Physical Exam: Female Reproductive System

I. History: sexually transmitted disease, menstrual history, obstetrical history, contraception

II. Inspection

• External genitalia: Normal findings

1. hair distribution: variable; usually inverted triangle starting at symphysis pubis
2. skin of perineum smooth, clean, slightly darker than other skin
3. labia majora - may be closed or gaping
4. clitoris - about 2 cm in length and 0.5 cm in width
5. urethral orifice - intact, pink without irritation
6. vaginal orifice - ranges from thin, vertical slit to larger orifice with moist tissue
7. anus - moist and hairless - skin more darkly pigmented

• Internal genitalia:

1. Cervix - normal findings: pink; midline; usually about 2 to 3 cm in diameter; smooth, firm, rounded or oval; odorless, creamy or clear secretions
2. papanicolau (Pap) smear
3. vagina - pink throughout; clear or cloudy, odorless secretions; about 10 to 15 cm in length

III. Palpation

• Ovaries may or may not be palpable; firm, slightly tender, oval, mobile; about 4 cm in diameter
• Uterus - mobile; rounded; palpable at level of pelvis
• Skene's glands and Bartholin's gland - normal findings: nontender, no discharge

IV. Geriatric Alterations

• Labial folds flatten
• Skin paler, shiny
• Meatus usually more posterior
• Cervix decreases in size; may appear paler
• Scanty cervical discharge
• Vagina shortens with age
• Decreased vaginal secretions
• Uterus diminishes in size; may not be palpable
• Ovaries atrophy with age