HA: female GU Exam

Focuses on normal anatomy, evidence-based exam techniques, documentation, and cervical cancer screening.

Vulva Anatomy:
- Includes mons pubis, labia majora, labia minora, clitoris, perineum.
- Hymen is normally patent and does not break during intercourse.
- Important for it to be tested for patentcy in newborns.
Pelvic Floor Anatomy:
- Comprises muscles including bladder, rectum, and vagina.
- Muscular tension can impact patient symptoms.
Uterus and Cervix:
- Cervix opening (os) varies based on childbirth history, affecting examination.
- Glandular cells can be found at the squamocolumnar junction, which may vary across patients.

Preparation:
- Ensure patient comfort: ask permission, provide chaperone, explain the process, and allow for patient control.
Speculum Selection:
- Use appropriate size/speculum type (Peterson vs. Graves) and warm the speculum for comfort.
Exam Steps:
- Conduct an external examination, internal via speculum, and bimanual exam to assess various reproductive structures, including the cervix and uterus.
- Rectovaginal exams are now not routinely part of physical exams unless indicated.

External Examination:
- Note inguinal lymphadenopathy, identify any abnormal lesions/discharge.
Bimanual Exam:
- Document the size, shape, position, and tenderness of the uterus and any associated masses.

Cervical Cancer Screening Goals:
- Early detection of precancerous changes to prevent cervical cancer.
HPV and Pap Testing:
- Routine Pap smears begin at age 21; HPV primary screening recommended at age 25.
- Enhanced screening methods: Pap every 3 years or co-testing every 5 years for those 30+.
Risk Factors:
- Includes immunosuppression, prior treatments, and synthetic estrogen exposure.
- Cervical cancer screenings can cease at age 65 if previous results are normal.

Gardasil 9:
- Approved for ages 9-45, prevents various cancers including cervical, anal, and head/neck cancers.
- Encourage vaccination in patients up to age 45; often covered by insurance.