HEALTH ASSESSMENT- FEMALE & MALE GENITO-URINARY SYSTEM

HEALTH ASSESSMENT:
FEMALE GENITO-
URINARY SYSTEM
BY: ROMMEL LUIS C. ISRAEL III

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STRUCTURES
• Mons pubis
• Clitoris
• Perineum
• Anus
• Uterus
• Ovaries
• Urethra
• Vagina
• Labia majora & minora
• Urinary meatus
• Bartholin’s glands
• Cervix
• Fallopian tubes
• Kidneys
• Bladder
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FUNCTIONS
•Mons pubis: subcutaneous pad
over symphysis pubis for
protection
•Labia majora/minora: folds of
adipose and connective tissue that
protect and lubricate external
genitalia
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FUNCTIONS
• Clitoris: erectile tissue for sexual
stimulation
• Urinary meatus: opening to urethra
•
• Skene’s glands: lubricate and protect
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FUNCTIONS
• Vaginal introitus: opening of the vagina
• Vagina: muscular tube for copulation,
birth canal, and menses
• Bartholin’s glands: secretes alkaline mucus
that improves viability & motility of sperm
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FUNCTIONS
•Cervix: end of the uterus into
vagina
•Uterus: hollow, muscular organ;
site for fertilized egg implantation;
protects fetus
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FUNCTIONS
•Tubes: passage for ovum to uterus, site
of fertilization
•Ovaries: produce ova, estrogen, and
progesterone
•Kidneys: filter and excrete wastes
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FUNCTIONS
• Ureter: connects kidneys to bladder
• Bladder: hollow muscular structure; holds
urine
• Urethra: connects bladder to urinary
meatus opening
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DEVELOPMENT VARIATIONS
What developmental variations of the female
genitourinary system might be seen with:
• Children
• Pregnant patients
• Older adults
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HISTORY
What can the history tell you about the female
genitourinary system?
• Biographical data
• Current health status
• Past health history
• Family history
• Review of systems
• Psychosocial history
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SYMPTOMS
What symptoms would signal a problem with
the female genitourinary system?
• Vaginal discharge
• Lesions
• Vaginal bleeding, pain
• Amenorrhea
• Urinary symptoms
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PHYSICAL ASSESSMENT
• Anatomical landmarks: external—note position of
structures; internal—visualize underlying
structures
• Approach: inspection, palpation
• Position: lithotomy
• Tools: gloves, speculum, lubricant, light, slides and
swabs for specimen collection
• General survey and head-to-toe scan
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INSPECTION
• External genitalia: color, hair distribution,
condition of skin, lesions, discharge, odor,
pubic pediculosis, prolapse
• Rectal area: condition of skin, lesions,
discharge, bleeding, hemorrhoids, fissures
•
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ABNORMAL
FINDINGS
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1. CYSTOCELE
•Bladder herniate into the vagina as
a result of pregnancy
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2. RECTOCELE
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•Results from a tear in the
rectovaginal septum (Rectal
tissue bulges through this tear,
into the vagina, as a hernia .
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3. HEMORRHOIDS
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INSPECTION
•Pelvic exam: color, lesions of
vaginal walls; color, lesions,
discharge, position, size, shape,
and patency of cervical os (obtain
specimens)
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PALPATION
• Skene’s and Bartholin’s glands: masses,
swelling, discharge, tenderness
• Vaginal wall: texture, swelling, lesions,
tenderness
• Cervix: size, shape, consistency, position,
mobility, tenderness
• Uterus: size, shape, symmetry, position, masses,
tenderness
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PALPATION
• Ovaries: size, shape, symmetry,
tenderness
• Anus and rectum: sphincter tone,
tenderness, lesions, masses,
hemorrhoids, polyps; test any stool for
occult blood
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SEQUENCE OF A PELVIC
EXAMINATION
• Mons pubis--note quantity and distribution of
hair growth
• Labia--usually plump and well-formed in adult
female
• Perineum--slightly darker than the skin of the
rest of the body. Mucous membranes appear
dark pink and moist
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SEQUENCE OF A PELVIC EXAMINATION
• Separate the labia and inspect the labia minora:
• Labia minora
• Clitoris
• Urethral orifice
• Hymen
• Vaginal orifice
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SEQUENCE OF A PELVIC EXAMINATION
•Note the following:
• Discharge
• Inflammation
• Edema
• Ulceration
• Lesions
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FINDINGS
• Note abnormalities such as:
• Bulges and swelling of vulva
and vagina
• Enlarged clitoris
• Syphilitic chancres (painless
ulcer)
• Sebaceous cyst
Primary Syphilis
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SPECULUM EXAMINATION OF INTERNAL
GENITALIA
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SPECULUM EXAMINATION OF
INTERNAL GENITALIA
• Select a speculum of appropriate
size, lubricate and warm with warm
water (Commercially prepared
lubricants interfere with pap smear
studies)
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• Small--not sexually active female
• Medium--sexually active
• Large--women who have had children
•Medium to large speculum may be
used if female has had children.
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EXAMINATION/COLLECTION SPECIMEN
OF THE CERVIX
•Inspect the cervix
• Discharge:
• Endocervical vs. from vaginal vault
• Physiological discharge--odorless,
colorless
• Culture any discharge.
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EXAMINATION/COLLECTION SPECIMEN
OF THE CERVIX
• Inspect the cervix
• Os:
• Nulliparous--
small, round, oval
• Parous/multiparou
s--linear, irregular,
stellate
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INSPECTION OF THE VAGINA
• Withdraw the speculum slowly while
observing the vaginal wall
• Close blades as the speculum emerges
from the introitus
• Inspect vaginal mucosa as the speculum is
withdrawn
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PAP SMEAR
• Papanicolaou test (also called Pap
smear, Pap test, cervical smear, or
smear test) is a screening test used in
gynecology to detect premalignant and
malignant (cancerous) processes in the
ectocervix.
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PERTINENT PHYSICAL FINDINGS
• External genitalia pink, moist, intact; small amount
of white, ordorless discharge; no lesions
• Vaginal walls and cervix pink, moist, intact; no
lesions
• Uterus anteverted, no masses, non-tender
• Ovaries and tubes non-palpable
• No rectal masses; hematest negative
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NORMAL FINDINGS: INSPECTION
• Pubic hair distribution shaped like an inverse
triangle
• No parasites present
• Labia majora and minora are symmetrical,
skin is slightly pigmented, intact
• Urethral opening is midline; free from
discharge, swelling, or redness
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NORMAL FINDINGS: INSPECTION
• Vaginal mucosa is pink and moist
• Normal vaginal discharge is clear to white,
free from odor
• Perineum is smooth, slightly darkened
• Anus is dark pink to brown and puckered
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NORMAL FINDINGS: PALPATION
• Labia are soft, free from swelling, pain,
induration, or purulent discharge
• Vaginal muscle tone is strong in nulliparous;
diminished in multiparous
• Perineum is smooth and firm
• Urethral meatus is free from pain or discharge
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NORMAL FINDINGS:
INTERNAL GENITALIA
•Cervix is pink, pale (menopause), or
blue (pregnancy)
•Cervix is midline
•Glistening pink cervical epithelium
•Cervical os is round in nulliparous; or
a horizontal slit in multiparous
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NORMAL FINDINGS
• Vaginal wall is nontender, free from
lesions, masses, or cysts
• Cervix is mobile, nontender, symmetrical,
rounded, and midline
• Uterus is pear-shaped in nongravid;
rounded in parous
• Ovaries are almond-shaped, firm, smooth,
and mobile without tenderness
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HEALTH ASSESSMENT:
MALE GENITO-
URINARY SYSTEM

External genitalia
Penis
• is a cylindrical organ that passes
urine and delivers sperm into the
female vagina.
It consists of three parts:
• A ROOT
- that attaches the penis to the
perineum
• A BODY
- (shaft) that makes up the bulk of
the penis.

External genitalia
• THE GLANS
- is the enlarged end of the
body.
- is covered by a prepuce
(foreskin), which may be
surgically removed in a
procedure called
circumcision.

External genitalia
FUNCTIONS OF THE PENIS:
• It is the organ for micturition.
• Delivers sperm into the female reproductive
system.
• It is the also the organ for copulation.
• It signifies sex for male at birth.

External genitalia
SCROTUM
• Is a thin sac consisting of skin
and superficial fascia that hangs
from the base of the penis.
• It is a continuation of the abdominal wall skin which
gets deeply pigmented after puberty due to increased
fat deposit.
• The scrotal wall has thin skin that is formed in folds
called Rugae.

External genitalia
SCROTUM
•The external scrotum positions the testes outside the
body in an environment about 37°C below that of the
body cavity.
•This is necessary for the development and storage
of sperm.
•Two muscles help to maintain this temperature in
response to the external conditions. (e.g- too cold or
hot).

HEALTH ASSESSMENT- FEMALE & MALE GENITO-URINARY SYSTEM

External genitalia
FUNCTIONS OF THE SCROTUM
• Creates room for sperm morbidity and viability.
• Protects and accommodates the testes, epididymis and
vas deferens.
• Readily responds to environmental changes to maintain a
constant temperature for the testes.
• Also signifies sex at birth.

Internal genitalia
TESTES
• Are a pair of two solid oval shaped
organs.
• They are suspended vertically in the
scrotum by the spermatic cord/vas
deferens.
• The left testis is lower than the right
because the left spermatic cord is
longer.
The testes are enclosed by two coats:
• The tunica vaginalis is the outer
double-layer of serous membrane
surrounding each testis.

Internal genitalia
SPERMATIC CORD
• Testes are suspended in the
scrotum by a spermatic cord.
• It contains blood vessels,
lymphatic vessels, nerves,
and the vas deferens or
ductus deferens.
• On the left side is usually
longer; thus the left testes
hangs lower than the right
testes.

Internal genitalia
EPIDIDYMIS
• Is a comma-shaped organ that lies adjacent to each testis.
• Each of the two epididymites contains a tightly coiled tube, called
the ductus epididymis.
• Here is where sperm complete their maturation and are stored
until ejaculation.
• During ejaculation, smooth muscles encircling the epididymis
contract, forcing matured sperm into the next tube, the ductus
deferens.

Internal genitalia
EPIDIDYMIS
• The lower part of the epididymis is continuous with the muscular
duct to form the Vas Deferens.
FUNCTIONS OF THE
EPIDIDYMIS
• Serves as the main storage
site for sperm.
• Helps in propelling sperm
into the vas deferens.

Internal genitalia
VAS DEFERENS
• The ductus deferens (vas deferens) is the tube through which
sperm travel when they leave the epididymis.
• Each of the two tubes enters the abdominal cavity, passes
around the urinary bladder and together with the duct from the
seminal vesicle to join the ejaculatory duct.
• Before entering the ejaculatory duct, the ductus deferens
enlarges, forming a region called the ampulla.

Internal genitalia
VAS DEFERENS
• AS (DUCTUS) DEFERENS Sperm are stored in the ductus
deferens until peristaltic contractions of the smooth muscles
surrounding the ductus force sperm forward during ejaculation.
FUNCTIONS OF THE VAS DEFERENS
• Helps in the transportation of sperm from the epididymis to the
urethra.
• Serve as a reservoir for sperm.
• Secrets some fluid that supports the sperm.

Internal genitalia
EJACULATORY DUCT
• The two ejaculatory ducts pass through the
urethra and then connect the seminal vesicles
to the urethra carrying the secretions of the
said organs. The ejaculatory duct is the
passageway of the semen.

Internal genitalia
Prostate Gland
• The prostate gland is located just below the
bladder in men and surrounds the top portion of
the tube that drains urine from the bladder
(urethra). The prostate's primary function is to
produce the fluid that nourishes and transports
sperm (seminal fluid).

Internal genitalia
Seminal Vesicle
• Is about 4 cm long. The thick mucoid
secretion of the seminal vesicles is high in
sugar and protein and has a low pH,
causing sperm cells to become more motile
once surrounded by this nourishing fluid.

Internal genitalia
Spermatozoa
• The sperm cell or spermatozoa is the male sex cell or
gamete.
• Spermatogenesis is the maturation of sperm cell. It takes
about 64 days for the sperm cells to attain maturity.

Inguinal area
• It is contained between the anterior superior iliac
spine laterally and the symphysis pubis medially.
• Is a tube-like structure 4 to 5 cm or 1.5 to 2 in
long in an adult through which the vas deference
travels as it passes through the lower abdomen.
• The external inguinal ring- is the exterior
opening of the inguinal canal
• The internal inguinal ring- is the internal
opening of the inguinal canal

Collecting Subjective Data
• History of present health concern
• Past health history
• Family history
• Lifestyle and health practices

Collecting Objective Data:
Physical Examination
Equipment :
• Stool
• Gown
• Disposable non-latex gloves
• Flashlight
• Stethoscope
• Specimen card

Procedure:
1. Introduce yourself and verify the client’s
identity. Explain to the client what you are
going to do, why it is necessary and how the
client cooperate.

Procedure:
2. Perform hand hygiene and observe other
appropriate infection control procedures.

Procedure:
2. Provide for client privacy.

Assessment Procedure
Penis
INSPECTION
1. Inspect the skin, prepuce (if present), and
glans
a) Retract the foreskin (or ask the patient to retract it)
b) The presence of smegma, secretions of the glans, is
normal
c) Do not retract the foreskin if it is painful/tight
2. Replace the foreskin

Penis
INSPECTION
3. Note any ulcerations, scars, nodules, or signs of
inflammation
4. Check the skin around the base of the penis for
excoriations or inflammation, also look for nits/lice in
the pubic hair

Condyloma acuminata Chancroid
Gonorrhea
Herpes
Granuloma inguinale

Penis
INSPECTION
5. Observe the location of the urethral meatus
6. Compress the glans gently between your index finger
and thumb to open the urethral meatus and inspect for
discharge
7. If the patient reports a history of discharge, gently milk
the shaft of the penis from the base to the glans (you
may ask the patient to do this)

Penis
PALPATION
1. Palpate the shaft of the penis between
your thumb and first two fingers
2. Note any tenderness, induration, or other
abnormalities

Scrotum
INSPECTION
1. The patient should be standing facing the
examiner
2. Inspect the skin of the scrotum and note the
position of the testes
a) Lift the scrotum to visualize the posterior surface
b) One side often hangs lower than the other
3. Note any swelling, lumps, rashes, or loss of rugae

Scrotum
PALPATION
1. The testicles are extremely sensitive and should be handled
gently
2. Warm your hands before palpating
a) A common cause of an undescended testicle is an examiners
cold hands
3. Using your thumb and first two fingers, palpate each testis,
epididymis, spermatic cord, and external ring
4. The testis has the consistency of a hard-boiled egg or
rubber ball

Scrotum
PALPATION
5. The epididymis is located on the superior posterior surface
of the testicle and is soft and wormlike
a) Do not confuse with an abnormal lump
6. Note size, shape, consistency, tenderness, presence of
nodules, dilated veins, thickening, or other abnormalities
7. Palpate each spermatic cord (including the vas deferens)
from the epididymis to the superficial inguinal ring
8. Note any nodules or swellings

Undescended Testis/
cryptorchidism
Inguinal Hernia

Inguinal area
INSPECTION
1. Inspect for inguinal and femoral hernia.

Inguinal area
PALPATION
1. Palpate for inguinal
hernia and inguinal
nodes.
2. Palpate inguinal lymph
nodes.
3. Palpate for femoral
hernia.

ABNORMAL FINDINGS
105

1. GENITAL WARTS
•highly contagious sexually
transmitted infection caused by
some sub-types of human
papillomavirus (HPV).
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2. TINEA CRURIS
•a fungal infection of the groin
region in either sex, though more
often seen in males.
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3. PHIMOSIS
•the male foreskin cannot be fully
retracted from the head of the penis.
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4. PRIAPISM
•potentially harmful and painful
medical condition in which the erect
penis does not return to its flaccid
state, despite the absence of both
physical and psychological
stimulation, within four hours
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5. SCROTAL SWELLING
•abnormal
enlargement of
the scrotum,
the sac
surrounding
the testicles.
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6. CHORDEE (PEYRONIE’S DISEASE)
•Head of the penis curves downward or
upward, at the junction of the head
and shaft of the penis
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7. HYDROCELE
•Accumulation of clear fluid in the
tunica vaginalis, the most internal of
membranes containing a testicle.
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PALPATION
•Penis: consistency, tenderness,
masses, discharge
•Scrotum & testes: size, shape,
symmetry, mobility, tenderness,
masses
•Epididymis: swelling, tenderness,
nodules
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PALPATION
• Inguinal area: hernias, lymph nodes,
tenderness
• Anus & rectum: sphincter tone,
tenderness, lesions, masses, hemorrhoids,
polyps, test any stool for occult blood
• Prostate: size, shape, symmetry, mobility,
consistency, nodules, tenderness, grade
size
124

Testicular Self-Exam
1. May be easiest to perform exam
after a warm shower/bath since heat
relaxes the scrotum which makes it
easier to examine
2. Standing in front of a mirror, check
for any swelling of the scrotal skin
3. Examine each testicle separately
4. Cup the testicle between your thumb
and fingers with both hands and roll it
gently between the fingers
Note: one testicle may be larger than the
other which is normal

5. Find the soft, tube-like structure at the back of the
testicle (the epididymis)
6. Report to your doctor immediately if you find any
abnormalities (e.g. lumps, painful areas, skin
changes, or swelling)
Testicular Self-Exam

https://www.youtube.com/watch?v=kbX9HAxirhw
https://www.youtube.com/watch?v=JcGSFif1eyg

HEALTH ASSESSMENT- FEMALE & MALE GENITO-URINARY SYSTEM

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HEALTH ASSESSMENT- FEMALE & MALE GENITO-URINARY SYSTEM