Female Genitalia - Examination and Findings

Assessment of the female reproductive system should be completed as part of a comprehensive client assessment or as part of a focused exam if the client is experiencing issues, such as vaginal discharge or pain with intercourse. This assessment provides the nurse with information about the genitalia, as well as general sexual and reproductive health. This assessment applies to any client with female reproductive organs, regardless of their gender identity.

Okay, the supplies needed for the female reproductive exam include drapes, gloves, and a good source of light. For certain parts of the exam, the nurse will assist the healthcare provider or act as a chaperone, which is often required by facilities to protect your client and clinician during female reproductive exams.

Before getting started, ask your client to empty their bladder, because a full bladder can make the examination uncomfortable. Also, ensure the temperature in the room is comfortable, and warm your hands since cold temperatures can cause rigidity of the pelvic muscles. Remember to provide privacy by closing the door and curtains.

Before getting started, be sure to answer any questions they might have before obtaining verbal consent. Then, perform hand hygiene and collect your supplies. Then, assist your client into the lithotomy position, meaning they are lying flat on their back with their feet in stirrups. You'll help your client get into this position by sliding their buttocks to the end of the examination table and draping them in a way that minimizes unnecessary exposure. You should lay the drape above their knees, up to the symphysis pubis, and then let the drape hang low between the knees.

During the examination, keep in mind that the female reproductive assessment can be uncomfortable, both physically and emotionally, so some special considerations should be made while completing this assessment. It's crucial to explain exactly what will happen at every step. Furthermore, this examination can be especially anxiety-producing for clients who are transgender or those who have experienced sexual abuse or trauma. For transgender clients, be sure to use gender appropriate terms and preferred pronouns. Also keep in mind that clients who have had gender-reaffirming surgery may have variations in their assessment depending on the procedures performed. For clients who have experienced sexual abuse or trauma, avoid rushing your assessment and use a gentle touch. You should let your client know that at any time the exam can be stopped or paused if they request. In addition, for all clients, it's recommended to let them know you're starting by touching your client in a neutral location, such as the lower leg.

Locating the anatomical landmarks of the female reproductive system will help guide your assessment. Now, the landmarks for the external female genitalia are contained in the perineum, called the perineal region, which is a diamond-shaped area that can be divided into two triangles, the anterior urogenital triangle and the posterior anal triangle. The urogenital triangle houses the external genitalia, called the vulva. The vulva is made up of the mons pubis, labia majora, labia minora, the clitoris, and the vestibular glands. Other landmarks include vaginal introitus or opening, urethral opening, as well as the anus, which is located in the anal triangle.

Methods of assessment for the female reproductive system are inspection and palpation.

Okay, begin your assessment with inspection of the external female genitalia. First, you should inspect the skin and look for hair distribution on the mons pubis and labia majora. The skin should be smooth, clean, and intact; and the hair should be evenly distributed. If your client complains of itching in the pubic area, check the hair for evidence of lice. The eggs, or nits, will appear as small, bluish spots. It's important to note that some clients will not have pubic hair due to shaving or waxing. Normally, the labia majora should not be swollen, as this can indicate an infection of the Bartholin gland.

At this time, you should look for labial redness, excoriation, rashes, or lesions, which may occur with an infection or if your client has been scratching. Check for genital warts, which appear as raised cauliflower-shaped papules. You should also note any signs of vaginal trauma, such as scarring or bruises, that could indicate abuse. When assessing for vaginal bruising, remember to look for deep blue or even a black tone in darker skin, instead of purple, blue, or green in clients with lighter skin.

Moving on to the labia minora, you'll use the fingers of one hand to separate the labia majora. The tissue of the labia minora should be moist and smooth and it may appear asymmetric, which is normal. You should note any signs of redness, excoriation, or caking of discharge, which may occur in clients with a yeast infection or poor hygiene. Ulcers and lesions can indicate a sexually transmitted infection, or STI. The clitoris should be 1 to 2 centimeters or less in length and 0.5 centimeters wide.

Clitoral enlargement is an unexpected finding and can indicate your client is undergoing masculinizing hormone therapy or it could be due to inflammation. Next, you should inspect the urethral orifice, which usually has an irregularly shaped opening. Assess for discharge, polyps, or fistulas. Redness, swelling, or dilation of the urethral meatus can occur with a urinary tract infection, or UTI. After that, visualize the vaginal introitus which may normally vary in shape and size. The skin of the vaginal introitus should look moist and be free from swelling, discoloration, discharge, lesions, or nodules.

You'll assess the perineum, which should be smooth, firm, and without lesions or nodules. However, if your client has undergone an episiotomy, scarring might be present. Then, inspect the anus, which should be darker in color than the rest of the perineum. Although the skin may appear coarse, it should be without lesions, redness, lumps, fissures, or skin tags.

Next up is palpation. Using the fingers of one hand, divide the labia majora to see the labia minora. Then with your other hand, you'll palpate the labia minora, clitoris, urethral orifice, and the perineum. The skin of the vulva, labia majora and labia minora should typically feel smooth, soft, and be non-tender.

As the nurse, it's your responsibility to correctly assess, interpret, report, and document your findings. If your assessment reveals something that's potentially abnormal or emergent, such as a perineal lesion, vaginal discharge, or pain, you should report this immediately to the healthcare provider; while continuing to monitor your client's progress or changes from baseline.

Alright, as a quick recap…. Assessment of the female reproductive system provides the nurse with information about the genitalia and general sexual and reproductive health. The supplies needed for the female reproductive exam include drapes, gloves, and a good source of light. Methods of assessment for the female reproductive system are inspection and palpation. As the nurse, it's your responsibility to correctly assess, interpret, report, and document your assessment findings.