This document provides guidance for conducting a physical assessment of the female genitalia, anus, and rectum. It outlines the structures and functions to understand as well as questions to ask the patient regarding their medical history. It then details how to prepare the patient and equipment for examination and describes performing a visual and manual inspection and palpation of the external genitalia, vagina, cervix, uterus, ovaries, and rectovaginal area. Findings considered normal and abnormal are provided. The goal is to conduct a thorough assessment to evaluate for any issues.

1. Assessment of the
Female Genitalia
NCM 101A – Health Assessment RLE
John Richard A. Danganan

2. Review of Anatomy and
Functions

3. In order to perform an adequate assessment of the female genitalia,
anus, and rectum, the examiner must have a knowledge base of the
structure and function of the female genitalia (external and internal
structures) and the anus and rectum.

4. External
Genitalia

5. Internal
Genitalia

6. Anus and
Rectum

7. Health Assessment
Collecting subjective data:
The nursing health History

8. History of Present Health Concerns
What was the date of your last menstrual period? Do your menstrual
cycles occur on a regular schedule? How long do they last? Describe
the typical amount of blood flow you have with your periods. Any
clotting?
What other symptoms do you experience before or during your
period (cramps, bloating, moodiness, breast tenderness)?
How old were you when you started your period?

9. History of Present Health Concerns
Have you stopped menstruating or have your periods become
irregular? Are you currently taking any contraceptives containing
estrogen or progesterone? Do you have any spotting between
periods? What symptoms have you experienced?
Are you still having periods? Have your periods changed?
Are you experiencing any symptoms of menopause?

10. History of Present Health Concerns
Are you on a hormone replacement therapy (HRT) regimen? If so,
what type, and dosage? Are you satisfied with HRT?
Are you continuing to have any symptoms of menopause while taking
HRT?
What are your concerns about going through menopause?

11. History of Present Health Concerns
Are you experiencing vaginal discharge that is unusual in terms of
color, amount, or odor?
Do you experience pain or itching in your genital or groin area?
Do you have any lumps, swelling, or masses in your genital area?
Do you have any problems with your sexual performance?

12. History of Present Health Concerns
Have you recently had a change in your sexual activity pattern or
libido?
Do you experience (or have you experienced) problems with fertility?
Do you have any difficulty urinating? Do you have any burning or pain
with urination? Has your urine changed color or developed an odor?
Have you noticed any blood in your urine?

13. History of Present Health Concerns
Do you have difficulty controlling your urine?
What is your usual bowel pattern? Have you noticed any recent
change in the pattern? Any pain while passing a bowel movement?
Do you experience constipation?
Do you experience diarrhea? Is the diarrhea associated with any
nausea or vomiting?
Do you have trouble controlling your bowels?

14. History of Present Health Concerns
What is the color of your stool? Hard or soft? Have you noticed any
blood on or in your stool? If so, how much?
Have you noticed any mucus in your stool?
Do you experience any itching or pain in the rectal area?

15. Past Health History
Describe any prior gynecologic problems you have had and the
results of any treatment.
When was your last pelvic or rectovaginal examination by a health
care provider? Was a Pap test performed? What was the result?
Have you ever been diagnosed with an STI? If so, what? How was it
treated?

16. Past Health History
Have you ever been pregnant? How many times? How many children
do you have? Is there any chance that you might be pregnant now?
Any miscarriages or abortions?
Have you ever been diagnosed with diabetes?
Have you ever had anal or rectal trauma or surgery? Were you born
with any congenital deformities of the anus or rectum? Have you had
hemorrhoids or surgery for hemorrhoids?

17. Past Health History
Have you ever had a fecal occult blood test (FOBT)? When? Guaiac or
Hemoccult?
Have you ever had a sigmoidoscopy?
Have you had a colonoscopy? When was your last one?

18. Lifestyle and Health Practices
Do you smoke?
How many sexual partners have you had in your lifetime? In the last 6
months? Currently?
Do you use contraceptives? What kind? How often? If you take oral
contraceptives, do you experience side effects?
Have genital problems affected the way in which you normally
function?

19. Lifestyle and Health Practices
What do you call your intimate partner or someone you consider to
be a significant other? What is your sexual preference? Are you
sexually active with males, females, or both? Do you have questions
or concerns about your sexual orientation, sexual desires, or
sexuality?
Do you engage in anal sex?
Do you feel comfortable communicating with your partner about
your sexual likes and dislikes?

20. Lifestyle and Health Practices
Do you have any fears related to sex? Can you identify any stress in
your current relationship that relates to sex?
Do you have concerns about fertility? If you have trouble with
fertility, how has this affected your relationship with your partner or
extended family?
Do you perform monthly genital self-examinations?
How do you anticipate going through menopause? Or how do you
feel about going through menopause if currently experiencing it?

21. Lifestyle and Health Practices
Have you ever been tested for HIV? What was the result? Why were
you tested?
What do you know about toxic shock syndrome? Have you ever had
toxic shock syndrome? If yes, describe your symptoms and treatment.
What do you know about STIs and their prevention? Have you ever
had an STI? If yes, describe your symptoms and how it was treated.

22. Lifestyle and Health Practices
Do you wear cotton underwear and avoid tight jeans?
After a bowel movement or urination, do you wipe from front to
back?
Do you douche frequently?
Do you use any laxatives, stool softeners, enemas, or other bowel
movement-enhancing medications?
How much high-fiber food and roughage do you consume every day?
Do you eat foods high in saturated fat?

23. Lifestyle and Health Practices
Do you engage in regular exercise?
Do you use calcium supplements?

24. Health Assessment
Collecting objective date:
Physical examination

25. Preparing the Client
Before the examination:
Tell the client before she comes in for the examination (at least 4-5
days ahead of time) not to douche.
Inform the client not to use vaginal creams, jellies, medicines, or
spermicidal foams for 2-3 days before the examination. (interferes
with cervical cells).
Inform client not to have sex within 24 hours of the examination
(tissue inflammation).

26. Preparing the Client
On the day of examination:
Ask the client to urinate before the examination.
Ask the client to remove underwear and put on a gown.
Assist the client into the dorsal lithotomy position. Position the
client’s hips toward the bottom of the examination table so that the
feet can rest comfortably in the stirrups.
Ask the client not to put her hands over her head because this
tightens the abdominal muscles

27. Preparing the Client
On the day of examination:
Ask the client not to put her hands over her head because this
tightens the abdominal muscles. Client should relax her arms at the
sides. Of possible, elevate the client’s head and shoulders. This allows
the nurse to maintain eye contact.

28. Preparing the Equipment
• Sterile gloves
• Examination drape and gown
• Spotlight or penlight
• Vaginal speculum of the appropriate size
• Lubricant (KY-jelly)

29. Physical Assessment
Inspect the mons pubis
Normal Findings: Pubic hair is distributed in an inverted triangular pattern and there are no signs of
infestation.
Abnormal Findings:
There is an increasing trend for women, especially younger women, to groom or shave pubic hair.
Lice or nits (eggs) at the base of the pubic hairs - pediculosis pubis infestation (crabs)

30. Physical Assessment
Observe and palpate inguinal lymph nodes
Normal Findings: There should be no enlargement or swelling of the lymph nodes.
Abnormal Findings:
Enlarged inguinal nodes - vaginal infection or irritation from hair removal.

31. Physical Assessment
Inspect the labia majora and perineum
Normal Findings: The labia majora are equal in size and free of lesions, swelling, and excoriation. A
healed tear or episiotomy scar may be visible on the perineum if the client has given birth. The
perineum should be smooth.
Abnormal Findings:
Lesions – infectious disease – herpes or syphilis
Excoriation and swelling – scratching or self-treatment of lesions.

38. Physical Assessment
Palpate the Bartholin glands
Normal Findings: Bartholin glands are usually soft, nontender, and drainage free. Abnormal
Findings:
Swelling, pain, and discharge – infection and abscess

40. Physical Assessment
Palpate the urethra
Normal Findings: No drainage should be noted from the urethral meatus. The area is normally soft
and nontender.
Abnormal Findings:
Drainage from the urethra - possible urethritis

42. Physical Assessment
Inspect the size of the vaginal opening and the angle of the vagina
Normal Findings: 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 45-
degree angle and should feel moist.
Abnormal Findings:
Vagina becomes thinner and dryer – vaginal atrophy (lack of estrogen)
In children, any loss of hymenal tissue between the 3 o’clock position and the 9 o’clock position -
trauma (penetration by digits, penis, or foreign objects) – possible sexual abuse

43. Physical Assessment
Inspect the vaginal musculature
Normal Findings: The client should be able to squeeze around the examiner’s finger. Typically, the
nulliparous woman can squeeze tighter than the multiparous woman.
No bulging and no urinary discharge.
Abnormal Findings:
Absent or decreased ability to squeeze the examiner’s finger – decreased muscle tone.
Bulging of the anterior wall - cystocele
Bulging of the posterior wall – rectocele
cervix or uterus protrudes down – uterine prolapse
Urine leaks out – stress incontinence

44. Assessment guide is using the speculum
1. Before using the speculum, choose the instrument that is the correct
size for the client. Vaginal speculums come in two basic types:
• Graves speculum—appropriate for most adult women and available in
various lengths and widths.
• 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.

46. Assessment guide is using the speculum
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.

47. Assessment guide is using the speculum
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.

48. Assessment guide is using the speculum
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 (Be careful during the speculum
insertion not to pinch the labia or pull the pubic hair. If the vaginal
orifice seems tight or you are having trouble inserting the speculum,
ask the client to bear down. This may help relax the muscles of the
perineum and promote opening of the orifice.)

50. Assessment guide is using the speculum
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 to open blades and allow visualization of the
cervix.
11. Secure the speculum in place by tightening the thumbscrew or
locking the plastic clip.

53. Physical Assessment
Inspect the cervix
Normal Findings: The surface of the cervix is normally smooth, pink, and even. Normally, it is
midline in position and projects 1–3 cm into the vagina. In pregnant clients, the cervix appears blue
(Chadwick sign)
The cervical os normally appears as a small, round opening in nulliparous women and appears slit
like in parous women
Cervical secretions are normally clear or white and without unpleasant odor.

55. Physical Assessment
Inspect the cervix
Abnormal Findings:
In a nonpregnant woman, bluish cervix – cyanosis
In a nonmenopausal woman, pale cervix – anemia
Redness - inflammation
Cervical lesions - polyps, cancer, or infection.
Cervical enlargement or projection into the vagina more than 3 cm - prolapse or tumor.
Colored, malodorous, or irritating discharge – possible cervical cancer (a specimen should be
obtained for culture)

59. Physical Assessment
Inspect the vagina
Normal Findings: The vagina should appear pink, moist, smooth, and free of lesions and irritation. It
should also be free of any colored or malodorous discharge. Abnormal Findings:
Reddened areas, lesions, and colored, malodorous discharge – vaginal infections, STIs, cancer.
Altered pH - infection

60. Physical Assessment
Palpate the vaginal wall
Normal Findings: The vaginal wall should feel smooth, and the client should not report any
tenderness
Abnormal Findings:
Tenderness or lesions - infection

62. Physical Assessment
Palpate the cervix
Normal Findings: The cervix should feel firm and soft (like the tip of your nose). It is rounded and
can be moved somewhat from side to side without eliciting tenderness.
Abnormal Findings:
Hard, immobile cervix – cancer
Pain with movement of the cervix (cervical motion tenderness, CMT) – infection (chandelier sign).

63. Physical Assessment
Palpate the uterus
Normal Findings: The fundus, the large, upper end of the uterus, is normally round, firm, and
smooth. In most women, it is at the level of the pubis; the cervix is aimed posteriorly (anteverted
position). However, several other positions are considered normal. The normal uterus moves freely
and is not tender.
Abnormal Findings:
Enlarged uterus above the level of the pubis is abnormal.
Irregular shape - myomas (fibroid tumors) or endometriosis.
fixed or tender uterus - fibroids, infection, or masses

67. Physical Assessment
Palpate the ovaries
Normal Findings: Ovaries are approximately 3 × 2 × 1 cm (or the size of a walnut) and almond-
shaped. Ovaries are firm, smooth, mobile, and somewhat tender on palpation. A clear, minimal
amount of drainage appearing on the glove from the vagina is normal.
Abnormal Findings:
Enlarged size, masses, immobility, and extreme tenderness are abnormal and should be evaluated.
Large amounts of colorful, frothy, or malodorous secretions are abnormal. Ovaries that are palpable
3 to 5 years after menopause are also abnormal.

71. Physical Assessment
Rectovaginal examination
Normal Findings: The rectovaginal septum is normally smooth, thin, movable, and firm. The
posterior uterine wall is normally smooth, firm, round, movable, and nontender.
Abnormal Findings:
Masses, thickened structures, immobility, and tenderness are abnormal.

73. Physical Assessment
Inspect the perianal area
Normal Findings:
The anal opening should appear hairless, moist, and tightly closed. The skin around the anal
opening is coarser and more darkly pigmented. The surrounding perianal area should be free of
redness, lumps, ulcers, lesions, and rashes.
No bulging or lesions appear.

74. Physical Assessment
Inspect the perianal area
Abnormal Findings:
Lesions - STIs, cancer, or hemorrhoids
A painful mass that is hardened and reddened – perianal abscess
A swollen skin tag on the anal margin - fissure in the anal canal
Redness and excoriation may be from scratching - infected by fungi or pinworms
A small opening in the skin that surrounds the anal opening - anorectal fistula
Thickening of the epithelium - repeated trauma from anal intercourse
Bulges of red mucous membrane - Rectal prolapse. Hemorrhoids or an anal fissure may also be
seen.

82. Physical Assessment
Inspect the sacrococcygeal area
Normal Findings: Area is normally smooth and free of redness and hair.
Abnormal Findings:
A reddened, swollen, or dimpled area covered by a small tuft of hair located midline on the lower
sacrum - pilonidal cyst

84. Physical Assessment
Palpate the anus
Normal Findings:
Client’s sphincter relaxes, permitting entry. Examination finger enters anus. The client can normally
close the sphincter around the gloved finger. The anus is normally smooth, nontender, and free of
nodules and hardness.

85. Physical Assessment
Palpate the anus
Abnormal Findings:
Sphincter tightens, making further examination unrealistic.
Examination finger cannot enter the anus.
Poor sphincter tone - spinal cord injury, previous surgery, trauma, or a prolapsed rectum
Tightened sphincter tone - anxiety, scarring, or inflammation
Tenderness - hemorrhoids, fistula, or fissure
Nodules - polyps or cancer
Hardness - scarring or cancer

87. Physical Assessment
Palpate the rectum
Normal Findings: The rectal mucosa is normally soft, smooth, nontender, and free of nodules.
Abnormal Findings:
Hardness and irregularities – scarring or cancer
Nodules - polyps or cancer

89. Physical Assessment
Palpate the cervix through the anterior rectal wall
Normal Findings: Cervix palpated as small, round mass. May also palpate tampon or retroverted
uterus. Should not have any bright red blood when gloved finger is removed.
Abnormal Findings:
Bright red blood on gloved finger when removed. Large mass palpated. Do not mistake tampon for
mass.

90. Physical Assessment
Check stool
Normal Findings: Stool is normally semisolid, brown, and free of blood.
Abnormal Findings:
Black stool - upper gastrointestinal bleeding
gray or tan stool - ack of bile pigment
yellow stool - steatorrhea (increased fat content)
Blood detected in the stool - cancer of the rectum or colon