Notes on the Female Genitourinary System

Female Genitourinary System Overview

  • Chapter focuses on the anatomy, physiology, and clinical considerations of the female genitourinary system.

Structure and Function

External Genitalia (Vulva)
  • Mons pubis: Rounded area over the pubic bone.
  • Symphysis pubis: Cartilage joint at the front of the pelvis.
  • Labia majora: Outer folds of skin.
  • Labia minora: Inner folds of skin.
  • Frenulum: Fold of tissue connecting the clitoris to the labia minora.
  • Clitoris: Sensitive organ; key for sexual arousal.
  • Urethral meatus: Opening for urine expulsion.
  • Paraurethral (Skene’s) glands: Associated with urethra; secrete lubricating fluid.
  • Vaginal orifice: Opening to the vagina.
  • Hymen: Membrane partially covering the vaginal orifice.
  • Vestibular (Bartholin’s) glands: Produce lubrication; located at the vaginal opening.
Internal Genitalia
  • Vagina: Elastic muscular tube leading to uterus.
  • Cervix: Lower part of uterus; connects to vagina.
  • Squamocolumnar junction: Area where two types of cells meet; clinically significant.
  • Fornices: Anterior and posterior; recesses created by form of the cervix.
  • Rectouterine pouch: Deep pouch between rectum and uterus.
  • Uterus: Hollow, muscular organ for fetal development.
  • Fallopian tubes: Conduct eggs from ovaries to uterus.

Developmental Considerations

Infants and Adolescents
  • Age of menarche: First menstrual period; signifies puberty.
  • Tanner’s table of sexual maturity: Stages of physical development.
Pregnant Women
  • Goodell’s sign: Cervical softening indicates pregnancy.
  • Chadwick’s sign: Bluish discoloration of cervix.
  • Hegar’s sign: Softening of uterine isthmus.
  • Mucus plug: Protective barrier that forms during pregnancy.
  • Changes to vaginal secretions: Increased due to hormonal changes.
Older Women
  • Hormonal changes lead to menopause symptoms and physiological changes.
  • Vaginal surfaces become more fragile; decreased lubrication.

Cultural and Social Considerations

  • Female circumcision: Known as genital mutilation; illegal in Canada.
  • STIs: Increasing rates; chlamydia as a common infection; untreated STIs can have serious consequences.
  • HIV/AIDS: Increasing proportion of infections in women.

Subjective Data: Health History Questions

  • Key areas include:
    • Menstrual history.
    • Obstetrical history.
    • Self-care behaviours.
    • Urinary symptoms.
    • Vaginal discharge.
    • Sexual activity and contraceptive use.
    • STI contact and risk reduction.

Objective Data: Physical Exam Preparations

  • Position of the patient: Typically lithotomy position.
  • Comfort measures: Draping and lighting considerations.
Equipment Needed
  • Gloves and strong lighting.
  • Speculums: Graves and Pederson types.
  • Applicators for cytological tests.
  • Lubricant for comfort.
External Examination
  • Assess skin color, hair distribution, and inspect for lesions.
  • Examine labia majora/minora, clitoris, urethral and vaginal openings, perineum, and anus.
Advanced Practice Considerations
  • Palpation:
    • Urethra and Skene’s glands.
    • Bartholin’s glands.
    • Evaluate pelvic musculature support.
Internal Examination
  • Insertion techniques for speculum examination:
    • Check cervix for color, position, size, surface abnormalities.
  • Obtain cervical smears and cultures for various tests including:
    • Pap smears, gonorrhea/chlamydia cultures.

Abnormal Findings in the Genitourinary System

Abnormalities of External Genitalia
  • Pediculosis pubis (pubic lice), herpes, syphilitic chancre, HPV warts, Bartholin’s gland abscess, urethritis.
Common Conditions
  • Vaginal infections: candidiasis, bacterial vaginosis, STIs like Chlamydia and Gonorrhea.
  • Uterine abnormalities: fibroids, endometriosis, carcinoma findings.
  • Adnexal complications: ectopic pregnancies, ovarian masses.

Health Promotion

HPV Vaccination
  • Recommended beginning ages: 9-14 years, with a series of two or three doses depending on age and immunization history.
  • Key populations: Healthy, non-HIV infected individuals prior to sexual activity.

Conclusion

  • Understanding the anatomy and functional considerations of the female genitourinary system is crucial for effective health assessments and screenings.
  • Addressing both physiological and psychosocial aspects is vital during health care delivery to female patients.