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FEMALE GENITOURINARY ADVANCED HEALTH
& ANORECTAL ASSESSMENT – LATEST 2025
Vulva - ANSWER- collective term for external part of female genitalia
Lithotomy position - ANSWER- Patient lying on dorsum with hips and knees flexed to 90° and hips
abducted 30°
Bartholin Glands - ANSWER- located posteriorly on both sides of the vaginal opening but are not
usually visible
- function is to secrete fluid to lubricate vagina
Epidermoid Cyst - ANSWER- - Firm, round cystic nodule
- Dark center marking opening of gland
Syphilitic Chancre - ANSWER- - firm, painless ulcer
- forms 21 days after exposure to syphilis (Treponema pallidum)
- primary syphilis
- resolves regardless of tx in 3-6 weeks
Genital herpes - ANSWER- - shallow, small, painful ulcers on a red base
- HSV 1 or 2
- may take 2-4 weeks to heal
- vesicles become ulcers
Genital warts (Condyloma Acuminatum) - ANSWER- warty lesions on labia and within vestibule
Secondary Syphilis (Condyloma Lotum) - ANSWER- large raised, round or oval, flat-topped gray or
white lesions
carcinoma of the vulva - ANSWER- ulcerated or raised red vulvar lesion
pelvic floor is composed of what - ANSWER- muscle, ligaments, and endopelvic fascia
function of pelvic floor - ANSWER- aids in sexual function (orgasm), urinary and fecal continence,
and stabilization of connecting joints
Cystocele - ANSWER- bulge of the upper 2/3 of the anterior vaginal wall along with the bladder
above
- results from weakened supporting tissues
Urethral Caruncle - ANSWER- small, red, benign tumor visible at posterior urethral meatus
- often in postmenopausal women
- may be mistaken for carcinoma (look for other signs)
Bartholin Gland Infection - ANSWER- causes labial swelling
- causes include trauma, gonococci, peptostreptococci, and C. trachomatis
- Acute infection is tense, hot, tender abcess with pus Chronic infection is nontender cyst felt large or small
Cystourethrocele - ANSWER- entire anterior vaginal wall, together with bladder and urethra
produces the bulge
- groove sometimes defines border between the urethrocele and cystocele
Prolapse of Urethral Mucosa - ANSWER- - swollen, ren ring around urethral meatus usually
before/after menopause
- urethral meatus should be at center of edema
myometrium endometrium
Perimetrium - ANSWER- serosal coating from the perineum
Myometrium - ANSWER- distensible smooth muscle of uterine wall
Endometrium - ANSWER- adherent inner coating of uterine wall
adnexa - ANSWER- ovaries, 3.5 x 2 x 1.5 cm
palpable in about 50% of women produces oocytes and secretes hormones
lymph from the vulva and vagina drain to which nodes - ANSWER- inguinal nodes
pelvic and abdominal lymph nodes - ANSWER- not palpable but lymph from internal genitalia,
including upper vagina flows into these nodes
Health History approach - ANSWER- - relaxed/private setting
- obtained while fully clothed
- interviewed alone
- open ended
- non judgemental
Health History - ANSWER- menarche
dymenorrhea premenstrual syndrome amenorrhea abnormal uterine bleeding (AUB) menopause postmenopausal bleeding
menarche - ANSWER- onset of menses
dysmenorrhea - ANSWER- pain with menses
premenstrual syndrome - ANSWER- cluster of symptoms beginning 5 days before menses and occurs
3 or more cycles in a row
amenorrhea - ANSWER- absence of menses
Abnormal uterine bleeding (AUB) - ANSWER- bleeding between menses or post-menopausal
bleeding
menopause - ANSWER- absence of menses for 12 consecutive months, usually occurring between
ages 48-55 y/o
Postmenopausal bleeding - ANSWER- bleeding occurring 6 months or more after cessation of
menses
Menarche age - ANSWER- median age 12-13 in well-nourished populations
how long does it take for females to establish regular cycles - ANSWER- generally over a year
what factors influence timing + progression of puberty - ANSWER- socioeconomic conditions
nutrition access to preventative health care
average interval of menses - ANSWER- 24 - 32 days
average menstrual flow lasts how long - ANSWER- 3 - 7 days
Menstrual history - ANSWER- - age at menarche
causes of secondary amenorrhea - ANSWER- - pregnancy
- lactation
- menopause
- low body weight
- malnutrition
- stress
- chronic illness
- hypothalamic-pituitary-ovarian (HPO) dysfunction caused by stress, nutritional deficiency, low intake
Menorrhagia - ANSWER- "Do you have periods where the bleeding is quite heavier (or the duration
is longer than usual)" (excessive flow) Tends to be bright red and may include "clots"
Metrorrhagia - ANSWER- "Do you have bleeding or spotting in between your menstruation"
(intermenstrual bleeding)
Oligomenorrhea - ANSWER- infrequent bleeding
Polymenorrhea - ANSWER- less than 21 day intervals between menses
Postcoital bleeding - ANSWER- bleeding after intercourse
- suggests cervical polyps or cancer or, in older women atrophic vaginitis
Perimenopause - ANSWER- Stages of erratic cyclical bleeding preceding the cessation of menses
with vasomotor symptoms like hot flashes, flushing, and sweating
hormones in menopause - ANSWER- - Ovaries stop producing estradiol and progesterone, and
estrogen levels drop significantly, although some testosterone synthesis persists
- Secretion of luteinizing hormone and follicle-stimulating hormone gradually becomes markedly elevated
menopause symptoms - ANSWER- Mood shifts; changes in self-image; hot flashes from vasomotor
changes; accelerated bone loss; increases in total and low-density lipoprotein cholesterol; and vulvovaginal atrophy with vaginal drying, dysuria, and dyspareunia are common
premature ovarian failure - ANSWER- Cessation of menses before the age of 40 (average age is 27);
symptoms similar to menopause
Postmenopausal bleeding may be due to - ANSWER- endometrial cancer, hormone replacement
therapy (HRT), and uterine and cervical polyps
acute pelvic pain in menstruating adolescent girls/women - ANSWER- warrants immediate attention
acute pelvic pain - ANSWER- dx is broad but may include ectopic pregnancy, ovarian torsion,
appendicitis (life threatening) but consider infections, GI, and urinary cases and ask about STIs, recent IUDs
- ask about sx in sexual partner
acute pelvic pain workup - ANSWER- pelvic exam
vital signs pregnancy test
most common causes of pelvic pain - ANSWER- 1. PID
- Ruptured ovarian cyst
- appendicitis rule out ectopic pregnancy Consider 1) Mittelschmerz, which is typically a mild unilateral pain lasting for a few hours to a few days arising at mid cycle from ovulation, 2) Ruptured ovarian cyst, or 3) Tubo-ovarian abscess
chronic pelvic pain - ANSWER- pain that lasts for more than 6 months and does not respond to
treatment
risk factors for chronic pelvic pain - ANSWER- - advancing age
- prior pelvic surgery or trauma
pain with urination from skin inflammation or urethritis dyspareunia
vulva and vaginal mucosa in trichomonal vaginitis - ANSWER- vestibule and labia minora may be
erythematous
- vaginal mucosa may be diffusely reddened with small red granular spots or petechiae in posterior fornix
- in mild cases, mucosa looks normal
Trichomonal vaginitis lab evaluation - ANSWER- scan saline wet mount for trichomonads
Candidal vaginitis causes - ANSWER- candida albicans, a yeast (normal overgrowth of vaginal flora)
Candidal vaginitis discharge - ANSWER- white and curdly
- may be thin but typically thick
- not as profuse as in trichomonal infections
- not malodorous
Symptoms of candidal vaginitis - ANSWER- pruritis
vaginal soreness pain on urination from skin inflammation dyspareunia
Vulva and vaginal mucosa in candidal vaginitis - ANSWER- vulva and surrounding skin are often
inflamed and sometimes swollen to variable extent
- vaginal mucosa is often reddened, with white tenacious patches of discharge
- mucosa may bleed when these patches are scraped off
- in mild cases mucosa looks normal
lab evaluation for candidal vaginitits - ANSWER- scan potassium hydroxide (KOH) preparation for the
branching hyphae of candida
Bacterial vaginosis causes - ANSWER- bacterial overgrowth probably from anaerobic bacteria
- often transmitted sexually
Bacterial vaginosis discharge - ANSWER- gray or white, thin, homogenous
malodorous coats vaginal walls usually not profuse may be minimal
Bacterial vaginosis symptoms - ANSWER- unpleasant fishy or musty genital odor
- reported to occur after intercourse
vulva and vaginal mucosa in bacterial vaginosis - ANSWER- vulva and vaginal mucosa usually appear
normal
lab evaluation for bacterial vaginosis - ANSWER- scan saline wet mount for clue cells (epithelial cells
with stippled borders)
- sniff for fishy odor after applying KOH (wiff test)
- test for vaginal secretions for pH over 4.
External Examination - ANSWER- assess sexual maturity
- inspect mons pubis, labia, perineum (inflammation, ulceration, discharge, swelling, nodules, any lesions)
Internal examination - ANSWER- inspect cervix (color, position, surface characteristics, ulcerations,
nodules, masses, bleeding, discharge)
- inspect vagina (masses, lesions, abnormal discharge or bleeding)
what should the patient do before a vaginal exam - ANSWER- avoid intervourse, douching, or vaginal
suppositories for 24-48 hours before examination
- empty bladder, lie supine with head and shoulders elevated, arms at sides or folded across chest
Bimanual Exam - ANSWER- - lubricate index/middle fingers
- insert into vagina, exerting pressure primarily posteriorly
- note lesions, tenderness in vaginal wall, including region of urethra and bladder anteriorly
- palpate cervix noting position, shape, consistency, regularity, mobility, tenderness
- palpate uterus and ovaries
- assess pelvic floor muscles and tenderness
- perform rectovaginal exam if indicated
normal cervix mobility - ANSWER- normally the cervix can be moved somewhat without pain
Assessing urethritis - ANSWER- To evaluate possible urethritis or inflammation of the paraurethral
glands, insert index finger into the vagina and milk the urethra gently outward from the inside
- not discharge and culture if present
risk factors for cervical cancer - ANSWER- - HPV types 16 and 18
- inadequate screening with pap smear
- immunosuppression
- long term use of oral contraception
- coinfection with chlamydia trachomatis
- previous cervical cancer or high-grade precancerous lesion
- tobacco smoking
- in utero exposure to diethylstilbestrol (DES)
- having more than 3 full term pregnancies
Cervical cancer screening aged less than 21 - ANSWER- no screening
Cervical cancer screening aged 21- 29 - ANSWER- cytology alone every 3 years
Cervical cancer screening aged 30- 65 - ANSWER- 1. Cytology alone every 3 OR
- FDA approved primary hrHPV testing alone every 5 years OR
- Cotesting (hrHPV testing and cytology) every 5 years
vaccination to prevent cervical cancer - ANSWER- HPV vaccine
HPV vaccination - ANSWER- routine vaccine at 11 or 12
can be started as young as 9
- can vaccinate through age 26 if not adequately vaccinated when younger
- for adults aged 27-45, clinicians consider discussing HPV vaccination with people who are most likely to benefit
- 2 doses if started before 15th bday 3 doses if after
Menopause and HRT - ANSWER- do not use estrogen alone or combined use of estrogen + progestin
d/t increased risks of cardiovascular events and breast cancer
- any doses should be low, early in menopause, and for shortest acceptable duration
Ovarian Cancer gene mutations - ANSWER- hereditary cancer syndromes such as mutations in
BRCA1 or BRCA2 genes which increase risk for ovarian and breast cancers
Screening for ovarian cancer - ANSWER- transvaginal ultrasound
pelvic examination serum cancer antigen USPSTF recommends against any screening among asymptomatic, average-risk women
