Reproductive System History and Examination

Female Breast and Pelvic ExamMale Genitourinary and Rectal

ExamDr. Lanice Jones 2008

Breast Examination

History: Common Concerns or Symptoms

Breast lump or mass

Breast pain or discomfort

Nipple Discharge

Risk Factors for Breast CancerAge - > 50 years old

Family History

Menstrual History

Risk Factors For Breast Cancer

Age – greater than 50Family History

First degree relativePre or Post MenopausalUnilateral or Bilateral

Menstrual HistoryMenarche < 12 years oldAge at menopause > 55

Pregnancy HistoryFirst live birth after 30 years of age or no pregnancyNot Breast Feeding or short time breast feeding

Breast Anatomy

Breast Exam: Inspection

Arms at sides

Hands pressed against hips

Arms overhead

Look for skin color,

Skin retraction, dimpling

Nipple shape, asymmetry

Palpation

Axillary Palpation Sitting

Check anterior, medial, lateral and posterior quadrant of axilla

Palpation Lying

Expose one breast at a time

3 different Palpation techniques

Wedge (clock hours)

Vertical strip

circular

Palpation techniques

Move fingers in small circles

One hand

Two hands for larger breasts – stabilize the tissue

Nipple exam

Check for nipple discharge

Pelvic Examination

HistoryMenarche, Menstruation, Menopause

Pregnancy

Pain

Vulvovaginal symptomsDischarge

Itching

Sores, lumps

Sexual activity

Female Pelvic Anatomy

Inspection

Inspection:Labia

Clitoris

Vaginal opening

Discharge

Lesions

Inspection: Speculum Exam

Inspect vaginal opening

Vaginal walls

Cervix

Palpation: Bimanual Examination

Use lubrication

Palpate cervix

Gently move cervix – test for pain with movement

Palpate uterus

Palpate each ovary

Male Genitourinary Hx and Exam

HistoryPain

Swelling

Discharge

Sexual Problems: Pain or Erectile Dysfunction

Pelvic Anatomy Male

Inspection

1. Testicles2. Epididymis3. Corpus cavernosis4. Foreskin5. Frenulum6. uretheral meatus7. Glans penis8. corpu8s spongiosum9. Penis10. scrotum

PalpationPalpate each testis and epididymis

Size, shape, consistency, tenderness, nodules

Palpate each spermatic cord and vas deferens

Palpate for Inguinal Hernias

Digital Rectal Examination

PositionLying on left side

Standing

Inspect perianal area

Examine anus and rectum

Use lubrication, wait for sphincter to relax

Note sphincter tone, tenderness, irregularities or nodules