Reproductive Systems Assessment

3 main parts to the female reproductive history

menstrual, obstetric, and sexual

Vulvovaginal symptoms

• Most common: Vaginal discharge and local itching

• Amount, color, consistency, odor

• Local sores or lumps

• Painful

Health History – Sexual health

• Establish trust

• Sexual orientation and gender identify

• Sexual response

• Sexually Transmitted Infections (STIs)

Physical Examination- Female

• External examination (inspection/palpation)

• Approach to the pelvic examination

• Sexual assault victims

Health Promotion & Counseling – Female

• Reproductive system education

• Appearance and function

• Changes with menopause

• Cervical cancer screening (Papanicolaou aka “pap” smear)

• Options for family planning – non-directive counseling

• Early prenatal care
  Lowers perimortality rate

• STIs
   

Changes with menopause

Mood swings, hot flashes, bone loss, vaginal atrophy/dryness

STIs Risk factors

< age 24, new/multiple partners, previous STIs, inconsistent condom use, sex work

Cervical cancer

Caused by persistent infection with high-risk HPV (human papilloma virus)

Risk factors for cervical cancer

• Failure to undergo screening (pap smear)

• Multiple sex partners

• Smoking

• Immunosuppression

• Long term use of oral contraceptives

• Coinfection with chlamydia

• High parity (number of times a patient has given birth)

• Sexual activity before age 17

• Prior cervical cancer

HPV vaccine

• Routine vaccination for ALL kids age 11 & 12 before their first sexual encounter (as early as age 9) given as a 2-dose series over 6-12 months

• If first dose given after age 15 (or with certain immunocompromised individuals), a 3-dose schedule is recommended

Health History – Male

• Sexual orientation and gender identity

• Sexual response

• Penile discharge or lesions
  Leaking, sores, history of STIs

• Scrotal pain, swelling, or lesions

• nguinal pain, swelling
  Hernias – indirect inguinal (most common), direct inguinal (less common), femoral

• Problems with urination

Benign Prostatic Hyperplasia (BPH)

prostate enlargement (men > 70 greatest risk)

Physical Examination – Male

• Penis

• Scrotum/Testes

• Inguinal/femoral areas

• Examination approach

Health Promotion & Counseling – Male

• Sexual orientation 

• Number of recent partners

• History of past STIs/treatment/testing

• Alcohol and drug use 

Important topics on sexual health history

• Limiting number of partners

• Correct use of condoms/dental dam

• Establishing regular medical care & testing

• Seek prompt attention for any genital lesions or penile discharge
  
  

Testicular cancer

• Most common cancer in males aged 15-34

• If detected early, excellent prognosis

• No formal screening recommendations

• Monthly testicular self-examination

Testicular cancer Risk factors

Caucasian, cryptorchidism, history of testicular cancer, family history

Prostate cancer

• No formal screening recommendations – shared decision making

• Blood test – prostate specific antigen (PSA) and digital rectal exam (DRE)

Prostate cancer Risk factor

age > 65, African American & African Caribbean, family history

Health Promotion & Counseling – LGBTQ+

• May be uncomfortable disclosing sexual behaviors because of bias/discrimination

• Noted barriers to accessing quality health care due to lack of provider education

• Transgender men who still have breasts/vagina/cervix/uterus still require routine mammograms & GYN care

• Transgender females who have a penis/testicles still require testicular/prostate screenings
   

Four groups of axillary nodes

• Central axillary nodes

• Pectoral (anterior)

• Subscapular (posterior)

• Lateral
   

Malignant cells from breast cancer

may spread directly into the infraclavicular nodes

Breast Health History

• Lump or mass

• Pain

• Change in shape

• Edema

• Rashes/scaling

• Nipple discharge

• Dimpling

• New onset nipple inversion

Gynecomastia (in XY males)

smooth, firm movable disc of glandular
issue (often seen in puberty/older age)

Galactorrhea

milky discharge not related to a pregnancy. Can be caused by hypothyroidism, pituitary tumor, and many psychotropic agents

Examine breasts in 4 positions

• Arms at side

• Arms over head

• Hands pressed against hips

• Leaning forward

Breasts Physical Examination

• Appearance of skin (color, skin thickening/unusually large pores)

• Size and symmetry of breasts

• Contour of breasts

• Characteristics of nipples

Inspection of Post-mastectomy or breast augmentation/reduction

• Scar

• Color

• Signs of inflammation

Lymphedema

Lymph fluid accumulates in the upper extremity on the side of surgery

Breast Palpation

• Patient supine (breast tissue best felt in this position)

• Reach arm of side being examined behind head

• Palpate with pads of 2nd-4th fingers in small dime like circles using light, medium, and deep pressure for:
  consistency of tissues, tenderness, masses

upper outer quadrant

the most common site for breast cancer to develop

Axillae Inspection

• Sitting position preferred

• Rash

• Unusual pigmentation

• Infection

• Nodules

Axillae Palpation

• Hold patient’s elbow to stabilize during exam

• Central nodes – most palpable of the lymph nodes but can be uncomfortable to examine

• Pectoral nodes

• Lateral nodes

• Subscapular nodes

Breast Self Examination

• 5 to 7 days after the start of menses is best time to do

• most useful when combined with Clinical Breast Examination and mammography

Assessing Risk for Breast Cancer

• Leading cancer diagnosis among females (XX) 2nd only to skin cancer

• Early detection has increased

• Slight increase in invasive diagnoses given increasing BMI and decreasing # of births

• More common in non-Hispanic whites, more FATAL in non-Hispanic blacks

Breast Cancer Nonmodifiable risks

• Sex

• Age

• Family history/genetics (maternal and paternal)

• Race

• Personal history

• Early menarche (< age 11)

• Late menopause

• Breast density (greater density = increased risk)

Breast Cancer Modifiable risks

• Postmenopausal obesity

• Use of Hormone Replacement Therapy (HRT)

• Alcohol use

• Smoking

• Physical inactivity
  

• Having children later in life or not having children at all (nulliparity)

US Preventive Task Force Service Recommendations

• Ages 40-74: Biennial (every 2 years) screening mammography

• Ages 75 and older: Individualized decision based on factors such as overall health, life expectancy, and previous screening history

The American Cancer Society recommends

between ages 45-54, women should get a
mammogram every year