care plane

1. SALALE UNIVERSITY COLLEGE OF
HEALTH SCIENCES
DEPARTMENT OF ADULT HEALTH
NURSING
Assessment of Female Reproductive System
Presented by : Merga Wekwaya
Presented to: Mr Bikila T. (BSc, MSc, Ass’t Prof.)
Jun 2023
Fitche
2:10:24 PM 1
Female Reproductive System

2. Objective
After studying this chapter you will be able to:
 Describe anatomy and physiology.
 Identify equipment, positioning, techniques.
 Explain process of performing assessment of
female reproductive systems.
 Differentiate between normal and abnormal
assessment data.
2:10:24 PM 2
Female Reproductive System

3. Introduction
 The female reproductive system is responsible
for producing gametes, sex hormones, and
keeping fertilized eggs alive until they mature
into fetuses and are prepared for birth.
 History, a comprehensive physical examination,
and an assessment of the external and internal
genitalia are all part of the physical exam's
section on the female reproductive system.
2:10:24 PM 3
Female Reproductive System

4. Female Reproductive System
External Structures
 Mons Pubis, Clitoris
 Labia Majora
 Labia Minora
 Skene’s Glands
 Hymen
 Bartholin’s Glands
2:10:24 PM 4
Female Reproductive System

5. Female Reproductive System
Internal Structures
 Vagina: Muscular tube from cervix to vulva.
 Cervix: lower, narrow portion of uterus
 Uterus: pear-shaped organ containing growing
fetus
 Fallopian Tubes: pathway for egg travel during
ovulation
 Ovaries: egg-producing organs
2:10:24 PM 5
Female Reproductive System

6. Internal Female Reproductive Organs
2:10:24 PM 6
Female Reproductive System

7. Equipment For Examination Female
Reproductive System
 Gloves
 Drape
 Vaginal Speculum
 Cotton-tipped
applicator
 Examination table
 Screen
 Ayre Spatula
(endocervical brush)
 Specimen container
 Small bottle(3)
 Warm water
 Lubricating jelly
 Flexible light source
2:10:24 PM Female Reproductive System 7

8. General Consideration
 Begin with woman in sitting position
 Explain each step in the exam before you do it.
 The patient must have an empty bladder.
 Place woman in lithotomy position
 Appropriately drape, covering the stomach, and
legs, exposing only the vulva to your view.
 Ask if she would like a friend, family member
present.
2:10:24 PM 8
Female Reproductive System

9. Health history:
 Present complaint
 Menstrual history: Age of Menarche? LMP?
Any changes or pain related to menstruation?
 Past Gynecological history: Age at which
puberty began? How old was the patient when
the first sexual encounter occurred and how
many sexual partners has the patient had?
2:10:24 PM 9
Female Reproductive System

10. Cont’d
 Obstetrics History:
 Past Medical, Surgical, and Social histories.
 Family history
 Medication and Drug history.
 Nutritional history
 Personal History
 Breast History:
2:10:24 PM 10
Female Reproductive System

11. Head-to-Toe Physical Assessment
 General Health Survey: Personality changes and
mental deterioration can accompany late-stage
syphilis, Depression can affect sexual functioning,
Loss of height seen in postmenopausal women
with osteoporosis, Wt. loss resulting from
anorexia can cause amenorrhea, Wt. gain is
associated with pregnancy, Unexplained weight
loss may be associated with malignancy.
2:10:24 PM Female Reproductive System 11

12. Cont’d
Integumentary : Skin & Hair
 Rashes and skin lesions are associated with
many STDs.
 Systemic rash: Secondary syphilis.
 Vesicles: Herpes simplex types 1 and 2.
 Increased skin pigmentation: Increased
hormones during pregnancy.
 Alopecia: Secondary syphilis.
 Abnormal increase in body hair (hirsutism):
Decrease in female hormones.
2:10:24 PM Female Reproductive System 12

13. Cont’d
HEENT:
 Palpable lymph nodes: May indicate systemic infection
or malignancy.
 Enlarged thyroid (hypo- or hyperthyroidism): May affect
reproductive and sexual functioning.
 Conjunctivitis: Can be caused by gonorrhea.
 Oral lesions: Associated with STDs.
Respiratory :
 Chronic lung disease may impair sexual functioning.
2:10:24 PM Female Reproductive System 13

14. Cont’d
Cardiovascular
 Anemia can cause tachycardia and a systolic
flow murmur.
 Oral contraceptives associated with increased
risk of thrombus formation
Breasts
 Cyclic hormonal changes may cause breast
fullness and tenderness
2:10:24 PM Female Reproductive System 14

15. Cont’d
Abdomen
 Palpable abdominal masses: May be a fetus or fibroid
tumor.
 Enlarged liver and ascites: Associated with metastasis
of gynecological cancers.
Musculoskeletal
 Weakness may limit sexual functioning, Neurosyphilis.
 Charcot joints: Late syphilis.
 Unexplained fractures or spinal changes (dowager’s
bump): Osteoporosis in postmenopausal women.
2:10:24 PM Female Reproductive System 15

16. Cont’d
Neurological
 Weakness and paralysis: Neurosyphilis.
 Changes in mental status/psychosis: Late syphilis.
 Depression may affect sexual functioning.
Lymphatic/Hematologic
 Palpable lymph nodes: May indicate infection.
 Inguinal lymph nodes: Associated with metastatic
disease
2:10:24 PM Female Reproductive System 16

17. Physical Examination Female Organ
1. Inspection & Palpation of the External Genitalia
2. Speculum assessment of Internal Genitalia
3. Collection of Specimens for Laboratory
4. Bimanual Examination
5. Rectovaginal Assessment
2:10:24 PM 17
Female Reproductive System

18. Mons Pubis & Pubic Hair Inspection
Normal Findings
 Skin over Mons Pubis clear with normal hair
distribution, inverse triangle
 There may be some growth on abdomen and
upper inner thigh, no nits or lice
 Geriatric: Gray and sparse
2:10:24 PM 18
Female Reproductive System

19. Vulva: Inspection & Palpation
Inspection
 Skin coloration and condition
of the mons pubis and vulva
 Inspecting the Vulva With gloved hands,
separate the labia majora
 Observe the labia majora and the labia minora
for discoloration, symmetric, lesions, trauma.
2:10:24 PM 19
Female Reproductive System

20. Cont’d
Normal Findings Labia majora and minora
• Symmetrical, Smooth to somewhat wrinkled,
unbroken, slightly pigmented skin surface
• No ecchymosis, excoriation, nodules, swelling,
rash, lesions.
• Occasional sebaceous cyst is within normal
limits, nontender, yellow nodules, < 1 cm.
2:10:24 PM 20
Female Reproductive System

21. Cont’d
 Geriatric: atrophied- appears flatter and smaller
 Nulliparous woman, labia meet in midline;
following vaginal delivery, labia are gaping and
slightly shriveled.
 Multiparrous women: majora are separated and
minora more prominent
2:10:24 PM 21
Female Reproductive System

22. Cont’d
Palpating the Labia
 Palpate each labium, vaginal introitus (Bartholin
glands) between the thumb and the index finger
of your dominant hand.
 Feel soft and uniform in structure, no swelling,
pain, induration, or purulent discharge.
 If discharge is present, obtain a specimen and
change the gloves into clean ones.
2:10:24 PM 22
Female Reproductive System

23. Clitoris: Inspection
 Using the dominant hand and index finger,
separate the labia minora laterally to expose the
prepuce of the clitoris
 ~ 2 cm in length and 0.5 cm in diameter
 Without lesions
 Abnormal Findings: Hypertrophy
(clitoromegaly), Chancre, FGM
2:10:24 PM 23
Female Reproductive System

24. Urethral Meatus: Inspect and Palpate
 Inspection by separate the labia minora to
expose the urethral meatus.
 Observe for shape, color, and size of urethra
 Urethral opening appears stellate or slit like
 Midline
 Free from discharge, swelling, or redness
 About the size of a pea
2:10:24 PM 24
Female Reproductive System

25. Cont’d
Palpation
 Milking the urethra and paraurethral glands
 Insert your dominant index finger into the vagina
 Apply pressure to the anterior aspect of the
vaginal wall and milk the urethra
 Observe for discharge and client discomfort
2:10:24 PM 25
Female Reproductive System

26. Vaginal Introitus: Inspect and Palpate
Inspection
 To inspect keep labia minora retracted laterally
 Vaginal opening may appear narrow, vertical slit
 Ask the patient to bear down.
 Observe for patency and bleeding.
 Normal Findings: pink and moist, patent, Without
bulging, normal vaginal discharge
2:10:24 PM 26
Female Reproductive System

27. Cont’d
Palpation
 Insert your dominant finger in the vagina, ask the
client to squeeze the vaginal muscles around
your finger, evaluate muscle strength and tone
Normal Findings Vaginal muscle tone
 In nulliparous woman: tight and strong
 In a parrous woman: it is diminished
2:10:24 PM 27
Female Reproductive System

28. Cont’d
Abnormal Findings
 Pale color and dryness (atrophy, aging)
 Discharge: Foul-smelling, irritating discharge
 Tear, fissure, Bulging
 Pelvic Organ Prolapse: Cystocele, Rectocele,
Cystourethrocele, Uterine Prolapse
2:10:24 PM 28
Female Reproductive System

29. Perineum:
Inspection the Perineum
 Observe texture, and color of the perineum and
shape of the anus
Palpating the Perineum
 Place the index finger posterior to the perineum
and the thumb anterior to the perineum
 Assess perineum between the thumb and index
finger for muscular tone and texture
2:10:24 PM 29
Female Reproductive System

30. Cont’d
Normal Findings of Perineum
 Smooth and Firm,Homogenous in nulliparous
 Thinner in parous women, Slightly darkened
 Well-healed episiotomy.
Abnormal Findings
 Atrophy, Perianal cyst or lump, swelling,
 Tear,Tenderness
2:10:24 PM 30
Female Reproductive System

31. Abnormal Findings of External Genitalia
 Nits (eggs) adherent to pubic hair
 Swelling, discharge
 Bartholin’s Cyst ,
 Carcinoma
 Painless mass indicates malignancy
 Painful mass indicates hernia
 Prolapse of urethral mucosa
2:10:24 PM Female Reproductive System 31

32. Common long-term complications of FGM
 Constant pain.
 Pain and difficulty having sex.
 Repeated infections, which can lead to infertility.
 Bleeding, cysts and abscesses.
 Problems peeing or holding pee in (incontinence)
 Depression, flashbacks and self-harm
2:10:24 PM Female Reproductive System 32

33. Cont’d
2:10:24 PM Female Reproductive System 33

34. Abnormal Findings of External Genitalia
2:10:24 PM Female Reproductive System 34
Syphilitic Chancre
Herpes Simplex Virus- Type 2
excoriations, erythematous areas.
Genital Human Papillomavirus

35. 2. Speculum Examination: Inspection
Cervical Examination
 Select the appropriate sized speculum
 Lubricate and warm the speculum by rinsing it with
warm water
 Do not use lubricant jel
 Hold the speculum with the closed blades between
the index and middle fingers .
2:10:24 PM 35
Female Reproductive System

36. Cont’d
 Insert your nondominant index and middle fingers,
ventral sides down, just inside the vagina and
apply pressure to the posterior vaginal wall
 Encourage client to bear down; this will help to
relax the perineal muscles opens introitus
 Encourage client to relax by taking deep breaths.
2:10:24 PM 36
Female Reproductive System

37. Cont’d
 Oblique insertion of the speculum
 Withdraw your nondominant hand from the
vagina
 Gently rotate the speculum to a horizontal angle
 Advance the speculum at a 45-degree angle
against the posterior vaginal wall. until it reaches
the end of the vagina.
2:10:24 PM 37
Female Reproductive System

38. Cont’d
 Final Adjustment of the Speculum
 Opening of the speculum blades, by depressing
the lever With your dominant thumb,
 Once the cervix is fully visualized, lock the
speculum blades into place.
 Adjust your light source so that it shines through
the speculum.
2:10:24 PM 38
Female Reproductive System

39. Cont’d
Normal Findings of cervix
 Glistening pink color, pale after menopause
 Blue (Chadwick’s sign) during pregnancy
 Midline in to the vaginal, 2.5 cm to 3 cm size in
young woman, Smaller in elderly
 Shape of cervical os: In nulliparous is small and
either round, In a parrous is a horizontal slit
2:10:24 PM 39
Female Reproductive System

40. Cont’d
Abnormal Findings
 Redness, Pallor wit anemia, cyanotic
 Lateral position- adhesion or tumor, Projection
>3 cm may be prolapse.
 Hypertrophy > 4 cm- inflammation or tumor.
 Venereal warts, Candidiasis, Endocervical
Gonorrhea
 Strawberry spots (trichomonal infection)
 Cervical lacerations, Cyst Ectropion, carcinoma
2:10:24 PM 40
Female Reproductive System

41. Cont’d
Inspection of the Vaginal Wall
 Inspection disengage the locking device of the
speculum
 Slowly withdraw the speculum but do not close
the blades
 Rotate the speculum into oblique, inspect the
vaginal walls for color and texture, Pink, Moist,
Deeply ruggated, Without lesions or redness.
2:10:24 PM 41
Female Reproductive System

42. Cont’d
 Geriatric Variation: thinner, drier, Less vascular,
Atrophic
 Abnormal Findings: Vaginal discharge: thick,
white, curdlike with candidiasis, gray, green-
yellow, white, or foul odorous discharge,
Vaginitis , Adenosis, Carcinoma, cysts contain
epithelial tissue, Bacterial Vaginosis
2:10:24 PM 42
Female Reproductive System

43. 3. Collecting Specimens For Culture
 That are obtained from 3 sites- Cervix, Vaginal
pool, Posterior fornix of the vagina
Smears and Cultures Smear
1. Pap test
2. Gonococcal Smear
3. Vaginal wet Mount (Wet Prep)
4. KOH Prep
5. 5% Acetic Acid Wash
2:10:24 PM 43
Female Reproductive System

44. 4. Bimanual Examination
Enables assessment of:
 Vagina
 Fornices
 Adnexa
 Cervix
2:10:24 PM 44
Female Reproductive System

45. Cont’d
Bimanual Examination Vaginal walls
 Palpate the walls of the vagina for any
irregularities or masses
 Lubricate the gloved index and middle fingers of
your dominant hand.
 Carefully separate the labia using the thumb and
index finger of your non-dominant hand.
2:10:24 PM 45
Female Reproductive System

46. Cont’d
 Gently insert the gloved index and middle finger
of your dominant hand into the vagina.
 Enter the vagina with your palm facing laterally
and then rotate 90 degrees so that your palm is
facing upwards.
2:10:24 PM 46
Female Reproductive System

47. Cont’d
Cervix; Examine the cervix to assess:
 Position (e.g. anterior or posterior)
 Consistency (e.g. irregular, smooth)
 Cervical motion tenderness: involves severe
pain on palpation of the cervix and may suggest
PID or ectopic pregnancy.
2:10:24 PM 47
Female Reproductive System

48. Cont’d
Fornices
 The fornices are the superior portions of
the vagina, extending into the recesses created
by the vaginal portion of the cervix.
 Gently palpate lateral fornices for any masses.
2:10:24 PM 48
Female Reproductive System

49. Cont’d
Bimanually palpate the uterus:
1. Place your non-dominant hand 4cm above the pubis
symphysis.
2. Place two of your dominant hand’s fingers into
the posterior fornix.
3. Push upwards with the internal fingers whilst
simultaneously palpating the lower abdomen with
your non-dominant hand. You should be able to feel
the uterus between your hands.
2:10:24 PM 49
Female Reproductive System

50. Cont’d
Assess the uterus:
 Size: approximately orange-sized in an average
female.
 Shape: may be distorted by masses
 Position: the uterus may be anteverted or
retroverted.
 Surface characteristics: note if the uterus feels
smooth or nodular.
 Tenderness: may suggest inflammation (e.g. PID,
ectopic pregnancy).
2:10:24 PM 50
Female Reproductive System

51. Cont’d
Bimanually palpate the adnexa:
1. Position your internal fingers in the left lateral
fornix.
2. Position your external hand onto the left iliac
fossa.
3. Perform deep palpation of the left iliac
fossa whilst moving your internal fingers
upwards and laterally (towards the left).
2:10:24 PM 51
Female Reproductive System

52. Cont’d
4. Feel for any palpable masses, size and shape
(e.g. ovarian cyst, ovarian tumour, fibroid).
5. Repeat adnexal assessment on the right.
6. Withdraw your fingers and inspect the glove for
blood or abnormal discharge.
 Provide paper towels for the patient to clean
themselves.
 Dispose of the used equipment into a clinical
waste bin.
2:10:24 PM 52
Female Reproductive System

53. Cont’d
Abnormal Findings
 Enlargement and lateral displacement
(asymmetric uterus), Immobile
 Nodules or irregular surface (leiomyomas)
 Non palpable uterus (hysterectomy)
 Extreme pain on palpation with inflammation or
ectopic pregnancy.
2:10:24 PM 53
Female Reproductive System

54. 5. Retrovaginal Examination
Performed to assess
 Pelvic pain,
 Rectal symptoms,
 Pelvic mass.
 It can also provide a
sample for fecal
occult blood testing.
2:10:24 PM 54
Female Reproductive System

55. Retrovaginal Examination
1. Assessing rectovaginal septum, post. Uterine wall,
cul-de-sac, and rectum.
2. Change gloves- avoids spreading poss. Infection.
3. Lubricate first two fingers.
4. Instruct pt. poss. Feeling of discomfort.
5. Ask pt. to bear down as fingers are inserted into
vagina, middle finger is gently inserted into rectum,
while pushing with abdominal hand.
2:10:24 PM 55
Female Reproductive System

56. Cont’d
6. Note: Rectovaginal spetum-smooth, thin, firm,
pliable.
7. Rectovaginal pouch, or cul-de-sac- not palpated.
8. Uterine wall and fundus feel firm, smooth.
9. Rotate intrarectal finger to check rectal wall and
anal sphincter tone.
10.Give pt. tissue to wipe area, help her up.
2:10:24 PM 56
Female Reproductive System

57. Abnormal Findings
 Stool test positive for occult blood: Warrants
further investigation.
 Masses or lesions: Consider malignancy or
internal hemorrhoids.
 Lax sphincter tone: Perineal trauma from
childbirth, anal intercourse, or neurological
disorders.
2:10:24 PM Female Reproductive System 57

58. Summery
 The female reproductive system is an area
where you can have a major impact on your
patient’s health through routine screening and
education.
 The assessment also requires sensitivity in
responding to the woman’s need for privacy and
in respecting her personal boundaries.
2:10:24 PM 58
Female Reproductive System

59. Reference
1. https://oer.pressbooks.pub/healthassessment.
montgomerycollege
2. F.A. Davis, 2007, Nursing Health Assessment,
A Critical Thinking Case Studies approach
2:10:24 PM Female Reproductive System 59

60. Thank You!
2:10:24 PM Female Reproductive System 60