Presentation On Assessment Of Female Reproductive System

Introduction

Assessment

Discharge Swelling Ulcerations Nodules Masses Tenderness Pain

Pruritis Pap Smear Menstrual Flow Menopause Para Gravida Prolapsed

Assess Nipples For :-

Colour Discharge Ulceration Bleeding Inversion

Assess Axilla For:- Nodes Enlargement Tenderness Rash Inflammation.

Equipments:-

Pair Of Gloves

Speculum Of Various Size

Lubricating Jelly

Spatula, Swabs And Endocervical Brush

Culture bottles And Test tube

Flexible Light Source

Examination Table

General Consideration

The patient must have an empty bladder.The patient must be appropriately gowned

and draped.Use non-sterile gloves on both hands. Properly dispose of soiled equipment and

supplies.

Cont… Both male and female examiners should

be chaperoned by a female assistant. Always tell the patient what you are about to

do before you do it. The breast exam is usually done just before

routine pelvic exams.

Positioning Supine position with head elevated 30 to 45

degrees. Assist the patient to place her heels in the

stirrups. Have the patient slide her hips down until she

contacts your hand at the edge of the table. Have the patient relax her knees outward just

beyond the angle of the stirrups.

Physical Assessment of the Older Adult Reproductive System:-

Taking History:- Do you experience hot flushes or flashes? If

so, how bothersome are they? Are you experiencing menstrual irregularities? Do you practice contraception?

Con t… Are you having any problems or changes you

attribute to menopause? What are they? Could anything else be causing these problems or changes?

How do you feel about approaching menopause?

Are you receiving hormone therapy for menopause?

If you have completed menopause, have you had any bleeding?

External Genitalia

FINDINGS :-

Hair Distribution Skin Of Perineum Labia Majora Closed Or

Gapping Clitoris - About 2 Cm In

Length And 0.5 Cm In Width

Urethral Orifice Vaginal Orifice Anus -

Internal Examination:-

NORMAL FINDINGS:-

Cervix :- pink midline usually about 2 to 3 cm in

diameter smooth firm, rounded or oval odorless, creamy or clear

secretions

Normal Findings:-

VAGINA

Pink throughout; Clear or cloudy, Odorless secretions; About 10 to 15 cm

in length.

Palpation:-  Ovaries may or may not be palpable; firm,

slightly tender, oval, mobile; about 4 cm in diameter

Uterus – mobile, rounded, palpable at level of pelvis.

Skene's glands and Bartholin's gland - normal findings: nontender, no discharge.

Geriatric Alterations

Labial folds flatten Skin paler, shiny Meatus usually more posterior Cervix decreases in size; may appear paler Scanty cervical discharge Vagina shortens with age Decreased vaginal secretions Uterus diminishes in size; may not be palpable Ovaries atrophy with age

External Examination:-

Uncover the vulva by moving the center of the drape away from you. Try to avoid creating a "screen" with the drape pulled tight between the patient's knees.

Announce what you are going to do and then touch the patient on the thigh with the back of your hand before proceeding.

Inspect the outer genitalia for redness, swelling, lesions, masses, or infestations.

Cont… Gently palpate the labia majora and minora. Inspect the labia, the folds between them, and

the clitoris. Note any redness, swelling, lesions, or

discharge. Reassure the patient, if the exam is normal so

far. 

Internal Examination:-

Speculum Examination Bimanual Examination

Speculum Examination

Warm and lubricate the speculum. Announce what you are going to do and then

touch the patient. Expose the introitis. Insert the speculum at a 45 degree angle

pointing slightly downward. 

Cont… Once past the introitis, rotate the speculum to a

horizontal position and continue insertion until the handle is almost flush with the perineum.

Open the "bills" of the speculum 2 or 3 cm using the thumb lever.

Secure the speculum by turning the thumb nut or clicking the ratchet mechanism.

 Do not move the speculum while it is locked open.

Cont… Observe the cervix and vaginal walls for

lesions or discharge. Obtain specimens for culture and cytology as

indicated. Withdraw the speculum slightly to clear the

cervix. Loosen the speculum and allow the "bills" to fall together. Continue to withdraw while rotating the speculum to 45 degrees.

Cont…

Remove the draping.

Reassure the patient, if the exam is normal so

far, say so.

Bimanual Examination

Bimanual Examination

Apply a small amount of lubricant. Uncover the vulva and lower abdomen Announce what you are going to do and then

touch the patient. Spread the labia and insert your lubricated

index and middle fingers into the vagina.  Avoid contact with the anterior structures.

Cont….

Cervix :-i. Palpate the cervix with your index finger

noting size, shape, and consistency.ii. Gently move the cervix side to side

between your fingers and note mobility and tenderness.

iii. Gently lift the cervix forward and note mobility and tenderness.

Cont…

iv. Examine the anterior uterine fundus.iv. Continue to lift the cervix with the vaginal

hand.v. Press downward with the abdominal hand

and palpate the uterus.vi. Note consistency and tenderness. Attempt to

estimate uterine size.

Adnexal Structures

• Pull back vaginal hand to clear cervix.• Reposition vaginal hand into the right fornix, palm

up.• Sweep the right ovary downward with the

abdominal hand 3 or 4 cm medial to the iliac crest.• Gently "trap" the ovary between the fingers of both

hands (if possible). Note its size and shape along with any other palpable adnexal structures.

• Pull back and repeat on the left side.

Following Examination

Switch off the examination light provide privacy Ensure the woman has tissue available is access to washing facilities and sanitary

pads, if needed. Recording findings clearly in patient’s notes Provide correct information about the findings

and results of the examination.

Cont….

If swabs are taken for screening following information should be given.

✦ How the results will be communicated.✦ When to expect results.✦ What to do if she does not get the expected results.✦ Possible outcomes.✦ Any further management.

Findings:- In estrogen deficiency (or following menopause)

the vaginal mucosa may be pale with loss of rugae.

Swelling of Bartholin’s glands could indicate infection (discharge should be cultured).

Pregnancy enlarges the cervix; cancer hardens it. In PID the client will experience severe pain

when the cervix is manipulated.

Cont… Blue-coloured cervix = pelvic congestion and

tumour or pregnancy. Infection may give the cervix a bright red or

spotted red appearance. A cervix projecting low into the vagina can

indicate uterine prolapse. A cystocele or rectocele may be observed in

clients with weak pelvic muscles. A laterally placed cervix can indicate tumour or

adhesions.

Cont….

Cervical ulcerations, masses, nodules or surface irregularities must be assessed carefully and considered malignant until proven otherwise.

Endocervical lining may protrude outwards (ectropion or eversion).

Cont…

Polyps – bright red, fragile, soft protrusions

into the cervical canal endocervical tissue.

Small, smooth, round, raised yellow cysts

(Nabothian cysts) appear with or after

chronic cervicitis or with cervical gland

duct obstructions.

Cont…

Cervical carcinoma appears as hard, granular, friable

lesions usually beginning the os and growing outward

irregularly. Venereal warts (condolamata acuminata) are dark pink to

pale, cauliflower like lesions on the mucosal surface.

They may or may not be visible and resemble irregular

small pumps on the cervix. Ulcerations indicate trauma or infection (Herpes simplex,

type I or II).

Venereal warts (condolamatua accuminata)

Cont…

Trichomonal infection usually produces strawberry spots (punctate haemorrhages).

Tumourous uterus feels hard if cancerous. A palpable ovary in a postmenopausal woman

is abnormal.