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Structure and Function
External Genitalia or
Mons Pubis –is the flat pad located
over the symphysis pubis.
-functions to absorb
force and to protect the
symphysis pubis during coitus.
Labia Majora – The main function of the labia
majora along with the coarse hairs on it is to
keep away germs and bacteria from entering
the inner parts of the vagina and the urethra.
Labia minora – labia minora close
together, protecting their inner mucous
membrane and closing off the vaginal entrance.
Frenulum - is a small fold of tissue that
secures or restricts the motion of a mobile
organ in the body.
Clitoris –The clitoris is the center of sexual
sensation in women.
Urethral meatus –Urethra meatus is the
transport tube leading from the bladder to
which brings urine outside the body. It is
shorter in female than in the male. The
opening of the female urethra is beneath the
Paraurethral (Skene’s) glands -
are glands located on the anterior wall of
the vagina, around the lower end of
the urethra. They drain into the urethra and
near the urethral opening and may be near
or a part of the G-spot.
Hymen -it tends to keep germs and dirt out of
the vagina. In infants and children, the hymen
can serve a protective purpose by helping to
prevent things from being pushed into the
Vestibular (Bartholin’s) glands -They
secrete mucus to provide vaginal lubrication.
And secrete relatively minute amounts (one or
two drops) of fluid when a woman is sexually
Vagina -this passage leads from the opening of
the vulva to the uterus (womb), but the vaginal
tract ends at the cervix
Cervix -The function of the cervix is to allow flow
of menstrual blood from the uterus into the
vagina, and direct the sperms into the uterus
Anterior fornix and posterior fornix -Stimulation of
the fornices has been reported to enhance sexual
pleasure for some women.
Rectouterine pouch or cul-de-sac of Douglas –Can
serve as a drainage point for fluids in the cavity.
Uterus –A uterus is the place that a fetus
develops. Uterus also supplies antibodies to
protect the young one from infectious diseases,
Fallopian tubes - The fallopian tubes connect the
ovaries to the uterus.
ExaminationThe physical examination of the
female genitalia 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.
Encourage the client to ask questions.
Begin by sitting on a stool at the end of
Preparing the client
• The client should be told ahead of time not to douche for 48 hours before
a gynecologic examination.
• When the client arrives for the examination, ask her to urinate before
the examination so she does not experience bladder discomfort.
• When the client is back in the examination room ask her to remove
her underwear and bra and to put on a gown with the opening in the back.
• After the client has changed and the nurse has returned to the
room, the nurse should help the patient into the dorsal lithotomy position.
• The client’s hip should be positioned toward the bottom of the
• Ask the client to put her hands over her head.
• She should relax her hands at her sides.
Inspect the Mons
Pubis. Wash your
hands and put on
gloves. As you begin
the examination note
the distribution of
the pubic hair. Also
be alert of the signs
-pubic hair is distributed
in an inverted triangular
pattern and there are no
signs of infestation.
-Older clients may have
gray, thinning pubic hair.
-Some clients shave or
pluck the pubic hair.
Piercing of the mons
pubis are for aesthetics
and do not enhance
-Absence of pubic hair in
the adult client is
-Lice or nits(eggs) at the
base of the pubic hairs
with pediculosis pubis.
This condition, commonly
reffered to as “crabs”, is
most often transmitted by
Observe and palpate
There should be no
enlargement or swelling
in the lymph nodes.
-Enlarged inguinal nodes
may indicate a vaginal
infection or may be the
result of irritation
fromshaving pubic hairs.
Inspect the Labia majora
and perineum. Observe the
labia majora and perineum
lesions, swelling, excoriatio
-The Labia majora are equal
in size and free of lesions,
swelling, and excoriation. A
healed tear or episiotomy
scar may be visibleon the
perineum if the clienthas
given birth. The perineum
should be smooth.
-Lesions may be from an
infectious disease such as
serps or syphilis. Excoriation
and swelling may be from
scratching or self-treatment
of the lesions. All lesions
must be evaluated and the
client referred for
Inspect the labia minora,
clitoris, urethral meatus,
and vaginal opening. Use
your gloved hand to
separate the labia majora
and inspect for lesions,
excoriation, swelling and/or
-The labia minora appear
symmetric, dark pink, and moist.
The clitoris is a small mound or
erectile tissue, sensitive of touch.
The normal size of the clitoris varies.
The urethral meatus is small and
slitlike. The vaginal opening is
positioned belowthe urethral
meatus. Its siz depends on sexual
activity or vaginal delivery; may be
covered partially or completely by
-Asymmetric labia may
indicate abscess. Lesions,
swelling, bulging in the
vaginal opening, and
discharge are abnormal
findings. Excoriation may
result from the client
scratching or self-treating a
Palpate Bartholin’s glands. If the
client has labial swelling or a
history of it, palpate Bartholin’s
glands for swelling, tenderness
and discharge. Place your index
finger in the vaginal opening and
your thumb on the labia majora.
With a gentle pinching
motion, palpate from the inferior
portion of theposterior labia
majora to the anterior portion.
Repeat on the opposite side.
-Bartholin’s glands are usually
soft, non tender, and drainage
-Swelling, pain and discharge
may result from infection and
abscess. If you detect a
discharge, obtain a specimen
to send to the laboratory for
Palpate the urethra. if the client
repots urethral symptoms of
urethritis, or if you suspect
inflammation of Skene’s glands,
insert your gloved index finger
into the superior portion of the
vagina and milk the urthra from
the inside, punshing up and out.
-No drainage should be noted
from the urethral meatus. The
area is normally soft and non-
-Drainage from the urethra
indicates possible urethritis.
Any discharge should be
cultured. Urethritis may occur
with infection with Neisseria
gonorrhoeae or Chlamudia
Inspect the size of the vaginal
opening and the angle of the
vagina. Insert your gloved index
finger into the vagina, noting the
size of the opening. Then attempt
to touch the cervix. This will help
you establish the size of the
speculum you need to use for the
examination and the angle at
which to insert it.
- The normal vaginal opening
varies in size according to the
client’s age, sexual history and
whether she has given birth
vaginally. The vagina is
typically tilted posteriorly at a
- Cervical enlargement or
projection into the vagina
more than 3cm may be from
prolapse or tumor, and further
evaluation is needed.
Inspect the vagina. Unlock the
speculum and slowly rotate
and remove it. Inspect the
vagina as you remove the
speculum. Note the vaginal
color, surface, consistency, and
-The vagina should appear
pink, moist, smooth and free
of lesions and irritation. It
should also be free of any
colored malodorous discharge.
-Reddened areas, lesions, and
colored, malodorous discharge
are abnormal and may
indicate vaginal infections.
STD’s or cancer.
Inspect the vaginal
musculature. Keep your
index finger inserted in the
client’s vaginal opening. Ask
the client to squeeze around
Use your middle and index
fingers to separate the labia
minora. Ask the client to bear
-the client should be able to
squeeze around the
examiner’s finger. Typically,
the nulliparous woman can
squeeze tighter thann the
No bulging and no urinary
-absent or decreased ability to
squeeze the examiner’s finger
indicates decreased muscle tone.
Decreased tone may decrease
Bulging of the anterior wall
may indicate a cystocele. Bulging
of the posterior wall may indicate
rectocele. If the cervix or uterus
protrudes down, the client may
have uterine collapse. If urine
leaks out, the client may have
Inspect the cervix. Follow the
guidelines for using a
speculum in equipment. With
the speculum inserted in
position to visualize the
cervix, observe cervical color,
size, and position.
-the surface of the cervix is
normally smooth, pink and
even. Normally, it is midline
position and projects 1 to
3cm into the vagina.
In a pregnant woman, a bluish
cervix may indicate cyanosis.
In a non menopausal woman,
a pale cervix may indicate
anemia. Redness may be from
Palpate the vaginal wall. Tell
the client that you are going to do a
manual examination and explain its
purpose. Apply water soluble lubricant
to the gloved index and middle fingers
of your dominant hand. Then stand and
approach the client at the correct at the
correct angle. Placing your
nondominant hand on the client’s lower
abdomen, insert your index and middle
fingers into the vaginal opening. Apply
pressure to the posterior wall and wait
for the vaginal wall to relax before
palpating the vaginal walls.
-the vaginal wall should feel
smooth and the client should
not report any tenderness.
-tenderness or lesions may
Palpate the cervix. Advance
your fingers until they touch
the cervix and run fingers
around the circumference.
Palpate for: contour,
-The cervix should feel firm
and soft. It is rounded, and
can be moved somewhat
from side to side without
A hard immobile cervix may
indicate cancer. Pain with
movement of the cervix may
Palpate the ovaries. Slide
your intravaginal fingers
toward the left ovary in the
left lateral fornix and place
your abdominal hand on the
left lower abdominal
quadrant. Press your
abdominal hand toward your
intravaginal fingers and
attempt to palpate the ovary.
-Ovaries are approximately
3x2x1cm and almond shape.
-Enlarged size, masses,
immobility and extreme
tenderness are abnormal and
should be evaluated.
Health Problems of
Amenorrhea –is an abnormal absence of menstruation.
-There are two types of amenorrhea: primary
amenorrhea and secondary amenorrhea. Primary amenorrhea
is when a young woman has not had her first period by the age
of 16. Secondary amenorrhea is when a woman who has had
normal menstrual cycles stops getting her monthly period for
three or more months.
Anuria -Failure of the kidneys to produce urine. Caused by failure
in the function of kidneys. It may also occur because of some
severe obstruction like kidney stones or tumors.
Bacteriuria -The presence of bacteria in the urine.
This is typically an indication of a urinary tract
Calculus/Calculi- A stone in the kidney (or lower
down in the urinary tract). Also called a kidney
Cryosurgery -Connective tissue separates the pelvic
organs. The tissue, called fascia, is attached to
nearby muscles. When healthy, the fascia and
muscles support the bladder, vagina and rectum.
Defects in the fascia can cause cystoceles and
Dysuria -Painful or difficult urination.
Hematuria -The presence of blood in urine.
Hyperplasia - is a condition of excessive
proliferation of the cells of the endometrium, or
inner lining of the uterus.
Menorrhagia -Abnormally heavy bleeding at
Metrorrhagia -Abnormal bleeding from the
Nephrolithiasis -the presence of kidney stones
(calculi) in the kidney.
Nocturia -excessive urination at night.
Oligomenorrhea -abnormally light or infrequent
Oliguria -The production of abnormally small
amounts of urine.
Ovarian cyst -a cystic tumor (usually benign) of
Polyuria -Production of too much dilute urine.
Pyuria -The presence of pus in the urine,
typically from bacterial infection.
Retrograde menstruation -The backward flow of
menstrual blood up into the fallopian tubes,
thought to be a cause of endometriosis.
Retroversion/retroflexion -is a uterus that is
tilted backwards instead of forwards.
Toxic Shock Syndrome (TSS) -Acute septicemia in
women, typically caused by bacterial infection
from a retained tampon
Urolithiasis -The formation of stony concretions
in the bladder or urinary tract.
Uterine prolapse - Uterine prolapse occurs
when pelvic floor muscles and ligaments
stretch and weaken, providing inadequate
support for the uterus. The uterus then slips
down into or protrudes out of the vagina.
Vesicoureteral reflux -is an abnormal
movement of urine from the bladder into
ureter or kidneys.
• Abscess of the Bartholin’s gland- a painful
condition and common sign of Neisseria
• Syphilitic Chancre-often most appear on the perianal
area as silvery white papules that become superficial
red ulcers. Syphilitic chancr are painless. They are
sexually transmitted and usually develop at the site of
initial contact with the infecting organism.
• Genital Herpes Simples- The initial outbreak of
herpes may have many small, painful ulcers
with erythematous base. Recurrent herpes
lesions are usually not as extensive.
• Rectocele- is 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.
• Cystocele- is a bulging in the anterior vaginal
wall caused by the thickening of the pelvic
musculature. As a result, the bladder caused by
vaginal mucosa, prolapses into the vagina.
• Uterine Prolapse- tis occurs when the uterus
protrudes into the vagina. It is graded according
to how far it protrudes into the vagina.
• 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.
• Trichomoniasis- this type of vaginal infection is
caused by a protozoan organism and is usually
sexually transmitted. This infection causes
itching and urinary frequency in the client.