WEEK 6- GENITORURINARY

Question 1

Outline subjective questions. Consider how to conduct this assessment when assessing sensitive topics such as sexual activity, birth control, sexually transmitted infections (STIs), & menopause. Understand the importance of asking questions about sexual health in all health history screening.

Answer 1

• non judgmental
• open
• proper terminology
• professional

Question 2

Outline abnormal findings: pediculosis pubis, herpes simplex virus type 2, syphilitic chancre, rash, human papillomavirus genital warts, cystocele, rectocele, uterine prolapse, candidiasis.

Answer 2

pediculosis pubis-
lice in pubic area

herpes simplex virus type 2- gential lesions or sores

syphilitic chancre-
firm painless sore

rash-
skin reddness

human papillomavirus genital warts
flesh/pink coloured lumps, painful

cystocele
bulging or protrusion of the bladder

rectocele
bulging of the rectum to the posterior vagina wall

uterine prolapse
fall of uterus through the vaginal wall

candidiasis-
gential yeast infection

Question 3

Describe & provide expected findings for the inspection & palpation of the penis & scrotum.

Question 4

Describe the inspection & palpation for hernia & inguinal lymph nodes.

Question 5

Describe purpose of self-care & method for testicular self-examination.

Answer 5

purpose- screen for any abnormalities

Question 6

Outline abnormal findings: Urethritis, renal calculi, tinea cruris, genital herpes: HSV-2 infection, gential warts, syphilitic chancre, phimosis, paraphimosis, scrotal edema,

Question 7

infant; developmental (male)

Answer 7

Infant
Testes in the abdominal cavity near the kidney during gestation
Testes descend along the inguinal canal into the scrotum prior to birth
The presence of palpable testes is a normal newborn finding
Round, smooth and firm is the expected finding on palpation
Cryptorchidism –refers to undescended tests-may require surgery

Question 8

male- puberty

Answer 8

Puberty begins between ages (9 & ½ to 13 and ½ years)& takes about 3 yrs
First sign is enlargement of testes
Refer to Sexuality Maturity Ratings in boys (Tanner’s Stages of Development) p 751 (Jarvis, 2019)

Question 9

MALE- developmental considerations- adults and older adult

Answer 9

Adults and Older Adults
It is important to understand normal changes that may occur so that you can answer questions and recognize changes make clients may be concerned about
Men- no definite end to fertility
Sperm decreases at age 40 but continues development to 80s or 90s
Testosterone decreases after 55 to 60
Age related physical changes that may be noted:
Decreased or greying pubic hair
Decrease in penis size
Adults & older Male
Scrotal contents hang lower, rugae decrease, scronatum pendulous
Testes decrease in size & are less firm on palpation
Decreased sperm production
Decreased testosterone- slower & less intense sexual response
(time to attain erection & firmness of erection decreased)
Longer time to ejaculation- less seminal fluid
Refractory period longer (unable to ejaculate 12-24 hours)

Question 10

FEMALE- developmental- infants

Answer 10

Infants and Adolescents
External genitalia engorged (appear swollen) due to estrogen
Puberty –estrogen stimulates development of secondary sex characteristics
Refer to Tanner’s stages of Sexual Maturity Ratings ( Jarvis, 2014 p.747)
Breast develop and pubic hair development ages 8 1/2 to 13 years
Development continues for a 3 year period
Menarch in last part of these 3 years
Menstrual cycle irregularity common in adolescent

Question 11

FEMALE- developmental- pregnancy

Answer 11

Pregnancy – often a time a woman may have several questions for the nurse
Signs of pregnancy at 4-6 weeks gestation
Goodell’s sign –cervix softens
Chadwick’s sign – cervix appears cyanotic (bluish)
Hegar’s sign – isthmus of the uterus softens
20-24 weeks – uterus at the umbilical region to liver region on measurement
Mucous plug development in cervical canal –protects fetus from infection

Question 12

FEMALE- developmental- adults

Answer 12

menopause (48-52)
declining estrogen
ovaries stop production of estrogen and progesterone
uterus shrinks
ovaries atrophy
sacral ligaments relax
vagina becomes dry- pain can happen

Question 13

FEMALES-Developmental- older adults

Answer 13

Older Female
Mon pubis appears smaller
Pubic hair thinner and sparse and greying
Labia and clitoris decrease in size
Sexual response diminished –reduced vaginal secretions and lubrication during excitement and shorter duration of orgasm and rapid resolution
No change to sexual pleasure and function

Question 14

MALE- cultural considerations

Answer 14

Male Circumcision:
May be discussed with the parent(s) after or before the birth
Canadian Pediatric Society – there is no medical indication for the procedure
Procedure no longer covered by health insurance (OHIP)
Research on HIV transmission – decreased incidence and spread
(Grayer, Warwer, Serwadda & Kigoz, 2009: Viscidi & Shah, 2010)

Research on STIs – reduction in incidence of Herpes Simplex Virus and in Human Papilloma Virus (Tobian et al, 2009)
Complications of circumcision
Pain, bleeding swelling inadequate skin removal, excessive blood loss and infection and urinary retention

Question 15

MALE- health promotion

Answer 15

Male Children
Care of uncircumcised male
Soap and water
Foreskin not forcibly retracted
Ages 3-4 clean under the foreskin
Adolescent Males
Risk of STI infection- teaching required- signs and symptoms
protection, condom, vaccination, screening partners
HPV- cause of genital warts and cancers of the penis and anus
HPV vaccine available for males
TSE- testicular self examination

Question 16

MALE- testicular self exam

Answer 16

As indicated in Jarvis- not enough males perform TSE on a regular basis
Inform male clients that early detection dramatically improves the survival rate from testicular cancer.

Question 17

FEMALE- health promotion

Answer 17

STI- teaching-signs, symptoms and prevention
Chlamydia- most common (Public Health Agency of Canada, 2015)
Prevention – condoms (male, female), screening, vaccination
Untreated Pelvic inflammatory disease, ectopic pregnancy, infertility
Urinary tract infections higher in females- can lead to AKF –(acute kidney failure)
Examination of Internal Genitalia- Advanced Practitioner Skill
Speculum, lighting, specimen container
Empty bladder position lithotomy
Inspect and palpate- cervical smear (Papanicoalaou) Pap smear

Question 18

INTERVIEW- MALE

Answer 18

Male
Do you have a discharge from your penis or pain on urination?
Do you have any sores or lumps?

Question 19

INTERVIEW- FEMALE

Answer 19

Female
Do you have a vaginal discharge, itching or pain on urination?
Do you have any sores or lumps?

Question 20

INTERVIEW- BOTH

Answer 20

Both male and female
Do you or your partner have risk factors for HIV/AIDS- blood transfusion, IV drug use, frequent sex with multiple partners/strangers, sex for money or drugs

Question 21

male- physiology

Answer 21

Frequency, urgency and nocturia
Dysuria
Hesitancy and straining
Urine colour
Past genitourinary history
Penis pain, lesions, discharge
Scrotum self care behaviours
Sexual activity and condom use
STI contact

Question 22

female- physiology

Answer 22

Menstrual history
Obstetrical history
Menopause
Self care behaviours
Urinary symptoms
Vaginal discharge
History of sexual health
Sexual activity
Contraceptive use
STI contacts
STI risk infections

Question 23

interview- sexual health

Answer 23

Do you have any problems with or concerns about sexual function?

The most important fact is to be nonjudgmental, professional and considerate when asking questions of a sensitive nature.

When exploring sexual development and health with an adolescent “ at your age some teens have questions about…” may be a lead in question to facilitate dialogue with a teen who may be uncomfortable with talking about sexual development but whom may have questions”