Repro

• External genitalia


  Generally referred to as the vulva or pudendum
• Parts of the external genitalia

  • Mons pubis
  • Labia majora
  • Labia minora
  • Clitoris
  • Vestibule
  • Perineum
• Mons pubis


  • Rounded mound of fatty tissue that covers the pubic bone
  • Becomes covered with hair during puberty
  • Contains oil-secreting glands that release pheromones
• Labia majora


  • Relatively large, fleshy folds of tissue that enclose and protect the other external genital organs
  • Comparable to the scrotum in males
  • Contain sweat and sebaceous glands that produce lubricating secretions
  • Protect the labia minora, urinary meatus and vaginal introitus
  • Hair appears during puberty
• Labia minora


  • Can be very small or up to 2 inches wide
  • Lie just inside the labia majora and surround the openings to the vagina and urethra
  • Have a rich supply of blood vessels that become engorged during sexual stimulation, causing the labia minora to swell and become more sensitive
• Perineum


  The area between the opening of the vagina and the anus, below the labia majora
• Clitoris


  • A small protrusion located at the anterior of the labia minora
  • Corresponds to the penis in the male
  • Rich vascular, highly sensitive to temperature, touch, and pressure sensation
  • Very sensitive to sexual stimulation
• Vestibule


  • An oval-shaped area formed between the labia minora, clitoris, and fourchette
  • Contains the external urethral meatus, vaginal introitus, and Bartholins glands
• Vagina


  • A flattened, tubular canal extending from the orifice up and backward into the pelvis
  • Leads into the female reproductive tract
  • Allows passage of the menstrual flow
  • Serves as the lower portion of the birth canal
• Layers of the vaginal wall

  • Outer layer - pink squamous epithelium and connective tissue
  • Second layer - submucosal layer with blood vessels, nerves and lymphatic channels
  • Third layer - smooth muscles
  • Fourth layer - connective tissue and vascular network
• Cervix


  • A cylinder-shaped neck of tissue that connects the vagina and uterus
  • Located at the lowermost portion of the uterus
  • Composed primarily of fibromuscular tissue
  • Allows the entrance of sperm into the uterus
  • Allows the passage of menstrual flow
  • Secretes mucus and prevents entrance of bacteria
  • Dilates during childbirth to allow the passage of the fetus
• Uterus


  • A pear-shaped, thick walled, muscular organ
  • Flattened antero-posteriorly, measuring 5.5 to 8 cm by 3.5-4 cm wide, and 2-2.5 cm thick
  • Houses the fetus until it is ready for birth
  • Has two parts: corpus (body) and the cervix (neck)
• Corpus (of the uterus)


  • The main body of the uterus
  • Very muscular and can stretch to accommodate a developing fetus
  • During labor, the muscular walls contract to help push the baby through the cervix and vagina
• Ovaries


  • The primary reproductive organ of the female
  • An egg-cell producing organ which is oval shaped, 3 cm long by 2 cm wide
  • Located at the lateral aspect of the pelvic cavity
  • Produce estrogen, progesterone and testosterone
• Phases of reproductive health

  • Prepuberty (premenstruation)
  • Puberty (menstruation)
  • Childbearing (menstruation)
  • Perimenopausal
  • Menopausal
• Information to collect in the menstrual history

  • Age at menarche
  • Date of last period
  • Menstrual cycle frequency
  • Duration of menstrual flow
  • Color and heaviness of flow
  • Presence of discomfort or pain
  • For middle-aged or older women: age at menopause, symptoms, any bleeding since menopause
• Information to collect in the obstetric history


  • Pregnancy history
  • Abortion/miscarriage history
  • Contraception methods
  • Vulvovaginal symptoms (discharge color, odor, consistency, amount)
• Information to collect in the sexual history

  • Sexual orientation and gender identity
  • Sexual responses (interest, arousal, lubrication, orgasm)
  • Sexually transmitted infections
• The female genital system assessment is very invasive and can be uncomfortable for both the patient and the nurse
• It is important to project a respectful, nonjudgmental demeanor and ensure privacy and comfort for the patient
• Patients from some cultures (e.g. Islam) may insist on having a female nurse for the assessment of the female genitalia, anus and rectum
• Western culture tends to emphasize the importance of a woman's reproductive ability, thereby entwining self-esteem and body image with female sex role
• The patient should empty her bladder before the examination, and all equipment needed should be set up and within reach
• The patient should be allowed to see the instruments and have their purpose explained, and be encouraged to ask questions
• The patient should be draped to keep the genitals visualized without completely exposing the legs and knees, and a mirror should be provided so she can see the examination better
• The patient should be assisted in assuming the semi-lithotomy position, and reassured that she can voice any discomfort during the examination
• Equipment needed for the examination

  • Examination gloves
  • Sheet or drape
  • Nonsterile examination gloves (non latex and latex)
  • Water-soluble vaginal lubricant
  • Lamp with either goose neck or speculum attachment
  • Wooden/plastic spatula
  • Cervical brush(broom)
  • Endo-cervical brush
  • Glass slide
  • Slide fixative
• The mons pubis should be inspected for distribution of pubic hair and signs of infestations
• The inguinal lymph nodes should be observed and palpated for any enlargement or swelling
• The labia majora and perineum should be inspected for lesions, swellings and excoriations
• The labia minora, clitoris, urethral meatus and vaginal opening should be inspected with the labia majora separated
• If the patient has labial swelling or history of it, the Bartholin glands should be palpated
• If the patient has urethral symptoms or urethritis, the urethra should be palpated by inserting a gloved index finger into the superior portion of the vagina and milking the urethra from the inside
• The size of the vaginal opening and the angle of the vagina should be inspected by inserting a gloved index finger
• Inspection of female genitalia

  • Look for lesions, excoriation, swelling and/or discharge
  • Appears symmetric, dark pink and moist
  • Size of clitoris varies
  • Urethral meatus is small and slit-like
  • The vaginal opening is found below the urethral meatus. A hymen may cover the vaginal opening partially or completely
• Palpation of Bartholin glands

  • If the client has labial swelling or history of it, palpate Bartholin glands
  • Usually soft, non tender and drainage free
  • Abscess of Bartholin's gland is a common sign of Neisseria gonorrhoeae infection
• Palpation of the urethra


  If the client manifests urethral symptom or urethritis, insert your gloved index finger into the superior portion of the vagina and milk the urethra from the inside pushing up and out
• Inspection of the size of the vaginal opening and the angle of the vagina

  • The vagina is typically tilted posteriorly at a 45-degree angle and feel moist
  • When the vagina becomes dryer and thinner – Vaginal atrophy (Menopause, Breast feeding, Surgical removal of the ovaries, chemotherapy)
• Inspection of the vaginal musculature


  1. Keep the index finger inserted in the client's vaginal opening

  2. Ask the clients to squeeze around the finger

  3. Use the middle finger to separate the labia minora

  4. Ask the client to bear down

  5. Client is able to squeeze around the examiner's finger

  6. Nulliparous woman can squeeze tighter than the multiparous woman

  7. No bulging and no urinary discharge
• Inspection of the size of the vaginal opening and the angle of the vagina

  • Absent or decrease ability to squeeze indicates decrease muscle tone
  • Bulging of the anterior wall may indicate a cystocele
  • Posterior wall bulging indicates rectocele
  • Protrusion of the cervix or uterus implies uterine prolapse
  • If urine leaks out, the client may have stress incontinence