ASSESSING THE MALE AND FEMALE GENITALIA, RECTUM AND ANUS
ASSESSING THE MALE GENITALIA muscle contracts when too cold, raising the
⚫ ANATOMY AND PHYSIOLOGY
 STRUCTURE AND FUNCTIONS
EXTERNAL GENITALIA
✓ PENIS: The penis is the male reproductive
organ. Attached to the pubic arch by
ligaments, the penis is freely movable.
✓ The shaft of the penis is composed of three
cylindrical masses of vascular erectile
tissue that are bound together by fibrous
tissue— two corpora cavernosa on the
dorsal side and the corpus spongiosum on
the ventral side.
✓ The corpus spongiosum extends distally to
form the acorn-shaped glans. The base of
the glans, or corona, is somewhat larger as
compared to the shaft of the penis. If the
man has not been circumcised, a hood-
like fold of skin called the foreskin or
prepuce covers the glans.
✓ SCROTUM: The scrotum is a thin-walled sac
that is suspended below the pubic bone,
posterior to the penis. This darkly
pigmented structure contains sweat and
sebaceous glands and consists of folds of
skin (rugae) and the cremaster muscle.
✓ The scrotum function as a protective
covering for the testes, epididymis, and vas
deferens and helps to maintain the cooler-
than-body temperature necessary for
production of sperm (less than 37°C).
✓ The scrotum can maintain temperature
control because the cremaster muscle is
sensitive to changes in temperature. The
NUNCM01C – HEALTH ASSESSMENT LECTURE | FINALS
scrotum and testes upward toward the body for
warmth (cremasteric reflex).
INTERNAL GENITALIA
✓ TESTES: Internally the scrotal sac is divided
into two portions by a septum, each
portion containing one testis.
✓ The testes are a pair of ovoid-shaped
organs, like the ovaries in the woman, that
are approximately 3.7 to 5 cm long, 2.5 cm
wide, and 2.5 cm deep. Each testis is
covered by a serous membrane called the
tunica vaginalis, which separates the testis
from the scrotal wall.
✓ SPERMATIC CORD: The testes are
suspended in the scrotum by a spermatic
cord. The spermatic cord contains blood
vessels, lymphatic vessels, nerves, and the
vas deferens (or ductus deferens), which
transports spermatozoa away from the
testis. The spermatic cord on the left side is
usually longer; thus, the left testis hangs
lower than the right testis.
✓ The epididymis is a comma-shaped,
coiled, tubular structure that curves up
over the upper and posterior surface of the
testis.
✓ The vas deferens is a firm, muscular tube
that is continuous with the lower portion of
the epididymis
• It travels up within the spermatic
cord through the inguinal canal into
the abdominal cavity.
• The vas deferens provides the
passage for transporting sperm from
the testes to the urethra for
ejaculation. Along the way,
secretions from the vas deferens,
seminal vesicles, prostate gland,
and Cowper’s (or bulbourethral)
glands mix with the sperm and form
semen.
✓ INGUINAL AREA: The inguinal area is
contained between the anterior
superior iliac spine laterally and the
symphysis pubis medially.
✓ Running diagonally between these two
landmarks, just above and parallel with
the inguinal ligament, is the inguinal
canal. The inguinal canal is a tube-like
1
structure (4–5 cm or 1.5–2 inches long in an COLLECTING SUBJECTIVE DATA
adult) through which the vas deferens travels
as it passes through the lower abdomen.
✓ ANUS AND RECTUM: The anal canal is
the final segment of the digestive
system. It begins at the anal sphincter
and ends at the anorectal junction (also
known as the pectinate line,
mucocutaneous junction, or dentate
line). It measures from 2.5 cm to 4 cm
long. It is lined with skin that contains no
hair or sebaceous glands but does
contain many somatic sensory nerves,
making it susceptible to painful stimuli.
• The anal opening (or anal verge)
can be distinguished from the
perianal skin by its hairless, moist
appearance. The anal verge
extends interiorly, overlying the
external anal sphincter.
✓ The external sphincter is composed of
skeletal muscle and is under voluntary
control. The internal sphincter is
composed of smooth muscle and is
under involuntary control by the
autonomic nervous system. Dividing the
two sphincters is the palpable inter-
sphincteric groove.
✓ The rectum is the lowest portion of the
large intestine and is approximately 12
cm long, extending from the end of the
sigmoid colon to the anorectal junction.
It enlarges above the anorectal
junction and proceeds in a posterior
direction toward the hollow of the
sacrum and coccyx, forming the rectal
ampulla.
✓ PROSTATE: The prostate gland is
approximately 2.5 to 4 cm in diameter,
surrounding the neck of the bladder
and urethra; it lies between these
structures and the rectum in male
clients. ▪ The prostate gland consists of
two lobes separated by a shallow
groove called the median sulcus (Fig.
26-4). It secretes a thin, milky substance
that promotes sperm motility and
neutralizes female acidic vaginal
secretions.

NUNCM01C – HEALTH ASSESSMENT LECTURE | FINALS 2

 COLLECTING OBJECTIVE DATA
Preparing the Client
• Before the examination, instruct the
client to empty his bladder so that he
will be comfortable.
• Change clothes to hospital gown.
• Explain to the client that he will be asked
to stand (if able) for most of the
examination of the genitalia. The most
frequently used position for inspection
and palpation of the anus, rectum, and
prostate is the left lateral position. This
position allows adequate inspection
and palpation of the anus, rectum, and
prostate (in men) and is usually more
comfortable for the client.
Equipment
• Stool
• Gown
• Disposable non-latex gloves
• Flashlight (for possible transillumination)
• Stethoscope (for possible auscultation)
• Water soluble lubricant
• Specimen card
INSPECTION AND PALPATION
⚫ PENIS
 Inspect the base of the penis and
pubic hair.
 Sit on a stool with the client facing
you and standing Ask the client to
raise his gown or drape. Note
pubic hair growth pattern and any
excoriation, erythema, or
infestation at the base of the penis
and within the pubic hair.
 Normal: Pubic hair is coarser than
scalp hair. The normal pubic hair
pattern in adults is hair covering
the entire groin area, extending to
the medial thighs and up the
abdomen toward the umbilicus.
 Abnormal: Absence or scarcity of
pubic hair may be seen in clients
receiving chemotherapy.
▪ Lice or nit (eggs) infestation
at the base of the penis or
pubic hair is known as
pediculosis pubis. This is
commonly referred to as
“crabs.”
NUNCM01C – HEALTH ASSESSMENT LECTURE | FINALS
⚫ INSPECT THE SKIN OF THE SHAFT
 Observe for rashes, lesions, or
lumps.
 Normal: The skin of the penis is
wrinkled and hairless and is
normally free of rashes, lesions, or
lumps. Genital piercing is
becoming more common, and
nurses may see male clients with
one or more piercings of the penis.
 Abnormal: Rashes, lesions, or lumps
may indicate STI or cancer.
▪ Drainage around piercings
indicates infection.
⚫ PALPATE THE SHAFT
 Palpate any abnormalities noted
during inspection. Also note any
hardened or tender areas.
 Normal: The penis in a nonerect
state is usually soft, flaccid, and
nontender
 Abnormal: Tenderness may
indicate inflammation or infection.
⚫ INSPECT THE FORESKIN
 Observe for color, location, and
integrity of the foreskin in
uncircumcised men.
 Normal: The foreskin, which covers
the glans in an uncircumcised
male client, is intact and uniform in
color with the penis.
 Abnormal: Discoloration of the
foreskin may indicate scarring or
infection.
3
 ⚫ INSPECT THE GLANS
 Observe for size, shape, and lesions
or redness.
 The glans size and shape vary,
appearing rounded, broad, or
even pointed. The surface of the
glans is normally smooth, free of
lesions and redness.
 Chancres (red, oval ulcerations)
from syphilis, genital warts, and
pimple-like lesions from herpes are
sometimes detected on the glans.
⚫ PALPATE FOR URETHRAL DISCHARGE
 Gently squeeze the glans between
your index finger and thumb
 Normal: The urinary meatus is
normally free of discharge.
 Abnormal: A yellow discharge is
usually associated with gonorrhea.
A clear or white discharge is usually
associated with urethritis. Any
discharge should be cultured.
⚫ SCROTUM
 Inspect the size, shape, and
position of the scrotum.
▪ Ask the client to hold his
penis out of the way.
Observe for swelling, lumps,
or bulges
▪ Normal: The scrotum varies
in size (according to
temperature) and shape.
The scrotal sac hangs below
or at the level of the penis.
The left side of the scrotal
sac usually hangs lower
than the right side. o
Abnormal: An enlarged
NUNCM01C – HEALTH ASSESSMENT LECTURE | FINALS
scrotal sac may result from fluid
(hydrocele), blood
(hematocele), bowel (hernia),
or tumor (cancer?
⚫ INSPECT THE SCROTAL SKIN
 Observe color, integrity, and
lesions or rashes. To perform an
accurate inspection, you must
spread out the scrotal folds (rugae)
of skin.
 Normal: Scrotal skin is thin and
rugated (crinkled) with little hair
dispersion. Its color is slightly darker
than that of the penis. Lesions and
rashes are not normally present.
 Abnormal: Rashes, lesions, and
inflammation are abnormal
findings
⚫ PALPATE THE SCROTAL CONTENTS
 Palpate each testis and epididymis
between your thumb and first two
fingers.
 Note size, shape, consistency,
nodules, masses, and tenderness.
 Normal: Testes are ovoid,
approximately 3.5–5 cm long, 2.5
cm wide, and 2.5 cm deep, and
equal bilaterally in size and shape.
They are smooth, firm, rubbery,
mobile, free of nodules, and rather
tender to pressure. The epididymis
is nontender, smooth, and softer
than the testes.
 Abnormal: Absence of a testis
suggests cryptorchidism (an
undescended testicle). Painless
nodules may indicate cancer.
Tenderness and swelling may
4
indicate acute orchitis, torsion of the spermatic
cord, a strangulated hernia, or epididymitis
⚫ PALPATE EACH SPERMATIC CORD AND
VAS DEFERENS FROM THE EPIDIDYMIS
TO THE INGUINAL RING
 The spermatic cord will lie between
your thumb and finger.
 Note any nodules, swelling, or
tenderness.
 Normal: The spermatic cord and
vas deferens should feel uniform
on both sides
▪ The cord is smooth,
nontender, and rope-like
 Abnormal: Palpable, tortuous veins
suggest varicocele.
▪ A beaded or thickened
cord indicates infection or
cysts. A cyst suggests
hydrocele of the spermatic
cord.
NUNCM01C – HEALTH ASSESSMENT LECTURE | FINALS
⚫ INGUINAL AREA
 Inspect for inguinal and femoral
hernia.
▪ Inspect the inguinal and
femoral areas for bulges.
Ask the client to turn head
and cough or to bear down
as if having a bowel
movement and continue to
inspect the areas.
▪ Normal: The inguinal and
femoral areas are normally
free from bulges.
▪ Abnormal: Bulges that
appear at the external
inguinal ring or at the
femoral canal when the
client bears down may
signal a hernia.
⚫ PALPATE FOR INGUINAL HERNIA AND
INGUINAL NODES.
 Ask the client to shift his weight to
the left for palpation of the right
inguinal canal and vice versa.
Place your right index finger into
the client’s right scrotum and press
upward, invaginating the loose
folds of skin.
 Palpate up the spermatic cord
until you reach the triangular-
shaped slit like opening of the
external inguinal ring.
 Try to push your finger through the
opening and, if possible, continue
palpating up the inguinal canal.
 When your finger is in the canal or
at the external inguinal ring, ask
the client to bear down or cough.
Feel for any bulges against your
5
 finger. Then, repeat the procedure
on the opposite side.
 Normal: Bulging or masses are not
normal
 Abnormal: Presence of bulge may
indicate a hernia.

⚫ PALPATE INGUINAL LYMPH NODES

 If nodes are palpable, note size,
consistency, mobility, or INGUINAL AND FEMORAL HERNIAS
tenderness.
 Normal: No enlargement or
tenderness is normal
 Abnormal: Enlarged or tender
lymph nodes may indicate an
inflammatory process or infection
of the penis or scrotum.

⚫ PALPATE FOR FEMORAL HERNIA

 Palpate on the front of the thigh in
the femoral canal area. Ask the
client to bear down or cough. Feel
for bulges. Repeat on the opposite
thigh.
 Normal: No bulges palpated
 Abnormal: Bulges or masses on
palpation

ABNORMALITIES OF THE PENIS

NUNCM01C – HEALTH ASSESSMENT LECTURE | FINALS 6

 ASSESSING THE FEMALE GENITALIA
⚫ ANATOMY AND PHYSIOLOGY
 STRUCTURE AND FUNCTIONS
EXTERNAL GENITALIA
✓ The area is sometimes referred to as the
vulva or pudendum and extends from the
mons pubis to the anal opening. The mons
pubis is the fat pad located over the
symphysis pubis. The normal adult mons
pubis is covered with pubic hair in a
triangular pattern. It functions to absorb
force and to protect the symphysis pubis
during coitus (sexual intercourse).
✓ The labia majora are two folds of skin that
extend posteriorly and inferiorly from the
mons pubis to the perineum. The skin folds
are composed of adipose tissue,
sebaceous glands, and sweat glands. The
outer surface of the labia majora is
covered with pubic hair in the adult,
whereas the inner surface is pink, smooth,
and moist.
✓ The labia minora are hairless and usually
darker pink. They contain numerous
sebaceous glands that promote
lubrication and maintain a moist
environment in the vaginal area.
✓ The clitoris is located at the anterior end of
the labia minora. It is a small, cylindrical
mass of erectile tissue and nerves with
three parts: the glans, the corpus, and the
crura. The glans is the visible rounded
portion of the clitoris.
✓ The skin folds of the labia majora and labia
minora form a boat-shaped area (or fossa)
NUNCM01C – HEALTH ASSESSMENT LECTURE | FINALS
called the vestibule. The vestibule contains
several openings. Located between the clitoris
and the vaginal orifice is the urethral meatus.
INTERNAL GENITALIA
✓ They include the vagina, the cervix, the
uterus, the fallopian tubes, and the ovaries.
The vagina, a muscular, tubular organ,
extends up and slightly back toward the
rectum from the vaginal orifice (external
opening) to the cervix. It lies between the
rectum posteriorly and the urethra and
bladder anteriorly and is approximately 10
cm long
✓ The vaginal wall comprises four layers.
• The outer layer is composed of pink
squamous epithelium and
connective tissue. It is under the
direct influence of the hormone
estrogen and contains many
mucus-producing cells. This outer
layer of epithelium lies in transverse
folds called rugae.
• The second layer is the submucosal
layer. It contains the blood vessels,
nerves, and lymphatic channels.
• The third layer is composed of
smooth muscle, and the fourth layer
consists of connective tissue and
the vascular network
✓ The cervix is composed of smooth
muscle, muscle fibers, and connective
tissue. Two types of epithelium cover the
external os or ectocervix—pink
squamous epithelium (which lines the
vaginal walls) and red, rough-looking
columnar epithelium (which lines the
endocervical canal).
• The cervix functions to allow the
entrance of sperm into the uterus
and to allow the passage of
menstrual flow.
• It also secretes mucus and
prevents the entrance of vaginal
bacteria.
• During childbirth, the cervix
stretches (dilates) to allow the
passage of the fetus.
✓ The uterus is a pear-shaped muscular
organ that has two components:
• The corpus, or body, and the
cervix, or neck.
7
 ovaries and enter the uterus just
•The corpus of the uterus is divided beneath the fundus
into the fundus (upper portion),
the body (central portion), and COLLECTING SUBJECTIVE DATA
the isthmus (narrow lower
portion).
• The uterus is usually situated in a
forward position above the
bladder at approximately a 45-
degree angle to the vagina
when standing (anteverted and
anteflexed position).
• The normal-sized uterus is
approximately 7.5 cm long, 5 cm
wide, and 2.5 cm thick. The
uterus is movable
✓ The endometrium, the myometrium,
and the peritoneum are the three layers
of the uterine wall.
• The endometrium is the inner
mucosal layer. The endometrium
is composed of epithelium,
connective tissue, and a
vascular network. Estrogen and
progesterone influence the
thickness of this tissue.
• The myometrium is the middle
layer of the uterus. It is composed
of three layers of smooth muscle
fibers that surround blood vessels.
This layer functions to expel the
products of conception.
• The peritoneum is the outer
uterine layer that covers the
uterus and separates it from the
abdominal cavity. The
peritoneum forms anterior and
posterior pouches around the
uterus.
✓ The ovaries are a pair of small, oval-
shaped organs, each of which is
situated on a lateral aspect of the
pelvic cavity. Each is approximately 3
cm long, 2 cm wide, and 1 cm deep.
• The ovaries are connected to the
uterus by the ovarian ligament.
• The ovary functions to develop
and release ova and to produce
hormones such as estrogen,
progesterone, and testosterone.
• The ovum travels from the ovary
to the uterus through the
fallopian tubes. These 8- to 12-cm
long tubes begin near the

NUNCM01C – HEALTH ASSESSMENT LECTURE | FINALS 8

 INSPECTION AND PALPATION

⚫ EXTERNAL GENITALIA
 Inspect the mons pubis.
▪ Wash your hands and put
on gloves. As you begin the
examination, note the
distribution of pubic hair.
Also be alert for signs of
infestation.
▪ Normal: Pubic hair is
distributed in an inverted
triangular pattern and there
are no signs of infestation.
COLLECTING OBJECTIVE DATA
▪ Abnormal: Absence of
pubic hair in the adult client
Preparing the Client
is abnormal.
• Tell the client ahead of time not to
douche for 48 hours before a ⚫ OBSERVE AND PALPATE INGUINAL LYMPH
gynecologic examination. NODES
• When the client arrives, ask her to  Normal: There should be no
urinate before the examination so that enlargement or swelling of the
she does not experience bladder lymph nodes.
discomfort.  Abnormal: Enlarged inguinal
• When the client is in the examining nodes may indicate a vaginal
room, ask her to remove her underwear infection or may be the result of
and bra and to put on a gown with the irritation from shaving pubic hairs.
opening in the back.
• Position the client’s hips toward the
bottom of the examination table so that
the feet can rest comfortably in the
stirrups (Lithotomy position)

Equipment
• Light
• Vaginal Speculum
• Water-soluble lubricant
• Large swabs for vaginal
examination
• Specimen container
• Gloves (non-sterile)
• Bifid spatula ⚫ INSPECT THE LABIA MAJORA AND
• Endocervical broom PERINEUM
• pH paper  Observe the labia majora and
• Feminine napkins perineum for lesions, swelling, and
• Hand-held Mirror excoriation
 Normal: The labia majora are
equal in size and free of lesions,
swelling, and excoriation.
 Abnormal: Lesions may be from an
infectious disease, such as herpes
or syphilis

NUNCM01C – HEALTH ASSESSMENT LECTURE | FINALS 9


▪ Excoriation and swelling
may be from scratching or
self-treatment of the lesions
⚫ INSPECT THE LABIA MINORA, CLITORIS,
URETHRAL MEATUS, AND VAGINAL
OPENING
 Use your gloved hand to separate
the labia majora and inspect for
lesions, excoriation, swelling,
and/or discharge.
 Normal: The labia minora appear
symmetric, dark pink, and moist.
The clitoris is a small mound of
erectile tissue, sensitive to touch.
▪The normal size of the clitoris
varies.
▪ The urethral meatus is small
and slit-like.
▪ The vaginal opening is
positioned below the
urethral meatus. Its size
depends on sexual activity
or vaginal delivery.
▪ A hymen may cover the
vaginal opening partially or
completely.
 Abnormal: Asymmetric labia may
indicate abscess. Lesions, swelling,
bulging in the vaginal opening, and
discharge are abnormal findings
Excoriation may result from the client
scratching or self-treating a perineal
irritation.
⚫ INSPECTING THE PUBIC HAIR, LABIA
MINORA, CLITORIS, URETHRAL ORIFICE, AND
VAGINAL OPENING
 PALPATE BARTHOLIN’S GLAND
▪ If the client has labial
swelling or a history of it,
palpate Bartholin’s glands
NUNCM01C – HEALTH ASSESSMENT LECTURE | FINALS
for swelling, tenderness, and
discharge.
▪ Place your index finger in
the vaginal opening and
your thumb on the labia
majora.
▪ With a gentle pinching
motion, palpate from the
inferior portion of the
posterior labia majora to
the anterior portion.
▪ Repeat on the opposite
side.
▪ Normal: Bartholin’s glands
are usually soft, nontender,
and drainage free.
▪ Abnormal: Swelling, pain,
and discharge may result
from infection and abscess.
▪ If you detect a discharge,
obtain a specimen to send
to the laboratory for culture.
⚫ PALPATE THE URETHRA
▪ If the client reports urethral
symptoms or urethritis, or if
you suspect inflammation of
Skene’s glands, insert your
gloved index finger into the
superior portion of the
vagina and milk the urethra
from the inside, pushing up
and out
▪ Normal: No drainage should
be noted from the urethral
meatus. The area is normally
soft and nontender.
▪ Abnormal: Drainage from
the urethra indicates
possible urethritis. Any
discharge should be
cultured. Urethritis may
occur with infection with
Neisseria gonorrhoeae or
Chlamydia trachomatis.
10

INSPECTION AND PALPATION
⚫ INTERNAL GENITALIA
 Inspect the size of the vaginal
opening and the angle of the
vagina.
▪ Insert your gloved index
finger into the vagina,
noting the size of the
opening and whether the
lining of the vagina is
thinning or feels dry.
▪ Then attempt to touch the
cervix. This will help you
establish the size of the
speculum you need to use
for the examination and the
angle at which to insert it.
▪ Next, while maintaining
tension, gently pull the labia
majora outward. Note
hymenal configuration and
transections or injury.
▪ Normal: The normal vaginal
opening varies in size
according to the client’s
age, sexual history, and
whether she has given birth
vaginally. The vagina is
typically tilted posteriorly at
45-degree angle and
should feel moist. o  Inspect the vagina as you remove
Abnormal: Vaginal atrophy
due to lack of estrogen. Any
loss of hymenal tissue
between the 3 o’clock
position and the 9 o’clock
position indicates trauma.
NUNCM01C – HEALTH ASSESSMENT LECTURE | FINALS
⚫ INSPECT THE VAGINAL MUSCULATURE
 Keep your index finger inserted in
the client’s vaginal opening. Ask
the client to squeeze around your
finger.
 Use your middle and index fingers
to separate the labia minora. Ask
the client to bear down.
 Normal: The client should be able
to squeeze around the examiner’s
finger.
 Typically, the nulliparous woman
can squeeze tighter than the
multiparous woman.
▪ No bulging and no urinary
discharge
 Abnormal: Absent or decreased
ability to squeeze the examiner’s
finger indicates decreased muscle
tone. Decreased tone may
decrease sexual satisfaction
▪ Bulging of the anterior.
⚫ INSPECT THE CERVIX
 With the speculum inserted in
position to visualize the cervix,
observe cervical color, size, and
position.
 Normal: The surface of the cervix is
normally smooth, pink, and even.
 Normally, it is midline in position
and projects 1–3 cm into the
vagina. In pregnant clients, the
cervix appears blue (Chadwick’s
sign).
 Abnormal: In a nonpregnant
woman, a bluish cervix may
indicate cyanosis; in a non-
menopausal woman, a pale cervix
may indicate anemia. Redness
may be from inflammation.
⚫ INSPECT THE VAGINA
 Unlock the speculum and slowly
rotate and remove it.
the speculum.
 Note the vaginal color, surface,
consistency, and any discharge.
 Normally: The vagina should
appear pink, moist, smooth, and
free of lesions and irritation. It
11
 should also be free of any colored
or malodorous discharge.
 Abnormal: Reddened areas,
lesions, and colored, malodorous
discharge are abnormal and may
indicate vaginal infections, STIs, or
cancer
BIMANUAL EXAMINATION
⚫ PALPATE THE VAGINA WALL
 Tell the client that you are going to
do a manual examination and
explain its purpose.
 Apply water soluble lubricant to
the gloved index and middle
fingers of your dominant hand.
 Then stand and approach the
client at the correct angle.
 Placing your nondominant hand
on the client’s lower abdomen,
insert your index and middle fingers
into the vaginal opening.
 Apply pressure to the posterior wall
and wait for the vaginal opening
to relax before palpating the
vaginal walls for texture and
tenderness.
 Normal: The vaginal wall should
feel smooth, and the client should
not report any tenderness.
 Abnormal: Tenderness or lesions
may indicate infection.
⚫ PALPATE THE CERVIX
 Advance your fingers until they
touch the cervix and run fingers
around the circumference.
Palpate for:
▪ Contour
▪ Consistency
▪ Mobility
▪ Tenderness
 Normal: The cervix should feel firm and
soft (like the tip of your nose). It is
rounded and can be moved somewhat
from side to side without eliciting
tenderness.
 Abnormal: A hard, immobile cervix may
indicate cancer. Pain with movement
of the cervix may indicate infection
(Chandelier’s sign).
NUNCM01C – HEALTH ASSESSMENT LECTURE | FINALS
⚫ PALPATE THE UTERUS
 Move your fingers intravaginally
into the opening above the cervix
and gently press the hand resting
on the abdomen downward,
squeezing the uterus between the
two hands. Note uterine size,
position, shape, and consistency.
 Normal: The fundus, the large,
upper end of the uterus, is normally
round, firm, and smooth. In most
women, it is at the level of the
pubis; the cervix is aimed
posteriorly (anteverted position).
 Abnormal: An enlarged uterus
above the level of the pubis is
abnormal; an irregular shape
suggests abnormalities such as
myomas (fibroid tumors) or
endometriosis
⚫ PALPATE THE OVARIES
 Slide your intravaginal fingers
toward the left ovary in the left
lateral fornix and place your
abdominal hand on the left lower
abdominal quadrant.
 Press your abdominal hand toward
your intravaginal fingers and
attempt to palpate the ovary
 Normal: Ovaries are approximately
3 × 2 × 1 cm (or the size of a walnut)
and almond-shaped.
 Abnormal: Enlarged size, masses,
immobility, and extreme
tenderness are abnormal and
should be evaluated
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 COMMON VARIATIONS OF THE CERVIX

ABNORMALITIES OF THE EXTERNAL GENITALIA

AND VAGINAL OPENING, CERVIX, AND
ADNEXAL MASSES

NUNCM01C – HEALTH ASSESSMENT LECTURE | FINALS 13


ASSESSING THE ANUS AND RECTUM
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
▪ Thickening of the epithelium
✓ Normal: 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.
✓ Abnormal: 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 previously
thrombosed hemorrhoid appears as a
skin tag that protrudes from the anus.
PALPATE THE ANUS
✓ Inform the client that you are going to
perform the internal examination at this
point
NUNCM01C – HEALTH ASSESSMENT LECTURE | FINALS
▪ Lumps
▪ Explain that it may feel like his
bowels are going to move but that
this will not happen.
▪ Lubricate your gloved index finger;
ask the client to bear down. 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.
▪ Normal: Client’s sphincter relaxes,
permitting entry.
▪ Abnormal: Sphincter tightens,
making further examination
unrealistic.
PALPATE THE RECTUM
✓ Insert your finger further into the rectum as
far as possible.
✓ Next, turn your hand clockwise then
counterclockwise. This allows palpation of
as much rectal surface as possible.
✓ Note tenderness, irregularities, nodules,
and hardness.
✓ Normal: The rectal mucosa is normally soft,
smooth, nontender, and free of nodules.
✓ Abnormal: Hardness and irregularities may
be from scarring or cancer. Nodules may
indicate polyps or cancer.
14
PALPATE THE PERITONEAL CAVITY
✓ This area may be palpated in men above
the prostate gland in the seminal vesicles
on the anterior surface of the rectum. Note
tenderness or nodules.
✓ Normal: This area is normally smooth and
nontender.
✓ Abnormal: A peritoneal protrusion into the
rectum, called a rectal shelf may indicate
a cancerous lesion or peritoneal
metastasis. Tenderness may indicate
peritoneal inflammation.
PROSTATE GLAND
✓ The prostate can be palpated on the
anterior surface of the rectum by turning
the hand fully counterclockwise so that the
pad of your index finger faces toward the
client’s umbilicus.
▪ Normal: The prostate is normally
nontender and rubbery. It has two
lateral lobes that are divided by a
median sulcus. The lobes are
normally smooth, 2.5 cm long, and
heart shaped.
▪ Abnormal: A swollen, tender
prostate may indicate acute
prostatitis. An enlarged smooth,
firm, slightly elastic prostate that
may not have a median sulcus
suggests benign prostatic
hypertrophy (BPH). A hard area on
the prostate or hard, fixed, irregular
nodules on the prostate suggest
cancer
HEALTH PROMOTION DIAGNOSIS
RISK DIAGNOSIS
✓ Risk for Ineffective Therapeutic Regimen
Management (monthly testicular
self examination, TSE) related to lack of
knowledge of the importance of TSE
✓ Risk for Injury related to poor lifting
techniques
✓ Risk for Infection related to unprotected
sexual intercourse
✓ Risk for Ineffective Sexuality Pattern related
to impending surgery
NUNCM01C – HEALTH ASSESSMENT LECTURE | FINALS
✓ Risk for Ineffective Health Maintenance
related to lack of knowledge of need for
recommended colorectal and prostate
examinations.
✓ Risk for Impaired Skin Integrity in rectal area
related to chronic irritation secondary to
diarrhea
ACTUAL DIAGNOSIS
✓ Fear of testicular cancer related to existing
risk factors
✓ Disturbed Body Image related to hernia
repair
✓ Pain: Dysuria related to gonorrhea,
infection, or genital reproductive surgery
✓ Acute Pain: Rectal
✓ Ineffective Therapeutic Regimen
Management related to
✓ lack of knowledge of testicular self-
examination
✓ Sexual Dysfunction related to decreased
libido secondary to fear of urinary
incontinence, pain in surgical site, anxiety,
or fear
✓ Sexual Dysfunction related to erectile
dysfunction secondary to psychological or
physiologic factors
✓ Sexual Dysfunction related to lack of
ejaculation secondary to surgical removal
of seminal vesicles and transection of the
vas deferens.
✓ Ineffective Sexuality Patterns related to
feelings of loss of masculinity and sexual
attractiveness secondary to chronic
diarrhea or pain.
✓ Anxiety related to impending genital
reproductive surgery and lack of
knowledge of outcome of surgery.
✓ Diarrhea related to chronic inflammatory
bowel disease
✓ Situational Low Self-Esteem related to loss
of control bowel elimination
15