ABNORMALITIES

• Hernia


  Protrusion of loops of bowel through weak areas of the musculature
• Types of Hernia

  • Reducible hernia can be pushed back in, irreducible hernia cannot be pushed back in
  • Indirect inguinal hernia is the most common, occurs above the inguinal ligament near the inguinal ring, often into the scrotum, often in children due to patent processus vaginalis
  • Direct inguinal hernia usually occurs in men over 40, above the inguinal ligament near the pubic tubercle and external inguinal ring
  • Femoral hernia is the least common and more common in women, below the inguinal ligament and more lateral

  
• Testicular cancer is the most common cancer of men ages 15 to 34
• Testicular cancer is the most common cancer in men ages 15 to 34, while prostate cancer is the most common cancer in men with no age limit
• Genital abnormalities

  • Phimosis (unable to retract foreskin)
  • Paraphimosis (unable to return foreskin to original position)
  • Hypospadias (ventral location of the meatus)
  • Epispadias (dorsal location of the meatus)
  • Pubic lice or nits (excoriated skin, pediculosis pubis, crab lice)
  • Stricture (narrowed opening)
  • Urethritis (red, everted, edematous edges, purulent discharge)
  • Balanitis (inflammation of the penis)
• Scrotal masses


  • Varicocele (varicose veins of the spermatic cord, feels like a "bag of worms", may be associated with pain or heaviness, but often asymptomatic)
  • Hydrocele (non-tender, fluid-filled mass within the tunica vaginalis, common in infancy but can occur with any age)
  • Tumors (non-tender, irregular, hard mass fixed on the testes, does not transilluminate, must rule out malignancy, most common tumor in males – ages 15 to 34)
  • Orchitis (acute inflammation of the testicles, usually unilateral, tender/painful with possible erythema, seen with mumps and other viral infections)
• Acute testicular swelling/pain


  • Torsion (twisting of testis on spermatic cord, surgical emergency, most common in newborns to adolescences but can occur at any age, acute onset of pain, scrotum becomes red and edematous, vomiting and anorexia are common, fever and dysuria are common, no cremasteric reflex on affected side)
• Genital warts (HPV)


  • Pedunculated (has a stalk)
  • Serrated (on the surface)
• Chlamydia symptoms


  • Urethral discharge (cloudy/clear, watery/milky)
  • Dysuria (painful urination)
  • Pain or swelling in one or both testicles
• Gonorrhea symptoms


  • Urethral discharge (green, yellow, or white)
  • Dysuria
  • Pain or swelling in one or both testicles
  • Majority of men show no symptoms
• Gonorrhea and Chlamydia co-infect each other
• Syphilis stages


  • Primary stage (chancre - 3 weeks to 3 months after infection)
  • Secondary stage (damage to the neurologic symptoms - tumors)
  • Late stage (damage to the neurologic symptoms - tumors, blindness, paralysis, and death after 10 to 20 years of infection)
• Genital herpes


  • Vesicles (do not pop as the fluid is contagious, fluid-filled)
  • HSV I (mouth/labialis)
  • HSV II (genital/genitalia)
• Family history for prostate gland

  • Rectal polyps
  • Colon cancer
  • Colon or prostate cancer
• Prostate gland disorders


  • Benign prostatic hypertrophy (BPH) (may feel enlarged, smooth, and firm with obliteration of the median sulcus, general symptoms: urinary frequency, nocturia, urinary urgency, change in stream, dysuria)

  Prostatitis (may be tender, swollen, boggy, and warm, acute - bacterial, chronic - bacterial/non-bacterial, acute symptoms: chills, fever, flushing of the skin, chronic symptoms: blood in the urine, burning or pain with urination, difficulty starting to urinate or emptying of the bladder, foul-smelling urine, weak urine stream, pain or achiness in the abdomen, pain with ejaculation or blood in the semen, pain with bowel movements)

  Prostate cancer (hard, irregular, painless nodule)
• Chlamydia


  Small bottle of normal saline, potassium hydroxide, and acetic acid (white vinegar)
• Abnormal findings on inspection


  • Refer any suspicious lesion for biopsy
  • Consider delayed puberty if no pubic hair or breast development has occurred by age of 13
  • Nits, or lice of pubic hair
  • Swelling
  • Excoriation, nodules, rash, or lesions
  • Inflammation or lesions
  • Polyps
  • Foul-smelling, irritating discharge - may indicate STDs
  • Strawberry cervix indicates STD
• Abnormal findings on palpation


  • Tenderness
  • Induration along urethra, pain, urethral discharge
  • Swelling, induration, pain with palpation, erythema around or discharge from duct opening
  • Tenderness, paper thin perineum, absent or decreased tone may diminish sexual satisfaction
  • Bulging of vaginal walls indicates cystocele, rectocele, or uterine prolapses
  • Urinary incontinence
• Abnormal findings on inspection of cervix and its os


  • Redness, inflammation
  • Pallor with anemia, cyanotic other than with pregnancy
  • Lateral position - adhesion or tumor; projection > 3cm may be prolapse
  • Hypertrophy > 4cm occurs with inflammation or tumor
  • Surface reddened, granular, asymmetric around OS
  • Friable, bleeds easily
  • Any lesions white patch on cervix, strawberry spots
  • Refer any suspicious red, white, or pigmented lesion for biopsy
  • There is nodule and tenderness
  • Malignant / cancerous nodules = hard, irregular, and immobile
• Abnormal findings on inspection of vaginal wall


  • Inflammation, lesions
  • Leukoplakia appears as spot of dried pain
  • Vaginal discharge - thick, white, curd-like with candidiasis, profuse, watery, gray-green, frothy with trich, gray, green-yellow, white, or foul odorous
• Abnormal findings on palpation of pelvic organs


  • Painful with inflammation or ectopic pregnancy
  • Enlarged uterus, lateral displacement, nodular mass, irregular, asymmetric uterus, fixed, immobile, tenderness
  • Enlarged adnexa, nodules or mass, immobile, marked tenderness, pulsation, palpable fallopian tube
• A painless nodule is most likely malignant / cancerous
• Abnormal findings on external genitalia


  • Pediculosis pubis (crab lice) - severe perineal itching, excoriations, erythematous areas, may see little dark spots or nits adherent to pubic near roots
  • Syphilitic chancre - begins as small, solitary, silvery papule, erodes to red, round, or oval superficial ulcer with yellowish serous discharge, palpation - non-tender indurated base; can be lifted like button between thumb and finger
  • Herpes simplex virus - type 2 - episodes of local pain, dysuria, and fever, clusters of small, shallow vesicles with surrounding erythema, erupt on genital areas and inner thighs, vesicles on labia rupture in 1 to 7 days, leaving painful ulcers, initial infection lasts 7 to 10 days virus remains dormant indefinitely, recurrent infections last 3 to 10 days with milder symptoms
  • Red rash (contact dermatitis) - history of skin contact with allergenic substance in environment, intense pruritus, primary lesion - red, swollen vesicles, may have weeping of lesions, crusts, scales, thickening of skin, excoriations from scratching, may result from reaction to feminine hygiene spray, or synthetic underclothing
  • Genital human papillomavirus (HPV, conylomata acuminata, genital warts) - painless warty growths, may be unnoticed by woman, pink or flesh-colored, soft, pointed, moist, warty papules, single or multiple in cauli-flowerlike patch, occur around vulva, introitus, anus, vagina, and cervix
• CERVICAL EVERSION This is a normal finding in many women and usually occurs after vaginal birth or when the woman takes oral contraceptives. The columnar epithelium from within the endocervical canal is everted and appears as a deep red, rough ring around the cervical os, surrounded by the normal pink color of the cervix.

  
• Nabothian cysts may occur when the everted columnar epithelium spontaneously transforms into squamous epithelium, a process called squamous metaplasia. Occasionally the tissue blocks endocervical glands and cysts develop.

  
• BILATERAL TRANSVERSE LACERATION This drawing illustrates a type of healed laceration that may be seen in a woman who has given birth vaginally.

  
• UNILATERAL TRANSVERSE LACERATION Vaginal birth may cause trauma to the cervix and produce tears or lacerations. Therefore, healed lacerations may be seen as a normal variation. This drawing illustrates a unilateral transverse laceration.

  
• STELLATE LACERATION This drawing illustrates a type of healed laceration that may be seen in a woman who has given birth vaginally.

  
• ANTEVERTED This is the most typical position of the uterus. The cervix is pointed posteriorly, and the body of the uterus is at the level of the pubis over the bladder.

  
• MIDPOSITION This is a normal variation. The cervix is pointed slightly more anteriorly (compared with the anteverted position), and the body of the uterus is positioned more posteriorly than the anteverted position, midway between the bladder and the rectum. It may be difficult to palpate the body through the abdominal and rectal walls with the uterus in this position.

  
• ANTEFLEXED Anteflexion is a normal variation that consists of the uterine body flexed anteriorly in relation to the cervix. The position of the cervix remains normal.

  
• RETROVERTED UTERUS Retroversion is a normal variation that consists of the cervix and body of the uterus tilting backward. The uterine wall may not be palpable through the abdominal wall or the rectal wall in moderate retroversion. However, if the uterus is prominently retroverted, the wall may be felt through the posterior fornix or the rectal wall.

  
• RETROFLEXED UTERUS Retroflexion is a normal variation that consists of the uterine body being flexed posteriorly in relation to the cervix. The position of the cervix remains normal. The body of the uterus may be felt through the posterior fornix or the rectal wall.

  
• 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 papillomavirus (HPV), are moist, fleshy lesions on the labia and within the vestibule. They are painless and believed to be sexually transmitted.

  
• 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.

  
• 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.

  
• 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.

  
• UTERINE PROLAPSE Uterine prolapse occurs when the uterus protrudes into the vagina. It is graded according to how far it protrudes into the vagina. In first-degree prolapse, the cervix is seen at the vaginal opening; in second-degree prolapse, the uterus bulges outside of the vaginal opening; in third-degree prolapse, the uterus bulges completely out of the vagina

  
• CYANOSIS OF THE CERVIX The cervix normally appears bluish in the client who is in her first trimester of pregnancy. However, if the client is not pregnant, a bluish color to the cervix indicates venous congestion or a diminished oxygen supply to the tissues.