genetalia

• Anal Canal


  Part of the digestive system
• External Anal Sphincter


  Voluntary muscle that helps hold the anal canal closed
• Internal Anal Sphincter


  Involuntary muscle that helps hold the anal canal closed
• Pectinate or Dentate Line

  Anatomical landmark in the anal canal
• Prostate Gland


  Part of the male reproductive system
• Valves of Houston


  Anatomical structures in the rectum
• The muscle actions of the voluntary external anal sphincter and involuntary internal anal sphincter normally hold the anal canal closed
• Common or Concerning Symptoms

  • Change in bowel habits
  • Blood in the stool (hematochezia/melena)
  • Pain with defecation; rectal bleeding or tenderness
  • Anal warts or fissures
  • Weak stream of urine
  • Burning with urination
• Inspect the sacrococcygeal and perianal areas

  • Look for lumps, ulcers, inflammation, rashes, or excoriations
• Adult perianal skin


  • More pigmented and somewhat coarser than the skin over the buttocks
• Palpate any abnormal areas


  • Note lumps or tenderness
• Anal fissure


  • A linear crack or tear, caused by large, hard stools, inflammatory bowel disease, or STDs
• Pilonidal cyst


  • A fairly common, probably congenital, abnormality located in the midline superficial to the coccyx or the lower sacrum
• Examine the anus and rectum

  1. Lubricate your gloved index finger

  2. Explain to the patient what you are going to do

  3. Ask the patient to strain down

  4. Inspect the anus, noting any lesions
• Sphincter tone of the anus


  • Normally, the muscles of the anal sphincter close snugly around your finger
• Palpate the region of the seminal vesicles and the peritoneal cavity


  • Note any nodules or tenderness
• Withdraw your finger


  1. Wipe the anus or give the patient tissues

  2. Note the color of any fecal matter on your glove, and test it for occult blood
• Examine the rectum in females

  1. Usually after the female genitalia, while the woman is in the lithotomy position

  2. Conduct the bimanual examination and delineate a possible adnexal or pelvic mass

  3. Test the integrity of the rectovaginal wall and palpate a cancer high in the rectum
• The cervix is readily palpated through the anterior wall, and a retroverted uterus may also be palpable
• Do not mistake the cervix or a vaginal tampon for a tumor
• Recording the Physical Examination—The Anus, Rectum, and Prostate


  • No perirectal lesions or fissures. External sphincter tone intact. Rectal vault without masses. Prostate smooth and nontender with palpable median sulcus. (Or in a female, uterine cervix nontender.) Stool brown and hemoccult negative.
  • Perirectal area inflamed; no ulcerations, warts, or discharge. Unable to examine external sphincter, rectal vault, or prostate because of spasm of external sphincter and marked inflammation and tenderness of anal canal.
  • No perirectal lesions or fissures. External sphincter tone intact. Rectal vault without masses. Left lateral prostate lobe with 1 × 1 cm firm, hard nodule; right lateral lobe smooth; median sulcus obscured. Stool brown and hemoccult negative.
• Vulva


  Includes the mons pubis, a hair-covered fat pad overlying the symphysis pubis
• Labia majora


  • Rounded folds of adipose tissue
• Labia minora


  • Thinner pinkishred folds that extend anteriorly to form the prepuce
• Vestibule


  Boat-shaped fossa between the labia minora
• Vaginal opening (introitus)


  Lies in the posterior portion which in virgins may be hidden by the hymen
• Perineum


  Tissue between the introitus and the anus
• Urethral meatus


  Opens into the vestibule between the clitoris and the vagina
• Paraurethral (Skene's) glands


  Openings lie just posterior to the urethral meatus on either side
• Vagina


  • Musculomembranous tube extending upward and posteriorly between the urethra and the rectum
  • Upper third takes a horizontal plane and terminates in the cup-shaped fornix
  • Vaginal mucosa lies in transverse folds, or rugae
• Uterus


  • Flattened fibromuscular structure shaped like an inverted pear
  • Has two parts: the body, or corpus, and the cervix, both joined at the isthmus
  • Convex upper surface of the body is termed the uterine fundus
  • Distal cervix protrudes into the vagina, dividing the upper vagina into three recesses, the anterior, posterior, and lateral fornices
• Ectocervix


  • Vaginal surface of the cervix seen easily with the help of a speculum
  • At its center is a round, oval, or slitlike depression, the external os of the cervix, which marks the opening into the endocervical canal
  • Covered by the plushy, red columnar epithelium surrounding the os, which resembles the lining of the endocervical canal, and a shiny pink squamous epithelium continuous with the vaginal lining
• Fallopian tube


  • Extends from each side of the uterus toward the ovary with a fanlike tip
• Ovaries


  • Almond-shaped structures that vary considerably in size but average approximately 3.5 × 2 × 1.5 cm from adulthood through menopause
  • Palpable on pelvic examination in roughly half of women during the reproductive years
• Adnexa


  Plural Latin word meaning appendages, refers to the ovaries, tubes, and supporting tissues
• Ovaries


  • Production of ova and the secretion of hormones, including estrogen, progesterone, and testosterone
  • Stimulate the development of secondary sex characteristics, including the breasts and pubic hair
• Rectouterine pouch (pouch of Douglas)

  Parietal peritoneum extends downward behind the uterus into this cul de sac, which can be reached on rectovaginal examination
• Pelvic organs


  • Supported by a sling of tissues composed of muscle, ligaments, and fascia, through which the urethra, vagina, and rectum all pass
• Tanner stages


  Assessment of sexual maturity in girls depends on the growth of pubic hair and the development of breasts, not internal examination
• Pubic hair


  • In most women, it spreads downward in a triangular pattern, pointing toward the vagina
  • In 10% of women, it may form an inverted triangle, pointing toward the umbilicus
  • Growth is usually not completed until the middle 20s or later