Female Genitourinary Assessment

Question 1

Health History

Answer 1

1. Menstrual History - LMP, frequency, quality,
   duration, amount of flow
2. Obstetrical History - GTPAL
3. Menopause - associated symptoms, hormone
   replacement therapy
4. Self-Care Behaviours - checkups, PAPs
5. Urinary Symptoms
   
   • increased urgency, frequency, quantity, burning
     sensations, issues with voiding, etc.
6. Vaginal Discharge - colour, odour, sediment,
   vaginal itching, rash, pain with intercourse
7. Gynecological History
8. Sexual Activity + Contraceptive use
9. STI Contact + Risk Reduction

Question 2

Menorrhagia

Answer 2

heavy menses

Question 3

Amenorrhea

Answer 3

the absence of menses
- note if this is secondary to menopause or if this
has occured suddenly (abnormal)

Question 4

Physical Exam Points

Answer 4

1. Inspection

Question 5

Inspection

Answer 5

• Skin Colour - should be evenly distributed, with no
  odd pigmentation or lesions
• Hair Distribution - inverted triangle that may
  travel up the umbilicus
• Labia Majora - symmetrical, plump, and well-
  formed
  - In nulliparous women, labia majora are
  midline, after vaginal delivery, the labia no
  longer meet in the middle and appear
  slightly shrunken and less defined
• Skin Texture - no lesions should be present
• Clitoris - should be without excoriation, nodules,
  rash, or lesions
• Labia Minora - dark pink, moist, and usually
  symmetrical
• Urethral opening - stellate or slitlike and is midline
• Perineum - usually smooth
• Anus - the skin of the anus is coarse and has
  increased pigmentation

Question 6

Positioning

Answer 6

Lithotomy Position

1. Help the patient into the lithotomy position, with
   the body supine, feet in the stirrups, knees apart,
   and the buttocks at the edge of the examining
   table
2. Ask the patient to life their hips up as you guide
   the patient to the edge of the table
3. Place the patients hands at their sides or across
   their chest (not over their head, as this increases
   tightness in the abdomen)

*Trauma and Violence Informed Care - Ensure
modesty draping and have the patient’s head
elevated to ensure proper eye contact can be
maintained

Question 7

Urethritis

Answer 7

Inflammation of the urethra due to infection

Symptoms: dysuria, pruitis, pain during sex

Observations: purulent discharge from meatus,
fever (erythema, tenderness and induration of
urethra in anterior vaginal wall)

Question 8

Older Adult Considerations

Answer 8

a. Menopause = the cessation of menses
- Usually occurs between ages 48-51 years old
- Preceding 1-2 years irregular menses (lighter
flow, further apart)

b. Ovaries stop producing progesterone and estrogen → physical changes to the female body is due to changes in hormone levels

c. The uterus shrinks due to a decreased myometrium and may droop (prolapsed uterus)

d. The ovaries atrophy to 1-2cm and are not palpable after menopause

e. The vagina becomes shorter, narrower, and less elastic because of increased connective tissue
- Without frequent sexual activity, the vagina
atrophies to 1/3 the length and width
- ↓ vaginal secretions = fragial mucosal surface
that is at risk for bleeding and vaginitis
- ↓ mons pubis due to decrease in fat pads
(adipose tissue redistribution)
- ↓ labia and clitoris size
- ↓ amount of public hair + colour change to grey/
white
f. Vaginal pH becomes more alkaline + glycine content decreases with a dec of estrogen (menopause)
- Conditions become more suitable for
pathogens and increasing the risk for vaginitis

g. Urinary incontinence occurs more frequently