PROCEDURES

• Testicular self-examination


  1. Perform 1x each month, best after a warm bath or shower while standing in front of a mirror

  2. See a doctor for any hard lump, absent or enlarged testicle, painful or swollen scrotum or any other abnormality
• Social history for prostate gland


  • Travel history
  • Diet/use of alcohol
• General considerations for physical assessment of prostate gland


  • Be calm, slowly paced, and gentle
  • Explain what you are going to do step by step
  • Use appropriate draping but retain very good visualization
  • Glove both hands
  • Examine for fecal material (color, consistency, blood or pus)
  • Test stool for occult blood using chemical guaiac test
• Position for prostate gland examination


  Males: Standing, flexed at waist with upper body supported on exam table, toes together and knees slightly flexed OR left lateral with top hip and knee flexed

  Females: Most often done as part of the rectovaginal exam in the lithotomy position
• Inspection of prostate gland


  • Sacrococcygeal and perineal area (skin characteristics, lesions, pilonidal dimpling and tufts of hair, inflammation, excoriation)

  Anus (skin characteristics, lesions, fissures, hemorrhoids or polyps, fistulas, prolapse)
• Palpation of prostate gland


  Sphincter (lubricate index finger over anus as patient strains down then insert finger tip to as patient relaxes, assess tone, tenderness, and lesions)

  Anal ring (rotate finger, note smoothness, evenness)

  Prostate (palpate the posterior surface through the anterior rectal wall, note size and symmetry, contour, consistency, mobility, tenderness, nodules, median sulcus)
• Equipment for physical examination of female genitalia


  • Gloves

  Protective clothing

  Vaginal speculum of appropriate size

  Large cotton-tipped applicators (rectal swabs)

  Materials for cytologic study (glass slide with frosted end, sterile cytobrush or cotton-tipped applicator, Ayre's spatula, spray fixative, specimen container for gonorrhea Cx/chlamydia, small bottle of normal saline, potassium hydroxide, and acetic acid (white vinegar), lubricant)

  Grave's speculum (for multiparous women)

  Pederson speculum (for nulliparous women)
• Position for physical examination of female genitalia

  Sitting position

  Lithotomy position, with the examiner sitting on a stool (feet in stirrups, knees apart, and buttocks at edge of examination table, arms at the woman's sides, not across chest or over the head, drape the woman fully, exposing only the vulva to your view)
• Techniques for physical examination of female genitalia


  Have the woman empty bladder

  Position the exam table so her perineum is not exposed to inadvertent open door

  Ask if she would like a friend or a family member present

  Elevate head and shoulders to a semi-sitting position to maintain eye contact

  Place stirrups so the legs are not abducted too far

  Explain each step of the examination
• Grave's speculum


  Tool used for multiparous woman (women who have given birth)
• Pederson speculum


  Tool used for nulliparous woman (woman who hasn't given birth)
• Position


  1. Sitting position

  2. Place woman in lithotomy position, with the examiner sitting on a stool

  3. Help the woman into position. Feet in stirrups, knees apart, and buttocks at edge of examination table

  4. Arms should be at the woman's sides, not across chest or over the head

  5. Drape the woman fully, exposing only the vulva to your view
• Techniques


  1. Have the woman empty bladder

  2. Position the exam table so her perineum is not exposed to inadvertent open door

  3. Ask if she would like a friend or a family member present

  4. Elevate head and shoulders to a semi-sitting position to maintain eye contact

  5. Place stirrups so the legs are not abducted too far

  6. Explain each step in the exam before you do it

  7. Assure the woman she can stop the exam at any point she should feel uncomfortable

  8. Use a gentle, firm, touch and gradual movements

  9. Communicate throughout the exam. Maintain dialogue to share information
• Normal findings on inspection


  • Hair distribution - usual pattern
  • Skin color, no lesions of inverted triangle
  • Labia majora - symmetric, plump and well-formed in nulliparous, gaping and shriveled in multiparous
  • Labia minora - dark pink, moist, and usually asymmetric
  • Urethral opening - appears slit-like, in midline
  • Vaginal opening (introits) - may appear as narrow, vertical slit, or as a larger opening
  • Perineum - smooth, well-healed episiotomy scar, midline or mediolateral following vaginal birth
  • Anus - course skin of increased pigmentation
  • Cervix - must be as hard as the nose, pink in color, smooth, and firm