FEMALE GENITOURINARY SYSTEM
External Genitalia
1. MONS PUBIS
 rounded mound of fatty subcutaneous
tissue
 highly sensitive to Estrogen
 also called Mons Veneres in Latin which
means “Mound of Venus”
 contains sebaceous glands which
secretes secretions that facilitates
sexual attraction to males.
Pheromones – substantial during sexual
intercourse
2. PREPUCE OF THE CLITORIS
 “clitoral hood”
 protects the clitoris
 covers the shaft of the clitoris
3. CLITORIS
 highly sensitive tissue or glands
 has an abundance of nerve endings
 not synonymous to the glans of the
penis because it does not contain
erectile tissue or nerve cells
 most common site of syphilitic infection
Cunnilingus – oral stimulation of the female
organ
4. LABIA MINORA
 inner lips
 serve or protect from mechanical
irritation, dryness and infection
 protects the urethral meatus
5. LABIA MAJORA
 enclose or protect the inner organs of
the female genitourinary systems
 contain sebaceous glands that secretes
oil to prevent dryness
6. PERINEUM
 the space between the anus and vulva
in females
 space between scrotum and rectum in
males
7. ANUS
 control the expulsion of feces
8. VAGINAL ORIFICE
 allows for the delivery of the fetus during
childbirth
 channels menstrual flow or menses
DEVELOPMENTAL CARE
Infants and Adolescence at birth
 the external genitalia are engorged
Newborns
 since they are not fully developed the
genitalia are engorged (namamaga)
 the ovaries are located in the abdomen
during childhood
 the Uterus is small with straight axis and
no anteflexion
Puberty
 development of secondary sex
characteristics occur
 first signs are breast and pubic hair
development
 Ovaries are now at the pelvic cavity
TANNER’S 5 STAGES OF SMR (Sexual
Maturity Ratings)
Stage 1
 females have no pubic hair, mons pubis
and labia covered with a fine, vellus hair
as on the abdomen
Stage 2
 grows mostly on labia
 long, downy hair and slightly pigmented
 straight and slightly curly occurs at 11
and 12
Stage 3
 grows and spread over the mons pubis
 darker, coarser, curly hair that occurs at
12 and 13
Stage 4
 hair is adult in type and occurs at an
area in the medial thigh that occurs at
12, 13, and 14
Stage 5
 adult in type and pattern is inverse
triangle and hair is present on the
medial thigh surface
Pregnant Female
These are the changes during pregnancy
 changes are highly influenced by the
hormones Estrogen and Progesterone
(key hormones which have important
roles in the physiologic changes of the
female genitourinary system
3 parameters in identifying pregnancy
1. Presumptive Signs
 these are the signs and symptoms
which are felt by the pregnant woman
* morning sickness, nausea and vomiting,
amenorrhea (absence of menstruation)
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2. Probable Signs
 physiologic changes felt by the examiner
Goodell’s Sign
 softening of the cervix at 4 to 6 weeks of
pregnancy
Chadwick Sign
 bluish or purplish discoloration of the
vaginal mucosa and cervix at 8 to 12
weeks
Heger’s Sign
 softening of the lower uterine segment
at 6 to 8 weeks
 uterus increases its capacity by 500 to
1000 times
Non-pregnant Uterus has a flat and pear
shaped by 10 to 12 weeks of gestation the
uterus becomes globular in shape
By 20-24 weeks the uterus is in oval shape
Mucous Plug
 “bloody show” – the sudden gush of
blood from the vaginal orifice
 thick, tenacious mucous that forms in a
space in the cervical canal
Positive Signs
 are the confirmatory tests of pregnancy
* Ultrasound
* Presence of Fetal Heart Tones using
Stethoscope or Fetuscope
Aging Females
1. Menopause
 cessation of Menses that usually occurs
at 48 to 51 years old
 Uterus shrinks in size
 Ovaries atrophy to 1 to 2 cm. and are
not palpable
 Sacral Ligaments relax
 Pelvic musculation weakens
 Cervix thins and looks paler with a thick,
glistening epithelium
 Vaginal epithelium atrophies also and
there is decreased vaginal secretions
and increase risk for Vaginitis and
impaired female sexual response
With all the atrophy, decreased vaginal
secretions, increased risk for Vaginitis this
is because of the diminished presence of
Estrogen
Why are aging females prone to Vaginitis?
Vaginitis is caused by decreased acidity of
the Vagina which creates a medium for
bacterial growth.
CROSS CULTURAL CARE
1. Mexican-Americans
 have strong social value that women do
not expose their genitalia to men
2. Chinese-Americans
 believe that examination of genitalia is
offensive
3. Muslims
 they value respect for female modesty
4. African
 Female Genital Mutilation is common
 “Infibulation” – there is the removal of
clitoris. This is an invasive procedures
that inhibits sexual response among
females
With all the Cultural Considerations,
maintain a calm and business-like manner
and explain to the client the procedure
carefully
Subjective Data Collection
A. Menstrual History
1. Assess for the day of last menstrual
period
 “LMP” or Last Menstrual Period
 obtain the first day of menstrual cycle
and not the last day
 Age at first period (Menarch) 12 to 15
y/o
 Delayed onset of menarch suggests
Endocrine and Underweight problems
B. Obstetric History
 G (Gravida) the total number of
pregnancy dead or alive
 T (Term) indicates the full term of
pregnancy (37-40 weeks AOG)
 P (Pre-term) no. of deliveries at the age
of 20-36 weeks AOG
 A (Abortion) before 20 weeks AOG
Viability: Ability of the fetus to survive
Fetus should be 24 weeks for the fetus
to survive
 L (Living) no. of baby alive
 M (Multiple Pregnancy or Deliveries)
Example Situation:
A 20-year old female is currently 8
weeks pregnant. She had a miscarriage of 12
weeks gestation 2 years ago. She has no living
children. What is the GTPALM?
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G–2
T–0
P–0
A–1
L–0
M–0
C. Menopause
3 Phases:
A. Peri-menopause
 8 to 10 years before menopause
 Ovaries gradually produce less estrogen
 usually starts in a woman’s 40 but can
start in the 30s as well
 women are still having menstrual cycle
and can get pregnant
B. Menopause
 woman no longer has menstrual cycle
 ovaries have stopped releasing eggs
and producing estrogen
 diagnose when a woman has gone
without menstrual cycle for 2
consecutive months
C. Post Menopause
 years after menopause
 menopausal symptoms (e.g. Hot
flushers, headache, mood swings,
vaginal dryness and itching occurs)
 associated symptoms related to
menopause
Osteoporosis
- because estrogen is the hormone that
protects the bones
Also ask the patient fo Self-care behaviors
* How often do you have Gynecologic
Check-ups and last Pap Smear?
Pap Smear is encouraged to women at 19
years old especially if women is sexually
active
D. Urinary Symptoms
Dysuria – painful urination
Nocturia – excessive urination at night
Hematuria – presence of blood in the urine
Difficulty in controlling urine
Diff. types of Urinary Incontinence
*FORUMS
1. Functional
 urinary tract is functioning properly but
other disabilities (e.g. dementia,
Alzheimer’s) are preventing the person
from staying dry
2. Overflow
 there is incomplete bladder emptying
due to blockage of urine from flowing
normally out of the bladder (e.g.
Prostate Cancer)
3. Reflex
 occurs when the bladder muscle
contracts and urine leaks without
warning or urge.
 poor bladder tone brought by neurologic
disorders
4. Urge or Overactive
 feeling of strong urge of feeling to
urinate even when the bladder is not full
 other term is Detrusor Overactivity, there
is affectation at the detrusor area of the
bladder
Detrusor – muscle in the bladder
5. Mixed
 combination of overactive and stress
incontinence
6. Stress
 urine leake out when you jump, cough or
laugh due to physical stress or
excursion which increases abdominal
tension and pressure of the bladder
E. Vaginal History
 Any unusual vaginal discharge note
character, smell and color
F. Pus History
 Any other problems in the genital area
(sores or lesions)
G. Sexual Activity
 ask about sexual relationship and how it
affects health, satisfaction and multiple
sex partners if there is.
 Because higher risk of developing STI is
common to polygamous clients
8. Contraceptive Use
 Method of Contraception being used
(e.g. Withdrawal, Pills, Cervical devices
or implants)
9. STD
 any sexual encounter with partner
having STD should be assessed to
gather information to avoid contact
tracing
Objective Data Assessment
Preparation:
 No gushing for 48 hours
 Urinate before examination to empty the
bladder and to palpate the Uterus and
the ovaries
 Place the patient into Dorsal Lithotomy
Position
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  No hands over the head
Rationale: To relax the abdominal area
of the patient
 Elevate the clients head and shoulders
Equipments:
 Stool
 Light
 Vaginal Speculum
Graves Speculum – for adult women
Pederson Speculum – for young adult
 Water-soluble Lubricant
* in some books use of lubricants are
avoided Rationale: Lubricants provide
bacteriostatic effect which will alter the
result of analysis
* Use warm water instead
 Specimen Container
 Gloves
 Spatula
 Endo Cervical Broom
 pH paper
 mirror
Rationale: The use of mirror helps you
teach the patient about the anatomy of
Female Reproductive System thereby
promoting calm manner and cooperation
from the patient
Inspection
1. Inspect for the skin color
- there should be no pigmented lesion
(if there are any, refer suspected lesion for
biopsy)
2. Hair Distribution
- consider delayed puberty if there is no pubic
hair and breast development
3. Inspect the Labia Majora
- symmetric, plump an well-formed
4. Inspect the Clitoris, Urethral Opening,
Vaginal Orifice and Perineum
5. Inspection of the Cervix and Oust
- use Speculum
- Normally the color of skin mucosa is pink and
even
- there is Chadwick Sign if the client is
pregnant
- Cervix is positioned midline either anterior or
posterior. 1 inch in diameter.
- Oust is small, round, horizontal and irregular
Normal Variations of the Cervix
1. Round
In parous client’s cervix is horizontal
Abnormal/Lacerations
1. Unilateral Laceration
2. Bilateral Laceration
3. Stellate Laceration
4. Cervical Eversion
5. Nabothian Cyst – contains fluid
Cervical Smears and Culture
1. Papanicolaou Smear – 3 specimens are
collected
a. Vaginal Pool
- you insert or gently rub the blunt end or
ayre spatula over the vaginal wall and under
and lateral to the cervix. Wipe the specimen on
the slide and spray with fixative immediately.
Rationale: To prevent drying and to preserve
the specimen.
b. Cervical Scrape
-insert the bifed end of the ayre spatula
into the vaginal wall. Rotate the spatula 360-
720 degrees using firm pressure.
c. Endocervical Speimen (performed last
because it can cause injury)
- insert the cytobrush into the oust.
Rotate the brush 720 degrees in one end
direction.
* the woman may feel a slight pinch of the
brush
Abnormalities in the External Genitalia
1. Pediculosis Pubis (Crab Lice)
 There is severe perineal itching
 There is excoriations
 There is Visible little dark spots
2. Syphilitic Chancre
 Begins as a small, silvery papule that is
round or oval
 There is superficial ulcer with a
yellowish serous discharge
 Causative Agent: Treponema pallidum
 Common site: Clitoris
 Treatment: Penicillin G antibiotic
3. Herpes Genitalis
 Episodes of local pain
 Dysuria
 Fever
 Cluster of small, shallow vesicles and
surrounding erythema
 Treatment: Anti-virals
4. Genital Warts
 Causative Agent: Human Papilloma
Virus
 Pain, flushed-colored, white, moist
papules, cauliflower-like patch
 Risk Factors: Women with multiple
sexual partners
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  Symptoms are worse during
5. Abscess of bartholin’s gland menstruation
Pathognomonic signs:
 Severe, local pain  frothy, yellow-green foul smelling
 Filled with abscess discharge
 Surgery: Incision and Drainage
4. Bacterial Vaginosis
6. Urethral Prolapse
 Constant wetness with foul, fishy rotten
 Tender, painful urination odor
 Urinary frequency  Thin, creamy gray white discharge
 Hematuria
 Small, deep, red mass protruding from 5. Chlamydia
meatus
 May bleed on contact  Urinary Frequency
 Dysuria
7. Urethritis  Vaginal Discharge
 Post-coital bleeding
 Dysuria  May have yellow or green mucopurulent
 Erythema discharge
 Tenderness  Causative Agent: Chlamydia
 Discharge from meatus caused by Trachomatis
Nisceria Gonorrhea, Clamidia and Staph
Infection 6. Gonorrhea (Tulo)

Abnormalities of the Pelvic Musculation  Variable vaginal discharge

1. Cystocele
 Feeling of pressure in vagina
 Stress Incontinence
 Vaginal Orifice Widening
 Soft, Round, Inferior Bulge Bladder
2. Rectocele
 Dysuria
 Abnormal Uterine Bleeding
 Abscess in Bartholin’s Gland
 May proceed to Pelvic Inflammatory
Disease
**This was based on the voice record of Sir
Far’s lecture. Please recheck nalang if you
feel na may sayop. Hihi studywell!

 Same with the case of Cystocele but the

Rectum part is infected

3. Uteral Prolapse

 Uterus protrudes into vagina

 Common among older adults
 Surgical Procedure: Hysterectomy

Bulbovaginal Inflammation

1. Acrotic Vaginitis

 Vaginal itching, dryness, burning

sensation
 Pale mucosa that bleed easily
 May have bloody discharge

2. Candidiasis

 Intense pleuritus
 Thick, whitish discharge
 Discharge like cottage-cheese

3. Trichomoniasis

 Watery pleuritus
 Urinary frequency
 Terminal Dysuria

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