Physical Examination

and Health Assessment:

Genitourinary System
 Objectives
At the end the session the participants are expected
to:
1. Describe the assessment of:
 Urinary system
 Male genitalia
 Female genitalia
2. Describe clinical features of disorders related to:
 Urinary system
 Male genitalia
 Female genitalia
Urinary System
Kidneys
Two bean-shaped- retroperitoneally
Well protected by the posterior ribs and musculature
The left kidney lies at the 11th and 12th ribs and the right
kidney rests 1-2 cm lower than the left kidney.
Each weighs 8 oz (248.8 gm).
Size:
4 to 5 inches long
2 to 3 inches wide
1 inch thick
Receive 20-25% of the total cardiac output.
One million nephrons per kidney
Ureters
Each kidney has a single ureter-connects renal pelvis with
urinary bladder

½ inch diameter

12 to 18 inches in length

Urinary bladder
Muscular sac
Men- in front of rectum
Women- in front of the vagina
Temporary urine storage site
Provides continence
Enables voiding
Urethra
Men- 6 to 10 inches
Women- 1 to 1.5 inches
Tube for eliminating urine from the body
Figure: The Urinary System

Figure 26.1
Figure: The Structure of the Kidney

Figure 26.4a, b
Nephron
Physiological unit of the kidney

Parts:
Cortex
Outer layer of the kidney
most of the nephron
main site for filtration, reabsorption and
secretion
Medulla
Inner core of the kidney
Pyramids
Columns
Papillae
Calyces
pelvis
parts of the nephron not located in the cortex
used for salt, water and urea absorption
Glomerulus

The site for blood filtration

Will remove both useful and non-useful

material (nonspecific filter)
Proximal convoluted tubule (PCT)
Reabsorbs most of the useful substances of the filtrate:
Sodium (65%)
Water (65%)
Bicarbonate (90%)
Chloride (50%)
Glucose (nearly 100%!), Etc.
The primary site for secretion (elimination) of drugs, waste and
hydrogen ions
Decending Limb of the Loop of Henle
Freely permeable to water and relatively impermeable to solutes
(salt particles)
“Saves water and passes the salt”
Ascending Limb of the Loop of Henle
Impermeable to water and actively transports (reabsorbs) salt
(NaCl) to the interstitial fluid
“Saves salt and passes the water.”
Functions of the renal system

Filtration of the blood

Occurs in the glomerulus of the kidney nephron
Contributes to homeostasis by removing toxins or waste

Reabsorption of vital nutrients, ions and water

Occurs in most parts of the kidney nephron
Contributes to homeostasis by conserving important materials
Secretion of excess materials

Assists filtration in removing material from

the blood

Contributes to homeostasis by preventing a

build-up of certain materials in the body
such as drugs, waste, etc
Release
Erythropoietin
Renin
Release
Secretion of H (+1) and reabsorption of HCO3 (-1)
Activation of Vitamin D

Eliminates excess hydrogen ions and conserves buffer

material such as bicarbonate

Activation of Vitamin D

Contributes to homeostasis by controlling acid/base

conditions in body fluids
Health History
Problems associated with changes in voiding
Frequency - voiding more than every 3 hours
Infection
obstruction of the lower urinary tract
Anxiety
Diuretics
BPH
urethral stricture
diabetic neuropathy
Polyuria
DM
diabetes insipidus
diuretics,
Oliguria – diminished quantity, <400ml/24 hours
Acute or chronic renal failure
Anuria- urine out put less than 50ml/day
Acute or chronic renal failure and complete obstruction
Urgency- strong desire to void
Infection; chronic prostatitis, urethritis
Obstruction of the lower urinary tract
Anxiety
Diuretics
BPH
Urethral Stricture
Diabetic Neuropathy
Hesitancy- delay, difficulty in initiating voiding
 BPH
 compression of urethra
 outlet obstruction
 neurogenic bladder
Nocturia
 Decreased renal concentrating ability
 heart failure
 DM
 nephritic syndrome
 cirrhosis with ascites
Dysuria
 acute cystitis
 Prostatitis
 urethritis
Hematuria- RBCs in the urine
Cancer of genitourinary tract
acute glomerulonephritis
renal stones
renal tuberculosis
trauma
Difficulty of controlling urine (Incontinence)
True incontinence- loss of urine without warning
Urgency incontinence- sudden loss, as with acute cystitis
Stress incontinence- loss of urine with physical strain due
to weakness of sphincters
History of renal disease, renal stones, flank pain,
urinary tract infections, and prostate trouble
Physical Examination
Landmarks
The costovertebral
The rectus abdominis muscles-
longitudinal muscles extending from the
pubis to the ribs on either side of the
midline.
The symphysis
Inspection
General appearance and mental status.
Edema of face and dependent parts of the body, like ankles and
sacral areas
Hydration status and skin color provide
The costovertebral angles and flanks
Color
Symmetry
masses
Auscultation

The renal arteries are auscultated

for bruits
Percussion
Pain elicited by blunt percussion of the back, flanks,
and costovertebral angle –tenderness
pyelonephritis
calculi
Urinary bladder
 To check for residual urine
 Begins at the midline just above the umbilicus and proceeds
downward.
 The sound changes from tympanic to dullness when percussing over
the bladder.
Palpation:
Technique of kidney palpation:

Position- supine with hand around shoulders

Place one hand under the patient’s back with the fingers under the
lower rib.

Place the palm of the other hand anterior to the kidney with fingers
above the umbilicus.
Push the hand on top forward as the patient inhales deeply.

Palpate the other kidney similarly.

Normal kidneys are not usually palpable
Bladder is palpable only if moderately distended
Diagnostic Evaluation
Laboratory Tests
Urinalysis:
color and appearance
measurement of pH
specific gravity
Protein
Glucose
RBCs
WBCs
Casts
Crystals
cells (urine sediment)
Cytology
Gram stain and cultures
Creatinine clearance (CrCl) is a measure of GFR

Normal value: 70 ± 14 mL/min/m2 for men and 60 ±

10 mL/min/m2 for women
• Kidney, Ureter, Bladder x-rays
• Intravenous urography (IVP)
• CT, US
• VCUG
• Renal scan
• Cystoscopy
Radiology
• Plain X rays (KUB)- For finding stones, calculus.
• Ultrasound(US)- For renal size, shape, hydronephrosis
and obstruction.
• Intravenous urography (IVP) - can be used to see
both the function and anatomy of the kidney.
• Computed Tomography (CT)
• Retrograde Urethrography (RGU)
• Digital Substraction Angiography (DSA)
• Interventional Procedures
A large calculus shown in
the bladder.

A broken hip with a nail

there (kidney,ureter or
bladder)
IVP
ULTRASOUND KIDNEY & BLADDER

Bladder: have
all the urine
looking like a
cyst.
HYDRONEPHROSIS (USG)

Something is blocking the ureter causing enlargement of the kidney.

RENAL CYST (US)

Liver

Kidney

Cyst
because
there is no
echoes in
Again the teacher mentioned you don’t have to recognize
it.
organs in images but you have to know what US is used for .
 Testes
• Descend into peritoneum in the last month of fetal life,
 Paired
 Ovoid
 Smooth
 Firm – not soft
• Encased in the scrotum
 i temp
Vas deferens (ductus deferens)
 Tube
 upward  abdomen cavity
 downward  base of the bladder
Seminal vesicles
 It acts as a reservoir for testicular secretions
 The tract is continued called the ejaculatory duct
 Passes through the prostate gland and enters into the urethra
Accessory glands
 Prostate gland
 below the neck of the bladder
 Surrounds the urethra
 Secrets chemicals to help
spermatozoa
 Cowper’s gland / bulbourethral gland
(bul-bo-urethral
 Below the prostate
 Lubrication for sperm
Penis
 Dual function
 Copulation
 Urination
 Urethra
 Tube carries urine & semen
 Opens at the tip of the glans
 The glans
 Covered penile skin – foreskin
 Retracted to expose the glans.
 Circumcision
 Foreskin removal
Physical Assessment
Digital Rectal Examination
(DRE)
 Recommended mainly > 40 yrs
 Annually
 Prostate gland
 Size, shape and
consistency
Subjective Data

• Health history and clinical manifestations focus on

Sexual function and manifestation

Sexual drugs function
1.Penis related:
• Pain
• Lesions
• Discharge
Amount: decreasing and increasing
since start
Color
Odor
Associated with pain or with urination
2.Scrotum and testes related:
• Any problem
• Testicular self examination
• Noticed lump or swelling
• Change in size
• Bulge or swelling – hernia
 Duration
• History of hernia
• Dragging heavy feeling in scrotum
3.Sexual activity:
• Current relationship of sexual intercourse
• Satisfaction to the patient and partner
• Communication about sex with partner
• Change in erection when aroused
• Sexual preference: with a woman or a man or both
• Awareness of sexual contact with individuals with gonorrhea,
herpes and chlamydia, veneral warts, syphilis
• Duration
• If contracted the disease
 Treatment
 Any complications
• Use of condom to prevent STDs
• Concern about any of STDs
4.Contraceptive use
• The patient and partner
• Method used
• Any question
Objective Data
Preparation
Equipment
 1.Gloves
 2.Glass slide for specimen
 3.Flashlight
Position
Client standing with under shorts down and
appropriate draping
Nurse sitting
Alternative: The client may be supine for the anterior part
of examination and stand to check for a hernia
Concern of clients:
• 1.Modestly (not showing much of the body)
• 2.Fear of pain
• 3.Negative judgment
• 4.Memory of previously uncomfortable
examination
• 5.To refuse being examined by females

Take time to consider these feelings, as well as

to explore your own.
To solve these feelings:
Discuss these concerns in group
confident and
relaxed,
unharmed
Do not discuss genitourinary history or sexual
practices while performing the examination
Use a form of deliberate touch, not a soft,
stroking one
If an erection does occur, do not stop the
examination or leave the room and reassure the
male.
Characteristics and Techniques of
Examination
Inspection and palpation
1.Hair pattern
Pubic hair distribution
May vary some what Abnormal findings:
from person to person
Only absence or extreme • Pubic lice or nits
sparseness in the adult • Excoriated skin
man needs to be
considered usually usually accompanies
Usually diamond shaped
pattern is observed
2.Penis
• The skin
normally looks
wrinkled,
hairless, and
without lesions
• The dorsal vein
may be
apparent
Abnormal findings
• Generalized swelling
• Inflammation
• Lessons:
1.nodules, solitary ulcer (an isolated density
usually smaller than 3 cm in diameter) –
syphilitic
1.chancre
2.grouped vesicles or superficial ulcers
 2.Herpes pro-genitalis
3.red, raised warty growth as an ulcer, with
watery discharge which later necrotized and
sloughed occurring almost always on glans or
inner lips the foreskin
 3.carcinoma
Foreskin
Retracting the Abnormal findings
foreskin of Phimosis- unable
to retract the foreskin
uncircumcise
Paraphimosis-
d male unable to return
foreskin to original
position
Urethral Meatus
positioned just Abnormal finding
about centrally
Hypospadias- Ventral
(under) location of
meatus

Epidspadias- dorsal
(upper) location of
meatus
 • Compress the glans
anteriroposteriorly between your
thumb and finger.
• The meatus edge should appear
pink, smooth and without
discharge.
• urethritis
Abnormal findings
Urethral Stricture
Pinpoint ( a very small spot)
constricted opening at meatus, or inside
along urethra

Edges that are red, everted,

edematous along with purulent
discharge
urethritis
Discharged
Abnormal findings

Thick, purulent of may suggest

gonorrhea
• Palpate the shaft Abnormal findings
between the thumb • Nodule
and first two fingers
• Induration
• Tenderness
normally the penis
• Hard, non-tender
feels smooth, semi
subcutaneous plaques
firm and non tender
palpated on dorsal or
lateral surface of penis
 Peyronie’s disease
3.Scrotum

Position:
Client standing
Nurses sitting in front of him
 Peyronie’s disease
Painful and deformed erection of the PENIS
caused by the formation of fibrous tissue. The
cause is unknown but it may be associated with
DUPUYTREN’S CONTRACTURE. The condition
may be improved by surgery
Inspect and palpate the scrotum
Inspect the scrotum as male holds the
penis out of the way.
Gross inspection
the left testis is lower than the right
Spread rugae out between your fingers.
Lift the sac to inspect the posterior
surface.
Normally there are no lesions, except
for the commonly found sebaceous
cysts.
Abnormal findings
Stretchening of skin and less wrinkling of
the scrotum may be caused by scrotal
edema.
Occurs with CHF renal failure,
or local inflammation
Palpate the scrotum by using your index and
middle fingers like a pair of scissors
Palate each scrotal half between your thumb
and first two fingers.
Normally:
The scrotal contents should slide easily
The testes are:
Tender and freely moveable
2x4 cm and are rubbery (neither hard nor soft)
Feel oval, smooth equal bilaterally
Scrotal size vanes with ambient room
temperature
Abnormal findings
• Absent testis because of:
• Temporary migration
• True cyptorchdism
• Atrophied testes- small soft and fixed testes
• Nodules on testes or epididymides
• Marked tenderness
4.Epididymis
• Palpate with thumb on the anterior surface and index finger
behind the scrotum
• Palpate on the posteriorlateral sides of each testis
Normally feels discrete, softer than the testis, smooth and non
tender
 Palpate each spermatic cord
between thumb and forefinger,
along its length from the epididymis
up to the external inguinal ring
Feels a smooth non tender
cord but harder than
epididymis
Abnormal findings
 Thickened
 Soft, swollen and tortuous
varicocele
 Induration, swelling and tender

epididymitis
Transillunuination: If swelling or mass is noted, darken the
room and shine a strong flash light from behind the scrotal
contents.
• Normal scrotal contents do not transilluminate.

Abnormal findings
Serous fluid does transilluminate and shows as a red glow, e.g.,
hydrocele, or sprematocele
Solid tissues and blood do not translluminate

., hernia, epididymitis, or
e.g

tumor
Hernia
Inspect and palpate for hernia.
Inspect the inguinal region for a bulge as the person stands and
as he strains down.
• Normally there is none.

Abnormal findings
• Bulge at external inguinal ring or femoral
canal.
Indirect hernia
• follows the spermatic cord through both the internal and
external rings and through the inguinal canal

To palpate an indirect inguinal hernia

• Have the client stand with his ipsilateral (some side being
examined) leg slightly flexed
• Place right index figure low in the right scrotal
half.
• Palpate up the length of the spermatic cord,
invaginating the scrotal skin as you go to the
external inguinal ring.
• It feels like a triangular slit line opening, and it
may admit or may not admit your finger.
• If it will admit your finger, gently insert your
finger in to the canal and ask the person to bear
down.
• Normally you feel no change
Abnormal findings

• Palpable herniating mass bumps your finger tip or pushes

against the side of your finger.
• Pain with straining
direct hernia
• A direct hernia is passed through the weak
muscular wall and into the external inguinal ring,
it may be visualized.

To palpate a direct hernia follow this procedure:

• Press the palmar aspects of the hand over the
inguinal area
• Instruct the client to cough or bear down
Painless, round swelling close to the pubis in an areas of the
internal inguinal ring
Inguinal lymph nodes and pulses
• It is normal to palpate an insolated node on occasion; it then
feels small (<1cm ) soft, discrete, and movable.
Abnormal findings
• Enlarged, hard, matted, fixed nodes
Prostate palpation
Have client stand and lean over the bed or table
Inform the client that he may experience the urge to
urinate but that there should be no tenderness
Identify the well marked median sulcus, which
divides the two lobes of the gland.
The prostate is normally firm and rubbery approximately
4cm in diameter, and the borders are discrete

there is no fixation of the

Normally,

gland.
Abnormal findings

Tenderness: BPH or other Urinary abnormalities

2.2. Female Genitalia
External Genitalia
Vulva
Mons pubis
Labia majora
Labia minora
Frenulum or fourchette
Clitoris
Vestibule
Urethral meatus
Paraurethral (Slene’s) glands
Vaginal orifice
Hymen
Vestibular (Barthlin’s) glands
Internal Genitalia
• Vagina (9cm long)
• Cervix
• Anterior fornix
• Posterior fornix
• Rectouterine pouch /cul-de-sac of Douglas
• Uterus
• Fallopian tubes
• Ovaries
Subjective data
1.Menstrual history
2.Obstetric history
3.Menopause
4.Self care behaviors
5.Urinary symptoms
6.Vaginal discharge
7.Sexual relation ship
8.Contraceptive use
9.Sexually transmitted disease (STD)
Menstrual history
• Usually non-threatening
• Last menstrual period (LMP)
• Menarche
• Onset between 12-14 years normal
• Onset between 16-17 years may suggest
endocrine problem
• Frequency
• Cycle – normally varies every 18-45 days
• Amenorrhea- absent menses
• Duration of period (days)
Average 3-7 days
• Amount of flow
Light, medium or heaving
Number of pads or tampons used per day or hour

Menorrhagia- heavy menses

• Any clotting
• Heaving clothing indicates heavy flow or
vaginal pooling
• Any pain or cramps before or during period
• Treatment
• Interference with ADL
• Other associated symptom
• Bloating
• Cramping
• Breast tenderness
• Spotting between periods
• Dysmenorrhea
Obstetric history
• Gravida
• Para
• Abortions
• For each pregnancy
• Duration
• Any complication
• Labor and delivery
• Baby’s sex
• Birth weight and Condition
• Current conception
History of Menopause
• Cessation of menstruation
• Associated symptoms
 Hot flash
 Numbers and tingling
 Head ache
 Palpitations
 Drenching sweats
 Mood swings
 Vaginal dryness
 Itching
• Any treatment
Self Care Behaviors

• Gynecologic check up- frequency

• Last Papnicolaou’s test
Urinary Symptoms
Vaginal Discharge
Normal discharge is small, clear or cloudy, non-
irritating
• Increased amount
• Color:
• White, yellow, green, curd-like, foul smelling
suggests vaginal infection and characteristics
causative organisms.
• Duration – acute or chronic
• Associated vaginal itching, rash, pain with
intercourse occurs secondary to irritation from
discharge.
• Any medication increasing the risk of vaginitis:
• Oral contraceptive
• Broad spectrum antibiotics alter balance of normal flora
• Family history of diabetes mellitus
• Use of vaginal douch
• History of any sores or lesions
• History of uterine, ovarian or vaginal surgery
Sexual Relationship
• Sexual partner
• Aspects of sex satisfactory to her and partner
• More than one sexual partner
• Sexual preference with man, women or both
• Plan of pregnancy or avoiding pregnancy
• Fertility condition
• Awareness of STDs
• Any precautious used to prevents transmission
of STDs
Objective Data
Equipment
• 1.Gloves
• 2.Goose- necked damp
• 3.Vaginal speculum of appropriate size
• 4.Large cotton tipped applicators (rectal swabs)
• Materials for Cytologic study
• 1.Glass slide
• 2.Sterile cotton tipped applicator Ayer’s spirituals
syare’s spatula
• 3.Spray fixative
• 4.A small bottle of normal saline
• 5.A small bottle of potassium hydroxide
• 6.A small bottle of acetic acid
• 7.Lubricant
Preparation
• Familiarizing with the vaginal speculum before the
examination
Position
Assessment of Extrenal Genitalia
Inspection

• 1Skin color
• Hair distribution: usually inverted triangle

Abnormal Findings
• No pubic hair or braest development till 13 years
 consider delayed pubery.
• Nits or lice at the base of pubic hair.
1.Labia majora
• Symmetric, plump, and well formed
• Midline in nulliparous
• Gaping and slightly shriveled following vaginal
delivery.
• No lesion, except for occasional sebaceous cyst.
Abnormal Findings
• Swelling
• Excoriation
• Nodules
• Rash or lesions
With the gloved hand separating the labia majora
inspect:
• Clitoris
• Labia minora: Symmetric, dark pink and moist
• Urethral opening: Stellate or slitlike and is midline
• Vaginal opening: narrow vertical slit or large opening
• Perineum: smooth
• Anus: coarse skin of increased pigmentation.
Abnormal Findings:

• Enlarged clitoris
• Inflammation
• Polyp
• Rash or lesion
• Foul smelling irritating discharge
2.Palpate Glands
Urethra And Skene’s Glands

Abnormal Findings
• Tenderness
• Indurations along urethra
• Urethral discharge
Bartholin’s glands
• Palpate the posterior parts of the labia majora
with index finger in the vagina and your thumb
outside.
Normally, the labia feel soft and homogeneous.
Abnormal Findings
Swelling—abscess of Bartholin’s glands
Indurations
Pain with palpation
Discharge from duct opening
3.Support of pelvic musculature
Palpate the perineum.
• Normally, it feels thick, smooth, and muscular in the
nulliparous women, and thin and rigid in the multiparous
women.
• Ask the women to squeeze the vaginal opening around your
fingers
 feel tight in the nulliparous women
 less tone in the multiparous women.
• Using index and middle fingers, separate the vaginal orifice
and ask the women to strain down.

Normally, there is no bulging of vaginal walls or urinary

incontinence.
Abnormal Findings
• Tenderness Paper thin perineum
• Absent or decreased tone may diminish sexual satisfaction
• Bulging of the vaginal
Cystocele
rectoncele
uterine prolapse
• Urinary incontinence
4.Internal Genitalia
Speculum examination
Inspect the cervix and its os. Note:
• Color: Normally the cervical mucosa is pink and even. During
the second month of pregnancy it looks blue (Chadwick’s
sign), and after menopause it is pale.
• Position: Middle, either anterior or posterior. Projects 1 to 3
cm into the vagina
• Size: Diameter is 2.5 cm (1inch)
Abnormal Findings
• Redness, inflammation
• Pallor with anemia
• Cyanotic
• Lateral position may be due to adhesion or tumor.
• Projection of more than 3 cm may be a prolapse.
• Hypertrophy of more than 4cm occurs with inflammation or
tumor.
Os:
• Small and round in the nulliparous womenn
• Horizontal irregular slit and also may show healed lacerations
on the sides- in parous women
Surface:
• This is normally smooth but cervical eversion
may occur normally after vaginal deliveries.
Abnormal Findings
• Surface reddened, granular, and asymmetric,
particularly around os  Erosion.
• Friable bleeds easily Carcinoma
• White patch on cervix
• bright red growth protruding from the os
Cervical polyp
Cervical secretions:
• Depending on the day of the menstrual cycle, secretions may be
clear and thin, or thick, opaque, and stringy. Always they are
odorless and nonirritating.
• If secretions are copious Swab the area with a thick- tipped rectal
Swab.
Abnormal Findings
• Foul smelling irritating with yellow, green white or gray or strawberry
spot
 trichomoniasis
Obtain Cervical Smears and Cultures
Papanicolaou, or pap, smear screens for cervical cancer
• Endocervical swab:
• Cervical scrape:
• Vaginal pool:
• Gonorrhea (GC) Culture:.
• Five Percent Acetic Acid Wash
Acetic acid wash screens for asymptomatic human
papilloma virus (HPV), which causes genital warts.
Normal response- indicating no HPV infection
No change in the cervical epithelium

Abnormal Finding: Rapid acetowhitening or

blanching, especially with irregular boarders, suggests
HPV infection.
Inspect the Vaginal Wall
Normal findings
the wall looks:
Pink
deeply rugated
moist and smooth
free of inflammation or lesions
Normal discharge is thin and clear, or opaque and stringy, but
always odorless.
Abnormal Findings
• Reddened
• Palor prior to menopause
• Lesions
• Leukoplakia, appears as a spot of dried white
paint
• Vaginal discharge:
Thick, white, crudlike with candidiasis
Profuse, watery, gray-green, and frothy with
trichomoniasis
Or any gray, green-yellow, white or foul smelling
discharge
Bimanual Examination
• Palpate the vaginal
wall.

Normally, it feels
smooth and has no
areas of induration
and or tenderness.

Abnormal Findings
• Nodule
• Tenderness
Locate the cervix in the midline, often
near the vaginal wall
Note the following characteristics of normal
cervix:
Consistency:
• Feels smooth and firm, as consistency of the tip
of the nose.
• It softens and feels velvety at 5 to 6 weeks of
pregnancy.
Abnormal Findings:
• Hard with malignancy
• Nodular
Counter: Evenly rounded
• Abnormal Findings: Irregular

Mobility: With a finger on either side, move the cervix gently

from side to side.
• Normally, this produces no pain.
• Abnormal Findings:
• Immobile with malignancy
• Painful with inflammation or ectopic pregnancy
Palpate all around the fornices; the wall should feel smooth.
• Abnormal Findings: Irregular
• With your intravaginal fingers in the anterior fornix, assess the
uterus.
Determine the position, or version, of the uterus, comparing the
long axis of the uterus with the long axis of the body .

anteverted-
In many women, the uterus is
palpated at the level of pubis with
cervix pointing posteriorly
Abnormal Findings
Enlarged uterus
Lateral displacement
Nodular mass
Irregular asymmetric
Fixed
Tenderness
Nodular immobile
Markedly tender
Mass
Pulsation or palpable fallopian tube suggests ectopic
pregnancy
Rectovaginal Examination
• Lubricate the first two fingers.
• Instruct the woman to bear down as you insert your index
finger into the vagina and your middle finger gently into the
rectum.
Note:
• Rectovaginal should feel smooth, thin, firm, and pliable.
Abnormal Findings: Nodular, thick
• Rectovaginal pouch or cu-de-sac is a potential space and usually not
palpated.

• Uterine wall and fundus feel firm and

smooth.
• Rotate the intrarectal finger to check the rectal wall and anal
sphincter tone
• withdraw hand and check secretions
on the fingers before discarding the
glove.

• Normal secretions are clear or cloudy

and odorless.
• Colposcopy
• Portable
microscope
• Obtain sample
References
Grimes, J and Burns, E., (1996). Health Assessment in Nursing.
Fourth Edition, Bosten: Little Brown Company.
Carolyn Jarvis, (1992). Physical Examination and Health
Assessment. First Edition, Philadelphia: W.B. Sauders
Company.
Brunner and Suddarth’s, (2004). Text Book of Medical-Surgical
Nursing. Tenth Edition: Lippincott Williams and Wilkins
Colposcopy is surgical instrument used to examine cervix and
vagina of womb.
Nursing Diagnoses Associated With Genitalia and
Related Disorders

Altered sexuality pattern

• Related factors:
 Effect of illness
 Medical treatment (drug, radiation)

• Defining characteristics
 Identification of sexual difficulties limitation, or change
Urinary retention
• Related factors:
 Diminished or absent sensory and/or motor impulses
 Strong sphincter
• Defining characteristics:
 Bladder distention
 Diminished force of urinary stream