M/F Genitalia and Rectum
Male Genitalia
EXTERNAL & INTERNAL MALE GENITALIA
Genitalia Subjective Data Collection
PAIN
• Do you have pain in your penis, scrotum, testes, or groin?
Rationale: Complaints of pain in these areas may
indicate a hernia or an inflammatory process, such
as epididymitis.
LESIONS
• Have you noticed any lesions on your penis or genital area? If
so, do the lesions itch, burn, or sting? Please describe the
lesions
Rationale: Lesions may be a sign of a sexually
transmitted disease (STD) or cancer.
DISCHARGE
• Have you noticed any discharge from your penis? If so, how
much? What color is it? What type of odor does it have?
Rationale: Discharge may indicate an infection
LUMPS, SWELLING, MASSES
• Do you have any lumps, swelling, or masses in your scrotum,
genital, or groin area? Have you noticed a change in the size
of the scrotum?
Rationale: These findings may indicate infection,
hernia, or cancer. Enlargement of the scrotum may
indicate hydrocele, hematocele, hernia, or cancer;
the scrotum also enlarges with aging
• Do you have a heavy, dragging feeling in your scrotum?
Rationale: A testicular tumor or scrotal hernia may
cause a feeling of heaviness in the scrotum.
ANAL & RECTAL STRUCTURES
URINATION
• Do you experience difficulty urinating (i.e., urgency,
hesitancy, frequency, or difficulty starting or maintaining a
stream)? How many times do you urinate during the night?
Rationale: Difficulty urinating may indicate an
infection or blockage including prostatic
enlargement. Urinating more than one time
during the night may indicate prostate
abnormalities. Excessive intake of fluids may also
cause nocturia.
• Have you noticed any change in the color, odor, or amount of
your urine?
Rationale: Changes in urine color or odor may
indicate an infection. Blood in the urine
(hematuria) should be referred for medical
investigation because this may indicate infection,
benign prostatic hypertrophy (BPH), or cancer. A
decrease in amount of voided urine may indicate
prostate enlargement or kidney problems.
• Do you experience any pain or burning when you urinate?
– KathleenVenus
Rationale: Painful urination may be a sign of
urinary tract infection, prostatitis, or an STD, also
called sexually transmitted infection (STI).
• Do you ever experience urinary incontinence or dribbling?
Rationale: Incontinence may occur after
prostatectomy. Dribbling may be a sign of overflow
incontinence.
SEXUAL DYSFUNCTION
• Have you recently had a change in your pattern of sexual
activity or sexual desire?
Rationale: A change in sexual activity or sexual
desire (libido) needs to be investigated to
determine the cause.
• Do you have difficulty attaining or maintaining an erection?
Do you have any problem with ejaculation? Do you have pain
with ejaculation?
Rationale: Erectile dysfunction occurs frequently
in adult males and may be attributed to various
factors or disorders (e.g., alcohol use, diabetes,
depression, antihypertensive medications). Pain
with ejaculation may indicate epididymitis.
• Do you have or have you had any trouble with fertility?
Rationale: About 30% of all infertility experienced
by couples is due to male infertility
FAMILY HISTORY
• Is there a history of cancer in your family? What type and
which family member(s)?
Rationale: Cancers of the prostate and testes have
a familial tendency.
LIFESTYLE AND HEALTH PRACTICES
• How many sexual partners do you have?
Rationale: A client with multiple sexual partners
increases his risk of contracting an STD or HIV
• Describe the activity you perform in a typical day. Do you do
any heavy lifting?
Rationale: Strenuous activity and heavy lifting
may predispose the client to development of an
inguinal hernia.
Rectal Subjective Data Collection
BOWEL PATTERNS
• What is your usual bowel pattern? Have you noticed any
recent change in the pattern? Any pain while passing a bowel
movement?
Rationale: A change in bowel pattern is associated
with many disorders and is one of the warning
signs of cancer. A more thorough evaluation,
including laboratory tests and
proctosigmoidoscopy, may be necessary.
• Do you experience constipation?
Rationale: Constipation may indicate a bowel
obstruction or the need for dietary counseling
• Do you have trouble controlling your bowels?
Rationale: Fecal incontinence occurs with
neurologic disorders and some gastrointestinal
infections.
STOOL
• What is the color of your stool? Hard or soft? Have you
noticed any blood on or in your stool? If so, how much?
Rationale: Black stools may indicate
gastrointestinal bleeding or the use of iron
supplements or Pepto-Bismol. Red blood in the
stool is found with hemorrhoids, polyps, cancer,
or colitis. Clay-colored stools result from a lack of
bile pigment.
• Have you noticed any mucus in your stool?
Rationale: Mucus in the stool may indicate
steatorrhea (excessive fat in the stool).
ITCHING AND PAIN
• Do you experience any itching or pain in the rectal area?
Rationale: Sexually transmitted diseases,
hemorrhoids, pinworms, or anal trauma may
cause itching or pain
PAST HEALTH HISTORY
• Have you ever had anal or rectal trauma or surgery? Were you
born with any congenital deformities of the anus or rectum?
Have you had prostate surgery? Have you had hemorrhoids or
surgery for hemorrhoids?
Rationale: Past conditions influence the findings
of physical assessment. Congenital deformities,
such as imperforate anus, are often surgically
repaired when the client is very young.
• Have you ever had proctosigmoidoscopy?
Rationale: A proctosigmoidoscopic examination is
recommended every 3 to 5 years after age 50 based
on the advice of a physician.
• When was the last time you had a digital rectal examination
(DRE) by a physician?
Rationale: A DRE may reveal rectal masses,
prostate enlargement, or prostate nodules.
FAMILY HISTORY
• Is there a history of polyps, colon or rectal cancer, or prostate
cancer in your family?
Rationale: Colorectal and prostate cancer have a
tendency to affect members of the same family
LIFESTYLE AND HEALTH PRACTICES
• Do you use any laxatives, stool softeners, enemas, or other
bowel movement-enhancing medications?
Rationale: Long-term use of these agents can
alter the body’s ability to regulate bowel function.
Short-term use may indicate the need for dietary
counseling.
• Do you engage in anal sex?
Rationale: Anal sex increases the risk for sexually
transmitted disease, infection by human
immunodeficiency virus (HIV), fissures, rectal
prolapse, and hemorrhoid formation.
• Do you take any medications for your prostate?
Rationale: Men with benign prostatic hypertrophy
(BPH) with “voiding symptoms,” such as urinary
urgency, may take an alphaadrenergic blocker
such as terazosin (Hytrin) or an androgen
hormone inhibitor such as finasteride (Proscar).
• For postmenopausal women: Do you use hormone
replacement therapy?
Rationale: Studies, including a retrospective study
of 400,000 women conducted by the American
Cancer Society and the Nurses’ Health Study, a
prospective study of 120,000 women, have
indicated that postmenopausal estrogen use
reduces the risk of colon cancer
Points to remember when performing
Assessment of the Genitalia
• Wear disposable gloves.
• Prepare the client thoroughly for the physical examination
to put the client at the greatest ease.
• Perform the examination professionally and preserve the
– KathleenVenus
client’s modesty.
• Preserve client’s privacy.
• Inspect and palpate penis, scrotum, and inguinal area for
inflammation, infestations, rashes, lesions, and lumps.
• During the testicular examination, describe the importance
of testicular self-examination and explain how to perform
the examination as you are performing it.
• Understand the structures and functions of the anorectal
region.
• Make sure to have a chaperone in the room while
performing the examination.
Assessment of the Penis
Inspection and Palpation
BASE OF THE PENIS AND PUBIC HAIR
• 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
o 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. The
base of the penis and the pubic hair are free of
excoriation, erythema, and infestation
• Abnormal findings
o Absence or scarcity of pubic hair may be seen in
clients receiving chemotherapy
o Pubic hair may be gray and sparse in elderly
clients. In addition, the penis becomes smaller and
the testes hang lower in the scrotum in elderly
clients.
PEDICULOSIS PUBIS
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.”
SKIN OF THE SHAFT
• Observe for rashes, lesions, or lumps.
o 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.
o Pubertal rites in some cultures include slitting the
penile shaft, leaving an opening that may extend
the entire length of the shaft
• Abnormal findings
o Rashes, lesions, or lumps may indicate STD or
cancer. Drainage around piercings indicates
infection.
SYPHILITIC CHANCRE
Initially a small, silvery-white
papule that develops a red oval
ulceration. Painless. A sign of
primary syphilis (a sexually
transmitted disease [STD]) that
spontaneously regresses. May be
misdiagnosed as herpes.
HERPES PROGENITALIS
Clusters of pimple-like, clear
vesicles that erupt and become
ulcers. Painful. Initial lesions of
this STD, typically caused by
HSV-1 or HSV2, disappear, and
the infection remains dormant
for varying periods of time.
Recurrences can be frequent or
GENITAL WARTS
Single or multiple, moist,
fleshy papules. Painless. STD
caused by the human
papillomavirus.
SHAFT
• Palpate the shaft. Palpate any abnormalities noted during
inspection. Also note any hardened or tender areas.
o The penis in a nonerect state is usually soft,
flaccid, and nontender.
• Abnormal findings
o Hardness along the ventral surface may indicate
cancer or a urethral stricture. Tenderness may
indicate inflammation or infection.
FORESKIN
• Inspect the foreskin. Observe for color, location, and
integrity of the foreskin in uncircumcised men.
o The foreskin, which covers the glans in an
uncircumcised male client, is intact and uniform
in color with the penis
• Abnormal findings
o Discoloration of the foreskin may indicate
scarring or infection
GLANS
• Inspect the glans. Observe for size, shape, and lesions or
redness.
o 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
CANCER OF THE GLANS
PENIS
Appears as hardened nodule
or ulcer on the glans.
Painless. Occurs primarily in
uncircumcised men.
– KathleenVenus
• If the client is not circumcised, ask him to retract his
foreskin, (if the client is unable to do so, the nurse may
retract it) to allow observation of the glans. This may be
painful.
o The foreskin retracts easily. A small amount of
whitish material, called smegma, normally
accumulates under the foreskin.
•

PHIMOSIS
Foreskin is so tight that it
cannot be retracted over the
glans
PARAPHIMOSIS
Foreskin is so tight that, once
retracted, it cannot be returned
back over the glans.
• Note the location of the urinary meatus on the glans
o The urinary meatus is slit-like and normally
found in the center of the glans.
o If pubertal mutilation has occurred, actual
discharge of urine and semen will occur at the
location of the shaft opening.
HYPOSPADIAS
Urethral meatus is located
underneath the glans (ventral side).
This condition is a congenital defect.
A groove extends from the meatus to
the normal location of the urethral
meatus
EPISPADIAS
The urethral meatus is located on
the top of the glans (dorsal side);
occurs rarely. This condition is a
congenital defect.
URETHRAL DISCHARGE
• Palpate the urethral discharge. Gently squeeze the glans
between your index finger and thumb
o The urinary meatus is normally free of discharge.
• Abnormal findings
o A yellow discharge is usually associated with
gonorrhea. A clear or white discharge is usually
associated with urethritis. All discharge should be
cultured.
GONORRHEA
A yellow discharge is usually
associated with gonorrhea
Assessment of the Scrotum
Inspection
SIZE, SHAPE, AND POSITION
• Inspect the size, shape, and position. Ask the client to hold
his penis out of the way. Observe for swelling, lumps, or
bulges.
o 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.
HYDROCELE
Collection of serous fluid in the scrotum,
outside the testes within the tunica vaginalis.
Appears as swelling in the scrotum and is
usually painless. Usually the examiner can get
fingers above this mass during palpation.
Will transilluminate (if there is blood in the
scrotum, it will not transilluminate and is
called a “hematocele”).
SCROTAL HERNIA
A loop of bowel protrudes into the
scrotum to create what is known as an
indirect inguinal hernia. Hernia
appears as swelling in the scrotum.
Palpable as a soft mass and fingers
cannot get above the mass
TESTICULAR TUMOR
Initially a small, firm, nontender
nodule on the testis. As the tumor
grows, the scrotum appears enlarged
and the client complains of a heavy
feeling. When palpated, the testis feels
enlarged and smooth—tumor replaces
testis. Will not transilluminate.
SCROTAL SKIN
• Observe color, integrity, and lesions or rashes. To perform an
accurate inspection, you must spread out the scrotal folds
(rugae) of skin. Lift the scrotal sac to inspect the posterior
skin.
o 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. However, sebaceous cysts (small,
yellowish, firm, nontender, benign nodules) are a
normal finding.
• Abnormal findings
– KathleenVenus
o Rashes, lesions, and inflammation
Inflammation of the penis
and scrotum may be seen in
Reiter’s syndrome, and
idiopathic inflammatory
disorder affecting the skin,
joints, and mucous
membranes
 Palpation
SCROTAL CONTENTS
• Palpate each testis and epididymis between your thumb and
first two fingers. Note size, shape, consistency, nodules, and
tenderness.
• *Do not apply too much pressure to the testes because this will
cause pain
o Testes are ovoid, approximately 3.5 to 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
o Testes do not get smaller with normal aging
although they may decrease in size with long-
term illness.
CRYPTORCHIDISM
Failure of one or both testicles
to descend into scrotum.
Scrotum appears undeveloped
and testis cannot be palpated.
Causes increased risk of
testicular cancer.
EPIDIDYMITIS
Infection of the epididymis. Client
usually complains of sudden pain.
Scrotum appears enlarged, reddened,
and swollen; tender epididymis is
palpated. Usually associated with
prostatitis or bacterial infection.
• 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.
o The spermatic cord and vas deferens should feel
uniform on both sides. The cord is smooth,
nontender, and ropelike.
• Abnormal findings
o Palpable, tortuous veins suggest varicocele.
Abeaded or thickened cord indicates infection or
cysts. If you palpate a scrotal mass, have the client
lie down. The mass may return to the abdomen by
itself. If it does not, place your fingers above the
scrotal mass. If you can get your fingers above the
mass, suspect hydrocele. Cyst suggests hydrocele of
the spermatic cord.
\ •
TORSION OF SPERMATIC CORD
Very painful condition caused by twisting of
spermatic cord. Scrotum appears enlarged and
reddened. Palpation reveals thickened cord
and swollen, tender testis that may be higher
in scrotum than normal. This condition
requires immediate referral for surgery because
circulation is obstructed.
VARICOCELE
Abnormal dilation of veins in the spermatic
cord. Client may complain of discomfort
and testicular heaviness. Tortuous veins are
palpable and feel like a soft, irregular mass or
“a bag of worms,” which collapses when the
client is supine. Infertility may be associated
with this condition.
Auscultation
• Continue the examination of a scrotal mass by auscultating
with a stethoscope.
o Normal findings are not expected.
• Abnormal findings
o Bowel sounds may be auscultated over a hernia but
will not be heard over a hydrocele
Transillumination
SCROTAL CONTENTS
• Transilluminate the scrotal contents. If an abnormal mass or
swelling was noted in the scrotum, transillumination should
be performed. Darken the room and shine a light from the
back of the scrotum through the mass. Look for a red glow.
o Normally scrotal contents do not transilluminate.
• Abnormal findings
o Swellings or masses that contain serous fluid—
hydrocele, spermatocele—light up with a red
glow. Swellings or masses that are solid or filled
with blood— tumor, hernias, or varicocele—do
not light up with a red glow.
SPERMATOCELE
Sperm-filled cystic mass located
on epididymis. Palpable as small
and nontender, and movable
above the testis. This mass will
appear on transillumination.
Assessment of the Inguinal Area
Inspection
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.
o The inguinal and femoral areas are normally free
from bulges.
Abnormal findings
o Bulges that appear at the external inguinal ring or
at the femoral canal when the client bears down
– KathleenVenus
may signal a hernia
INDIRECT INGUINAL HERNIA
Bowel herniates through internal
inguinal ring and remains in the
inguinal canal or travels down into the
scrotum (scrotal hernia). This is the most
common type of hernia. It may occur in
adults but is more frequent in children.

DIRECT INGUINAL HERNIA
Bowel herniates from behind and
through the external inguinal ring. It
rarely travels down into the scrotum. This
type of hernia is less common than an
indirect hernia. It occurs mostly in adult
men older than age 40.
FEMORAL HERNIA
Bowel herniates through the femoral
ring and canal. It never travels into
the scrotum, and the inguinal canal
is empty. This is the least common
type of hernia. It occurs mostly in
women.
Assessment of the Anorectal
Palpation
INGUINAL HERNIA AND INGUINAL NODES
Positions for Anorectal Examination
• 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 finger. Then, repeat the
procedure on the opposite side
o Bulging or masses are not normally palpated.
• Abnormal findings
o A bulge or mass may indicate a hernia.
Inspection
PERIANAL AREA
Palpating for an Palpating for a
inguinal hernia femoral hernia
INGUINAL LYMPH NODES
• If nodes are palpable, note size, consistency, mobility or
tenderness.
o No enlargement or tenderness is normal.
• Abnormal findings
o Enlarged or tender nodes may indicate an
inflammatory process or lesion on the penis or
scrotum.
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.
o Bulges or masses are not normally palpated
• Abnormal findings
o A bulge or mass may be from a hernia.
SCROTAL HERNIA
• If you discovered a mass during inspection and palpation of
the scrotum and you suspect it may be a hernia, ask the client
to lie down; note whether the bulge disappears. If the bulge
remains, auscultate it for bowel sounds. Finally, gently
palpate the mass and try to push it upward into the abdomen
to lie down; note whether the bulge disappears. If the bulge
remains, auscultate it for bowel sounds. Finally, gently
palpate the mass and try to push it upward into the abdomen
• *If the client complains of extreme tenderness or nausea, do
not try to push the mass up into the abdomen.
o If the bulge disappears, no scrotal hernia is
present, but the mass may result from something
else and the client should be referred for further
evaluation. A mass on or around the scrotum
should be considered malignant until testing
proves otherwise.
• Abnormal findings
o If the bulge disappears when the client lies down, a
scrotal hernia is present. Bowel sounds auscultated
over the mass indicate the presence of bowel and
thus a scrotal hernia. If you cannot push the mass
into the abdomen, suspect an incarcerated hernia.
A hernia is strangulated when its blood supply is
cut off. The client typically complains of extreme
tenderness and nausea
Standing Squatting Knee-Chest
Left Lateral Lithotomy
• 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
o 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 findings
o Lesions may indicate sexually transmitted diseases,
cancer, or hemorrhoids.
o A thrombosed external hemorrhoid appears
– KathleenVenus
swollen. It is itchy, painful, and bleeds when the
client passes stool.
o A previously thrombosed hemorrhoid appears as a
skin tag that protrudes from the anus.
o A painful mass that is hardened and reddened
suggests a perianal abscess.
o A swollen skin tag on the anal margin may
indicate a fissure in the anal canal.
o Redness and excoriation may be from scratching
an area infected by fungi or pinworms.
o an area infected by fungi or pinworms. A small
opening in the skin that surrounds the anal
opening may be an anorectal fistula (Abnormal
 o A small opening in the skin that surrounds the
anal opening may be an anorectal fistula.
o Thickening of the epithelium suggests repeated
trauma from anal intercourse.
Inspecting the perianal
area.
EXTERNAL HEMORRHOIDS
Hemorrhoids are usually painless papules
caused by varicose veins. They can be internal
or external (above or below the anorectal
junction). This external hemorrhoid has
become thrombosed—it contains clotted
blood, is very painful and swollen, and itches
and bleeds with bowel movements.
PERIANAL ABSCESS
Perianal abscess is a cavity of pus,
caused by infection in the skin
around the anal opening. It causes
throbbing pain and is red, swollen,
hard, and tender.
ANAL FISSURE
These splits in the tissue of the anal
canal are caused by trauma. A swollen
skin tag (“sentinel tag”) is often
present below the fissure on the anal
margin. They cause intense pain,
itching, and bleeding.
ANORECTAL FISTULA
This is evidenced by a small, round
opening in the skin that surrounds
the anal opening. It suggests an
inflammatory tract from the anus or
rectum out to the skin. A previous
abscess may have preceded the fistula.
• Ask the client to perform Valsalva’s maneuver by straining
or bearing down. Inspect the anal opening for any bulges or
lesions.
o No bulging or lesions appear
• Abnormal findings
o Bulges of red mucous membrane may indicate a
rectal prolapse. Hemorrhoids or an anal fissure
may also be seen
o *Document any abnormalities by noting position in
relation to a face of a clock
RECTAL PROLAPSE
This occurs when the mucosa of the
rectum protrudes out through the anal
opening. It may involve only the mucosa
or the mucosa and the rectal wall. It
appears as a red, doughnutlike mass with
radiating folds.
SACROCOCCYGEAL AREA
• Inspect this area for any signs of swelling, redness, dimpling,
or hair.
o Area is normally smooth, and free of redness and
hair
• Abnormal findings
o A reddened, swollen, or dimpled area covered by a
small tuft of hair located midline on the lower
sacrum suggests a pilonidal cyst
PILONIDAL CYST
This congenital disorder is
characterized by a small dimple or
cyst/sinus that contains hair. It is
located midline in the sacrococcygeal
area and has a palpable sinus tract.
Palpation
ANUS
• Inform the client that you are going to perform the internal
examination at this point. Explain that it may feel like his or
her 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.
• *Never use your fingertip—this causes the sphincter to tighten
and, if forced into the rectum, may cause pain
o Client’s sphincter relaxes, permitting entry.
• Abnormal findings
o Sphincter tightens, making further examination
unrealistic
• When you feel the sphincter relax, insert your finger gently
with the pad facing down
o Examination finger enters anus.
• Abnormal findings
o Examination finger cannot enter the anus.
o *If severe pain prevents your entrance to the anus,
do not force the examination.
• If the sphincter does not relax and the client reports severe
pain, spread the gluteal folds with your hands in close
approximation to the anus and attempt to visualize a lesion
that may be causing the pain. If tension is maintained on the
– KathleenVenus
gluteal folds for 60 seconds, the anus will dilate normally.
• Ask the client to tighten the external sphincter; note the
tone.
o The client can normally close the sphincter
around the gloved finger.
• Abnormal findings
o Poor sphincter tone may be the result of a spinal
cord injury, previous surgery, trauma, or a
prolapsed rectum. Tightened sphincter tone may
indicate anxiety, scarring, or inflammation
 o The prostate is normally nontender and rubbery.
• Rotate finger to examine the muscular anal ring. Palpate for
It has two lateral lobes that are divided by a
tenderness, nodules, and hardness
median sulcus. The lobes are normally smooth, 2.5
o The anus is normally smooth, nontender, and free
cm long, and heart-shaped
of nodules and hardness.
o Identify any tenderness with examination or
• Abnormal findings
nodules palpable.
o Tenderness may indicate hemorrhoids, fistula, or
• Abnormal findings
fissure. Nodules may indicate polyps or cancer.
o A swollen, tender prostate may indicate acute
Hardness may indicate scarring or cancer.
prostatitis. An enlarged smooth, firm, slightly
RECTUM elastic prostate that may not have a median sulcus
• Insert your finger further into the suggests benign prostatic hypertrophy (BPH). A
rectum as far as possible. Next, turn hard area on the prostate or hard, fixed, irregular
your hand clockwise then nodules on the prostate suggest cancer.
counterclockwise. This allows o * Palpating prostate prior to drawing a prostate
palpation of as much rectal surface specific antigen (PSA) will raise the PSA level
as possible. Note tenderness, STOOL
irregularities, nodules, and
• Withdraw your gloved finger. Inspect any fecal matter on
hardness Palpating the rectal your glove. Assess the color, and test the feces for occult
o The rectal mucosa is wall blood. Provide the client with a towel to wipe the anorectal
normally soft, smooth,
area.
nontender, and free of
o Stool is normally semi-solid, brown, and free of
nodules.
blood
• Abnormal findings • Abnormal findings
o Hardness and irregularities may be from scarring o Black stool may indicate upper gastrointestinal
or cancer. Nodules may indicate polyps or cancer bleeding, gray or tan stool results from the lack of
bile pigment, and yellow stool suggests steatorrhea
RECTAL POLYPS (increased fat content). Blood detected in the stool
may indicate cancer of the rectum or colon. An
These soft structures are rather endoscopic examination of the colon should be
common and occur in varying performed.
size and number. There are two
types: Pedunculated (on a stalk) Female Genitalia
and sessile (on the mucosal surface

PERITONEAL CAVITY
• This area may be palpated in men above the prostate gland in
the area of the seminal vesicles on the anterior surface of the
rectum. In women, this area may be palpated on the anterior
rectal surface in the area of the rectouterine pouch (behind
the cervix and the uterus). Note tenderness or nodules.
o This area is normally smooth and nontender.
• Abnormal findings
o A peritoneal protrusion into the rectum, called a
rectal shelf, may indicate a cancerous lesion or
peritoneal metastasis. Tenderness may indicate
peritoneal inflammation.

Assessment of the Prostate Gland

Palpation EXTERNAL FEMALE GENITALIA
• In male clients, palpate the prostate. The prostate can be
palpated on the anterior surface of the rectum by turning the MONS PUBIS/MONS VENERIS
hand fully counterclockwise so the pad of your index finger • Is a pad of adipose tissue located over symphysis pubis, the
faces toward the client’s umbilicus. Tell the client that he pubic bone joint. The purpose of mons veneris is to protect
may feel an urge to urinate but that he will not. Move the
– KathleenVenus

the junction of the bone from the trauma.

pad of your index finger over the prostate gland, trying to
feel the sulcus between the lateral lobes. Note the size, shape,
and consistency of the prostate, and identify any nodules or
tenderness.
• *You may need to move your body away from the client to
achieve the proper angle for examination
o 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
CLITORIS
• Is sensitive to touch and temperature and is the center of
sexual arousal and orgasm in the female.
LABIA MAJORA
• Covered by pubic hair, the labia majora serve as protection
for the external genitalia and the distal urethra and vagina.
LABIA MINORA
• Normally the folds of the labia minora are pink, the internal
surface is covered with mucous membrane the external
surface with the skin
URETHRAL MEATUS AND PARAURETHRAL GLANDS
• The paraurethral glands, or Skene’s glands, open into the
posterior wall of the urethra close to its opening. Their
secretions lubricate the vaginal opening, facilitating sexual
intercourse.
VAGINAL VESTIBULE
• Boat-shape depression enclosed by the labia majora and
visible when they are separated
HYMEN
• Is thin, elastic collar or semi collar of tissue that surrounds
the vaginal opening.
Subjective Data Collection
• Clients from some cultures (e.g., Islam) may accept subjective
or physical assessment only by a female nurse, especially
when genital and/or sexual issues are being addressed.
MENSTRUAL CYCLE
• What was the date of your last menstrual period? Do your
menstrual cycles occur on a regular schedule? How long do
they last? Describe the typical amount of blood flow you have
with your periods. Any clotting?
Rationale: A normal menstrual cycle usually
occurs approximately every 18 to 45 days. The
average length of menstrual blood flow is 3 to 7
days. The absence of menstruation, excessive
bleeding, or a marked change in menstrual
pattern indicates a need to collect more
information
• What other symptoms do you experience before or during
your period (cramps, bloating, moodiness, breast
tenderness)?
Rationale: Headache, weight gain, mood swings,
abdominal cramping, and bloating are common
complaints before or during the menstrual period.
Some women experience premenstrual syndrome
(PMS), in which the symptoms become severe
enough to impair the women’s ability to function.
• How old were you when you started your period?
Rationale: In North America, the average age is
12.5 years. Menstruation usually begins when the
woman reaches 48 kg (106 lb).
* Menarche (beginning of menstruation) tends to
begin earlier in women living in developed
countries and later in women who live in
undeveloped countries. Ages of menarche range
from 10 to 16 years of age, with earlier onset in
shorter and fatter girls). Women who are poor or
from less developed countries have earlier
menopause.
• Have you stopped menstruating or have your periods become
irregular? Do you have any spotting between periods? What
symptoms have you experienced?
Rationale: Irregularities or amenorrhea may be
due to pregnancy, depression, ovarian tumors,
ovarian cysts, autoimmune disease, and hormonal
imbalances. Cessation of menstruation is termed
menopause, see next rationale.
MENOPAUSE
• Are you still having periods? Have your periods changed?
Rationale: Menopause is a normal physiologic
process that occurs in women between the ages of
40 to 58 years, with a mean age of 50. Menopause
occurring before age 30 is termed premature
menopause; menopause between ages 31 and 40 is
considered early; menopause occurring in women
older than age 58 years is termed delayed
menopause. Premature and delayed menopause
may be due to genetic predisposition, an
endocrine disorder, or gynecologic dysfunction.
menopause. Premature and delayed menopause
may be due to genetic predisposition, an
endocrine disorder, or gynecologic dysfunction.
Artificial or surgical menopause occurs in women
who have dysfunctional ovaries or who have had
their ovaries removed surgically.
During the perimenopausal period, hormone
levels may fluctuate, resulting in menstrual
irregularities. Periods may be heavier or may
become scant.
• Are you experiencing any symptoms of menopause?
Rationale: Hormone fluctuations impact
vasomotor instability resulting in symptoms.
About 60% of menopausal women experience hot
flashes and night sweats. Mood swings, decreased
appetite, vaginal dryness, spotting, and irregular
vaginal bleeding may also occur.
• Are you on a hormone replacement therapy (HRT) regimen?
If so, what type, and dosage? Are you satisfied with HRT?
Rationale: It is important to discuss and explain
risk versus benefits of HRT.
• Are you continuing to have any symptoms of menopause
while taking HRT?
Rationale: If vasomotor symptoms continue, the
client may need to have type of HRT or dosage
adjusted.
• What are your concerns about going through menopause?
Rationale: Menopause is a normal stage in a
woman’s life. Some women have mixed feelings
about experiencing menopause. Some may grieve
their loss of child-bearing capabilities; while
others may welcome this new phase of life, as they
feel relieved no longer having to be concerned
about pregnancy.
VAGINAL DISCHARGE, PAIN, MASSES
• Are you experiencing vaginal discharge that is unusual in
terms of color, amount, or odor?
Rationale: Vaginal discharge may be from an
infection.
• Do you experience pain or itching in your genital or groin
area?
Rationale: Complaints of pain in the area of the
vulva, vagina, uterus, cervix, or ovaries may
indicate infection. Itching may indicate infection
or infestation. The older client is more susceptible
to vaginal infection because of atrophy of the
vaginal mucosa associated with aging
• Do you have any lumps, swelling, or masses in your genital
area?
Rationale: These findings may indicate infection,
lymphedema, or cancer. Past occurrences should
be monitored for recurrence.
URINATION
• Do you have any difficulty urinating? Do you have any
burning or pain with urination? Has your urine changed
color or developed an odor? Have you noticed any blood in
your urine?
– KathleenVenus
Rationale: Urinary frequency, burning, or pain
(dysuria) are signs of infection (urinary tract or
sexually transmitted disease), whereas hesitancy or
straining could indicate blockage. Change in
color and development of an abnormal odor could
indicate infection
• Do you have difficulty controlling your urine?
Rationale: Difficulty controlling urine
(incontinence) may indicate urgency or stress
incontinence. During sneezing or coughing,
increased abdominal pressure causes spontaneous
urination
 Urination. Urinary incontinence may develop in
older women from muscle weakness or loss of
urethral elasticity
SEXUAL DYSFUNCTION
• Do you have any problems with your sexual performance?
Rationale: A broad opening question about sex
allows the client to focus the interview to areas
where she has concerns. Some women have
difficulty achieving orgasm and may believe there
is something wrong with them.
• Have you recently had a change in your sexual activity
pattern or libido?
Rationale: A change in sexual activity or libido
needs to be investigated for the cause. A woman
who is dissatisfied with her sexual performance
may experience a decreased libido.
• Do you experience (or have you experienced) problems with
fertility?
Rationale: Infertility is defined as unprotected sex
for 1 year without pregnancy. Approximately 35%
of infertility cases are related to female fertility
factors from a variety of causes.
OBSTETRICAL HISTORY
•Have you ever been pregnant? If so, how many times? How
many living children do you have? Were births vaginal or
cesarean?
Rationale:
Gravida: Number of pregnancies a woman has
had, including if she is presently pregnant.
Para: Number of births a woman has had after 20
weeks even if the fetus died at birth.
GYNECOLOGIC HISTORY
• Have you ever had a Papanicolaou (Pap) smear? When? Have
Pap results been normal? If not, did you receive treatment?
When? Have you had previous surgeries? Have you been
treated for vaginal infection? Do you have frequent vaginal
infections? Do you use over-the-counter (OTC) vaginal
medication?
Rationale: Pap smear is cytologic evaluation of
cervical cells to screen for pre- cancerous lesions. It
does NOT screen for sexually transmitted
infections (STIs) or any cancers other than cervical
cancer. A patient with recurring yeast infections
should be evaluated for diabetes and HIV.
Frequent use of OTC creams or suppositories can
mask other more serious infections.
CONTRACEPTION
• Do you use condoms or other barriers during sex? Sometimes
or always? Do you use contraception? If so, what is currently
used? Have you ever used anything different? Have you had
any problems with any contraceptive forms?
Rationale: Condoms provide some but not
complete protection against STIS. The only 100%
safe sex practice is abstinence
Inspection
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.
o Pubic hair is distributed in an inverted triangular
pattern and there are no signs of infestation.
o Older clients may have gray, thinning pubic hair.
o Some clients, particularly younger ones, shave or
pluck the pubic hair. Piercing of the mons pubis is
for aesthetics and does not enhance sexual
pleasure.
LABIA MAJORA AND PERINEUM
• Observe the labia majora and perineum for lesions, swelling,
excoriation
o The labia majora are equal in size and free of
lesions, swelling, and excoriation. A healed tear or
episiotomy scar may be visible on the perineum if
the client has given birth. The perineum should be
smooth.
• Abnormal findings
o Lesions may be from an infectious disease such as
herpes or syphilis. Excoriation and swelling may
be from scratching or self-treatment of the
lesions. All lesions must be evaluated and the
client referred for treatment.
Inspecting the pubic Inspecting the labia minora, Technique for
hair, labia majora, clitoris, urethral orifice, and palpating Bartholin’s
and perineum vaginal opening. gland.
GENITAL HERPES SIMPLEX
The initial outbreak of herpes
may have many small, painful
ulcers with erythematous base.
Recurrent herpes lesions are
usually not as extensive.
SYPHILITIC CHANCRE
Syphilitic chancres often first appear on
the perianal area as silvery white papules
that become superficial red ulcers.
Syphilitic chancres are painless. They are
sexually transmitted and usually develop
at the site of initial contact with the
infecting organism.
GENITAL WARTS
Genital warts, caused by the human
papilloma virus (HPV), are moist,
fleshy lesions on the labia and within
the vestibule. They are painless and
believed to be sexually transmitted.
LABIA MINORA, CLITORIS, URETHRAL MEATUS, AND
VAGINAL OPENING
– KathleenVenus
• Use your gloved hand to separate the labia majora and
inspect for lesions, excoriation, swelling, and/or discharge
o 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; it may be
covered partially or completely by a hymen.
 • Abnormal findings
o Asymmetric labia may indicate abscess. Lesions, UTERINE PROLAPSE
swelling, bulging in the vaginal opening, and Uterine prolapse occurs when the uterus
discharge are abnormal findings. Excoriation may protrudes into the vagina. It is graded
result from the client scratching or self-treating a according to how far it protrudes into the
vagina. In first-degree prolapse, the cervix is
perineal irritation.
seen at the vaginal opening; in second-degree

Palpation
prolapse the uterus bulges outside of vaginal
openings; in third-degree prolapse, the uterus
bulges completely out of the vagina.
BARTHOLIN’S GLANDS
• If the client has labial swelling or a history of it, palpate
Bartholin’s glands 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.
o Bartholin’s glands are usually soft, nontender, and
drainage free.
• Abnormal findings
o 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.

ABSCESS OF BARTHOLIN’S
GLAND
a painful condition and
common sign of Neisseria
gonorrhoeae infection

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
o No drainage should be noted from the urethral
meatus. The area is normally soft and nontender.
• Abnormal findings
o Drainage from the urethra indicates possible
urethritis. Any discharge should be cultured.
Urethritis may occur with infection with Neisseria
gonorrhoeae or Chlamydia trachomatis.

CYSTOCELE
A cystocele is a bulging in the
anterior vaginal wall caused by
thickening of the pelvic
musculature. As a result, the
bladder, covered by vaginal
mucosa, prolapses into the vagina.
– KathleenVenus

RECTOCELE
A rectocele is a bulging in the
posterior vaginal wall caused by
weakening of the pelvic
musculature. Part of the rectum
covered by the vaginal mucosa
protrudes into the vagina.