Chapter 25 & 26: Genitourinary Assessment (Male and Female)

Chapter 25 & 26: Genitourinary Assessment (Male and Female) Anatomy Review Health History: Male Genitalia & Rectum · pain · difficulty with urination · erectile dysfunction · changes in libido · penile lesions, discharge · scrotal swelling, heaviness, pain, or aching · hernias · rectal bleeding, itching, burning, pain · flatulence · dribbling (urinary or fecal incontinence) Health History: Female Genitalia & Rectum · pain, tenderness swelling · frequent urination/lack of · incontinence · change in libido · pain during intercourse · masses, nodules, lumps · discharge, bleeding, itching · cramping, spotting · traumatic events Physical Examination · inspection & palpation ↳ external genitalia and perineum ↳ inguinal nodes, hernias · bimanual vaginal palpation (for cervix, uterus, ovaries, fallopian tubes, and uterine ligaments) · Rectovaginal examination · Rectal examination for prostate Male Examination Testicular Examination · inspect the scrotal sac, and then palpate each testicle separately, then palpate the vas deferens, then the inguinal canal for any hernias · testicular cancer has high incidences around ages 15-29, but can occur at any age ↳ risk factors include: family history, undescended testicle, HIV infection, family history Prostate & Rectal Exam · standing position is preferred, but you can also have patient lay on their left side · spread buttocks and inspect anus. Apply lubricant to a gloved hand and insert into the rectum and feel gently along the canal. Next, feel for the posterior portion of the prostate (it should have the consistency of a rubber ball) Upon removing your finger, examine it for the consistency and colour of the stool ↳ the patient may feel like they will have a bowel movement or urinate, but assure them that they won't · Male annual check-ups > 50 may include DRE or PSA, or prostate MRI · prostate Cancer incidence is 1 in 7 men · risk factors include: African ancestry, family history, BRCA gene in family - - Female Examination Female Exam · first inspect and palpate the outer genitalia, then use a warmed speculum to see into the vaginal canal. You would then inspect the cervix and do a swab (Pap smear of cervix) · Bimanual and rectovaginal examination comes next Cervical Cancer Screening · in Alberta, screening for cervical cancer is done with the Pap test · HPV testing can be done if there are abnormal cells on the Pap test · Current screening guidelines: first test at 25 or 3 years after becoming sexually active (whichever comes LATER) * · At 70 years if there are 3 negative Pap tests in 10 years there is no need for further screening Tanners Developmental Stages STI’s Herpes · groups of small blisters or sores that usually occur on or around the genitals or anus Gonorrhea · female: purulent discharge from the cervix. Tenderness or pain with pelvic examination · male: men may present with urethral discharge, rectal pain or discharge Chlamydia · This STI is often asymptomatic, although there are occasionally clear or white secretions. Patients report dyspanuria (pain w/intercourse), bleeding after sex, or both · It is transmitted by sexual fluids through oral, vaginal, or anal sex Syphillis · This STI has 4 different stages · can be congenital · can check by epitrochlear node on arm Urologic Emergencies Priapism: persistent erection for 4+ hours Paraphimosis: foreskin retracted leading to edema and lack of circulation Ectopic Pregnancy: fertilized egg implants into the fallopian tube which can cause it to burst and lead to extreme internal bleeding ↳ lower quadrant pain, nausea, referred pain to neck or shoulder... Penile Fractures: corpus cavernosum is ruptured during intercourse, you may hear an audible POP! Testicular Torsion: surgical emergency that must be fixed under 6 hours, happens when spermatic cord rotates and becomes twisted Pelvic Organ Prolapse: muscles supporting the pelvic organs become weak or loose and something falls