| Skill 3-8 | Assessing the Female Genitalia | ||||||||||||||||||
The external female genitalia consist of the mons pubis, labia majora and minora, clitoris, vestibular glands, vaginal vestibule, vaginal orifice, and urethral opening (Figure 1). During the physical assessment, examine the external genitalia by inspection and palpation. The internal pelvic examination is a skill most often performed by an advanced practice professional. Women from some cultures or those who practice certain religions may agree to a physical examination of the genitalia only if it is performed by a female nurse or female practitioner. Delegation Considerations Assessment of the patient's genitalia should not be delegated to assistive personnel (AP). However, the AP may notice some items while providing care. The nurse must then validate, analyze, document, communicate, and act on these findings, as appropriate. Depending on the state's nurse practice act and the organization's policies and procedures, the licensed practical/vocational nurses (LPN/LVNs) may perform some or all the parts of assessment of the patient's genitalia. The decision to delegate must be based on careful analysis of the patient's needs and circumstances as well as the qualifications of the person to whom the task is being delegated. Refer to the Delegation Guidelines in Appendix A. Assessment Complete a health history, focusing on the female genital system. Identify risk factors for altered health by asking about the following:
Actual or Potential Health Problems and Needs Many actual or potential health problems or needs may require the use of this skill as part of related interventions. An appropriate health problem or need may include: Outcome Identification and Planning The expected outcome to achieve in performing an examination of the female genitalia is that the assessments are completed without causing the patient to experience anxiety or discomfort, the findings are documented, and the appropriate referral is made to other health care professionals, as needed, for further evaluation. Other outcomes may be appropriate, depending on the specific diagnosis or patient problem identified for the patient. Implementation
Evaluation The expected outcomes have been met when the patient has participated in the assessment of the genitalia; the patient has verbalized an understanding of the assessment techniques as appropriate; the assessment has been completed without the patient experiencing anxiety or discomfort; the findings have been documented; and the appropriate referrals have been made to the other health care professionals, as needed, for further evaluation. Documentation Guidelines Document assessment techniques performed, along with specific findings. Note and record the color, size of the labia majora and vaginal opening, lesions, and presence of any discharge. Document any patient statements of pain and risk factors. Sample Documentation 1/12/25 1645 Patient denies vaginal itching, pain, lumps, or discharge. Vulva with darker pigmentation than surrounding skin tone; mucous membranes are dark pink and moist. Skin and mucosa smooth, without lesions or swelling. Labia are symmetric without lesions or swelling. No discharge noted. Vulva is without lumps or masses.Developing Clinical Reasoning and Clinical Judgment Special Considerations Infant and Child Considerations
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1. Perform hand hygiene and put on PPE, if indicated.
2. Identify the patient.