Assessment by RN's
Please note: Nurses without special training assess mainly by history and inspection of external genitalia.
Interviewing Tips
Be aware of verbal and nonverbal
Start with general and least threatening questions
Use a concerned conversational tone
Use terms client understands
Conduct in private setting
Do interview first (client dressed), then physical exam, then answer questions
Interview Questions
What brings you in today?
Concerns about reproductive health?
History of menstruation?
Any unusual symptoms?
Surgeries?
Annual Exam?
DES exposure?
Specific Questions
Contraception use?
Sexual activity?
Sexual satisfaction?
Pregnancy?
Infertility?
Post menopausal?
Self care?
DO NOT FORGET
Use gloves to inspect and palpate.
Exam Inspect
Pubic hair: distibution, amount, can be altered infestation
Labia Majora
Labia Minora
Clitoris
Urethral orifice
Vaginal opening
Perineum
Female Gentitalia
Clitoris
Labia
Urethra
Skene's glands
Vagina
Bartholin's gland
Normal Vaginal Inspection Findings
Labia Majora
-fuller and rounded in center, symmetrical, smooth, intact
-free of bruising or lesions, rashes, warts, vesicles or ulcers
Labia Minora
-smooth, symmetrical, pink, moist, intact, free of bruising
Clitoris
-midline, 1cm, more full in center, s
Abnormal Vaginal Inspection Findings
Dermatitis
Redness
Unusual discharge
Foul odor
Lesions
Tears
Abscess
Bruises
STI's - Sexually Transmitted Infections
Gonorrhea = abscess of Bartholin's gland, discharge, pain, swelling
Herpes Simplex Virus - Type 2 = small, painful, red based, ulcer-like lesions
Syphilitic Chancre - silvery white papules, become superficial red ulcers, painless, develops at site of cont
Prolapse
Uterine Prolapse (photo) - uterus protrudes into vagina
Cystocele - bladder prolapse into vagina
Rectocele - rectum bulges into vagina
Frequently seen in elderly females
Clitorectomy
Female circumcision
culturally puberty rite
clitoris is surgically removed
labia may be sutured, leaving small opening for menstrual flow
surgery when married to reopen labia
scarring may cause difficulty during childbirth
Palpate
Labia Majora
Labia Minora
Urethra & Skene's glands
Bartholin's glands
All should be free of tenderness, masses and discharge
Elderly Considerations
Less pubic hair,
Mons pubis smaller
Clitoris size decreases
Decreased size and elasticity of labia
Decreased vaginal secretions
Uterus smaller & firmer