SUMMARY NOTES
Assessment of the Female Genitalia and Rectum
I.
Collection of Subjective Data
a. History of Present Health Concern
Menstrual Cycle
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Menopause
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Vaginal discharge, Pain, Masses
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Sexual Dysfunction
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Urination
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Bowel patterns
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Normal menstrual cycle: approximately 18-45 days
Average length: 3-7 days
Common complaints before or during menstruation:
- Headache
- Weight gain
- Abdominal cramps
- Bloating
Ages of menarche range from 10.5 to 15.5 years of age
Irregularities in menstruation due to:
- Pregnancy
- Depression
- Ovarian tumors
- Ovarian cysts
- Autoimmune disease
- Hormonal imbalance
- Medications
Menopause (Cessation of menstruation)
Normal physiologic process that occur at ages 40-58 years
Premature menopause
- Occur before age 30
Delayed menopause
- Occur older than 58 years old
Premature and delayed menopause may be due to genetic predisposition, an
endocrine disorder, or gynecologic dysfunction.
During the perimenopausal period, hormone levels may fluctuate, resulting
in menstrual irregularities. Periods may be heavier or may become scant.
May experience:
- Hot flashes
- Night sweats
- Mood swings
- Decrease appetite
- Vaginal dryness
- Spotting
- Irregular vaginal bleeding
Vaginal discharge may be from an infection.
Complaints of pain in the area of the vulva, vagina, uterus, cervix, or
ovaries may indicate infection. Itching may indicate infection or
infestation.
A change in sexual activity or libido needs to be investigated for the cause.
A woman who is dissatisfied with her sexual performance may experience
a decreased libido.
Infertility is the failure to conceive (regardless of cause) after 1 year of
unprotected intercourse.
Urinary frequency, burning, or pain (dysuria) are signs of infection (urinary
tract or sexually transmitted infections [STIs]), whereas hesitancy or
straining could indicate blockage.
Change in color and development of an abnormal odor could indicate
infection
Difficulty controlling urine (incontinence) may indicate urgency or stress
incontinence. During sneezing or coughing, increased abdominal pressure
causes spontaneous urination.
A change in bowel pattern is associated with many disorders and is one of
the warning signs of cancer. A more thorough evaluation, including
laboratory tests, may be necessary.
Constipation may indicate a bowel obstruction or the need for dietary
NCM 101: Health Assessment
Topic: Assessment of the Female Genitalia and Rectum
Prepared By: K. Abuan
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Stool
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Itching and Pain
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II.
counseling.
Diarrhea may signal impaction or indicate the need for dietary counseling.
Fecal incontinence occurs with neurologic disorders and some
gastrointestinal infections.
Black stools may indicate gastrointestinal bleeding or the use of iron
supplements or Pepto-Bismol.
Red blood in the stool is found with hemorrhoids, polyps, cancer, or colitis.
Clay-colored stools result from a lack of bile pigment.
Pelvic and rectal examinations are used to detect masses, ovarian
tenderness, or organ enlargement.
The Pap smear test is a screening test for cervical cancer.
The American Cancer Society (ACS, 2013a) recommends that an annual
Pap test and pelvic examinations should be done at age 21 (not before).
The Pap test may be performed less frequently at the discretion of the
health care provider
STIs can increase the client’s risk of pelvic inflammatory disease (PID),
which leads to scarring and adhesions on the fallopian tubes.
Scarred fallopian tubes increase the risk for infertility and ectopic
pregnancy
Health Promotion and Disease Prevention
a.
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Hemorrhoids
Hemorrhoids are swollen blood vessels in the lower rectum and anus.
May be located inside the rectum or under the skin around the anus
Symptoms:
o Painless bleeding during BM
o Itching or irritation in the anal region
o Pain or discomfort in the anal region
o Swelling in the anal region
o Lump near the anus
o Leakage of feces
Risk factors:
o Straining at bowel movements
o Prolonged sitting on the toilet
o Obesity
o Pregnancy
o Anal intercourse
o Familial tendency
o Lack of erect posture
o Higher socioeconomic status
o Chronic diarrhea or constipation
o Colon cancer
o Liver disease
o Anything causing elevated anal resting pressure
o Spinal cord injury
o Loss of rectal muscle tone
o Rectal surgery
o Episiotomy
o Inflammatory bowel disease (ulcerative colitis, Crohn’s disease)
Client Education:
o Avoid straining in BM
o Avoid standing or sitting for prolonged periods
o Attempt to have BM as soon as the feeling occurs
o Avoid anal intercourse
o Avoid rubbing or cleaning too hard on the anus
o High fiber diet
o Drink 6-8 glasses of water
o If with hemorrhoids:
▪ Used OTC creams or soothing pads
▪ Soak anal area in plain warm water 10-15 minutes for 2-3 times a day
▪ Bathe or shower daily
▪ Do not use dry toilet paper
▪ Apply ice packs or cold compress on anus
NCM 101: Health Assessment
Topic: Assessment of the Female Genitalia and Rectum
Prepared By: K. Abuan
▪
b.
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OTC pain medication if not contraindicated
Cervical Cancer
Cervical cancer originates in the uterine cervix, usually from the squamous cell layer of the surface of the cervix.
This is a slow developing cancer and it is preceded by a precancerous stage of dysplasia
Easily diagnosed with a Pap smear test.
Most cervical cancers develop in women who do not have routine Pap smears.
Most cervical cancers are caused by a variety of HPVs acquired through sexual intercourse with an infected
partner.
Screening:
o Screening for cervical cancer in women ages 21 to 65 years with cytology (Pap smear) every 3 years
o Screening with a combination of cytology and HPV testing every 5 years for women ages 30 to 65 years
who want to lengthen the screening interval
o No screening is done in:
▪ Cervical cancer in women younger than age 21 years
▪ Cervical cancer in women older than age 65 years who have had adequate prior screening and are
not otherwise at high risk for cervical cancer
▪ Cervical cancer in women who have had a hysterectomy with removal of the cervix and who do
not have a history of a high-grade precancerous lesion (i.e., cervical intraepithelial neoplasia
[CIN] grade 2 or 3) or cervical cancer
▪ Cervical cancer with HPV testing, alone or in combination with cytology, in women younger than
age 30 years
Risk factors:
o Having sex at an early age
o Multiple sexual partners
o Sexual partners that engage in high-risk sexual activities
o No HPV Vaccination
o Poor economic status
o Women whose mothers took the drug diethylstilbestrol
o Weakened immune system
Client Teaching:
o Avoid risky sexual practices
▪ No multiple partners
▪ No high-risk sexual activities
o HPV Vaccination
▪ Females: as early as 9 years old and up to 26 years old
▪ Males: No recommendation for vaccine
o Routine Pap smear
o Eat nutritious foods
o If mother took DES: preventive screening
c. Colorectal Cancer
- Colorectal cancer is one of the cancers that can affect the large intestine or rectum.
Colorectal cancer originates in the large intestine or rectum as opposed to other cancers that may affect the colon,
such as lymphoma, sarcoma, melanoma, and others.
- Colorectal cancer begins initially in the lining of the colon or rectum. For this reason, early diagnosis is essential
before the cancer has spread to deeper tissues.
- Screening:
o For ages 50 years until 75 years old:
▪ FOBT
▪ Sigmoidoscopy
▪ Colonoscopy
- Risk Factors:
o Above 60 years old
o African-American or eastern European descent
o Have cancer elsewhere in the body
o Colon polyps
o Have IBD
o History of colon cancer
o Personal history of breast cancer
o With familial adenomatous polyposis or hereditary nonpolyposis colorectal cancer (Lynch’s Syndrome)
o Smoking, alcohol
o High fat diet
o Low fiber diet
- Client Teaching:
NCM 101: Health Assessment
Topic: Assessment of the Female Genitalia and Rectum
Prepared By: K. Abuan
o
o
o
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Call the HCP if the following occurs:
▪ Black, tarry stool
▪ Blood during BM
▪ Change in bowel habits
▪ Unexplained weight loss
Preventive screening between 50 and 75 years old
Avoid diet high in red and processed meat, high fat, or low in fiber
Avoid smoking and limit alcohol intake
III.
Collecting Objective Data
✓ The physical examination of the female genitalia, anus, and rectum may create client anxiety.
- The client may be very embarrassed about exposing her genitalia and nervous that an infection or disorder will be
discovered.
- Be sure to explain in detail what you will be doing throughout the examination and to explain the significance of
each portion of the examination.
- Encourage the client to ask questions.
✓ Begin by sitting on a stool at the end of the examination table and draping the client so that only the vulva is exposed.
- This helps to preserve the client’s modesty.
- Shine the light source so that it illuminates the genital area, allowing full visualization of all structures.
✓ A digital rectal exam (DRE) may also be performed as part of the examination.
- Detecting problems with the anus and rectum is the primary objective of this examination.
- This is important because some conditions, such as cancerous tumors, may be asymptomatic.
- Early detection of a problem is one way to promote early treatment and a more positive outcome.
✓ Use this time (especially if the examination is a well examination) to integrate teaching about ways to reduce risk
factors for diseases and disorders of the anus and rectum.
- Proceed slowly and explain all steps of the examination as you proceed.
- When performing the examination of the anus and rectum, use gentle movements with your finger and make sure
you use adequate lubrication.
- Listen to and watch the client for signs of discomfort or tensing muscles. Encourage relaxation and explain each
step of the examination along the way.
✓ If the examination is being performed as part of the comprehensive physical examination, perform the examination of
the anus and rectum at the end of the genitalia examination.
a.
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Preparing the Client
No douching for 48 hours before gynecologic examination
Ask client to urinate before the exam
If a clean-catch urine specimen is needed: provide container and vaginal wipes
Remove underwear and bra in the examination room
Position the client in supine position with feet on stirrups. The hips should be positioned toward the bottom of the
examination table
Put hands over head because this tightens abdominal muscles
Another technique is to offer the client a mirror so that she can view the examination. This is a good way to teach
normal anatomy and to get the client more involved and interested in maintaining or improving her genital health.
ASSESSMENT FINDINGS:
External Genitalia
NORMAL FINDINGS
 Pubic hair is distributed in an inverted
triangular pattern
 No infestation
 No enlargement or swelling in the inguinal
lymph nodes
 The labia majora:
- Equal in size
- Free of lesions
- No swelling
- No excoriation
 The labia minora:
- Symmetric
- Dark, pink and moist
 The clitoris may vary in size.
 The vaginal opening is positioned below the
urethral meatus.
 The perineum should be smooth
 The Bartholin’s Gland:
ABNORMAL FINDINGS
 Lesions from:
- Syphilis
- Herpes
 Excoriation
or
swelling
from
scratching or self-treatment of lesions
 Asymmetric labia
 Swelling and bulging of vaginal
opening
 Drainage from the urethra
NCM 101: Health Assessment
Topic: Assessment of the Female Genitalia and Rectum
Prepared By: K. Abuan
Internal Genitalia
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Bimanual
Examination
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Rectovaginal
Examination
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- Soft
- Nontender
- Drainage free
No drainage from the urethral meatus
The vaginal opening varies in size.  Vaginal atrophy (vagina becomes
(According to age and sexual history)
thinner and dryer, occurs with lack of
The vagina is tilted posteriorly at a 45estrogen)
degree angle and feel moist
- Causes:
The client should be able to squeeze
1. around
Menopause
examiner’s finger
2. Breast feeding
No bulging
3. Surgical removal of ovaries
No urinary discharge
4. Cancer treatments
The cervix:
 Loss of hymenal tissue between
- Smooth
3o’clock position and 9 o’clock
- Pink
position indicates trauma in children
- Even
 Decreased ability to squeeze finger of
- Midline in position
examiner
- Projects 1-3 cm into the vagina
 Bulging of anterior wall indicate
- In pregnant: it appears blue (Chadwick’s
cystocele
sign)
 Bulging of posterior wall indicate
The cervical os:
rectocele
- Small round opening (nulliparous  Cervix or uterus protrudes down
women)
indicate uterine prolapse
- Slit-like (parous women)
 Urine leaks out indicates stress
Cervical secretions:
incontinence
- Clear or white
 Nonpregnant:
- Without unpleasant odor
- Bluish cervix indicate cyanosis
- May vary according to timing within  Non-menopausal:
menstrual cycle
- Pale cervix indicate anemia
The vagina:
- Redness indicate inflammation
- Pink
 Asymmetric,
reddened
areas,
- Moist
strawberry spots and white patches
- Smooth
 Cervical lesions result from polyps,
- Free of lesions and irritation
cancer, infection
- Free of discharge and malodorous  Cervical enlargement more than 3cm
discharge
 Colored, malodorous, or irritating
discharge
The vaginal wall should feel smooth,  Tenderness and lesions
nontender
 Hard immobile cervix
The cervix:
 Pain with movement of cervix indicate
- Firm
infection (Chandelier’s sign)
- Soft
 Enlarged
uterus
(myoma,
- Rounded
endometriosis, fibroid tumors)
- Can be moved somewhat from side to  Fixed or tender uterus (fibroids,
side without tenderness
infection, masses)
- Aimed posteriorly (anteverted)
 Large amount of colorful, frothy,
The fundus:
malodorous secretions
- Large, upper end of the uterus
 Ovaries palpated 3-5 years after
- Round, firm, smooth
menopause are abnormal
- At the level of the pubis
The uterus:
- Move freely
- Nontender
The ovaries:
- Approximately3x2x1 cm (size of a
walnut)
- Almond-shaped
- Firm
- Smooth
- Mobile
- Somewhat tender on palpation
The rectovaginal septum:
 Masses
- normally smooth
 Thickened structures, immobility, and
- thin
tenderness
- movable
NCM 101: Health Assessment
Topic: Assessment of the Female Genitalia and Rectum
Prepared By: K. Abuan
Anus and Rectum
Stool
- firm
 The posterior uterine wall:
- normally smooth
- firm
- round
- movable
- nontender
 The anal opening:
- Hairless
- Moist
- Tightly closed
- Skin is more coarse
- Darkly pigmented
 Perianal area:
- No redness
- No lumps, ulcers, lesions, rashes
 Lesions may indicate STI, cancer,
hemorrhoids
 Thrombosed external hemorrhoid:
- Swollen
- Itchy
- Painful
- Bleeds when stool passes
 Previously thrombosed hemorrhoid:
- Appears as a skin tag that
protrudes from the anus
 A painful mass that is hardened and
reddened (perianal abscess)
 Stool is normally semi-solid, brown, free of  Black, tarry stool
blood
 Yellow stool (steatorrhea)
✓ Using a speculum:
1. Before using the speculum, choose the instrument that is the correct size for the client. Vaginal speculums come
in two basic types:
o Graves speculum—appropriate for most adult women and available in various lengths and widths.
o Pederson speculum—appropriate for virgins and some postmenopausal women who have a narrow
vaginal orifice. Speculums can be metal with a thumbscrew that is tightened to lock the blades in place or
plastic with a clip that is locked to keep the blades in place.
2. Encourage the client to take deep breaths and to maintain her feet in the stirrups with her knees resting in an open,
relaxed fashion.
3. Place two fingers of your gloved nondominant hand against the posterior vaginal wall and wait for relaxation to
occur.
4. Insert the fingers of your gloved nondominant hand about 2.5 cm into the vagina and spread them slightly while
pushing down against the posterior vagina.
5. Lubricate the blades of the speculum with vaginal secretions from the client. Do not use commercial lubricants on
the speculum. Lubricants are typically bacteriostatic and will alter vaginal pH and the cell specimens collected for
cytologic, bacterial, and viral analysis.
6. Hold the speculum with two fingers around the blades and the thumb under the screw or lock. This is important
for keeping the blades closed. Position the speculum so that the blades are vertical.
7. Insert the speculum between your fingers into the posterior portion of the vaginal orifice at a 45-degree angle
downward. When the blades pass your fingers inside the vagina, rotate the closed speculum so that the blades are
in a horizontal position
8. Continue inserting the speculum until the base touches the fingertips inside the vagina.
9. Remove the fingers of your gloved nondominant hand from the client’s posterior vagina.
10. Press handles together (Figure C) to open blades and allow visualization of the cervix.
11. Secure the speculum in place by tightening the thumbscrew or locking the plastic clip
✓ Obtaining Tissue for Analysis:
a. Pap Smear
- Papanicolaou (Pap) Smear The new standard of care for the Pap smear is liquid-based technology.
- The specimen for the Pap smear is obtained in the same way, using a wooden spatula, cotton swab, or brush
The specimen is placed in the preservative solution rather than on a slide.
- This solution may be used to test for human papilloma virus (HPV) and to determine HPV type.
b. Obtaining Ectocervical and Endocervical Specimen
- The procedure for gathering endocervical and ectocervical specimens is performed on nonpregnant clients.
- This combined procedure uses a special cytobroom to collect both endocervical and ectocervical cells.
1. Insert the cytobroom into the cervical os
2. Rotate the cytobroom in a full circle five times, collecting cell specimens from the squamocolumnar junction
and the cervical surface
3. Withdraw the cytobroom
4. Swish the broom in the preservative solution by pushing the broom into the bottom of the vial 10 times,
forcing the bristles apart. Swirl the broom vigorously to further release material
5. Discard the cytobroom
6. Tighten the cap on the preservative. This solution is sent to the laboratory
NCM 101: Health Assessment
Topic: Assessment of the Female Genitalia and Rectum
Prepared By: K. Abuan
c. Obtaining Ectocervical Specimen
1. Insert one end of plastic spatula (that is longer on the ends than in the middle) into the cervical os
2. Press down and rotate the spatula, scraping the cervix and the transformation zone (squamocolumnar
junction) in a full circle
3. Withdraw the spatula
4. Rinse the spatula in the preservative solution by swishing the spatula vigorously in the vial 10 times
5. Discard the spatula.
d. Obtaining Endocervical Specimen
1. Insert the endocervical brush into the cervical os. Use the endocervical brush to increase the number of cells
obtained for analysis
2. Rotate the brush one half-turn in one direction very gently to minimize possible bleeding
3. Withdraw the brush
4. Rinse the brush in the preservative solution by rotating the device in the solution 10 times while pushing
against the vial wall. Swirl the brush vigorously to further release material
5. Discard the brush
6. Tighten the cap on the solution
7. Record client’s name and date on the vial
8. Send vial to laboratory.
e. Vaginal Specimen
1. Select appropriately sized speculum; warm speculum and test it on the patient’s leg for comfortable
temperature.
2. Insert speculum at a 45-degree angle, then rotate and open when completely inserted
3. Obtain a specimen of vaginal fluid from the posterior fornix
4. On a single glass slide, place a drop of sodium chloride (NaCl) and a drop of potassium hydroxide (KOH)
on separate ends of the slide
5. Mix a small amount of vaginal fluid with each solution and apply coverslip
f. Culture Specimens: Gonorrhea and Chlamydia
1. Insert a cotton-tipped applicator into the cervical os and rotate it in a full circle
2. Leave the applicator in place for approximately 20 seconds to make sure it becomes saturated with specimen
3. Withdraw the applicator
4. For Neisseria gonorrhoeae cultures: Spread the specimen onto a special culture plate (Thayer-Martin) in a
“Z” pattern while rotating the applicator, or put in a liquid medium for transport and send to the laboratory
5. For Chlamydia trachomatis cultures: Immerse a special swab (provided with test medium) in a liquid
medium and refrigerate the sample until it is transported to the laboratory.
NCM 101: Health Assessment
Topic: Assessment of the Female Genitalia and Rectum
Prepared By: K. Abuan
COMMON VARIATIONS OF THE CERVIX:
Cervical Eversion
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Normal finding in many women
Usually occurs after vaginal birth or when woman
takes contraceptives
The columnar epithelium from within the
endocervical canal is everted and appears as a
deep red, rough ring around the cervical os,
surrounded by the normal pink color of the cervix.
Bilateral Transverse
Laceration
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This drawing illustrates a type of healed laceration
that may be seen in a woman who has given birth
vaginally
Unilateral
Transverse
Laceration
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Vaginal birth may cause trauma to the cervix and
produce tears or lacerations. Therefore, healed
lacerations may be seen as a normal variation.
This drawing illustrates a unilateral transverse
laceration.
Nabothian Cyst
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Nabothian (retention) cysts (normal findings after
childbirth) are small (less than 1 cm), yellow,
translucent nodules on the cervical surface.
Normal odorless and nonirritating secretions may
be present on pink, healthy tissue. (Irritating
secretions would appear on reddened tissue.)
The viscosity of these secretions ranges from thin
to thick; their appearance ranges from clear to
cloudy, depending on the phase of the menstrual
cycle.
Nabothian cysts may occur when the everted
columnar epithelium spontaneously transforms
into squamous epithelium, a process called
squamous metaplasia. Occasionally the tissue
blocks endocervical glands and cysts develop.
Healed laceration that may be seen in a woman
who has given birth vaginally
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Stellate Laceration
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NCM 101: Health Assessment
Topic: Assessment of the Female Genitalia and Rectum
Prepared By: K. Abuan
COMMON VARIATIONS IN POSITIONS OF THE UTERUS:
Anteverted
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This is the most typical position of the uterus. The
cervix is pointed posteriorly, and the body of the
uterus is at the level of the pubis over the bladder.
Retroverted
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and body of the uterus tilting backward. The
uterine wall may not be palpable through the
abdominal wall or the rectal wall in moderate
retroversion. However, if the uterus is prominently
retroverted, the wall may be felt through the
posterior fornix or the rectal wall.
Midposition
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This is a normal variation. The cervix is pointed
slightly more anteriorly (compared with the
anteverted position), and the body of the uterus is
positioned more posteriorly than the anteverted
position, midway between the bladder and the
rectum. It may be difficult to palpate the body
through the abdominal and rectal walls with the
uterus in this position.
Retroflexed
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Retroflexion is a normal variation that consists of
the uterine body being flexed posteriorly in
relation to the cervix. The position of the cervix
remains normal. The body of the uterus may be
felt through the posterior fornix or the rectal wall.
Anteflexed
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Anteflexion is a normal variation that consists of
the uterine body flexed anteriorly in relation to the
cervix. The position of the cervix remains normal.
NCM 101: Health Assessment
Topic: Assessment of the Female Genitalia and Rectum
Prepared By: K. Abuan
ABNORMALITIES OF THE EXTERNAL GENITALIA
Syphilitic Chancre
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Syphilitic chancres often first appear on the
perianal area as silvery white papules that
become superficial red ulcers. Syphilitic
chancres are painless. They are sexually
transmitted and usually develop at the site of
initial contact with the infecting organism.
Genital Herpes
Simplex
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The initial outbreak of herpes may have many
small, painful ulcers with erythematous base.
Recurrent herpes lesions are usually not as
extensive.
Genital Warts
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Genital warts, caused by the human papilloma
virus (HPV), are moist, fleshy lesions on the
labia and within the vestibule. They are painless
and believed to be sexually transmitted.
Cystocele
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A cystocele is a bulging in the anterior vaginal
wall caused by thickening of the pelvic
musculature. As a result, the bladder, covered
by vaginal mucosa, prolapses into the vagina
Rectocele
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A rectocele is a bulging in the posterior vaginal
wall caused by weakening of the pelvic
musculature. Part of the rectum covered by the
vaginal mucosa protrudes into the vagina.
NCM 101: Health Assessment
Topic: Assessment of the Female Genitalia and Rectum
Prepared By: K. Abuan
Uterine Prolapse
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Uterine prolapse occurs when the uterus
protrudes into the vagina. It is graded according
to how far it protrudes into the vagina. In firstdegree prolapse, the cervix is seen at the
vaginal opening; in second-degree prolapse the
uterus bulges outside of vaginal openings; in
third-degree prolapse, the uterus bulges
completely out of the vagina.
NCM 101: Health Assessment
Topic: Assessment of the Female Genitalia and Rectum
Prepared By: K. Abuan
ABNORMALITIES OF CERVIX
Cyanosis of the
Cervix
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The cervix normally appears bluish in the client
who is in her first trimester of pregnancy.
However, if the client is not pregnant, a bluish
color to the cervix indicates venous congestion
or a diminished oxygen supply to the tissues.
Cervical Cancer
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A hardened ulcer is usually the first indication
of cervical cancer, but it may not be visible on
the ectocervix. In later stages, the lesion may
develop into a large cauliflower-like growth. A
Pap smear is essential for diagnosis.
Cervical Polyp
•
A polyp typically develops in the endocervical
canal and may protrude visibly at the cervical
os. It is soft, red, and rather fragile. Cervical
polyps are benign
Cervical Erosion
•
This condition differs from cervical eversion in
that normal tissue around the external os is
inflamed and eroded, appearing reddened and
rough.
Erosion
usually
occurs
with
mucopurulent cervical discharge.
Mucopurulent
Cervicitis
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This condition produces a mucopurulent
yellowish discharge from the external os. It
usually indicates infection with Chlamydia or
gonorrhea. However, these STIs may also occur
with no visible signs, although the discharge
may change the cervical pH.
NCM 101: Health Assessment
Topic: Assessment of the Female Genitalia and Rectum
Prepared By: K. Abuan
Malformation from
exposure to
Diethylstilbestrol
(DES)
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Women who were exposed to this drug as
fetuses may have cervical abnormalities that
may progress to cancer.
Some abnormalities associated with maternal
DES use include columnar epithelium that
covers most or all of the ectocervix; columnar
epithelium that extends onto the vaginal wall; a
circular column of tissue that separates the
cervix from the vaginal wall; transverse ridge;
and enlarged upper ectocervical lip.
NCM 101: Health Assessment
Topic: Assessment of the Female Genitalia and Rectum
Prepared By: K. Abuan
VAGINITIS
Trichomonas
Vaginitis
(Trichomoniasis)
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Causative Agent: Protozoan Organisms
Mode of Transmission: Sexual Transmission
Signs and Symptoms:
1. Yellow-green, frothy and foul-smelling
discharge
2. Labia appear swollen and red
3. Vaginal walls are red, rough, and covered
with small red spots (petechiae)
4. Itching
5. Urinary frequency
6. pH of vaginal secretion is greater than 4.5
Candida Vaginitis
•
This infection is caused by the overgrowth of
yeast in the vagina.
Signs and Symptoms:
1. Thick, white, cheesy discharge
2. Labia is inflamed and swollen
3. Vaginal mucosa reddened and contains
patches of discharge
4. Intense itching
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Atrophic Vaginitis
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Bacterial Vaginosis
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Atrophic vaginitis occurs after menopause
when estrogen production is low.
Signs and symptoms:
1. Blood-tinged discharge
2. Labia and vaginal mucosa appear atrophic
3. Vagina mucosa appear pale, dry, with areas
of abrasion that bleed easily
4. Itching, burning, dryness
5. Painful urination
The cause of bacterial vaginosis is unknown
(possibly anaerobic bacteria), but it is thought
to be sexually transmitted.
Signs and symptoms:
1. Thin and gray-white
2. Fishy smell/positive amine
3. Vagina walls and labia may appear normal
4. pH greater than 4.5
NCM 101: Health Assessment
Topic: Assessment of the Female Genitalia and Rectum
Prepared By: K. Abuan
UTERINE ENLARGEMENT
Normal
Enlargement
(Pregnancy)
•
Uterine Fibroids
(Myoma)
•
•
•
•
•
The only uterine enlargement that is normal
results from pregnancy and fetal growth.
In such cases, the isthmus feels soft (Hegar’s
sign) on palpation, and the fundus and isthmus
are compressible at between 10 and 12 weeks
of pregnancy.
Uterine fibroid tumors are common and benign.
They are irregular, firm nodules that are
continuous with the uterine surface.
They may occur as one or many and may grow
quite large.
The uterus will be irregularly enlarged, firm,
and mobile.
Uterine Cancer
(Cancer of the
Endometrium)
•
The uterus may be enlarged with a malignant
mass. Irregular bleeding, bleeding between
periods, or postmenopausal bleeding may be
the first sign of a problem.
Endometriosis
•
•
In endometriosis, the uterus is fixed and tender.
Growths of endometrial tissue are usually
present throughout the pelvic area and may be
felt as firm, nodular masses.
Pelvic pain and irregular bleeding are common.
•
NCM 101: Health Assessment
Topic: Assessment of the Female Genitalia and Rectum
Prepared By: K. Abuan
ADNEXAL MASSES
Pelvic Inflammatory
Disease (PID)
•
•
PID is typically caused by infection of the
fallopian tubes (salpingitis) or fallopian tubes
and ovaries (salpingo-oophoritis) with an STI
(i.e., gonorrhea, Chlamydia).
It causes extremely tender and painful bilateral
adnexal masses (positive Chandelier’s sign).
Ovarian cyst
•
•
Ovarian cysts are benign masses on the ovary.
They are usually smooth, mobile, round,
compressible, and nontender.
Ovarian Cancer
•
Masses that are cancerous are usually solid,
irregular, nontender, and fixed.
Ectopic pregnancy
•
Ectopic pregnancy occurs when a fertilized egg
attaches to the fallopian tube and begins
developing instead of continuing its journey to
the uterus for development.
A solid, mobile, tender, and unilateral adnexal
mass may be palpated if tenderness allows.
The cervix and uterus will be softened, and
movement of these structures will cause pain.
•
•
NCM 101: Health Assessment
Topic: Assessment of the Female Genitalia and Rectum
Prepared By: K. Abuan