EXAMINATION OF

FEMALE
GENITALIA &
ANUS
 Techniques.
• Inspection and palpation.
 Preparation.
• Client in lithotomy position with knees flexed
perpendicular to bed.

• Client to relax thighs to allow each leg to abduct to

side.

• Client’s head may be elevated for comfort.

• Place drape over client’s torso and thighs to expose

external genitalia.
• Don gloves.

• Assessment may produce feelings of fear,

anxiety, indignity, and loss of control.

• Nurse should be sensitive before, during, and

after the assessment
 Mons pubis and vulva.
• Observe skin coloration and condition.

• Separate labia majora with thumb & index finger.

• Note color, lesions, or trauma.

• Palpate the labium between thumb and index

finger for swelling, indurations, pain, or
discharge from a Bartholin gland.
 Abnormal findings.
• Rashes over the mons pubis or labia could be due to contact
dermatitis or infestations.

• Labial swelling may be due to a hematoma, Bartholin’s cyst, or

obstruction of lymphatic system.

• Broken areas of the skin may be due to ulcerations secondary to

infections or trauma.

• A painless mass with pruritus is suspicious of malignancy.

• Venous prominence (varicose veins) of the labia may be due to a

congenital predisposition, prolonged standing, or pregnancy.
 Common abnormal lesions of external female
genitalia

• Chancre:
– Reddish, round ulcer with a depressed center and
raised edges.
– Appears in primary phase of syphilis at the site where
the treponema enters the body.
– It lasts for 4 weeks, then disappears.

• Condyloma acuminatum:
– White, dry, painless growth with a narrow base
– Caused by the human papilloma virus.
• Condylomata lata:
– Raised, round, wart like plaque with a moist
surface covered by a gray exudate
– Appears during the secondary stage of syphilis.

• Herpes simplex:
– Small, red vesicles that fuse together to form a
large ulcer that may be painful and itchy.
• Condylomata lata
lesions of secondary
syphilis
• Granulating ulcer on
right labia characteristic
of HSV
• Syphilitic chancre-male
 The clitoris
• Using the thumb and index finger separate the labia
minora laterally to expose the prepuce of the clitoris.

• Note the size and condition.

• Approximately 2 cm long and 0.5 cm in diameter; free

from lesions.

• Enlarged (hypertrophy) clitoris may indicate female

pseudohermaphroditism caused by androgen excess.

• Clitoris common site for a chancre lesion.

 Urethral meatus
• Using thumb and index finger, separate the labia minora
laterally to expose the urethral meatus

• Inspect shape, color, and size.

• Avoid touching the meatus because this may cause pain

and urethral spasm.

• Midline, slit-like opening, free of discharge, swelling, or

redness.
• Discharge indicates a urinary tract infection.

• Swelling or redness indicates infection,

urethral carcinoma, or prolapse of the urethral
mucosa.
 Vaginal introitus.
• Keeping the labia minora retracted laterally, inspect
the vaginal introitus

• Instruct the client to bear down while you note

patency and bulging.

• Introitus mucosa is pink and moist with a clear to

white discharge that contains white clumps of
epithelial cells.

• Free of foul odor and bulging.

• Pale color and dryness reveal atrophy from topical steroids
or aging.

• Foul-smelling discharge indicate vaginitis or cervicitis.

• External tear of the vaginal introitus may indicate trauma

from sexual activity or abuse.

• Bulging of the anterior wall may indicate a cystocele

– Protrusion of the urinary bladder through the wall of the vagina
due to weakness of supporting tissues and ligaments.
 Perineum and anus.
• Note texture and color of perineum and color
and shape of anus.

• Perineum is smooth, intact, and slightly

darkened.

• The anus is dark pink to brown.

• Fissure or tear results from area trauma,

abscess, or unhealed episiotomy.
• Venous prominence of anal area indicates
external hemorrhoids (varicose dilatation of a
vein of the inferior hemorrhoidal plexus
covered with modified anal skin).
EXAMINATION OF
MALE GENITALIA
ANUS &
RECTUM.
 Includes assessment of …
• Testes

• Accessory organs: seminal vesicles ,bulbourethral

glands

• Ducts (epididymis,vas deferens, ejaculatory duct),and

the urethra.

• Supporting structures: scrotum, penis, spermatic cord.

• Anorectal examination: rectum and prostate gland

 Testicular self examination (TSE)
• Important for middle aged men to ensure
early detection of testicular cancer.

• Teach client about monthly TSE

 Teaching about TSE
• Review anatomy of scrotum by describing that
testicles are ovoid structures that feel firm and
rubbery and that the epididymis, located behind the
testicles, is softer and feels
rope-like.

• Instruct the client to perform TSE using the thumb

and first two fingers to gently feel each testicle and
the epididymis.
• The testicles should move freely within the
scrotum and have a smooth surface; the
epidiymis should be softer.

• Instruct the client to report any findings that

deviate from normal such as lumps and
nodules, especially if they are non mobile.
 Examination.
• Place client supine, with legs spread slightly,
or in standing position.

• Don gloves.
Assess glans penis, urethral meatus & scrotum.

• Instruct uncircumcised clients to retract the

foreskin.

• Inspect the anterior and posterior surfaces by

lifting the penis.

• Note lesions, swelling, or inflammation.

• Uncircumcised men can develop phymosis (foreskin

cannot be retracted over the glans penis)
• Priapism is a continuous and pathologic
erection of the penis

• Palpate penile shaft using thumb and first two

fingers to assess the entire length of penis.

• Note pulsations, tenderness, swelling, masses,

or plaques.
• Absent pulsations indicate vascular
insufficiency associated with systemic disease,
localized trauma, or disease that interrupts
blood flow.
 Common abnormal lesions of the external male genitalia

• Candidiasis:
– Multiple, discrete, flat pustules with scaling .

• Chancroid:
– Tender, ulcerated, exudative, lesion with an
erythematous halo surrounding edema and a
friable base that results from small breaks in
epidermal tissue and inoculation of Hemophilus
ducreyi.
• Tinea cruris:
– Erythematous plaques with scaling, papular,
lesions with sharp margins caused by fungal
infections of the groin
• Inspect the urethral meatus.

• Note location , color, and discharge (culture any

discharge).

• Epispadias: Meatus that opens dorsally on penis

• Hypospadias: Congenital defect in which the meatus

opens on the underside of the penis
• Inspect the scrotum by displacing the penis to
one side to assess the scrotal skin.

• Lift up the posterior side.

• Note lesions, inflammation, and swelling.

• Palpate the right testicle between your thumb

and first two fingers.
• Proceed to the epididymis, then to the
spermatic cord , and to the external ring,
noting consistency, presence of tenderness or
masses.

• Repeat on left side.

 Abnormalities...

• Painless swelling that is unilateral with a hard,

fixed nodule may indicate a cancerous mass.

• Sensitive, enlarged testicle may indicate a

testicular torsion (twisting).

• Swollen, tender epididymis indicates

epididymitis (inflammation).
• Warm scrotal skin, tenderness, and swelling
indicates orchitis (inflammation of the testes)

• Enlarged, reddened scrotum with taut skin and

nonpalpable contents is scrotal edema.

• A bluish discoloration of the scrotal mass that

disappears with supine positioning is a
varicocele.
• Undescended testicle (cryptorchidism) is
usually unilateral.

• The testicle remains in the inguinal canal.

Inspect and palpate the inguinal and femoral areas with client standing.

• Instruct the client to strain down. Observe for bulges.

• Using your right hand, invaginate scrotal skin with index finger.

• Follow spermatic cord upward to opening of external inguinal ring.

• Ask client to cough or strain down. If mass is present, it will touch

your finger.

• Repeat palpation on client’s left side with your left hand.

– Inguinal area is smooth, free from swelling or bulges.

– Oval swelling at the pubic tubercle just above the
inguinal ligament indicates an inguinal hernia
(portions of the bowel or omentum protrude
through the external inguinal ring).

– A mass medial to the femoral vessels and inferior

to the inguinal ligament is indicative of a femoral
hernia (portions of the bowel or omentum
protrude through the femoral wall).
 Examine the anal and rectal area with the client in a sidelying position.

• Spread the buttocks with your nondominant hand.

• Inspect sacrococcygeal and perineal areas. Observe

for rashes, inflammation, and nodes.

• Palpate any nodules for tenderness.

• Lubricate gloved index finger of dominant hand.

Instruct client to strain down while inspecting anus
for hemorrhoids, fissures, excoriation, and growths.
• As client strains down, place pad of index
finger over anus.

• As sphincter relaxes, insert finger pad into the

anal canal, pointing toward umbilicus.

• Note sphincter tone, tenderness, or nodules.

• Insert finger further and palpate rectal wall in
sequence (right lateral, posterior, left lateral
surfaces), noting nodules, irregularities, or
tenderness.

• Palpate surface of prostate gland (lateral lobes

and median sulcus).
• Extend finger pad above prostate gland and instruct
client to strain down.

• Note size, shape, consistency, and mobility of

prostate.

• Withdraw finger and wipe anal area.

– Prostate gland is small (about the size of a chestnut-

20grams), smooth, mobile, and median sulcus is palpable
• Fissure or tear results from trauma or abscess.

• Venous prominence of anal area indicates

external hemorrhoids.

• A soft, nontender, enlarged prostate may reveal

benign prostatic hypertrophy that occurs with
the loss of androgens (e.g., as with aging).
• Firm, hard, nodules on prostate may indicate acinar
adenocarcinoma.

• A firm, tender, or fluctuant mass may reveal a

prostatic abscess.

• A tender, warm prostate may indicate acute bacterial

prostatitis associated with a bladder infection (e.g., E.
coli).
• After a digital rectal examination, the color of
feces on your gloved finger should be noted.
Bright red or tarry, black stools are indicative
of bleeding.

• A sample of feces is tested for occult blood

Thank you for your attention