Download Chapter 20

Structure and Function
N1037
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Mons pubis
Labia majora
Labia minora
Frenulum
Clitoris
Vestibule = urethral meatus,
opening of Skene’s glands (multiple),
hymen, opening of Bartholin’s gland
(x2)
Perineum
Anus
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Skene’s Gland openings not
visible but open posterior to the
urethra at the 5 and 7 o’clock
positions
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Bartholin’s glands secrete a
clear lubricating mucus
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Vagina
◦ Is a tubular canal extending from the orifice
up and backward into the pelvis
◦ 9 cm long and sits between the rectum
posteriorly and the bladder/urethra
anteriorly
◦ Walls are in thick transverse folds (rugae)
which enable expansion during childbirth.
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Cervix projects into the vagina
◦ Uterine cervix lies in front of the anterior
rectal wall and may be palpated through it
◦ Rectovaginal palpation allows for
assessment of the rectovaginal septum,
posterior uterine wall, cul-de-sac and
rectum (repeat bimanual examination steps)
OS-is the opening in the
cervix.
OS changes shape following
Childbirth.
Included in your handout.
GOODELL’S SIGN
4-6 weeks: cervix softens,
Mucus plug, vag secret white
HEGAR’S SIGN
6-8 WKS: uterus softens
CHADWICK’S SIGN
8-12 wk: cyanosis of vaginal
Mucosa and cervix.
20–4
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Rectouterine pouch
 (cul-de-sac of Douglas) lies behind
(separate from) the posterior fornix.
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Uterus
 pear-shaped, thick-walled,
muscular organ
 Top of the uteris is the Fundus
 Body of uterus is the Corpus
 Freely movable, not fixed and
usually tilts forward and superior to
the bladder (anteverted or
anteflexed)
 See p.701 to view other positions
◦ Vagina
◦ Uterus
 Positions of the Uterus
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Anteverted (most common)
Anteflexed
Midposition
Retroverted
Retroflexed
◦ Fallopian tubes
 trumpet shaped, 10 cm in length
 Fimbriae direct ova into tube
◦ Ovaries
 oval shaped, are located one on
each side of the uterus at the level
of the superior iliac spine.
 Serve to develop ova (eggs) as well
as female hormones = oogenesis
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20–7
See Table-20-1 page 703, Sex Maturity Ratings in girls
The first signs of puberty are breast and pubic hair
development around the ages of 8 ½ and 13 years.
They take about 3 years to complete
Menarche = the onset of menstruation
 occurs during the latter half of this sequence, just after the peak of
growth velocity.
Menopause occurs between the ages of 48 and 51 (35 to 60)
◦ Irregular menses x 1 – 2 years
◦ Ovaries stop producing progesterone and estrogen which
brings dramatic physical changes.
◦ Decrease vaginal secretions leave the vagina dry and at risk
fro irritation and pain with intercourse.
◦ Increased risk for vaginitis
◦ Sexual desire and the need for full sexual expression
continues.
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Follicular phase
◦ FSH
◦ LH
◦ Ovulation
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Luteal phase
◦ LH
◦ Corpus luteum
20–8
20–9
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Age
◦ Adolescent to young adult
◦ Middle to late adulthood
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Race
◦ African American
20–10
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Common chief complaints
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Uterine bleeding
Vaginal discharge
Urinary symptoms
Pelvic pain
Characteristics of Chief Complaints
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20–11
Quality
Quantity
Associated manifestations
Aggravating factors
Alleviating factors
Setting
Timing
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Medical history
Surgical history
Medications
Communicable diseases
Allergies
Injuries and accidents
Special needs
Childhood illnesses
20–12
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Family history
Social history
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20–13
Alcohol and tobacco use
Sexual practices
Home environment
Hobbies and leisure activities
Stress
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20–14
Sleep
Diet
Exercise
Use of safety devices
Health check-ups
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Menstrual, obstetric, and menopause hxy
PMS
Vaginal discharge
Uterine bleeding
Sexual functioning
Reproductive medical history
Method of birth control
20–15
General equipment
Examination table, lamp
Stool, preferably with wheels
Gloves
Linens for draping
Special equipment
Vaginal specula
Cytological materials
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General approach
◦ Before
 Preparation for patient
 Show instruments and explain
 Prepare room, ensure comfort
◦ During
 Keep patient informed
◦ After
 Support and discuss
20–17
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menstrual history
obstetric history
menopause
self-care behaviours
urinary symptoms
vaginal discharge, itching
past history
sexual activity
contraceptive use
STD contact
20–18
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Pubic hair
distribution
Skin color and
condition
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Mons pubis and vulva
Clitoris
Urethral meatus
Vaginal introitus
Perineum and anus
20–19
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Normal Findings:
◦ Pubic hair distribution shaped like an inverted triangle
◦ No parasites present
◦ Labia majora and minora are symmetrical; skin is
slightly pigmented, intact
◦ Urethral opening is midline; free from discharge,
swelling, or redness
◦ Vaginal mucosa is pink and moist
◦ Normal vaginal discharge is clear to white, free of odor
◦ Perineum is smooth, slightly darkened
◦ Anus is dark pink to brown and puckered
20–20
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Abnormal Findings:
◦ Pubic Hair
 Pediculosis pubis (Lice)
 alopecia
◦ Vaginal Discharges
 Pale color, dryness = aging,
estrogen changes
 Foul-smelling discharge, color
changes
 See Table 20-3, pg 715
 Cystocele, cystourethrocele,
rectocele
◦ Genital warts
◦ Genital Herpes Simplex
 Figures on pg 713
◦ Urethral Meatus
 Discharge = UTI
◦ Perineum & anus
 Fissure/ tear
 Venous prominences =
hemorrhoids
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Labia
Urethral meatus and Skene’s glands
Vaginal introitus
Perineum
20–22
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Labia are soft, free from swelling, pain,
induration, or purulent discharge
Vaginal muscle tone is strong in nulliparous;
diminished in multiparous
Perineum is smooth and firm
Urethral meatus is free from pain or
discharge
20–23
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Abnormal Findings:
◦ Labia
 Swelling, reddness, pain or
purulent discharge +
Bartholin’s Gland Infection
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Urethral Meatus
◦ Pain on contact & Discharge from
urethra = UTI or Skene Gland
Infection
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Vaginal
◦ Bulging of vaginal or pelvic
contents = uterine prolapse,
cystocele, retrocele
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Perineum
◦ Tears or fissures
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Pap smear – 3 specimens collected –
tests for Ca
◦ Endocervical
◦ Cervical
◦ Vaginal
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Chlamydia culture
Gonococcal culture- Z pattern
Saline mount – tests for WBC & protoza
KOH prep – tests for Candida albincans
Five percent acetic acid wash –
tests for
humanpapillomavirus = genital warts
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Anal culture-
20–25
tests for presence of gonorrheoae in Anal tissues
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Pap smear within normal limits
Cervicovaginal tissues free of
Neisseria gonorrhoeae, Candida
albicans
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20–26
< 10 WBCs in the saline mount
specimen
Negative acetic acid wash test
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Menopause-related changes
Low estrogen levels
Cessation of menses
Generalized atrophy of external and internal
female organs
20–27