Physical assessment - Female reproductive system: Nursing

Assessment of the female reproductive system should be completed as part of a comprehensive client assessment or as part of a focused exam if the client is experiencing issues, such as vaginal discharge or pain with intercourse. This assessment provides the nurse with information about the genitalia, as well as general sexual and reproductive health. This assessment applies to any client with female reproductive organs, regardless of their gender identity.

Okay, the supplies needed for the female reproductive exam include drapes, gloves, and a good source of light. For certain parts of the exam, the nurse will assist the healthcare provider or act as a chaperone, which is often required by facilities to protect your client and clinician during female reproductive exams.

Before getting started, ask your client to empty their bladder, because a full bladder can make the examination uncomfortable. Also, ensure the temperature in the room is comfortable, and warm your hands since cold temperatures can cause rigidity of the pelvic muscles. Remember to provide privacy by closing the door and curtains.

Before getting started, be sure to answer any questions they might have before obtaining verbal consent. Then, perform hand hygiene and collect your supplies. Then, assist your client into the lithotomy position, meaning they are lying flat on their back with their feet in stirrups. You’ll help your client get into this position by sliding their buttocks to the end of the examination table and draping them in a way that minimizes unnecessary exposure. You should lay the drape above their knees, up to the symphysis pubis, and then let the drape hang low between the knees.

During the examination, keep in mind that the female reproductive assessment can be uncomfortable, both physically and emotionally, so some special considerations should be made while completing this assessment. It’s crucial to explain exactly what will happen at every step. Furthermore, this examination can be especially anxiety-producing for clients who are transgender or those who have experienced sexual abuse or trauma. For transgener clients, be sure to use gender appropriate terms and preferred pronouns. Also keep in mind that clients who have had gender-reaffirming surgery may have variations in their assessment depending on the procedures performed. For clients who have experienced sexual abuse or trauma, avoid rushing your assessment and use a gentle touch. You should let your client know that at any time the exam can be stopped or paused if they request. In addition, for all clients, it’s recommended to let them know you’re starting by touching your client in a neutral location, such as the lower leg.

Locating the anatomical landmarks of the female reproductive system will help guide your assessment. Now, the landmarks for the external female genitalia are contained in the perineum, called the perineal region, which is a diamond-shaped area that can be divided into two triangles, the anterior urogenital triangle and the posterior anal triangle. The urogenital triangle houses the external genitalia, called the vulva. The vulva is made up of the mons pubis, labia majora, labia minora, the clitoris, and the vestibular glands. Other landmarks include vaginal introitus or opening, urethral opening, as well as the anus, which is located in the anal triangle.

Methods of assessment for the female reproductive system are inspection and palpation.

Okay, begin your assessment with inspection of the external female genitalia. First, you should inspect the skin and look for hair distribution on the mons pubis and labia majora. The skin should be smooth, clean, and intact; and the hair should be evenly distributed. If your client complains of itching in the pubic area, check the hair for evidence of lice. The eggs, or nits, will appear as small, bluish spots. It’s important to note that some clients will not have pubic hair due to shaving or waxing. Normally, the labia majora should not be swollen, as this can indicate an infection of the Bartholin gland.