad of adipose tissue covering the
symphysis pubis.
 Labia majora- Two rounded folds of adipose tissue extending
from the mons pubis down and around to the perineum.
 Labia minora- Two smaller, darker folds of skin inside the labia
majora.
 Frenulum- A transverse fold which joins the labia minora
poseriorly.
 Clitoris- A small, pea –shaped erectile body, homologous with the
male penis and highly sensitive to tactile stimulation.
 The labial structures encircle a boat-shaped space termed the
Vestible.
 Urethral meatus- A dimple 2.5 cm posterior opening posterior
to the clitoris.
 Vagina- A flattened, tubular canal extending from the orifice up
and backward into the pelvis. Leads into the female reproductive
tract.
 Rugae- Thick transverse folds which enable the vagina to dilate
widely during childbirth.
 Cervix- A smooth doughnut-shaped area with a small circular hole
or os, found at the end of the canal that leads into the uterus.
 Anterior fornix- A continuous recess, present in front of the
cervix.
 Posterior fornix- Continuous recess found in back of cervix.
 Rectouterine pouch, or cul-de-sac of Douglas- Found behind
the posterior fornix, a deep recess, formed by the peritoneum, dips
down between the rectum and cervix.
 Uterus- A pear-shaped, thick walled, muscular
organ which a fetus develops. Flattened
anteroposteriorly, measuring 5.5 to 8 cm by 3.5-4
cm wide, and 2-2.5 cm thick.
 Fallopian tubes- Two pliable, trumpet-shaped
tubes, 10 cm long, extending from the uterine
fundus laterally to the brim of the pelvis. Transports
an egg cell from the region of the ovary to the
uterus.
 Ovaries- The primary reproductive organ of the
female; An egg-cell producing organ which is oval
shaped, 3 cm long by 2 cm wide.
Nursing Assessment:

Supjective data:
 Keep in mind the sensitivities of the pt as well as your own feelings
regarding body image,fear of cancer,sexuality, and the like.
 History of present health:
 What was the date of your last menstrual period?
 What other symptoms do you experience before or during your
period?
 How old were you when you started your period?
 Do you have any spotting between periods?
 Are you still having periods?Have your periods changed?
 Are you experiencing any symptoms of menopause?
Vaginal discharge,pain,masses
 Are you experiencing vaginal discharge that is unusual in terms
of color,amount, or odor?
 Do you experience pain in your genital or groin area?
 History of past health:
 Do you have any problems with your sexual performance?
 Have you recently had a change in your sexual activity pattern?
 Do you experience problems with fertility?
 Have you ever been diagnosed with diabetes?
 History of family health:
 Is there a history of reproductive or genital cancer in your
family? What type? How is the family member related do you?
 Life style health:
 Do you smoke?
 How many sexual partners do you have?
 Do you use contraceptives? What kind? How often?
 What is your sexual preference?
 How do you feel about going through menopause?
 Do you take estrogen replacement therapy?
 What do you know about toxic shock syndrome?
 Do you wear cotton underwear and avoid tight jeans?
 Do you douche frequently?
Objective data:
 The physical examination of the female
genitalia may create patient anxiety.
 The pt may be very embarrassed about
exposing her genitalia and nervous that an
infection or disorder will be discovered.
 Equipment
For Female Examination
 Gloves  Materials for cytologic
 Protective clothing study:
 Vaginal Speculum  Glass slide with frosted
end
Of appropriate size
 Sterile Cytobrush or
 Large cotton-tipped cotton-tipped applicator
applicators (rectal
swabs)  Ayre’s spatula
 Spray fixative
 Specimen container for
gonorrhea Cx/chlamidia
 Small bottle of normal
saline, potassium
hydroxide, and acetic
acid (white vinagar)
 Lubricant
Physical Assessment:

Inspection:
 Inspect the Mons Pubis.
 Observe inguinal lymph nodes.
 Inspect the labia majora and perineum.
 Inspect the labia minora,clitoris,urethral
meatus, and vaginal opening.
 Inspect the vaginal musculature.
 Inspect the cervix.
 Inspect the vagina.
Physical Assessment:

Palpation:
 Palpate Bartholins gland.
 Palpate the urethra.
 Palpate the vaginal wall.
 Positioning for
Female Examination
1. Begin with woman in sitting position to
establish equal status and trust.
2. Place woman in lithotomy position, with the
examiner sitting on a stool.
3. Help the woman into position, feet in
stirrups, knees apart, and buttocks at edge of
examination table.
4. Arms should be at the woman’s sides,not
across chest or over the head.
5. Drape the woman fully, covering the
stomach,and legs, exposing only the vulva to
your view.
 Techniques

 Have woman empty bladder.

 Position the exam table so her perineum
is not exposed to inadvertent open door.
 Ask if she would like a friend, family
member present.
 Elevate her head and shoulders to a semi-
sitting position to maintain eye contact
 Place stirrups so the legs are not
abducted too far.
 Explain each step in the exam before you
do it.
 Assure the woman she can stop the exam
at any point she should feel
uncomfortable.
 Use a gentle, firm, touch, and gradual
movements.
 Communicate throughout the exam.
Maintain dialogue to share information.
 Assessment of the
Female Genitalia
 Normal Findings:  Abnormal Findings:
Inspection: Inspection:
Note:
Note:
 Hair distribution- usual
• Refer any suspicious lesion
pattern
for biopsy
 Skin color, no lesions
• Consider delayed puberty if
 of inverted triangle.
no pubic hair or breast
 Labia Majora symmetric, development has occurred by
plump, age of 13.
 and well formed. Nulliparous Nits, or lice at base of pubic
woman, labia meet in midline; hair
following vaginal delivery, labia • Swelling
are gaping and slightly
shriveled.
Normal Findings: Abnormal findings:
 No lesions, except for  Excoriation, nodules,
occ. Sebaceous cysts.
rash, or lesions.
(with gloved hand sep-
arate labia majora to inspect).
 Clitoris
 Labia minora- dark pink, and moist,  Inflammation or lesions.
usually symmetric.
 Urethral opening appears
stellate or slitlike, midline.  Polyp
 Vaginal opening (introits) may appear as  Foul-smelling, irritating
narrow, vertical slit or as a larger
opening. discharge.
 Perineum-smooth. A well-healed
episiotomy scar, midline or mediolateral
following vaginal birth.
 Anus- course skin of increased
pigmentation.
Obtaining tissue specimens for analysis:
 Papanicolaou.
 Obtaining an Ectocervical Specimen
 Vaginal specimen.
 Conorrhea and chlamydia.
Abnormalities of the External Genitalia and
Vaginal Opening:
 Cystocele
 Rectocele
 Uterine Prolapse
Abnormalities of the cervix:
 Cervical Polp
 Cervical Erosion
 Cancer of the cervix
Vaginitis:
 Atrophic Vaginitis
Adnexal Masses:
 Ovarian cancer
 Ectopic pregnancy
Abnormal Findings of External
Genitalia
 Pediculosis Pubis
(Crab Lice):
Severe perineal itching,
excoriations,
erythematous areas.
May see little dark
spots, nits (eggs)
adherent to pubic
hair near roots.
 Syphilitic Chancre
• Begins as small, solitary
silvery papule, erodes
to red, round
 or oval, superficial
ulcer with yellowish
serous discharge.
 Palpation- nontender
indurated base; can be
lifted like button
 between thumb and
finger.
Herpes Simplex Virus- Type 2
Episodes of local pain, 
dysuria, fever.
Clusters of small, shallow 
vesicles with surrounding
erythema, erupt on genital
areas, inner thigh.
Vesicles on labia rupture in
1-7 days, leaving painful
ulcurs.
Initial infection lasts 7-10
days.
Virus remains dormant
indefinitely;
recurrent infections last
3-10 days
with milder symptoms.
Red Rash- Contact Dermatitis
History of skin contact with allergenic
substance in environment, intense
pruritus.
Primary lesion- red, swollen, vesicles.
May have weeping of lesions, crusts,
scales, thickening of skin, excoriations
from scratching. May result from reaction
to feminine hygiene spray, synthetic
underclothing.
Genital Human Papillomavirus
(HPV, Condylomata Acuminata,
Genital Warts
Painless warty growths,
may Be unnoticed by
woman.
Pink or flesh-colored,
soft, pointed, moist,
warty papules.
Single or multiple in
cauli-flowerlike patch.
Occur around vulva,
introitus, anus, vagina,
cervix.
 Internal Genitalia
 Speculum
Examination:
Select proper-sized
speculum
Grave’s Speculum  Pederson Speculum
Speculum Examination
 Warm and lubricate speculum under warm running water.
 Avoid gel lubricant – bacteriostatic, distorts cell in cytology
specimen collected.
 Insert by asking woman to bear down. Relaxes perineal muscles
and opens introitus.
 Insert speculum at 45-degree angle downward toward the small
of woman’s back.
 After blades are fully inserted, open them by squeezing handles
together.
 Cervix should be in full view.
 Try closing blades by tightening the thumbscrew.
 Inspect the cervix
Normal Findings:
 Color: normally pink,even; 2nd
month preg. Blue (Chadwick’s
sign); past menopause-pale.
 Position: midline,anterior or post.
Projects 1-3 cm into vagina.
 Size: Diameter-2.5 cm (1”).
 OS: Small, round in nulliparous,
horizontal irreg. slit, may show
healed laceration on sides.
Abnormal Findings:
 Redness, inflammation
 Pallor wit anemia, cyanotic other
than with pregnancy.
 Lateral position- adhesion or
tumor. Projection >3 cm may be
prolapse.
 Hypertrophy > 4 cm occurs with
inflammation or tumor.
 Surface: Smooth,  Surface reddened,
eversion, or ectropion, granular, asymmetric,
past vaginal delivery; around os.
Endocervial canal  Friable, bleeds easily.
everted or rolled out.  Any lesions: white
Red, beefy halo inside patch on cervix,
strawberry spot.
the pink cervix
surrounding os.  Refer any suspicious,
red, white, or
pigmented lesion for
biopsy.
 Inspect the Vaginal Wall
Normal Findings: Abnormal Findings:
 As you remove the  Inflammation, lesions.
speculum, inspect  Leukoplakia, appears as
vaginal wall. Pink, spot of dried paint.
deeply rugated, moist,  Vaginal discharge: thick,
white, curdlike with
smooth, normal candidiasis, profuse,
discharge thin, clear, watery, gray-green,
opaque, stringy, frothy with trich.; or
odorless. gray, green-yellow,
white, or foul odorous
discharge.
Bimanual Exam
 Bimanual Exam
Technique of exam:
I. Lithotomy position,
II. lubricate fingers of gloved hand.
III. Insert fingers into vagina posteriorly.
IV. Use both hands to palpate internal genitalia to
assess location, size, & mobility, screen for
tenderness or mass.
V. One hand is on the abdomen, the other into
the vagina.
VI. Palpate the vaginal wall. Should feel smooth, no
area of induration or tenderness.
VII. Locate cervix in midline. Palpate using palmar
surface of fingers. Note consistancy.
Normal findings of Abnormal findings of
cervix: cervix:
 Consistency: smooth,
firm, tip of nose.  Nodule, Tenderness.
Softens, feels velvety at
5-6 wks gest.
(Goodell’s sign).  Hard with malignancy,
 Contour: Evenly Nodular, Irregular,
rounded. Immobile with
 Mobility: With finger malignancy.
on either side, move
cervix gently from side
to side. No pain.
Always encourage self
care by:
TEACHING EVERY MALE FROM 13-14
YEARS OLD THROUGH ADULTHOOD
TO PERFORM TESTICULAR SELF-
EXAMINATION (TSE).
References:
HEALTH ASSESSMENT BOOK

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 prepared by:
• Ghadeer alobaid • Hanan alumtairi
• Nouf almutairi • Rawabi almutairi
• Wala alumtairi • Bashayer almutairi
• Rana almutairi
• Mona alrshidi
• Ahlam saud
• Sara alotaibi
• Hadel almutairi