assessment of the female genitalia
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assessment of the female genitalia including diseases

assessment of the female genitalia including diseases

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assessment of the female genitalia Presentation Transcript

  • 1. Physical Assessment of Male & Female Genitalia, Anus & RectumMaria Carmela Lacsa Domocmat, RN, MSNInstructor, School of NursingNorthern Luzon Adventist College
  • 2. Female Genitalia Anatomy Physical Assessment Abnormalities
  • 3. Anatomy
  • 4. Female ExternalReproductive Organs Maria Carmela L. Domocmat, RN, MSN
  • 5. Female InternalAccessory Organs • uterine tubes • uterus • vagina Maria Carmela L. Domocmat, RN, MSN
  • 6. Uterus 22-38 Maria Carmela L. Domocmat, RN, MSN
  • 7. Maria Carmela L. Domocmat, RN, MSN
  • 8. Assessment
  • 9. Good News!!!Deaths due to uterine and cervical cancershave declined by more than 50% since1960s Maria Carmela L. Domocmat, RN, MSN
  • 10. Why?Because of early detection Physical Assessment Papanicolau test (Pap Smear) Increase patient knowledge Maria Carmela L. Domocmat, RN, MSN
  • 11. History taking
  • 12. Physical Examination
  • 13. Physical Examination1. Inspection and Palpation of the External Genitalia2. Speculum assessment of Internal Genitalia3. Collection of Specimens for Laboratory Analysis.4. Inspection of the Vaginal walls5. Bimanual Examination6. Rectovaginal Assessment
  • 14. Preparation for the exam
  • 15. Preparation for the exam • Instruct the patient while she is dressed • Instruct her to empty her bladder prior to the exam (depending on the history and complaints of client) • Close the door and curtain • Ask for an assistant Maria Carmela L. Domocmat, RN, MSN
  • 16. External Genitalia •Mons Pubis and Pubic Hair •Vulva •Clitoris •Urethral Meatus •Vaginal Introitus •Perineum and Anus
  • 17. External Genitalia •Mons Pubis and Pubic Hair •Vulva •Clitoris •Urethral Meatus •Vaginal Introitus •Perineum and Anus
  • 18. Mons Pubis & Pubic HairInspection
  • 19. Inspection• Observe the pattern of pubic hair distribution• Note the presence of nits or liceNormal FindingsSkin over Mons Pubis: • Clear with normal hair distribution Maria Carmela L. Domocmat, RN, MSN
  • 20. Normal Findings (cont’d)Pubic Hair Distribution – inverse triangle • There may be some growth on abdomen and upper inner thigh • Note: Diamond-shaped pattern from the umbilicus may be due to cultural or familial differences No nits or lice Maria Carmela L. Domocmat, RN, MSN
  • 21. Geriatric Variation: Gray and sparse Maria Carmela L. Domocmat, RN, MSN
  • 22. Abnormal Finding Pediculosis Pubis
  • 23. Crab lice, Pthiruspubis Maria Carmela L. Domocmat, RN, MSN
  • 24. Vulva Inspection Palpation
  • 25. Inspection• Observe the skin coloration and condition of the mons pubis and vulva• Inform the patient that you will touch the inside of her thigh before you touch the genitals Maria Carmela L. Domocmat, RN, MSN
  • 26. Inspecting the Vulva• With glovedhands, separatethe labia majorausing the thumband the indexfinger of thedominant hand. Maria Carmela L. Domocmat, RN, MSN
  • 27. Inspecting the Vulva (cont’d)• Observe boththe labia majoraand the labiaminora fordiscoloration,lesions, trauma. Maria Carmela L. Domocmat, RN, MSN
  • 28. Normal FindingsLabia majora andminora Symmetrical Smooth to somewhat wrinkled, unbroken, slightly pigmented skin surface. Maria Carmela L. Domocmat, RN, MSN
  • 29. Normal FindingsLabia majora andminora (cont’d) No ecchymosis, ecchymosis, excoriation, nodules, swelling, rash, lesions. •Occasional sebaceous cyst is within normal limits •Sebaceous cysts are nontender, yellow nodules nontender, that are less than 1 cm. Maria Carmela L. Domocmat, RN, MSN
  • 30. Skene’s glandsand Bartholin’s glands Maria Carmela L. Domocmat, RN, MSN
  • 31. Normal Findings Skene’s glands and Bartholin’s glands are not normally seen by naked eye Maria Carmela L. Domocmat, RN, MSN
  • 32. Normal Deviations Geriatric: atrophied- appears flatter and smaller Multiparrous women: majora are separated and minora more prominent Maria Carmela L. Domocmat, RN, MSN
  • 33. Abnormal Findings VulvaBartholin’s CystSkene’s Gland CystVulvar epidermal cystEdema, SwellingRash (contact dermatitis, infestation)Chancre (Syphilis)Wartlike papules (condyloma latum)Ulcer (Herpes)Venous prominence (varicose veins)Carcinoma
  • 34. Inflammation of Bartholin Glands Maria Carmela L. Domocmat, RN, MSN
  • 35. Skene Gland Cyst Maria Carmela L. Domocmat, RN, MSN
  • 36. Vulvar epidermalVulvar hypertrophy cysts develop from sebaceous glands. Multiple, bilateral vulvar epidermal inclusion cysts, previously referred to as Maria Carmela L. Domocmat, RN, MSN are shown. sebaceous cysts,
  • 37. Benign vulvar lesions. Pemphigus vulgarismucosal involvement vulvar involvement Maria Carmela L. Domocmat, RN, MSN
  • 38. Benign vulvar lesionsAllergic Vulvitis Psoriasis Maria Carmela L. Domocmat, RN, MSN
  • 39. Benign vulvar lesions Vulvar Melanosis Hemangioma Maria Carmela L. Domocmat, RN, MSN
  • 40. Condyloma Latum Condyloma(Secondary Syphilis) Acuminatum (Genital Or Venereal Wart) Maria Carmela L. Domocmat, RN, MSN
  • 41. Herpes genitalis Maria Carmela L. Domocmat, RN, MSN
  • 42. Well- Advanceddifferentiated carcinoma of vulva, involving entire vagina,carcinoma of urethra and rectumvulva Maria Carmela L. Domocmat, RN, MSN
  • 43. Palpating the Labia
  • 44. Palpating the Labia Palpate each labium between the thumb and the index finger of your dominant hand. Observe for swelling, induration, pain, or discharge from a Bartholin’s gland duct. Maria Carmela L. Domocmat, RN, MSN
  • 45. Palpating the LabiaLabium:• Feel softand uniformin structure•No swelling,pain,induration,or purulentdischarge Maria Carmela L. Domocmat, RN, MSN
  • 46. Palpating around the vaginal introitus (Bartholin glands) glands) Maria Carmela L. Domocmat, RN, MSN
  • 47. If discharge is present , obtain a specimen and change the gloves into clean ones.Maria Carmela L. Domocmat, RN, MSN
  • 48. Abnormal Findings Painless mass indicatesmalignancy Painful mass indicates hernia
  • 49. Hernia or not? If hernia is suspected, re-palpate the mass with the patient in a standing position (+) hernia: If increase in bulging when standing and ask patient to cough Maria Carmela L. Domocmat, RN, MSN
  • 50. Clitoris Inspection
  • 51. Inspection Using the dominant hand and index finger, separate the labia minora laterally to expose the prepuce of the clitoris Maria Carmela L. Domocmat, RN, MSN
  • 52. Normal Findings•Approximately 2 cm in length and 0.5cm in diameter•Without lesions Maria Carmela L. Domocmat, RN, MSN
  • 53. Abnormal FindingsHypertrophy(clitoromegaly,pseudohermaphroditism)Chancre
  • 54. Clitoromegaly A 22-year-old 19-year-old gravida O gravida O 20 mm 30 mmclitoroplasty Maria Carmela L. Domocmat, RN, MSN
  • 55. Urethral Meatus Inspect Palpate
  • 56. Inspection Using the dominant hand and index finger, separate the labia minora to expose the urethral meatus. Do not touch the urethral meatus. may cause pain and urethral spasm Observe shape, color, and size of urethra Maria Carmela L. Domocmat, RN, MSN
  • 57. Normal Findings Slitlike in appearance Midline Free from discharge, swelling, or redness About the size of a pea Maria Carmela L. Domocmat, RN, MSN
  • 58. Abnormal Findings Discharge or swelling Urethral caruncle Urethral carcinoma Prolapse of urethral mucosa
  • 59. Urethral caruncle Maria Carmela L. Domocmat, RN, MSN
  • 60. Palpation Milking the urethra and paraurethral glands
  • 61. PalpationInsert your dominantindex finger into thevaginaApply pressure to theanterior aspect of thevaginal wall and milkthe urethraObserve for dischargeand client discomfort Maria Carmela L. Domocmat, RN, MSN
  • 62. Milking the urethra and paraurethral glands Maria Carmela L. Domocmat, RN, MSN
  • 63. Normal Findings Should not cause pain Or result in any urethral discharge Maria Carmela L. Domocmat, RN, MSN
  • 64. If urethral dischargeis present, obtain aspecimen and changeto a clean pair ofglovesMaria Carmela L. Domocmat, RN, MSN
  • 65. Let’s Watch: Palpatingthe Skene Glands and Bartholin Glands
  • 66. Vaginal Introitus Inspect Palpate
  • 67. Inspection Keep labia minora retracted laterally to inspect the vaginal introitus. Ask the patient to bear down. Observe for patency and bleeding. Maria Carmela L. Domocmat, RN, MSN
  • 68. Normal FindingsIntroitus Mucosa Pink and moist Patent Without Bulging Maria Carmela L. Domocmat, RN, MSN
  • 69. Nulliparous Multiparous withwith intact remaining hymen hymen Maria Carmela L. Domocmat, RN, MSN
  • 70. Normal Vaginal Discharge – white andfree of foul odor (some white clumpsmay be seen—mass clamps of epitheliacells) Maria Carmela L. Domocmat, RN, MSN
  • 71. Palpation Insert your dominant finger in the vagina, ask the client to squeeze the vaginal muscles around your finger. Evaluate muscle strength and toneNormal Findings Vaginal muscle tone In nulliparous woman: tight and strong In a parrous woman: it is diminished Maria Carmela L. Domocmat, RN, MSN
  • 72. Abnormal Findings Pale color and dryness (atrophy, aging) Tear, fissure Bulging Discharge
  • 73. Pelvic Organ Prolapse Cystocele Cystourethrocele Rectocele Uterine Prolapse
  • 74. CystoceleMaria Carmela L. Domocmat, RN, MSN
  • 75. RectoceleMaria Carmela L. Domocmat, RN, MSN
  • 76. Degrees of Uterine Prolapse Maria Carmela L. Domocmat, RN, MSN
  • 77. Second degree uterine prolapse Maria Carmela L. Domocmat, RN, MSN
  • 78. Symptomaticposthysterectomyvault prolapse in60-year-oldpatient. Maria Carmela L. Domocmat, RN, MSN
  • 79. Perineum Inspect Palpate
  • 80. Inspection• Observe texture and color of the perineum• Observe for color and shape of the anusNormal Findings Perineum Smooth Slightly darkened Well-healed episiotomy scar is normal after vaginal delivery Maria Carmela L. Domocmat, RN, MSN
  • 81. Abnormal Findings Fissure or tear (trauma, abscess, or unhealed episiotomy) Keloid
  • 82. Maria Carmela L. Domocmat, RN, MSN
  • 83. Maria Carmela L. Domocmat, RN, MSN
  • 84. Giant perineal keloid Maria Carmela L. Domocmat, RN, MSN
  • 85. Palpating the Perineum
  • 86. Palpating the PerineumPlace thedominant indexfinger posteriorto the perineumand the thumbanterior to theperineum Maria Carmela L. Domocmat, RN, MSN
  • 87. Palpating the Perineum(cont’d)Assess perineumbetween thedominant thumband index fingerfor muscular toneand texture Maria Carmela L. Domocmat, RN, MSN
  • 88. Normal Findings Smooth & Firm Homogenous in nulliparous Thinner in parous woman Well-healed episiotomy scar is also within normal limits for parous woman Maria Carmela L. Domocmat, RN, MSN
  • 89. Abnormal Findings Thin (atrophy) Fissure or tear (trauma, abscess, or unhealed episiotomy)
  • 90. Speculum Examination of theInternal Genitalia Inspection
  • 91. Cervical Examination
  • 92. Select theappropriate-sizedspeculumBased onclient’shistory, sizevaginalintroitus, andvaginal muscletone Maria Carmela L. Domocmat, RN, MSN
  • 93. Maria Carmela L. Domocmat, RN, MSN
  • 94. Lubricate and warm thespeculum by rinsing it withwarm water Do not use lubricant, may be bacteriostatic and can alter Pap test results Maria Carmela L. Domocmat, RN, MSN
  • 95. Holding theSpeculum •Hold the speculum by your dominant hand with the closed blades between the index and middle fingers Maria Carmela L. Domocmat, RN, MSN
  • 96. Insert yournondominantindex and middlefingers, ventralsides down, justinside the vaginaand applypressure to theposterior vaginalwall Maria Carmela L. Domocmat, RN, MSN
  • 97. Encourage client tobear down This will help to relax the perineal musclesEncourage client torelax by taking deepbreaths Be careful not to pull on pubic hair or pinch the labia Maria Carmela L. Domocmat, RN, MSN
  • 98. Preparing for the Applyinsertion of the downward pressure inspeculum posterior vaginal opening with two fingers Maria Carmela L. Domocmat, RN, MSN
  • 99. Oblique insertion of thespeculum When you feel the muscles relax, insert the speculum at an oblique angle on a plane parallel to the examination table until the speculum reaches the end of the fingers that are in the vagina. Maria Carmela L. Domocmat, RN, MSN
  • 100. Withdraw your nondominant hand from the vagina Maria Carmela L. Domocmat, RN, MSN
  • 101. Directing speculum downward 0at 45 angle. Gently rotate the speculum blades to a horizontal angle and advance the speculum at a 45-degree- 45-degree- angle against the posterior vaginal wall until it reaches the end of the vagina. Maria Carmela L. Domocmat, RN, MSN
  • 102. Final Adjustment of the Speculum Maria Carmela L. Domocmat, RN, MSN
  • 103. Opening of the •With yourspeculum blades dominant thumb, depress the lever to open the blades and visualize the cervix. Maria Carmela L. Domocmat, RN, MSN
  • 104. If the cervix is not visualized, closethe blades and withdraw the speculum2 to 3 cm and reinsert it at a slightlydifferent angle to ensure that thespeculum is inserted far enough intothe vagina.Once the cervix is fully visualized,lock the speculum blades into place.Adjust your light source so that itshines through the speculum. Maria Carmela L. Domocmat, RN, MSN
  • 105. Speculum in place, locked, andstabilized. Note cervix in full view. Maria Carmela L. Domocmat, RN, MSN
  • 106. Normal FindingsColor Glistening pink Pale after menopause Blue (Chadwick’s sign) during pregnancyPosition Located midline in the vagina with an anterior or posterior position relative to the vaginal vault Maria Carmela L. Domocmat, RN, MSN
  • 107. Size: 2.5 cm to 3 cm in young woman. Smaller in elderlySurface characteristics: Covered by glistening pink squamous epithelium, which is similar to vaginal epitheliumDischarge: Note characteristics of any discharge Maria Carmela L. Domocmat, RN, MSN
  • 108. Shape of cervical os In nulliparous woman: os is small and either round or oval. In a parrous woman: os is a horizontal slit Maria Carmela L. Domocmat, RN, MSN
  • 109. Let’s Watch:Inspecting the Cervix
  • 110. Abnormal Findings Lacerations Cyanosis Redness or friable appearance Reddish circle around os (ectropion or eversion) Small, round, yellow lesion (nabothian cyst)
  • 111. Abnormal Findings Condyloma Acuminata Candidiasis Cervicitis Endocervical Gonorrhea Strawberry spots (trichomonal infection) Cauliflower overgrowth (carcinoma)
  • 112. Maria Carmela L. Domocmat, RN, MSN
  • 113. Cervical Nabothian CystEctropion Maria Carmela L. Domocmat, RN, MSN
  • 114. Condyloma acuminata Candidiasis (venereal warts)caused by "Human Papilloma Virus" (HPV). Maria Carmela L. Domocmat, RN, MSN
  • 115. Chlamydial cervicitis Maria Carmela L. Domocmat, RN, MSN
  • 116. Endocervical gonorrhea Maria Carmela L. Domocmat, RN, MSN
  • 117. “Strawberry”cervix Cervical Cancer(Trichomonasis) Maria Carmela L. Domocmat, RN, MSN
  • 118. Collecting Specimens forCytological Smears andCulturesSmear •Pap •Gonococcal Culture Specimen •Saline Mount or “Wet Prep” •KOH Prep •Five Percent Acetic Acid Wash •Anal Culture
  • 119. Pap Smear Endocervical Smear Cervical Smear Vaginal Pool Smear
  • 120. Pap Smear Equipments Maria Carmela L. Domocmat, RN, MSN
  • 121. A collection of three specimensthat are obtained from three sites Cervix Vaginal pool Posterior fornix of the vagina Maria Carmela L. Domocmat, RN, MSN
  • 122. Endocervical Smear Using your nondominant hand, insert the cytobrush through the speculum into the cervical os approximately 1 cm May cause cramping sensation, so forewarn the patient. Maria Carmela L. Domocmat, RN, MSN
  • 123. Endocervical Smear (cont’d)Rotate the cytobrushbetween your indexfinger and thumb 360degrees clockwise, then counterclockwise.Keep cytobrush in contact with thecervical tissue If you have to use a cotton-tipped applicator instead of cytobrush, leave the applicator in the os for 30 seconds to ensure saturation. Maria Carmela L. Domocmat, RN, MSN
  • 124. Endocervical Smear(cont’d) Remove the cytobrush and, using a rolling motion, spread the cells on the section of the slide marked E, if a sectional slide is being used. Do not press down hard or wipe the cytobrush back and forth. Doing so will destroy the cells. Discard the brush. Maria Carmela L. Domocmat, RN, MSN
  • 125. Cervical SmearInsert the bifurcatedend of Ayre spatulathrough the speculumbase.Place the longer projection ofthebifurcation into the cervical os. Maria Carmela L. Domocmat, RN, MSN
  • 126. Cervical Smear(cont’d) The shorter projection should be snug against the ectocervix Rotate the spatula 360 degrees one time only Remove the spatula and gently spread the specimen on the section of the slide labeled C, if a sectional slide is being used. Maria Carmela L. Domocmat, RN, MSN
  • 127. Vaginal Pool Smear Reverse the Ayre spatula and insert the rounded end into the posterior fornix and gently scrape the area Maria Carmela L. Domocmat, RN, MSN
  • 128. Vaginal Pool SmearCotton-tipped applicatormay be the preferred vehiclefor obtaining specimen ifvaginal secretions areviscous or dry. By moistening the cotton-tipped applicator with normal saline solution, viscous secretions can be removed with less trauma to the surrounding membranes. Maria Carmela L. Domocmat, RN, MSN
  • 129. Vaginal Pool SmearRemove the spatula and gently spreadthe specimen on the section of theslide marked V, if a sectional slide isbeing used.Dispose of the spatula cotton-tippedapplicator .Spray the entire slide or the slideswith cytological fixative.Submit the specimens to thelaboratory. Maria Carmela L. Domocmat, RN, MSN
  • 130. Normal findingsNormal classifications for allcervicovaginal cytology should read“within normal limits” (WNL) usingBethesda system. Denotes lack of pathogenesis Maria Carmela L. Domocmat, RN, MSN
  • 131. Inspection of theVaginal Wall
  • 132. Inspection Disengage the locking device of the speculum Slowly withdraw the speculum but do not close the blades Rotate the speculum into oblique position as you retract it to allow full inspection of the vaginal walls Observe vaginal wall color and texture Maria Carmela L. Domocmat, RN, MSN
  • 133. Normal findings Vaginal walls Pink Moist Deeply ruggated Without lesions or redness Maria Carmela L. Domocmat, RN, MSN
  • 134. Geriatric Variation Thinner Drier Less vascular Maria Carmela L. Domocmat, RN, MSN
  • 135. Abnormal Findings Vaginitis Adenosis Carcinoma
  • 136. Atrophic vaginitisExternal genitalia of a67-year-old woman whois naturally menopausalfor two years and is noton estrogen replacementtherapy. Note loss oflabial and vulvar fullness,pallor of urethral andvaginal epithelium, anddecreased vaginalmoisture. Maria Carmela L. Domocmat, RN, MSN
  • 137. Vaginal inclusion Bacterialcysts contain epithelial Vaginosistissue Maria Carmela L. Domocmat, RN, MSN
  • 138. Vaginal adenosis Vaginal Carcinoma Maria Carmela L. Domocmat, RN, MSN
  • 139. Bimanual Examination •Vagina •Fornices •Adnexa •Cervix •Uterus
  • 140. Steps of Bimanual Exam:1. Observe the client’s face for signs of discomfort during the assessment process.2. Inform the client of the steps of the bimanual assessment, and tell her that the lubricant gel may be cold. Maria Carmela L. Domocmat, RN, MSN
  • 141. Steps of Bimanual Exam: (cont’d)3. Squeeze the lubricant onto the fingertips of your dominant hand.4. Stand between the legs of the client as she remains in the lithotomy position, and place your non- dominant hand on her abdomen and below the umbilicus. Maria Carmela L. Domocmat, RN, MSN
  • 142. Steps of Bimanual Exam: (cont’d)5. Insert your lubricated index and middle fingers 1 cm into the vagina. The fingers should be extended with the palmer side up. Exert gentle posterior pressure. Maria Carmela L. Domocmat, RN, MSN
  • 143. Steps of Bimanual Exam: (cont’d)6. Inform the client that pressure from palpation may be uncomfortable. Instruct the patient to relax the abdominal muscles by taking deep breaths. Maria Carmela L. Domocmat, RN, MSN
  • 144. Steps of Bimanual Exam (cont’d)7. When you feel the client’s muscles relax, insert your fingers slowly to their full length into the vagina. Simultaneously palpate the vaginal walls. Maria Carmela L. Domocmat, RN, MSN
  • 145. Steps of Bimanual Exam (cont’d)8. Remember to keep your thumb widely abducted and away from the urethral meatus and clitoris throughout the palpation in order to prevent pain or spasm. Maria Carmela L. Domocmat, RN, MSN
  • 146. Vagina Complete steps 1-8 of the bimanual exam. Rotate the wrist so that the fingers are able to palpate all surface aspects of the vagina. Maria Carmela L. Domocmat, RN, MSN
  • 147. Vagina Normal Findings Vaginal wall non tender Smooth or ruggated surface No lesions, masses, or cysts Maria Carmela L. Domocmat, RN, MSN
  • 148. Cervix1. Position the dominant hand so that the palmar surface faces upward.2. Place the non-dominant hand on the abdomen approximately 1/3 of the way down between the umbilicus and the symphysis pubis. Maria Carmela L. Domocmat, RN, MSN
  • 149. Cervix3. Use the palmar surfaces of the dominant hand’s fingerpads, which are in the vagina, to assess the cervix for consistency, position shape, and tenderness.4. Grasp the cervix between the fingertips and move the cervix from side to side to assess mobility. Maria Carmela L. Domocmat, RN, MSN
  • 150. CervixNormal Findings Mobile Without pain Smooth and firm Symmetrically rounded Midline Softening between 5th or 6th week of pregnancy- Goodell’s sign Maria Carmela L. Domocmat, RN, MSN
  • 151. Abnormal Findings Extreme pain on palpation (Chandelier’s sign –PID) Irregular surface (malignancy, nabothian cyst, polyps)
  • 152. Fornices• With the fingertips and palmar surfaces of the fingers, palpate around the fornices.• Note nodules or irregularities. Maria Carmela L. Domocmat, RN, MSN
  • 153. FornicesNormal Findings Walls should be smooth No nodules Maria Carmela L. Domocmat, RN, MSN
  • 154. Uterus1. With the dominant hand, which is in the vagina, push the pelvic organs out of the pelvic cavity and provide stabilization while the non-dominant hand, which is on the abdomen, performs the palpation. Maria Carmela L. Domocmat, RN, MSN
  • 155. Uterus2. Press the hand that is on the abdomen inward and downward toward the vagina, and try to grasp the uterus between your hands. Maria Carmela L. Domocmat, RN, MSN
  • 156. Uterus2. Press the hand that is on the abdomen inward and downward toward the vagina, and try to grasp the uterus between your hands. Maria Carmela L. Domocmat, RN, MSN
  • 157. Bimanual palpation of Uterus Maria Carmela L. Domocmat, RN, MSN
  • 158. UterusNormal Findings Size varies based on parity Nongravid client: Pear-shaped Parous: more rounded Smooth Without masses Maria Carmela L. Domocmat, RN, MSN
  • 159. UterusNormal Findings (cont’d) May be non-palpable if it is retroverted or retroflexed (rectovaginal assessment) Non palpable uterus is normal in older women Due to secondary uterine atrophy Maria Carmela L. Domocmat, RN, MSN
  • 160. Anteverted uterus Maria Carmela L. Domocmat, RN, MSN
  • 161. Anteverted uterus Anteflexed Uterus Maria Carmela L. Domocmat, RN, MSN
  • 162. Retroverted RetroflexedUterus Uterus Maria Carmela L. Domocmat, RN, MSN
  • 163. Abnormal Findings Enlargement and changes in shape Nodules or irregularities (leiomyomas) Non palpable uterus (hysterectomy) Maria Carmela L. Domocmat, RN, MSN
  • 164. Adnexa1. Move the intravaginal hand to the right lateral fornix, and the hand on the abdomen to the right lower quadrant just inside the anterior iliac spine.2. Press deeply inward and upward toward the abdominal hand. Maria Carmela L. Domocmat, RN, MSN
  • 165. Adnexa3. Push inward and downward with the abdominal hand and try to catch the ovary between your fingertips. Palpate for size, consistency, and mobility of the adnexa. Repeat the above maneuvers on the left side. Maria Carmela L. Domocmat, RN, MSN
  • 166. Palpation of Left Adnexa Maria Carmela L. Domocmat, RN, MSN
  • 167. AdnexaNormal FindingsOvaries Almond-shaped Firm Smooth Mobile Without tenderness Maria Carmela L. Domocmat, RN, MSN
  • 168. Geriatric Variation Rarely palpable Maria Carmela L. Domocmat, RN, MSN
  • 169. Let’s Watch:Bimanual Palpation of Uterus
  • 170. Abnormal Findings Enlarged, irregular, nodular, painful, with decreased mobility (ectopic pregnancy, ovarian cyst, PID or malignancy)
  • 171. Collecting Specimens
  • 172. Five Percent Acetic Acid Wash 1. After completing all other vaginal specimens, swab the cervix with cotton-tipped applicator that has been soaked in 5% acetic acid. 2.Leave for one minute.
  • 173. Normal FindingThere should be no change inthe appearance of the cervix(HPV) Maria Carmela L. Domocmat, RN, MSN
  • 174. Abnormal FindingsRapid acetowhitening or blanchingwith jagged borders (HPV)
  • 175. Apparently normal cervix Maria Carmela L. Domocmat, RN, MSN
  • 176. After application of acetic acid Maria Carmela L. Domocmat, RN, MSN
  • 177. RectovaginalExamination
  • 178. Rectovaginal Examination Maria Carmela L. Domocmat, RN, MSN