Learning Objectives #
1. To perform a thorough inspection of the external genitalia
2. To become familiar with normal anatomy of external genitalia
3. To be able to examine a Bartholin
Introduction #
Inspection of the external genitalia needs a systematic approach, perianal skin to the mons pubis or the other way around. During inspection, it is often useful to touch the patient. Tell the patient that you are going to touch her leg. Use the back of your hand.
The external genitalia should be inspected carefully. The hair is inspected for its pattern and for pubic lice and nits. The skin of the vulva is inspected for any abnormal findings. Any abnormal lesion should be palpated for tenderness.
Inspection of the labia minora need gentle lateral traction with your fingers. The labia minora may show wide variation in size and shape, they may be asymmetrical. Occasionally, yellow-white, asymptomatic papules may be seen over the inner labia minora. These are ectopic sebaceous glands and are called Fordyce’s spots and are normal.
To adequately visualize the vestibule, apply gentle lateral traction of labia minora. In some situations having the woman do this traction herself will reduce or alleviate anxiety.
The clitoris is inspected for size and lesions. The clitoris is normally 3-4 mm in size.
Inspect the urethral meatus for pus or inflammation. A urethral caruncle is a small benign tumor at the urethral orifice and is relatively common in postmenopausal women. It appears as a bright red or flesh-colored mass extending through the urethral orifice. It may be asymptomatic or may cause pain or bleeding. Urethral caruncles must be differentiated from other tumors by biopsy.
Normal Bartholin’s glands can be neither seen nor felt. At times the gland duct becomes obstructed and results in a swollen cyst filled with mucoid secretions. The cyst may turn into an abscess with a superimposed infection. A Bartholin’s abscess is warm, red and extremely tender.
To examine the Bartholin glands tell the patient that you are going to palpate the glands of the labia. With a moistened glove, palpate the area of the right gland ( at 7-8 o’clock position) by grasping the posterior portion of the right labia between the right index finger in the vagina and the right thumb on the outside. Look for tenderness, swelling or pus. Use the left hand to examine the area of the left gland (at the 4-5 o’clock position)
In case of an abscess, the glad is enlarged, warm, red, and extremely tender.
The perineum and anus are inspected for masses, scars, fissures, and fistulas. The anus should be inspected for hemorrhoids, irritation, and fissures.