Weber Ch 23 & 24 Male & Female Genitalia

•Menstrual cycle/problems

• –Dysmenorrhea
• = painful menses
• Menorrhagia = heavy bleeding/menses

•Lower abdominal or pelvic pain

•Discharge (vaginal), pain, masses, itching, or lymphedema


•Genital lesions or rashes

•Changes in urination (burning or incontinence)

•Menopausal symptoms

•Lump or swelling in breast

• •Problems with uterus/ovaries, or reproduction? Describe.
• •Surgery—what kind, when, why; how affected you?
• •Past history of cancer (ovarian, endometrial or colon)?
• •Chronic illness? (DM, endocrine disorders)
• •Menstruation time period (menarche to menopause)
• •Pregnancies – reproductive history
• –how many times
• –number of babies
• –miscarriages, abortions, stillborn

• Gravida = # pregnancies
• Para
• = # pregnancies > 20 wks. (usually as # preterm births & # term births)
• #
• abortions (spontaneous miscarriages or therapeutic pregnancy terminations)

Last Pap smear, results? - papaniocolaou

• PAP smears q 1yrs after sexually active or age 21
• q2-3 yrs. If 3 in a row normal if > 30 yrs.
• Old
• > 70 yrs. Old can stop PAP tests if not had
• hysterectomy for cancer (ex. 90 y/o nun getting PAP’s)

• Gravida = # pregnancies
• Para
• = # pregnancies > 20 wks. (usually as # preterm births & # term births)
• #
• abortions (spontaneous miscarriages or therapeutic pregnancy terminations)

• •External genitalia
• –Inspect pubic hair—distribution, nits
• –Inspect skin mons pubis/inguinal area—surface characteristics
• –Inspect labia majora/minora—pigmentation/surface
• characteristics
• –Inspect urethral meatus, vaginal introitus/entrance,
• perineum—positioning/surface characteristics

Inspect anus—color, surface characteristics

• •Breasts: paired mammary glands
• –Lie over muscles, anterior chest wall - anterior to: pectoralis major, serratus anterior
• –Extend: horizontally:2nd to 6th rib; vertically:sternum to midaxillary line
• –Functions of female breasts:
• •Production & storage of milk for newborn
• •Sexual stimulation
• •Breasts with 3 types of tissue:
• –3 types of tissue:
• •Glandular
• •Fibrous
• •Fatty

•Breasts: divided into 4 quadrants intersecting at nipple

•Tail of Spence: upper outer quadrant; extends to axillary area; location of most frequent occurrences of breast tumors

• •Inspect breast for size, shape, contour, & symmetry
• •Inspect skin of breast for color, pigmentation, vascularity , surface characteristics & lesions
• •Inspect areola for color & surface characteristics
• Inspect nipples for position, symmetry, lesion, or discharge

• Notes:
• Male with same exam (can have gynecomastia/bilat enlarged or breast CA/unilat. hard painless lump)
• Inspect in various positions (hands over head, hands on hips, hands squeezed together & leaning forward)
• Breasts slightly asymmetrical without dimpling, retractions or bulges (malignancy)
• Breast color & vascularity

• Smooth, evenly pigmented & slightly lighter than other skin exposed to sun
• Bilateral venous pattern of obese or pregnant
• women; increased circulation with malignancy
• Peau d’orange = rough, tough thickened skin due to edema /blocked lymphatic drainage (orange peal skin)
• No erythema/redness or heat (inflammation)
• Areola color varies pink to black yet bilateral with Montgomery tubercles (raised bumps)
• Nipples normally may be flat, protrude, or inverted as long as not recent change (malignancy)
• Supernumerary nipple line from axilla to groin along milk
• line
• Discharge – only normal = serous/yellow; all others abnormal
• Clear/watery with pharmacologic causes (hormones)
• Serosanguineous (straw) = CA
• Sanguineous (bloody) = CA
• Milky = galactorrhea (inappropriate lactation in 20 – 25% women; pituitary tumor with HA & vision problems, hypothyroid, Cushings,
• Tricyclic antidepressants, histamines, antihypertensives)
• Purulent = infectious process
• Multicolored (green, gray, brown) = fibrocystic process/disease

• •Inspect breasts in various postures for bilateral equal pull
• •Inspect & palpate axilla for rashes, lesions or masses
• •Palpate breast for tissue characteristics (tender, temp., mass)
• Palpate nipples for surface characteristics & discharge

• •Breasts atrophy beginning at age 40
• •Decrease in estrogen so clitoris smaller & difficult to palpate ovaries
• •Thinning of pubic hair
• •Drying of mucosa with itching of labia & vagina (atrophy)with dyspareunia

• •Pelvic muscles with less elasticity leads to urinary
• incontinence
• •Vagina & cervix smaller & pale
• •Still do breast exams & PAP smears even if mastectomy or hysterectomy, if for cancer

• •Age > 50 yrs. (77%)
• •Family history
• •Genetics (BRCA1 or BRCA2 genes 10%)
• •Early menarche (before 12)
• •Late menopause (after 50)
• Nulliparous or first child after age 30
• •Caucasian > Black
• •High fat diet, obesity
• •oral contraceptive use
• •Radiation exposure
• •Presence of other cancer
• •Dense breast tissue
• •HRT > 5 yrs.
• •Alcohol (more than 2 drinks per day)

• •Asymptomatic, diagnose by mammogram
• •Nontender lump/thickening in breast UOQ
• •Burning, stinging, or pricking (not pain)
• •Abnormal nipple discharge
• •Rash around nipple
• •Nipple retraction
• •Dimpling of skin or nipple off position
• •Lump under arm or above collar bone
• •Peau d’orange

• •Readiness for enhanced health management RT female
• reproductive system
• •Health seeking behavior: request information on STD’s, birth control, or HRT
• •Risk for infection RT STD’s
• •Disturbed body image RT perceived feminine role &
• sexuality AEB mastectomy
• •Fear of cancer (CA) of reproductive system
• •Acute pain RT dyspareunia (painful intercourse)
• •Ineffective sexuality pattern RT decreased libido &
• menopause
• Anticipatory grieving RT cervical/uterine/ ovarian CA

• •Pain or itching
• •Lumps or swelling in groin, testicles or scrotum
• •Penile lesion or discharge
• •Urinary problems
• •Change in bowel function
• •Rectal bleeding
• Erectile dysfunction

• Hydrocele = fluid accumulation in scrotum
• Variocele = dilation & tortuosity of veins of spermatic cord
• Spermatocele = cystic mass in epididymis or spermatic cord filled with sperm & seminal fluid
• Preventative Exams (Amer. Cancer Society recommends):
• Testicular exam by MD q 3yrs. Ages 30 – 39
• then q 1yr. > age 40 (self exams q month in shower)
• PSA screenings q 1 yr. > age 50 yet younger
• if + family history or Afr. American (age 40-45)
• DRE q 1 yr. > age 40 Digital rectal exam

• •Inspect & palpate:
• –Penis
• –Scrotum
• –Inguinal areas
• Perform rectal exam & palpate prostate

• •Pubic hair
• –Inspect for distribution, general characteristics, & nits
• •Penis
• –Inspect and palpate for surface characteristics, color,
• tenderness, and discharge
• •Circumcised—variable foreskin, uncircumcised – foreskin folded over glans (ask to retract);
• phimosis =tight foreskin, unable to retract
• paraphimosis
• =unable to return foreskin over glans
• •If discharge or smegma present, obtain specimen
• •Palpate glans anteroposteriorly to open distal end of urethra
• –Slit like opening at distal tip of glans (central)
• »Epispadias
• =Urethra opens on upper penis
• »Hypospadias=urethra opens onto lower penis
• •Palpate shaft of penis (non-tender)—semi-firm consistency without nodules

• •Scrotum and testes:
• –Inspect scrotum for color, texture, surface characteristics, position
• •Left side lower; deeply pigmented with sebaceous cysts
• •Appearance affected by temperature
• –Palpate scrotum—surface characteristics and tenderness
• •Scrotum should be nontender

• –Palpate testes, epididymides, vas deferens—location, consistency, tenderness, and nodules
• •Should be smooth and tender
• •Cryptorchidism
• •Transilluminate
• •Teach testicular self-exam
• –Inspect inguinal & femoral areas for bulges while client bears down

• –Inspect perianal area & anus for pigmentation
• & surface characteristics
• –Palpate anus for sphincter tone (hypo or hypertonic tone)
• –Palpate anal canal & rectum for surface characteristics
• (AP)
• –Palpate anterior rectal surface to evaluate prostate (AP)
• –Examine & test stool for presence of occult blood

• •Sexual activity declines in frequency
• •Erection develops more slowly; ejaculation less intense
• •Hyperplasia of prostate (rubbery) is major change (BPH)
• •If excessive prostate enlargement , decrease or obstruction of urinary flow will occur
• •Decreased sperm viability
• •Less abundant & finer pubic hair
• •Elongated scrotal sac & softer testes
• •Internal sphincter less responsive so stool retention
• •External sphincter with less control so fecal incontinence

• •Health seeking behavior : request information on colorectal exams
• •Risk for ineffective health maintenance RT testicular self
• exams
• •Risk for injury RT hernia due to poor lifting technique
• •Ineffective sexuality pattern RT decreased libido with aging
• •Fear RT prostate cancer
• •Acute pain RT dysuria from STD
• •Disturbed body image RT hernia
• •Anxiety RT prostate surgery/cancer
• •Anticipatory grieving RT testicular cancer