BACHELOR OF SCIENCE IN NURSING:

HEALTH ASSESSMENT
COURSE MODULE COURSE UNIT WEEK
3 18 15

Adult Physical Assessment: Female Genitalia & Rectum

✓ Read course and unit objectives

✓ Read and comprehend study guide prior to class
attendance
✓ Read and comprehend required learning
resources
✓ Engage in classroom discussions
✓ Participate in weekly discussion board (Canvas)
✓ Answer and submit course unit tasks

At the end of this unit, the students are expected to:

Cognitive:
1. Describe the structure and the function of female genitalia, anus and rectum.
2. Interview a client for an accurate nursing history of the female genitalia, anus and rectum.
3. Explain the correct method for teaching a client how to perform self-examination.
4. Describe the findings frequently seen with assessing the older client’s genitalia, anus and
rectum.
5. Differentiate between normal and abnormal findings of female genitalia, anus and rectum
 6. Analyze the data from the interview and physical assessment of the genitalia, anus and
rectum to formulate valid nursing diagnosis, collaborative problems, and/or referrals.

Affective:
1. Listen attentively during class discussions
2. Demonstrate tact and respect when challenging other people’s opinions and ideas
3. Accept comments and reactions of classmates on one’s opinions openly and graciously.

Psychomotor:
1. Participate actively during class discussions
2. Confidently express personal opinion and thoughts in front of the class

Weber, J.R., and Kelley, J. H., (2018) Health Assessment in Nursing 6th Edition, Philadelphia:
Wolters Kluwer

ASSESSMENT OF THE MALE AND FEMALE GENITALIA

ASSESSMENT PROPER
• Inspection
o Skin
▪ With patient in lithotomy position
• note for pubic hair distribution
• check skin for lesions
• edema
• ecchymosis
• pubic pediculosis
▪ Normal
• Pubic hair is distributed in an inverted triangular pattern
• May be some growth on abdomen and upper inner thighs
• Diamond-shaped pattern extending up to the umbilicus
• No signs of infestation
• Skin over mons pubis is clear
• Older clients may have gray, thinning pubic hair
• Labia majora and minora
o symmetrical with smooth to moderately wrinkled
 o slightly pigmented skin without
▪ ecchymosis
▪ excoriation
▪ nodules
▪ edema
▪ rash
▪ lesions
o Clitoris
▪ Note position, redness or lesions
▪ Clitoris about 2 cm long and 0.5 cm in diameter
▪ No redness or lesions
o Urethral Orifice
▪ Use thumb on dominant hand to separate labia minora to expose urethral
meatus, which is very sensitive to touch
▪ Note shape, color, and size
▪ Note color, position, redness, edema, lesions, or discharge
▪ Urethral opening slit-like, midline, and free of discharge, swelling, redness, or
lesions
o Perineum and Anus
▪ Perineum is smooth and slightly darkened
▪ A well-healed episiotomy scar is normal after vaginal delivery
▪ Anus is dark pink to brown and puckered
▪ Skin tags are common around anal area
▪ Note color, lesions, bulges, or hemorrhoids

DEVIATIONS FROM NORMAL

▪ Pubic lice, nits, or flecks of residual blood on skin
▪ Ecchymosis
• May be caused by blunt trauma
▪ Labial varicosities
• Pregnancy or uterine tumor
▪ Edema
• Hematoma formation, obstruction of lymphatic system
▪ Broken areas of skin
• Ulcerations or abrasions caused by infection or trauma
▪ Rash over mons pubis and labia
▪ Chancre
• Primary syphilis. Painless, reddish, round ulcer with depressed center
and indurated edges
▪ Condylomata acuminatum (venereal warts):
• White, dry, painful growths with narrow bases
• Cause
 o HPV
▪ Herpes simplex
• Small, red, painful vesicles that progress to ulcer stage
• Pruritus may be present
▪ Hypertrophy of clitoris
• May indicate female PSEUDOHERMAPHRODITISM caused by
androgen excess
▪ Chancroid
• Painful ulcer with rough floor and purulent yellow exudate heals,
leaving a scar
▪ Discharge of any color from meatus
• May indicate UTI
▪ Female circumcision is removal of all or part of the clitoris, labia minora, and
labia majora, usually in early childhood or early adolescence
• This practice is widespread in many African countries and among
some Muslim groups
▪ Swelling or redness around meatus:
• Possible infection of
o Skene’s gland
o urethral caruncle
o urethral carcinoma
o prolapse of urethral mucosa
▪ Possible atrophy from topical steroids and aging
▪ Foul-smelling discharge that is not clear to slightly pale white is abnormal
• Gonorrhea
• Chlamydia
• Candida
• Trichomonas
• Bacterial vaginosis
• Atrophic vaginitis
• Cervicitis
▪ External tear
• May indicate trauma from sexual activity or abuse
▪ Fissure
• May indicate congenital malformation or childbirth trauma

▪ Cystocele is bulging of bladder into

anterior vaginal wall
 ▪ Cystourethrocele is bulging of anterior vaginal
wall, bladder, and urethra into vaginal introitus

▪ Fissure or tear of perineum:

• Trauma
• Abscess
• Unhealed episiotomy
▪ Venous prominences in anal area
• May indicate external hemorrhoids
▪ Perineal Lacerations
▪ Vaginal Necrosis / Ecchymosis
▪ Rectocele
• Prolapse of the front wall of the rectum to the back wall of the vagina
• Palpation
o Labia
▪ Palpate each labium between thumb and
index finger of your dominant hand
▪ Normal
• Labia soft and uniform in structure
with no swelling, pain, induration, or
purulent discharge

o Urethral Meatus, Skene's & Bartholin's Glands

▪ Insert index finger of your dominant hand
into vagina, and apply pressure to anterior
aspect of vaginal wall to milk urethra
▪ Swab any discharge with cotton-tipped
applicator for microscopic exam
▪ Normal
• Milking urethra no pain or urethral
discharge
• Skene’s glands surround urethral meatus
 • Bartholin’s glands deep in perineal structures
o Vaginal Introitus
▪ Keep your finger in the vagina, and ask the patient to squeeze the vaginal
muscles around it
▪ Normal
• Vaginal muscle tone tight and strong in nulliparous women and
diminished in parous women
o Perineum
▪ Partially remove your finger from the introitus until it is posterior to the
perineum, with your thumb anterior to the perineum
▪ Assess tone and texture
▪ Normal
• Perineum smooth, firm, and homogenous in nulliparous women and
thinner in parous women

DEVIATIONS FROM NORMAL

• Swelling, redness, induration, or purulent discharge from labial folds
with hot, tender areas
o Bartholin’s gland infection
▪ cause
• gonococci
• Chlamydia trachomatis
• Pain and discharge
o Skene’s gland infection
▪ UTI
• Significantly diminished/absent muscle tone
o cause
▪ injury
▪ age
▪ childbirth
• Bulging from vagina
o Cystocele
o Rectocele
o Uterine prolapse
• Thin perineum, fissures, tears
o Atrophy
o Trauma
o Unhealed episiotomy

Anus and Rectum

• Inspection
 o Inspect the perianal area. Spread the client’s buttocks and inspect the anal opening
and surrounding area for the following:
▪ Lumps
▪ Ulcers
▪ Lesions
▪ Rashes
▪ Redness
▪ Fissures
o Normal findings
▪ The anal opening should appear hairless, moist, and tightly closed.
▪ The skin around the anal opening is more coarse and more darkly pigmented.
The surrounding perianal area should be free of redness, lumps, ulcers,
lesions, and rashes.
o Abnormal findings
▪ Lesions may indicate STIs, cancer, or hemorrhoids.
▪ A thrombosed external hemorrhoid appears swollen.
▪ It is itchy, painful, and bleeds when the client passes stool.
▪ A painful mass that is hardened and reddened suggests a perianal abscess.
▪ A swollen skin tag on the anal margin may indicate a fissure in the anal canal.
▪ Redness and excoriation may be from scratching an area infected by fungi or
pinworms.
▪ A small opening in the skin that surrounds the anal opening may be an
anorectal fistula
▪ Thickening of the epithelium suggests repeated trauma from anal intercourse

o Ask the client to perform Valsalva’s maneuver by straining or bearing down. Inspect
the anal opening for any bulges or lesions.
o Normal findings
▪ No bulging or lesions appear.
o Abnormal findings
▪ Bulges of red mucous membrane may indicate a rectal prolapse.
▪ Hemorrhoids or an anal fissure may also be seen
• Palpation
o Palpate the anus.
o Inform the client that you are going to perform the internal examination at this point.
o Explain that it may feel like her bowels are going to move but that this will not
happen.
o Lubricate your gloved index finger; ask the client to bear down.
o As the client bears down, place the pad of your index finger on the anal opening and
apply slight pressure; this will cause relaxation of the sphincter.
o Normal findings
▪ Client’s sphincter relaxes, permitting entry
 o Abnormal findings
▪ Sphincter tightens, making further examination unrealistic.

o Palpate the rectum.

o Insert your finger further into the rectum as far as possible
o Next, turn your hand clockwise then counterclockwise.
o This allows palpation of as much rectal surface as possible.
o Note tenderness, irregularities, nodules, and hardness.
o Normal findings
▪ The rectal mucosa is normally soft, smooth, nontender, and free of nodules
o Abnormal findings
▪ Hardness and irregularities may be from scarring or cancer. Nodules may
indicate polyps or cancer

o Palpate the cervix through the anterior rectal wall.

o 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.
o Abnormal findings
▪ Bright red blood on gloved finger when removed.
▪ Large mass palpated.
▪ Do not mistake tampon for mass.

D’Amico, D., and Barbarito, C., (2019) Health & Physical Assessment in Nursing 3rd Edition,
Singapore: Pearson Education, Inc.
http://childabusemd.com/physical-exam/genital-exam.shtml
https://www.ebmconsult.com/articles/male-genitalia-exam
https://www.duq.edu/academics/schools/nursing/newborn-assessment/genitalia

Weber, J.R., and Kelley, J. H., (2018) Health Assessment in Nursing

6th Edition, Philadelphia: Wolters Kluwer