ELDER TIP The testes of an older male may be slightly smaller than those of a younger male, but they should be equal in size, smooth, freely moveable, and soft without nodules.
❑ Inspect and palpate the inguinal canal; you shouldn’t observe any bulging of tissues or organs. (See Male sexual anatomy, page 994.)
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Source: Professional Guide to Diseases (Eighth Edition), 2005
Genital lesions in the male:
History and physical examination
(Professional Guide to Signs & Symptoms (Fifth Edition))
Begin by asking the patient when he first noticed the lesion. Did it erupt after he began taking a new drug or after a trip out of the country? Has he had similar lesions before? If so, did he get medical treatment for them? Find out if he has been treating the lesion himself. If so, how? Does the lesion itch? If so, is the itching constant or does it bother him only at night? Note whether the lesion is painful. Ask for a description of any drainage from the lesion. Next, take a complete sexual history, noting the frequency of relations, the number of sexual partners, and the pattern of condom use.
Before you examine the patient, observe his clothing. Do his pants fit properly? Tight pants or underwear, especially those made of nonabsorbent fabrics, can promote the growth of bacteria and fungi. Examine the entire skin surface, noting the location, size, color, and pattern of the lesions. Do genital lesions resemble lesions on other parts of the body? Palpate for nodules, masses, and tenderness. Also, look for bleeding, edema, or signs of infection, such as purulent drainage or erythema. Finally, take the patient’s vital signs.
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Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006
Vaginal discharge:
History and physical examination
(Professional Guide to Signs & Symptoms (Fifth Edition))
Ask the patient to describe the onset, color, consistency, odor, and texture of her vaginal discharge. How does the discharge differ from her usual vaginal secretions? Is the onset related to her menstrual cycle? Also, ask about associated symptoms, such as dysuria and perineal pruritus and burning. Does she have spotting after coitus or douching? Ask about recent changes in her sexual habits and hygiene practices. Is she or could she be pregnant? Next, ask if she has had a vaginal discharge before or has ever been treated for a vaginal infection. What treatment did she receive? Did she complete the course of medication? Ask about her current use of medications, especially antibiotics, oral estrogens, and hormonal contraceptives.
Examine the external genitalia and note the character of the discharge. (See Identifying causes of vaginal discharge, page 792.) Observe vulvar and vaginal tissues for redness, edema, and excoriation. Palpate the inguinal lymph nodes to detect tenderness or enlargement, and palpate the abdomen for tenderness. A pelvic examination may be required. Obtain vaginal discharge specimens for testing.
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Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006
Vaginal Discharge:
Physical examination (4)
(The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter)
A general physical examination should be performed if systemic illness is suspected. Record vital signs, including temperature, blood pressure, and pulse.
In most cases, a genital examination with the patient in the lithotomy position is adequate.
The external genitalia is carefully inspected for evidence of trauma, blisters, lymph nodes excoriations, swelling, erythema, ulcerations, tenderness or pain.
The amount, color, texture, odor, and location of the discharge should be noted. A complete pelvic examination should be performed with particular attention given to the cervix for evidence of friability or inflammation and a cervical motion test which may indicate pelvic inflammatory disease.
Testing (5)
A. Vaginal fluid pH. Immersing pH paper in the vaginal discharge or the lateral wall of the vagina will give the vaginal pH.
A pH greater than 4.5 indicates BV or T. vaginalis.
B. Saline wet mount. Obtain a drop of vaginal discharge from the posterior fornix; place it on a slide with a drop of saline and apply a cover slip.
1. Clue cells, which are bacteria-coated, stippled epithelial cells, are characteristic of BV.
2. Trichomonads, which are mobile, oval flagellated parasites, confirm the presence of trichomoniasis.
C. Potassium hydroxide (KOH) preparation. Place a second drop of vaginal secretions on a slide containing a drop of KOH; “a positive whiff test” indicates the presence of BV. Threadlike hyphae and budding yeast observed microscopically are characteristic of a candidal infection.
D. Cultures for gonorrhea and chlamydia are not routinely indicated, but should be taken with a history of a new sexual partner, prurulent cervical discharge, or cervical motion tenderness.
Diagnostic assessment
BV causes 40% to 50% of vaginitis, followed by candidiasis (20% to 25%) and trichomoniasis (15% to 20%). Together, these infections account for more than 90% of vaginitis diagnoses.
When evaluating a woman with a vaginal complaint, be sure to hear her true concern. Evaluate and treat appropriately those with acute symptoms (e.g., pain or swelling) and be careful to understand the effect of pretreatment with OTC preparations in the presumptive diagnosis. It is wise to be mindful of the possibility of sexually transmitted diseases with any vaginal complaint and to test appropriately for these diseases. If a vaginitis, presumably infectious, does not respond to initial therapy, consider other causes including trauma, herpes, menopause, contact dermatitis, toxic shock syndrome, steroid-responsive inflammatory vaginitis, and collagen-vascular or other systemic disease.
References
1. Lash DJ, Garcia TA. Diagnosis and treatment of vaginitis. The Female Patient 1998;23:25–41.
2. Carr PL, Majeroni BA, Robinson JC, Talarico LD. Vaginitis: solid diagnosis means effective treatment. Patient Care 1999;33(2):86–106.
3. Miller KE. Sexually transmitted diseases. Prim Care 1997;24(1):179–193.
4. Chan PD, Winkle CR, eds. Gynecology and obstetrics’ 1999–2000 edition. Laguna Hills, CA: Current Clinical Strategies Publishers, 1999:73–79.
5. Sabel JD. Vaginitis. N Engl J Med 1997;337:1896–1903.
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Source: The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter, 2000
Vaginal Discharge:
Diagnostic Approach
(Field Guide to Bedside Diagnosis)
Symptoms of vaginitis include vaginal discharge, pruritis, irritation, soreness, odor, and less commonly bleeding, dysuria, or pain with intercourse. It is important to distinguish burning on urination due to cystitis, which is internal and accompanied by irritative signs (urinary frequency), from dysuria due to vaginitis, which feels external as the urine passes over an inflamed vulva. Similarly, it is important to distinguish vaginitis, characterized by discharge and pruritus, from cervicitis, with discharge and pelvic pain.
On examination, the vulva appears normal in bacterial vaginosis, while erythema, edema or fissures suggest candidiasis, trichomonas or dermatitis. An erythematous, friable cervix with a mucopurulent discharge is consistent with cervicitis rather than vaginitis. This must be distinguished from ectropion (normal endocervical glandular tissue visible on the exocervix), which is not friable.
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Source: Field Guide to Bedside Diagnosis, 2007
Genital lesions in the male:
Physical assessment
(Signs & Symptoms: A 2-in-1 Reference for Nurses)
Before you examine the patient, observe his clothing. Do his pants fit properly? Tight pants or underwear, especially those made of nonabsorbent fabrics, can promote the growth of bacteria and fungi. Examine the entire skin surface, noting the location, size, color, and pattern of the lesions. Do genital lesions resemble lesions on other parts of the body? Palpate for nodules, masses, and tenderness. Also, look for bleeding, edema, or signs of infection, such as purulent drainage or erythema. Finally, take the patient’s vital signs.
» READ BOOK EXCERPT ONLINE »
Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007
Vaginal discharge:
Physical assessment
(Signs & Symptoms: A 2-in-1 Reference for Nurses)
Examine the external genitalia and note the character of the discharge. (See Identifying causes of vaginal discharge, page 680.) Observe vulvar and vaginal tissues for redness, edema, and excoriation. Palpate the inguinal lymph nodes to detect tenderness or enlargement. Palpate the abdomen for tenderness. A pelvic examination may be required. Obtain vaginal discharge specimens for testing.
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Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007
Vaginal Discharge:
Diagnostic Approach
(The Diagnostic Approach to Symptoms and Signs in Pediatrics)
Nonspecificvulvovaginitis is most common cause of vaginal discharge in prepubertal girls.If discharge fails to improve with good perineal hygiene or if itis purulent, specific bacterial infection, sexually transmittedinfection, or foreign body should be suspected. Wet mounts (salineand KOH), Gram stain, and vaginal cultures should be performed.Exam under anesthesia may be necessary for suspected foreign body.In pubertal girls who are not sexuallyactive, most common causes of vaginal discharge are physiologicleukorrhea, bacterial vaginosis, and C. albicans. Wet preparations(saline and KOH) and Gram stain should be performed. Bacterial andfungal cultures also should be considered.In girls who are sexually active, thesame diagnoses described for pubertal nonsexually active femalesare possible, but sexually transmitted infections also are likely.In addition to wet preparations and Gram stain, cultures for C.trachomatis, N. gonorrhoeae, and other aerobic and anaerobic bacteria shouldbe performed. In some centers nucleic acid amplification technologyis available for detection of C. trachomatis and N. gonorrhoeaefrom endocervical and urine specimens. Laparoscopy may provide definitivediagnosis in suspected pelvic inflammatory disease with negativecervical cultures.If sexual abuse is suspected at anyage, vaginal, rectal, and throat cultures for N. gonorrhoeae andvaginal and rectal cultures for C. trachomatis should be performed,even in an asymptomatic child. HIV testing should be considered.So should pregnancy prophylaxis, which depends on whether menarche hasbeen reached and on nature of abuse.
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Source: The Diagnostic Approach to Symptoms and Signs in Pediatrics, 2006
Vaginal discharge:
History and physical examination
(Nursing: Interpreting Signs and Symptoms)
Ask the patient to describe the onset, color, consistency, odor, and texture of her vaginal discharge. How does the discharge differ from her usual vaginal secretions? Is the onset related to her menstrual cycle? Ask about associated symptoms, such as dysuria and perineal pruritus and burning. Does she have spotting after coitus or douching? Ask about recent changes in her sexual habits and hygiene practices. Is she or could she be pregnant? Ask if she has had vaginal discharge before or has ever been treated for a vaginal infection or sexually transmitted disease. What treatment did she receive? Did she complete the course of medication and were all sexual contacts treated? Ask about her current use of medications, especially antibiotics, oral estrogens, and hormonal contraceptives.
Examine the external genitalia and note the character of the discharge. (See Identifying causes of vaginal discharge.) Observe vulvar and vaginal tissues for redness, edema, and excoriation. Palpate the inguinal lymph nodes to detect tenderness or enlargement, and palpate the abdomen for tenderness. A pelvic examination may be required. Obtain vaginal discharge specimens for testing.
» READ BOOK EXCERPT ONLINE »
Source: Nursing: Interpreting Signs and Symptoms, 2007
Genital lesions, male:
History and physical examination
(Nursing: Interpreting Signs and Symptoms)
Begin by asking the patient when he first noticed the lesion. Did it erupt after he began taking a new drug or after a trip out of the country? Has he had similar lesions before? If so, did he get medical treatment for them? Find out if he has been treating the lesion himself. If so, how? Does the lesion itch? If so, is the itching constant or does it bother him only at night? Note whether the lesion is painful. Ask for a description of any drainage from the lesion. Next, take a complete sexual history, noting the frequency of relations, number of sexual partners, and pattern of condom use.
Before you examine the patient, observe his clothing. Do his pants fit properly? Tight pants or underwear, especially those made of nonabsorbent fabrics, can promote the growth of bacteria and fungi. Examine the entire skin surface, noting the location, size, color, and pattern of the lesions. Do genital lesions resemble lesions on other parts of the body? Palpate for nodules, masses, and tenderness. Also, look for bleeding, edema, or signs of infection, such as purulent drainage or erythema. Finally, take the patient's vital signs.
» READ BOOK EXCERPT ONLINE »
Source: Nursing: Interpreting Signs and Symptoms, 2007
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