Female and Male Reproductive History, Exam, and Diagnostics
Kaleigh Beadlecomb, MSPAS, PA-C and Sierra Holland PhD, CPM, LM CA 3 Spring 2026
Let's go!
Objectives
-Obtain a problem-oriented history and an appropriate review of systems, given a patient with a genitourinary complaint. -Know the respective anatomy for the female and male genitourinary exams and breast/chest exams -Be able to complete the female and male GYN/GU exams in a thorough, respectful, and stepwise manner -Accurately record a GYN/GU and sexual history and physical exam findings.
-Determine appropriate imaging and diagnostic tests for various GYN/GU and breast/chest complaints -Recall GYN/GU/breast cancer screening tests and their frequency -Recall screening recommendations for common sexually transmitted infections including HIV, gonorrhea, chlamydia, syphilis, HPV, and HSV.
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But first, how is everyone feeling?
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A note on terminology
There may be reference to to the terms female and male throughout this discussion. These refer to biologic sex, inclusive of all gender identities including cisgender women, transgender men, and non-binary individuals.
In general, screening of transgender and gender diverse persons should be adapted based on anatomy and sexual practices.
Physical exams will generally be referred to as breast or chest, pelvic and rectal exams.
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This lecture will cover...
GU Exam with normal findings
GYN Exam with normal findings
Abnormal findings and Diagnostics
Sexual History
Step by step and what is normal
The 5 (or 6) P's and how to take a sexual history
STIs, cancer, infection,
Step by step and what is normal
Screenings
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Part 1: Sexual History
"Sex is... perfectly natural. It's something that's pleasurable. It's enjoyable, and it enhances a relationship. So why don't we learn as much as we can about it and become comfortable with ourselves as sexual human beings because we are all sexual?" — Sue Johanson
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Why do we care about a sexual history?
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Practices that apply to every patient
Introduce yourself and wash your hands
Use professional/anatomic language. If you are not familiar with a term your patient used, ask for an explanation. Make sure you are on the same page.
Take the patient's history while they are fully clothed
Let your patient know that you ask everyone these questions.
Keep your face and body language neutral- even if you feel uncomfortable or embarrassed.
Rephrase your questions or briefly explain why you are asking a question if a patient seems offended or reluctant to answer.
Pose your questions in a non-judgmental manner.
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Your idea is already here, now it's time to move it. Add interactivity, play with the rhythm, surprise with details. The static is left behind: create experiences that trigger clicks, gestures, and desire for more.
What you create makes sense when someone lives it. Share your content to inspire, teach, or move. This is the final step of the journey, but also the beginning of new connections.
- Being humans in space
- Laying out the plan
- Clarifying scope
- Sharing authority
- Who is the expert?
- What are their goals?
- How will this interaction impact them?
- Risk vs. wellbeing
- Relevance vs. curiosity
- Next steps and plans
Sexual health as wellbeing
Lived experience
Mutual comfort + clarity
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- Being humans in space
- Laying out the plan
- Clarifying scope
- Sharing authority
- Who is the expert?
- What are their goals?
- How will this interaction impact them?
Your idea is already here, now it's time to move it. Add interactivity, play with the rhythm, surprise with details. The static is left behind: create experiences that trigger clicks, gestures, and desire for more.
What you create makes sense when someone lives it. Share your content to inspire, teach, or move. This is the final step of the journey, but also the beginning of new connections.
- Risk vs. wellbeing
- Relevance vs. curiosity
- Next steps and plans
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Share your story
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-What do you do to protect yourself from STIs, including HIV?
-When do you use this protection? With which partners?
-Have you been vaccinated against HPV? Hepatitis A? Hepatitis B?
-Are you currently having sex of any kind—oral, vaginal, or anal—with anyone? If no, have you ever had sex of any kind with another person? In recent months, how many sex partners have you had? -What is/are the gender(s) of your sex partner(s)? - Do you or your partner(s) currently have other sex partners? - In the past 3 months, have you had sex with someone you didn’t know or had just met?
The 5 P's
Protection (against STIs)
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Partners
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Have you ever had a sexually transmitted infection (disease)?
-If yes: Which STI? Where was the infection? When did you have it? Was (were) your partner(s) treated too?
Have you ever been tested for HIV?-If yes: How long ago was that test? What was the result?
-Do you have any desire to have(more) children?
If yes: How many children would you like to have?
-When would you like to have a child?
What are you and your partner doing to prevent pregnancy until that time?
-If no: Are you doing anything to prevent pregnancy?
*Be sure to ask to AFAB transgender patients who still have intact uterus/ovaries
In the past 3 months, what kinds of sex have you had? Anal? Vaginal? Oral?
(For men who have sex with men: Ask about receptive anal sex, insertive anal sex, or both.)
Have you or any of your partners used alcohol or drugs when you had sex?
Have you exchanged sex for your needs (money, housing, drugs, etc.)?
Past (history of STIs)
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Pregnancy Prevention/Plans
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Practices
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How can we ask this sensitively?
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Sexual Function or The 6th P: Pleasure
-How satisfied are you with your ability to perform sexually? -Do you have any difficulty achieving orgasm? Erection? Ejaculation? Do you ever have unintended pain with sexual activity? Do you have any difficulty with lubrication? -Do you take any medications to enhance your sexual function? -History of medical interventions that have impacted sexual function (ie surgery, radiation)
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Part 2a: Chest + GYN Exams with Normal Findings
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Prep + purpose
Apply principles from history taking to sensitive exams:
- Be humans together
- Communication and CONSENT throughout
- Invite engagement with tools
- Use appropriate language
- Offer chaperone
- Prepare everything you need in advance
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Chest Anatomy
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Visual Inspection
- Neutral
- Hands on hips, elbows flexed forward
- Hands above head
- Leaning forward
- Cover/drape and assist to supine
Begin sitting neutrally and disrobe upper body, observe for asymmetry
Note!
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Variations
Normal striations and vasculature
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Variations
Nipple inversion
Nipple retraction
Supernumerary nipples
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Palpation
Assess for consistency, tenderness, nodules
- Finger pad palpation
- Vertical strip pattern
- Concentric circles
- Light - medium - firm
- Include chest wall + tail
Chest tissue + wall
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- In sitting position
- Reach high into axilla with flat hand
- Press towards chest wall and move downwards
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Axilla
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A mass may have well-defined or nondiscrete margins and be associated with clinical findings including ecchymosis, erythema, peau d'orange, or skin dimpling; nipple discharge; or nipple retraction
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Post-top surgery, mastectomy, reconstruction considerations
Palpate gently along scar and bordering tissue in circular motion
Inspect scar tissue for masses, nodules, skin changes
Assess as appropriate for residual tissue
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Mass descriptions
Documentation
- Location using clock or quadrant + cm from nipple
- Size
- Shape
- Consistency
- Border/circumscribed
- Tenderness
- Mobility
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Part 2b: Chest + GYN Exams with Normal Findings
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External anatomy
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Internal anatomy
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Adnexa
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GYN exam tools
Broom or brush
Speculum
Light source
For adequate visualization
For visualizing cervix and vaginal tissues
For cervical cancer screening sample collection
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Assess for:
- Hair distribution pattern
- Atrophy or hypertrophy
- Erythema
- Lesions of any kind
- Discharge
- Varicosities
- Bulges or masses
- Scars
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Speculum exam
Bimanual exam
Pelvic exam: 2 parts
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Open slowly to sight the cervix, remembering that wider is not necessarily better
Move labia to the side and insert the speculum at a downward angle, consider beginning semi-vertical
Overview of steps
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The cervix
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Cervical/vaginal testing
Cervical cancer screening
STI screening
Vaginitis testing
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Sample collection
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Cervical cancer screening
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Wet mount
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Bimanual exam
Texture
Masses
Mobility
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Normal uterine positions
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For trans patients
Provide adaptations for comfort, like lidocaine jelly and small speculum
Ask desired gender of chaperone
Use non-specific (or patient-preferred) anatomical terms
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- Location in pelvis
- Tenderness
- Gravid?
Documentation
External genitalia
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Uterus
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- Appearance
- Location/orientation
- Disturbances/abnormalities
- Internal os features
- Presence of IUD strings
- Motion tenderness
- Sample collection
- Appearance
- Discharge (presence and description)
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Adnexa
Cervix
Vaginal wall
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- Hair distribution pattern
- Atrophy or hypertrophy
- Erythema
- Lesions of any kind
- Discharge
- Varicosities
- Bulges or masses
- Scars
- Location in pelvis
- Tenderness
- Gravid?
Documentation
- Appearance
- Location/orientation
- Disturbances/abnormalities
- Internal os features
- Presence of IUD strings
- Motion tenderness
- Sample collection
- Appearance
- Discharge (presence and description)
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Vaginal wall
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Uterus
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Adnexa
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Cervix
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Part 3: GU Exam with Normal Findings
"I think there's three in there." "No, there are only two...at least, there should be only two. Don't hurt yourself." -Perhaps a coversation between Prof Beadlecomb and one of her kids
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Exam Prep
-CONSIDER: Anxiety of patient
-Use professional/anatomic language
-Explain what you will be doing in detail
-Offer chaperone
-Examiner sits on chair or stool, patient stands
-Patient wears a gown or may choose to wear their own clothes and drop their trousers if that is more comfortable for them.
Observe the patient for:
-habitus
-posture
-level of comfort
-signs of distress
-affect
EXPLAIN TO PATIENT IF ERECTION OCCURS, THIS IS NORMAL.
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Anatomy
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Use a stepwise approach
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Grip the glans firmly between thumb and index finger to inspect both the dorsal and ventral aspects of the penis for excoriations, lesions, inflammation
If present, retract the prepuce (foreskin) or have the patient retract on their own. Inspect the glans for nodules, inflammation.
Gently squeeze the glans between the thumb and index finger to inspect for irritation or discharge
2. Inspect the glans
1. Inspect the skin of the penis
3. Inspect the urethral meatus
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If present, retract the prepuce (foreskin) or have the patient retract on their own. Inspect the glans for nodules, inflammation.
Grip the glans firmly between thumb and index finger to inspect both the dorsal and ventral aspects of the penis for excoriations, lesions, inflammation
Gently squeeze the glans between the thumb and index finger to inspect for irritation or discharge
If present, retract the prepuce (foreskin) or have the patient retract on their own. Inspect the glans for nodules, inflammation.
Gently squeeze the glans between the thumb and index finger to inspect for irritation or discharge
2. Inspect the glans
3. Inspect the urethral meatus
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Inspection and Palpation of the Scrotum
1. Inspect the skin and countours of the scrotum, including the posterior surface, for skin changes, visible masses/lumps.
6. Repeat palpation for the opposite testicle, epididymis and spermatic cord
5. Palpate the spermatic cord between the thumb and fingers from the epididymus to the external inguinal ring.
2. Inspect the inguinal areas for erythema, abscesses, adenopathy
3. Palpate the testicle between the thumb and first two fingers. Evaluate size, shape, consistency, tenderness
4. Palpate the epididymis on the posterior surface of the testicle (feels cordlike or like a small bump on the top of the testis)
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Hernias
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Be hernia expert!
https://painepodcast.com/page/2/
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The Rectal Exam
May be performed on any patient, regardless of sex or gender
Can be performed to assess pelvic floor function or...
For hemorrhoids, cancer, GI bleed, etc
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Prostate Exam: To do or not to do
- USPSTF no longer recommends DRE with prostate exam for low risk prostate cancer screening
- DRE with prostate exam alone is not sufficient for prostate cancer screening and should be used along with a PSA blood test
- BUT, PSA blood tests are somewhat controversial
- Ultimately, if you are a primary care provider, you should be assessing risks for men starting at age 40 and discussing options for screening depending on assessed risk
- More on screening later...
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Part 4: Abnormal Findings
"Mommy! What happened to that eye?!" "It got gonorrhea." "What's gonorrhea?" "................It's a bacteria people can get when they aren't safe." "Are we safe?! What if a large animal eats us?!" -another conversation between Prof B and her kids (PA school was a wild time)
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GYN/GU Abnormalities and STIs
Uterine, Cervical, and Ovarian Abnormalities
Breast/Chest abnormalities
GU Abnormalities
STIs
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Breast Abnormalities
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- What is it: solid, invasive tumor. Several different types
- History:
- Finding on routine screening vs self palpated mass
- Ages 50+ most common, but may be much younger
- +/- family history or genetic risk factors
- Physical exam:
- May not be palpable at all if early stage
- Usually painless, firm, fixed lump
- Usually unilateral
- What is it: Fluid filled sac arising in the breast tissue
- History:
- Often fluctuates with a person's menstrual cycle
- More common in ages 30-50 and regresses after menopause
- On exam:
- May be tender
- Well circumscribed
- NO associated overlying skin changes
Most Common Breast Lesions
Cysts
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Cancer
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- What is it: Cystic changes along with fibrous tissue
- History:
- Usually bilateral
- Can be painful
- Pain and tenderness are usually cyclical
- Abates with menopause
- Exam: "Busy breasts"
- dense, fibrous tissue
- May feel "ropey" or "cordlike" with some nodules more pronounced than others
- What is it: a rare breast cancer subtype that starts as a rash on the nipple
- History:
- Most common in post-menopausal females
- Rash has been persistent and worsening
- +/- pruritis
- Physical exam:
- Eczema like rash
- May progress to eschar or ulceratino of the nipple
- +/- nipple discharge or bleeding
- +/- palpable lump deep to the nipple
- What is it: A solid, benign breast tumor
- History:
- Ages 15-35 most common
- PainLESS
- Unilateral
- Exam: firm, well circumscribed, freely mobile, nontender
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Paget's disease
Fibroadenoma
Fibrocystic Change
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- What is it: Fluid filled sac arising in the breast tissue
- History:
- Often fluctuates with a person's menstrual cycle
- More common in ages 30-50 and regresses after menopause
- On exam:
- May be tender
- Well circumscribed
- NO associated overlying skin changes
- What is it: solid, invasive tumor. Several different types
- History:
- Finding on routine screening vs self palpated mass
- Ages 50+ most common, but may be much younger
- +/- family history or genetic risk factors
- Physical exam:
- May not be palpable at all if early stage
- Usually painless, firm, fixed lump
- Usually unilateral
Most Common Breast Lesions
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Cancer
Cysts
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- What is it: A solid, benign breast tumor
- History:
- Ages 15-35 most common
- PainLESS
- Unilateral
- Exam: firm, well circumscribed, freely mobile, nontender
- What is it: a rare breast cancer subtype that starts as a rash on the nipple
- History:
- Most common in post-menopausal females
- Rash has been persistent and worsening
- +/- pruritis
- Physical exam:
- Eczema like rash
- May progress to eschar or ulceratino of the nipple
- +/- nipple discharge or bleeding
- +/- palpable lump deep to the nipple
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- What is it: Cystic changes along with fibrous tissue
- History:
- Usually bilateral
- Can be painful
- Pain and tenderness are usually cyclical
- Abates with menopause
- Exam: "Busy breasts"
- dense, fibrous tissue
- May feel "ropey" or "cordlike" with some nodules more pronounced than others
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Paget's disease
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Fibrocystic Change
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Fibroadenoma
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Breast Mass Work-up
A patient presents with a palpable breast mass. What do you want to know?
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Palpable Breast Mass: Patient <30y
If suspicous clinical features, family history, or patient persistence, start with US
May proceed to mammography if suspicious features on US
If low clinical suspicion of breast cancer, reasonable to observe for 1-2 cycles
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Palpable Breast Mass: Patient >30y
For patients 30-40 and low clinical suspicion, may start with ultrasound then proceed to mammogram
Breast MRI if indicated by mammography (dense breasts, history of breast surgery, other difficult interpretation
For patients 40+, start with mammography usually accompanied by ultrasound if suspicious features
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Benign vs Malignant US features
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Suspicious mammography features
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Next Steps
Imaging and exam suspicious for fibroadenoma vs cyst
Imaging suspicious for cancer
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Image guided core needle biopsy
Fine need aspiration with cytology
Image guided core needle biopsy
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Fine need aspiration with cytology
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Match the menstrual cycle vocab!
Having fewer than 9 menstrual cycles in a year
Menorrhagia
Oligomenorrhea
Periods that are excessively heavy or lasting longer than 7 days
The permanent cessation of the menstrual cycle
Menarche
Painful menstruation
Amenorrhea
The cessation of the menstrual cycle in a person of reproductive age after it has been established
Dysmenorrhea
The first menstrual cycle
Menopause
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Abnormal Uterine Bleeding
- What is it?
- Bleeding that occurs outside the normal menstrual cycle in a person of reproductive age (postmenopausal bleeding is classified by itself because it is ALWAYS abnormal)
- Causes:
COEIN
PALM
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AUB Work Up
Thorough history driven by PALM-COEIN and exam including pelvic and bimanual
Imaging: Pelvic ultrasound (TVUS vs TAUS)
Lab panel
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Pelvic Organ Prolapse
- What is it?
- Laxity of connective tissue and pelvic floor musculature results in loss of organ support
- Most common: Cystocele. Prolapse involves the anterior vaginal wall
- Others: Rectocele, Uterine prolapse
- Symptoms
- Feeling of pressure in the pelvic floor
- Incontinence or difficulty with urination or defecation
- LBP
- Dyspareunia
- Physical exam is diagnostic
- Can sometimes visualize prolapse at introitus vs w/ speculum exam
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Ovarian Disorders
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PCOS: Presentation and Work-up
- History/symptoms: Oligomenorrhea, +/- AUB, weight gain/obesity, hirsutism, infertility
Labs
Imaging
First...
- Can be a broad panel
- Typically:
- LH/FSH- ratio will be elevated
- Testosterone (total or free)- elevated
TVUS shows abundant immature follicles
Exclude other endocrine disorders (TFTs, adrenal labs, prolactin, etc)
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Ovarian Torsion
- What is it?
- A GYN SURGICAL EMERGENCY
- The ovary twists on its supporting ligaments, cutting off blood supply
- Symptoms: PAIN, adnexal mass, nausea/vomiting, fever, vaginal bleeding (less frequently)
- Testing: URGENT/EMERGENT pelvic US
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Ovarian Cancer
Testing
- What is it?
- Generally speaking, badness
- Most are epithelial cancers arising from the ovary OR the Fallopian tube
- History/symptoms: vague and persistent
- Most often in women >50
- BRCA- 30-70% of carriers will develop ovarian ca by age 70
- Abdominal distension/bloating, early satiety
- Urinary symptoms
- Symptoms of metastatic disease (localized)
- Physical exam
- +/- Adnexal mass
- Palpable ovaries in people 3-5y post menopause need further evaluation
- THERE IS NO SCREENING TEST FOR OVARIAN CANCER
- TV vs Abdominal pelvic US shows a large (usually >6cm) heterogenous mass with irregular borders and septated cystic components
- CT Abd/pelvis to evaluate for metastatic disease
- Labs: CA125 is often elevated
- Biopsy to confirm
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Cervical Abnormalities
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Cervical Dysplasia/Cancer
- Cervical dysplasia may be a precursor to invasive carcinoma...or it may resolve on its own
- Pap can identify low grade dysplasia through carcinoma, but endocervical biopsy is needed to determine invasive vs in situ carcinoma
- HPV is often associated with dysplasia/carcinoma; however there may be other causes as well such as environmental exposures or cigarette smoking
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Cervicitis -> PID
- What is it?
- Inflammation of the cervix caused by infectious (STI) vs other causes (mechanical, chemical, BV, candida)
- Hx/Symptoms
- Often preceded by unprotected intercourse
- Intermenstrual bleeding
- purulent vaginal discharge
- dysuria/dyspareunia
- Vulvovaginal irritation
- Exam: mucopurulent discharge, cervical ectropion/edema/erythema
- Labs: Vaginal/cervical swab with nucleic acid amplification test for CT/NG; wet prep, other STI testing
- What is it?
- Inflammation of the cervix caused by infectious (STI) vs other causes (mechanical, chemical, BV, candida)
- Hx/Symptoms
- Often preceded by unprotected intercourse
- Intermenstrual bleeding
- purulent vaginal discharge
- dysuria/dyspareunia
- Vulvovaginal irritation
- Exam: mucopurulent discharge, cervical ectropion/edema/erythema
- Labs: Vaginal/cervical swab with nucleic acid amplification test for CT/NG; wet prep, other STI testing
- Infection/inflammation ascends to involve the uterus +/- Fallopian tubes +/- ovaries
- Hx/symptoms: same as cervicitis +
- pelvic/lower abdominal pain
- fever/chills
- nausea/vomiting
- Physical exam
- Cervical motion tenderness and palpable tenderness of adnexa
- Labs: same as cervicitis +
- CBC/CMP
- Pelvic US (transabdominal)
- Infection/inflammation ascends to involve the uterus +/- Fallopian tubes +/- ovaries
- Hx/symptoms: same as cervicitis +
- pelvic/lower abdominal pain
- fever/chills
- nausea/vomiting
- Physical exam
- Cervical motion tenderness and palpable tenderness of adnexa
- Labs: same as cervicitis +
- CBC/CMP
- Pelvic US (transabdominal)
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Pelvic Inflammatory Disease
Cervicitis
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Write a brief description here
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Non-STI Vulvovaginal Conditions
- History/symptoms:
- Often arises after disrupting events to vaginal pH (intercourse, menstruation)
- Abundant, malodorous vaginal discharge
- Exam: Homogenous thin/watery white to grayish discharge coating vaginal walls
- Testing: wet prep shows "clue cells;" fishy odor with addition of 10% KOH
- C/o pruritis and abundant white, curd-like discharge
- Exam: Thick, creamy, white-yellowish discharge, adherent to vaginal wall, vulvar erythema and edema, +/- excoriations
- Visible on wet prep as pseudohyphae with buds
- Cysts may arise in the Bartholin's gland when the Bartholin's duct becomes blocked
- May progress to abscess
- Hallmarks of inflammation
- Painful
- Make sure you wear PPE including eye and head gear when you lance these!
- Hx/symptoms: vulvar pruritis, bleeding, non-healing vulvar lesions
- Diagnosed through physical exam and biopsy
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Bacterial Vaginosis
Vulvar Carcinoma
Bartholin's gland cyst/abscess
Candida
- Cysts may arise in the Bartholin's gland when the Bartholin's duct becomes blocked
- May progress to abscess
- Hallmarks of inflammation
- Painful
- Make sure you wear PPE including eye and head gear when you lance these!
- C/o pruritis and abundant white, curd-like discharge
- Exam: Thick, creamy, white-yellowish discharge, adherent to vaginal wall, vulvar erythema and edema, +/- excoriations
- Visible on wet prep as pseudohyphae with buds
- Hx/symptoms: vulvar pruritis, bleeding, non-healing vulvar lesions
- Diagnosed through physical exam and biopsy
- History/symptoms:
- Often arises after disrupting events to vaginal pH (intercourse, menstruation)
- Abundant, malodorous vaginal discharge
- Exam: Homogenous thin/watery white to grayish discharge coating vaginal walls
- Testing: wet prep shows "clue cells;" fishy odor with addition of 10% KOH
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"Know syphilis in all its manifestations and relations, and all other things clinical will be added unto you" — Sir William Osler (1897)
Sexually Transmitted Infections
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Genital Warts
- Anogenital region
- Pathophysiology: numerous HPV subtypes
- 6 & 11 are benign warts
- 16 & 18 are oncogenic (SCC)—penile, anal, vaginal, vulvar, cervical, oropharyngeal
- SXS: none, growths or pruritus
- DX Testing: cervical only
- No (FDA)-approved tests clinically available to detect HPV infection of oropharyngeal, anal, or male genital specimen
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Herpes
- HSV-1 and 2
- SXS: dramatic variation, can be mild, asymptomatic or VERY painful +/- dysuria, fever, tender local inguinal lymphadenopathy, and headache
- DX testing: viral culture, polymerase chain reaction (PCR), direct fluorescence antibody, and type-specific serologic tests
*Routine serologic screening for herpes simplex virus-1 or 2 (HSV-1 or HSV-2) is not recommended in asymptomatic adolescents and adults
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Herpes
- HSV-1 and 2
- SXS: dramatic variation, can be mild, asymptomatic or VERY painful +/- dysuria, fever, tender local inguinal lymphadenopathy, and headache
- DX testing: viral culture, polymerase chain reaction (PCR), direct fluorescence antibody, and type-specific serologic tests
*Routine serologic screening for herpes simplex virus-1 or 2 (HSV-1 or HSV-2) is not recommended in asymptomatic adolescents and adults
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Syphilis
- Caused by the highly infectious Treponema pallidum
- Initially presents with primary chancre
- PainLESS ulceration on the genitalia
- Condyloma lata is a diffuse rash associated with secondary syphilis
- Diagnostics: LOW threshold to test
- Non-treponemal tests first:
- If non-treponemal test is reactive proceed with fluorescent treponemal antibody absorption (FTA-ABS)
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Chancroid
- Caused by Hemophilis ducreyi
- Presents with multiple painFUL ulcers (makes you cry...like duCReYi)
- May also have "buboes" which are pustular lesions
- Uncommon in North America, although consider strongly if history of exchanging sex for cocaine or travel to African, Asian, Latin American countries
- Diagnostics:
- Swab of ulcer with culture is preferred vs aspiration of bubo
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Chlamydia and Gonorrhea
- Chlamydia trachomatis and Neisseria gonorrheae - They go together like peas and carrots
- Cause a wide variety of -itises
- CERVICITIS/PID-mucopurulent discharge, pelvic pain, etc
- URETHRITIS-–mucoid or watery urethral discharge and dysuria, d/c best seen when milking the urethra
- EPIDIDYMITIS- testicular discomfort
- PROSTATITIS--dysuria, urinary dysfunction, pain with ejaculation, and pelvic pain
- PROCTITIS--anorectal pain, discharge, tenesmus, rectal bleeding, and constipation
- Other—conjunctivitis, pharyngitis, reactive arthritis--> Can’t see, Can’t pee, Can’t climb a tree
- Testing: Nucleic acid amplification test via urine, vaginal/cervical swab, swab of urethral discharge
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Trichomoniasis
- A sexually transmitted, flagellated protozoa
- The majority of people are asymptomatic
- Folks with a vagina may have abundant foul-smelling, yellow-green discharge, dysuria, dyspareunia, vulvovaginal itching and burning
- Testing
- May be seen on wet prep (see left)
- Gold standard is NAAT with first morning urine in males or vaginal swab
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GU Abnormalities Not Previously Covered
"My friends glued my peehole closed... I was drunk." -An actual, real-live triage note from the hospital Prof Beadlecomb used to work at
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Phimosis vs Paraphimosis
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Peyronie's disease
- Fibrous plaques in the corpus cavernosum can cause deformity of the penis leading to erectile/sexual dysfunction
- Most common in men >50 and typically will have history of penile trauma
Continue
- Most common cause of testicular pain in adults in the outpatient setting
- NG/CT are most common causes, so test for those
- Physical exam:
- Tenderness and edema on palpation of affected epididymis
- +PHREN sign (elevation of scrotum relieves the pain
- Cremasteric reflex remains intact
- Testing: STI labs; US will show hyperemia, edema, increased blood flow of epididymis on color Doppler
- A symptom of something else
- Note whether symmetric or unilateral as this will impact your differential
- May be seen in non-urologic conditions such as heart failure or end stage liver disease
- A symptom of something else
- Note whether symmetric or unilateral as this will impact your differential
- May be seen in non-urologic conditions such as heart failure or end stage liver disease
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Acute Epididymitis
Scrotal edema
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- Most common cause of testicular pain in adults in the outpatient setting
- NG/CT are most common causes, so test for those
- Physical exam:
- Tenderness and edema on palpation of affected epididymis
- +PHREN sign (elevation of scrotum relieves the pain
- Cremasteric reflex remains intact
- Testing: STI labs; US will show hyperemia, edema, increased blood flow of epididymis on color Doppler
- Non-tender fluid filled mass in the tunica vaginalis
- Transilluminates
- Secondary to other causes (inflammatory processes vs congenital)
Sick Scrotums
- Varicose veins in the pampiniform plexus
- "Bag of worms"
- May have history of infertility
- Tortuous veins may be grossly visible or palpable on exam
- Non-tender fluid filled mass in the tunica vaginalis
- Transilluminates
- Secondary to other causes (inflammatory processes vs congenital)
- Varicose veins in the pampiniform plexus
- "Bag of worms"
- May have history of infertility
- Tortuous veins may be grossly visible or palpable on exam
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Hydrocele
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Varicocele
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Cryptorchidism
- AKA hidden testis (es)
- One or both testicles do not descend into the scrotum by four months of age (or corrected age for premature infants)
- Pediatricians continue to check for undescended vs ascending testes at routine visits
- INflammation of one or both testes
- Most often caused by bacterial infection (STI, UTI) or viral infection (mumps)
- Symptoms: severe testicular pain, fever, N/V
- Physical exam: edema, tenderness on palpation
- Diagnostics: STI testing (NG/CT), UA with culture
- AKA hidden testis (es)
- One or both testicles do not descend into the scrotum by four months of age (or corrected age for premature infants)
- Pediatricians continue to check for undescended vs ascending testes at routine visits
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Acute Orchitis
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- INflammation of one or both testes
- Most often caused by bacterial infection (STI, UTI) or viral infection (mumps)
- Symptoms: severe testicular pain, fever, N/V
- Physical exam: edema, tenderness on palpation
- Diagnostics: STI testing (NG/CT), UA with culture
- UROLOGIC EMERGENCY
- Most common in neonates>post-pubertal males>adults
- Sx: acute onset of mod-severe testicular pain with diffuse tenderness and swelling
- Physical exam:
- Loss of cremasteric reflex
- "Bell clapper deformity"- asymmetrically high-riding testis with its long axis oriented transversely instead of longitudinally
- DX: PE + ultrasound, +/- doppler ultrasonagraphy
Testicular Problems
- Extremely rare
- Sx: Unilateral painless nodule or swelling; pelvic or lower abdominal heaviness
- On palpation, nodule will feel firm/hard and FIXED
- Testing
- Labs: beta-hCG, AFP, and LDH will be elevated
- Imaging: Scrotal US followed by CT abd/pelvis
- Confirm dx with biopsy
- UROLOGIC EMERGENCY
- Most common in neonates>post-pubertal males>adults
- Sx: acute onset of mod-severe testicular pain with diffuse tenderness and swelling
- Physical exam:
- Loss of cremasteric reflex
- "Bell clapper deformity"- asymmetrically high-riding testis with its long axis oriented transversely instead of longitudinally
- DX: PE + ultrasound, +/- doppler ultrasonagraphy
- Extremely rare
- Sx: Unilateral painless nodule or swelling; pelvic or lower abdominal heaviness
- On palpation, nodule will feel firm/hard and FIXED
- Testing
- Labs: beta-hCG, AFP, and LDH will be elevated
- Imaging: Scrotal US followed by CT abd/pelvis
- Confirm dx with biopsy
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Testicular Torsion
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Testicular Cancer
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Part 5: Screenings
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USPSTF Guidelines
- Who: women with a personal or family history of breast, ovarian, tubal, or peritoneal cancer or who have an ancestry associated with breast cancer susceptibility 1 and 2 (BRCA1/2) gene mutations with an appropriate brief familial risk assessment tool
- Guideline does not specify age
- Who: Persons with a cervix ages 21-65
- How:
- 21-29: q 3yrs w/ cytology alone
- 30-65: q 3yrs w/ cytology alone -OR- q 5yrs hrHPV testing -OR- q 5yrs hrHPV w/ cytology (cotesting)
- Who: sexually active women 15-24 and >25 if they have increased risk factors (insufficient evidence to recommend screening in men)
- Frequency: annually
BRCA-related Cancer: Risk assessment, Genetic counseling, and Genetic testing
Cervical Cancer
Chlamydia and Gonorrhea
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- Who: women with a personal or family history of breast, ovarian, tubal, or peritoneal cancer or who have an ancestry associated with breast cancer susceptibility 1 and 2 (BRCA1/2) gene mutations with an appropriate brief familial risk assessment tool
- Guideline does not specify age
- Who: Persons with a cervix ages 21-65
- How:
- 21-29: q 3yrs w/ cytology alone
- 30-65: q 3yrs w/ cytology alone -OR- q 5yrs hrHPV testing -OR- q 5yrs hrHPV w/ cytology (cotesting)
- Who: sexually active women 15-24 and >25 if they have increased risk factors (insufficient evidence to recommend screening in men)
- Frequency: annually
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USPSTF Guidelines
- Who: AMAB ages 55-69
- What: PSA blood test; however, evidence for this recommendation is Grade C and USPSTF makes this caveat regarding patient counseling-->
- Who: Women aged 40-74
- Frequency: Biennial in low risk patients
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Breast Cancer
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HIV
Prostate
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- Who: Persons aged 15-65, younger or older if at increased risk of infection
- What test: Ag/Ab immunoassay
- Frequency: USPSTF found insufficient evidence to make recommendations on ideal screening intervals. Use clinical judgment and shared decision making
- Who: Persons aged 55-69
- What: PSA blood test; however, evidence for this recommendation is Grade C and USPSTF makes this caveat regarding patient counseling-->
- Who: Women aged 40-74
- Frequency: Biennial in low risk patients
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I do recommend referencing these for clinical practice; however for testing purposes in this course you will be tested on USPSTF recommendations.
The CDC has their own guidelines regarding STI screening which are more verbose in their recommendations.
https://www.cdc.gov/std/treatment-guidelines/screening-recommendations.htm
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To watch before lab
Pelvic Exam
https://accessmedicine-mhmedical-com.une.idm.oclc.org/MultimediaPlayer.aspx?MultimediaID=18341346
Breast Exam https://accessmedicine-mhmedical-com.une.idm.oclc.org/MultimediaPlayer.aspx?MultimediaID=18563279
Male Genital Exam
https://accessmedicine-mhmedical-com.une.idm.oclc.org/MultimediaPlayer.aspx?MultimediaID=18563284
Examination of Anus and Rectum
https://accessmedicine-mhmedical-com.une.idm.oclc.org/MultimediaPlayer.aspx?MultimediaID=18563281
Continue
Resources
- Bickley, LS & Szilagyi PG. (Eds) Bates’Guide to Physical Examination and History Taking, 12th Ed. 2017: Philadelphia, PA: Wolters Kluwer
- Klatt EC (Ed.) Robbins and Cotran Atlas of Pathology, 4th Edition. 2021: accessed online.
- https://www.cdc.gov/std/treatment-guidelines/screening-recommendations.htm
- https://www.cdc.gov/sti/hcp/clinical-guidance/taking-a-sexual-history.html
- https://www.aafp.org/pubs/afp/issues/2020/0301/p286.html
- https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2013/04/management-of-acute-abnormal-uterine-bleeding-in-nonpregnant-reproductive-aged-women
- https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(07)60462-0/fulltext
- https://www.ncbi.nlm.nih.gov/books/NBK532913/
- https://pmc.ncbi.nlm.nih.gov/articles/PMC2095004/
- UptoDate
- Female and Male GU lectures by S. Patton for CA3 Spring 2024
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Thank You!
Anatomic variations
Hypospadias is a condition in which the opening of the urethra is on the underside of the penis instead of at the tip.
The location of the opening can vary and can be anywhere from underneath the tip of the penis (more common) to the base of the penis (less common)
Vary by material, length, and shape of bill
Anatomic variations
Hypospadias is a condition in which the opening of the urethra is on the underside of the penis instead of at the tip.
The location of the opening can vary and can be anywhere from underneath the tip of the penis (more common) to the base of the penis (less common)
- Up to 80% of women > 50 years of age
- 25% symptomatic: abnormal uterine bleeding, particularly heavy menstrual bleeding , pelvic or abdominal pressure, bowel dysfunction, and bladder symptoms, particularly with larger fibroids
- PE: Firm, irregular nodules continuous with uterine surface
- Common, particularly > 40 years
- Can be due to inflammation or hormonal factors
- Should be removed if they are symptomatic
- (e.g,. bleeding, excessive discharge)
- OR large (≥3 cm) or appear atypical
- Malignancy is rare
Benign features: Smooth, well-defined borders, anechoic, posterior echoic enhancement
Ways to ask about practices
- “I need to ask some more specific questions about the kinds of sex you have had over the last 12 months to better understand if you have risk factors for sexually transmitted infections or STIs. Would that be OK?”
- We have different tests that are used for the different body parts people use to have sex. What kinds of sexual contact do you have, or have you had? What parts of your body are involved when you have sex?
- https://www.aafp.org/pubs/afp/issues/2020/0301/p286.html
- https://www.cdc.gov/sti/hcp/clinical-guidance/taking-a-sexual-history.html
USPSTF Regarding PSA Testing
Before deciding whether to be screened, men should have an opportunity to discuss the potential benefits and harms of screening with their clinician and to incorporate their values and preferences in the decision. Screening offers a small potential benefit of reducing the chance of death from prostate cancer in some men. However, many men will experience potential harms of screening, including false-positive results that require additional testing and possible prostate biopsy; overdiagnosis and overtreatment; and treatment complications, such as incontinence and erectile dysfunction. In determining whether this service is appropriate in individual cases, patients and clinicians should consider the balance of benefits and harms on the basis of family history, race/ethnicity, comorbid medical conditions, patient values about the benefits and harms of screening and treatment-specific outcomes, and other health needs. Clinicians should not screen men who do not express a preference for screening.
Lab Panel for AUB
- Beta hCG
- CBC with iron panel
- TSH
- FSH/LH
- ChlamydiaCoags if suspicion for coagulopathy (not in the scope of this course)
Structural causes
- Polyp: Endometrial or cervical
- Adenomysosis: The presence of endometrial tissue in the uterine musculature
- Leiomyoma: AKA fibroids
- Malignancy: Cervical vs endometrial
Malignant features: irregular borders, hypoechoic, sometimes with posterior acoustic shadowing or microcalcifications
This may include a moveable light source, a headlamp, a light inside the speculum, etc.
Non-structural causes
- Coagulopathy: vonWillebrand disease, etc
- Ovulatory dysfunction: PCOS, hypothalamic d/o, thyroid d/o
- Endometrial disorders: typically transient issues such as inflammation, infection that inhibit vasoconstriction in the uterus
- Iatrogenic: Contraceptive devices and medications, anticoagulants, Asherman's syndrome
- Not otherwise classified: AVM, cesarean scar issues, etc...
Female and Male Reproductive History, Exam, and Diagnostics
Kaleigh Beadlecomb
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Transcript
Female and Male Reproductive History, Exam, and Diagnostics
Kaleigh Beadlecomb, MSPAS, PA-C and Sierra Holland PhD, CPM, LM CA 3 Spring 2026
Let's go!
Objectives
-Obtain a problem-oriented history and an appropriate review of systems, given a patient with a genitourinary complaint. -Know the respective anatomy for the female and male genitourinary exams and breast/chest exams -Be able to complete the female and male GYN/GU exams in a thorough, respectful, and stepwise manner -Accurately record a GYN/GU and sexual history and physical exam findings. -Determine appropriate imaging and diagnostic tests for various GYN/GU and breast/chest complaints -Recall GYN/GU/breast cancer screening tests and their frequency -Recall screening recommendations for common sexually transmitted infections including HIV, gonorrhea, chlamydia, syphilis, HPV, and HSV.
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But first, how is everyone feeling?
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A note on terminology
There may be reference to to the terms female and male throughout this discussion. These refer to biologic sex, inclusive of all gender identities including cisgender women, transgender men, and non-binary individuals.
In general, screening of transgender and gender diverse persons should be adapted based on anatomy and sexual practices.
Physical exams will generally be referred to as breast or chest, pelvic and rectal exams.
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This lecture will cover...
GU Exam with normal findings
GYN Exam with normal findings
Abnormal findings and Diagnostics
Sexual History
Step by step and what is normal
The 5 (or 6) P's and how to take a sexual history
STIs, cancer, infection,
Step by step and what is normal
Screenings
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Part 1: Sexual History
"Sex is... perfectly natural. It's something that's pleasurable. It's enjoyable, and it enhances a relationship. So why don't we learn as much as we can about it and become comfortable with ourselves as sexual human beings because we are all sexual?" — Sue Johanson
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Why do we care about a sexual history?
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Practices that apply to every patient
Introduce yourself and wash your hands
Use professional/anatomic language. If you are not familiar with a term your patient used, ask for an explanation. Make sure you are on the same page.
Take the patient's history while they are fully clothed
Let your patient know that you ask everyone these questions.
Keep your face and body language neutral- even if you feel uncomfortable or embarrassed.
Rephrase your questions or briefly explain why you are asking a question if a patient seems offended or reluctant to answer.
Pose your questions in a non-judgmental manner.
Title
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Subtitle
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Your idea is already here, now it's time to move it. Add interactivity, play with the rhythm, surprise with details. The static is left behind: create experiences that trigger clicks, gestures, and desire for more.
What you create makes sense when someone lives it. Share your content to inspire, teach, or move. This is the final step of the journey, but also the beginning of new connections.
Sexual health as wellbeing
Lived experience
Mutual comfort + clarity
Activate your content
Share your story
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Your idea is already here, now it's time to move it. Add interactivity, play with the rhythm, surprise with details. The static is left behind: create experiences that trigger clicks, gestures, and desire for more.
What you create makes sense when someone lives it. Share your content to inspire, teach, or move. This is the final step of the journey, but also the beginning of new connections.
Activate your content
Share your story
Continue
-What do you do to protect yourself from STIs, including HIV? -When do you use this protection? With which partners? -Have you been vaccinated against HPV? Hepatitis A? Hepatitis B?
-Are you currently having sex of any kind—oral, vaginal, or anal—with anyone? If no, have you ever had sex of any kind with another person? In recent months, how many sex partners have you had? -What is/are the gender(s) of your sex partner(s)? - Do you or your partner(s) currently have other sex partners? - In the past 3 months, have you had sex with someone you didn’t know or had just met?
The 5 P's
Protection (against STIs)
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Partners
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Have you ever had a sexually transmitted infection (disease)? -If yes: Which STI? Where was the infection? When did you have it? Was (were) your partner(s) treated too? Have you ever been tested for HIV?-If yes: How long ago was that test? What was the result?
-Do you have any desire to have(more) children? If yes: How many children would you like to have? -When would you like to have a child? What are you and your partner doing to prevent pregnancy until that time? -If no: Are you doing anything to prevent pregnancy? *Be sure to ask to AFAB transgender patients who still have intact uterus/ovaries
In the past 3 months, what kinds of sex have you had? Anal? Vaginal? Oral? (For men who have sex with men: Ask about receptive anal sex, insertive anal sex, or both.) Have you or any of your partners used alcohol or drugs when you had sex? Have you exchanged sex for your needs (money, housing, drugs, etc.)?
Past (history of STIs)
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Pregnancy Prevention/Plans
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Practices
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How can we ask this sensitively?
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Sexual Function or The 6th P: Pleasure
-How satisfied are you with your ability to perform sexually? -Do you have any difficulty achieving orgasm? Erection? Ejaculation? Do you ever have unintended pain with sexual activity? Do you have any difficulty with lubrication? -Do you take any medications to enhance your sexual function? -History of medical interventions that have impacted sexual function (ie surgery, radiation)
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Part 2a: Chest + GYN Exams with Normal Findings
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Prep + purpose
Apply principles from history taking to sensitive exams:
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Chest Anatomy
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Visual Inspection
Begin sitting neutrally and disrobe upper body, observe for asymmetry
Note!
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Variations
Normal striations and vasculature
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Variations
Nipple inversion
Nipple retraction
Supernumerary nipples
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Palpation
Assess for consistency, tenderness, nodules
Chest tissue + wall
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Axilla
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A mass may have well-defined or nondiscrete margins and be associated with clinical findings including ecchymosis, erythema, peau d'orange, or skin dimpling; nipple discharge; or nipple retraction
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Post-top surgery, mastectomy, reconstruction considerations
Palpate gently along scar and bordering tissue in circular motion
Inspect scar tissue for masses, nodules, skin changes
Assess as appropriate for residual tissue
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Mass descriptions
Documentation
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Part 2b: Chest + GYN Exams with Normal Findings
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External anatomy
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Internal anatomy
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Adnexa
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GYN exam tools
Broom or brush
Speculum
Light source
For adequate visualization
For visualizing cervix and vaginal tissues
For cervical cancer screening sample collection
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Assess for:
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Speculum exam
Bimanual exam
Pelvic exam: 2 parts
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Open slowly to sight the cervix, remembering that wider is not necessarily better
Move labia to the side and insert the speculum at a downward angle, consider beginning semi-vertical
Overview of steps
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The cervix
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Cervical/vaginal testing
Cervical cancer screening
STI screening
Vaginitis testing
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Sample collection
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Cervical cancer screening
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Wet mount
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Bimanual exam
Texture
Masses
Mobility
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Normal uterine positions
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For trans patients
Provide adaptations for comfort, like lidocaine jelly and small speculum
Ask desired gender of chaperone
Use non-specific (or patient-preferred) anatomical terms
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Documentation
External genitalia
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Uterus
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Adnexa
Cervix
Vaginal wall
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Documentation
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Vaginal wall
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Uterus
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Adnexa
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Cervix
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Part 3: GU Exam with Normal Findings
"I think there's three in there." "No, there are only two...at least, there should be only two. Don't hurt yourself." -Perhaps a coversation between Prof Beadlecomb and one of her kids
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Exam Prep
-CONSIDER: Anxiety of patient -Use professional/anatomic language -Explain what you will be doing in detail -Offer chaperone -Examiner sits on chair or stool, patient stands -Patient wears a gown or may choose to wear their own clothes and drop their trousers if that is more comfortable for them.
Observe the patient for: -habitus -posture -level of comfort -signs of distress -affect
EXPLAIN TO PATIENT IF ERECTION OCCURS, THIS IS NORMAL.
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Anatomy
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Use a stepwise approach
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Grip the glans firmly between thumb and index finger to inspect both the dorsal and ventral aspects of the penis for excoriations, lesions, inflammation
If present, retract the prepuce (foreskin) or have the patient retract on their own. Inspect the glans for nodules, inflammation.
Gently squeeze the glans between the thumb and index finger to inspect for irritation or discharge
2. Inspect the glans
1. Inspect the skin of the penis
3. Inspect the urethral meatus
Info
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If present, retract the prepuce (foreskin) or have the patient retract on their own. Inspect the glans for nodules, inflammation.
Grip the glans firmly between thumb and index finger to inspect both the dorsal and ventral aspects of the penis for excoriations, lesions, inflammation
Gently squeeze the glans between the thumb and index finger to inspect for irritation or discharge
If present, retract the prepuce (foreskin) or have the patient retract on their own. Inspect the glans for nodules, inflammation.
Gently squeeze the glans between the thumb and index finger to inspect for irritation or discharge
2. Inspect the glans
3. Inspect the urethral meatus
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Inspection and Palpation of the Scrotum
1. Inspect the skin and countours of the scrotum, including the posterior surface, for skin changes, visible masses/lumps.
6. Repeat palpation for the opposite testicle, epididymis and spermatic cord
5. Palpate the spermatic cord between the thumb and fingers from the epididymus to the external inguinal ring.
2. Inspect the inguinal areas for erythema, abscesses, adenopathy
3. Palpate the testicle between the thumb and first two fingers. Evaluate size, shape, consistency, tenderness
4. Palpate the epididymis on the posterior surface of the testicle (feels cordlike or like a small bump on the top of the testis)
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Hernias
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Be hernia expert!
https://painepodcast.com/page/2/
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The Rectal Exam
May be performed on any patient, regardless of sex or gender
Can be performed to assess pelvic floor function or...
For hemorrhoids, cancer, GI bleed, etc
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Prostate Exam: To do or not to do
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Part 4: Abnormal Findings
"Mommy! What happened to that eye?!" "It got gonorrhea." "What's gonorrhea?" "................It's a bacteria people can get when they aren't safe." "Are we safe?! What if a large animal eats us?!" -another conversation between Prof B and her kids (PA school was a wild time)
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GYN/GU Abnormalities and STIs
Uterine, Cervical, and Ovarian Abnormalities
Breast/Chest abnormalities
GU Abnormalities
STIs
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Breast Abnormalities
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Most Common Breast Lesions
Cysts
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Cancer
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Paget's disease
Fibroadenoma
Fibrocystic Change
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Most Common Breast Lesions
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Cancer
Cysts
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Paget's disease
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Fibrocystic Change
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Fibroadenoma
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Breast Mass Work-up
A patient presents with a palpable breast mass. What do you want to know?
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Palpable Breast Mass: Patient <30y
If suspicous clinical features, family history, or patient persistence, start with US
May proceed to mammography if suspicious features on US
If low clinical suspicion of breast cancer, reasonable to observe for 1-2 cycles
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Palpable Breast Mass: Patient >30y
For patients 30-40 and low clinical suspicion, may start with ultrasound then proceed to mammogram
Breast MRI if indicated by mammography (dense breasts, history of breast surgery, other difficult interpretation
For patients 40+, start with mammography usually accompanied by ultrasound if suspicious features
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Benign vs Malignant US features
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Suspicious mammography features
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Next Steps
Imaging and exam suspicious for fibroadenoma vs cyst
Imaging suspicious for cancer
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Image guided core needle biopsy
Fine need aspiration with cytology
Image guided core needle biopsy
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Fine need aspiration with cytology
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Match the menstrual cycle vocab!
Having fewer than 9 menstrual cycles in a year
Menorrhagia
Oligomenorrhea
Periods that are excessively heavy or lasting longer than 7 days
The permanent cessation of the menstrual cycle
Menarche
Painful menstruation
Amenorrhea
The cessation of the menstrual cycle in a person of reproductive age after it has been established
Dysmenorrhea
The first menstrual cycle
Menopause
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Abnormal Uterine Bleeding
COEIN
PALM
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AUB Work Up
Thorough history driven by PALM-COEIN and exam including pelvic and bimanual
Imaging: Pelvic ultrasound (TVUS vs TAUS)
Lab panel
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Pelvic Organ Prolapse
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Ovarian Disorders
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PCOS: Presentation and Work-up
Labs
Imaging
First...
TVUS shows abundant immature follicles
Exclude other endocrine disorders (TFTs, adrenal labs, prolactin, etc)
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Ovarian Torsion
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Ovarian Cancer
Testing
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Cervical Abnormalities
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Cervical Dysplasia/Cancer
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Cervicitis -> PID
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Pelvic Inflammatory Disease
Cervicitis
Title
Title
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Write a brief description here
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Non-STI Vulvovaginal Conditions
Title
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Bacterial Vaginosis
Vulvar Carcinoma
Bartholin's gland cyst/abscess
Candida
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"Know syphilis in all its manifestations and relations, and all other things clinical will be added unto you" — Sir William Osler (1897)
Sexually Transmitted Infections
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Genital Warts
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Herpes
- HSV-1 and 2
- SXS: dramatic variation, can be mild, asymptomatic or VERY painful +/- dysuria, fever, tender local inguinal lymphadenopathy, and headache
- DX testing: viral culture, polymerase chain reaction (PCR), direct fluorescence antibody, and type-specific serologic tests
*Routine serologic screening for herpes simplex virus-1 or 2 (HSV-1 or HSV-2) is not recommended in asymptomatic adolescents and adultsContinue
Herpes
- HSV-1 and 2
- SXS: dramatic variation, can be mild, asymptomatic or VERY painful +/- dysuria, fever, tender local inguinal lymphadenopathy, and headache
- DX testing: viral culture, polymerase chain reaction (PCR), direct fluorescence antibody, and type-specific serologic tests
*Routine serologic screening for herpes simplex virus-1 or 2 (HSV-1 or HSV-2) is not recommended in asymptomatic adolescents and adultsContinue
Syphilis
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Chancroid
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Chlamydia and Gonorrhea
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Trichomoniasis
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GU Abnormalities Not Previously Covered
"My friends glued my peehole closed... I was drunk." -An actual, real-live triage note from the hospital Prof Beadlecomb used to work at
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Phimosis vs Paraphimosis
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Peyronie's disease
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Title
Acute Epididymitis
Scrotal edema
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Sick Scrotums
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Hydrocele
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Varicocele
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Cryptorchidism
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Acute Orchitis
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Testicular Problems
Title
Testicular Torsion
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Testicular Cancer
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Part 5: Screenings
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USPSTF Guidelines
BRCA-related Cancer: Risk assessment, Genetic counseling, and Genetic testing
Cervical Cancer
Chlamydia and Gonorrhea
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USPSTF Guidelines
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Breast Cancer
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HIV
Prostate
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I do recommend referencing these for clinical practice; however for testing purposes in this course you will be tested on USPSTF recommendations.
The CDC has their own guidelines regarding STI screening which are more verbose in their recommendations.
https://www.cdc.gov/std/treatment-guidelines/screening-recommendations.htm
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To watch before lab
Pelvic Exam https://accessmedicine-mhmedical-com.une.idm.oclc.org/MultimediaPlayer.aspx?MultimediaID=18341346
Breast Exam https://accessmedicine-mhmedical-com.une.idm.oclc.org/MultimediaPlayer.aspx?MultimediaID=18563279
Male Genital Exam https://accessmedicine-mhmedical-com.une.idm.oclc.org/MultimediaPlayer.aspx?MultimediaID=18563284
Examination of Anus and Rectum https://accessmedicine-mhmedical-com.une.idm.oclc.org/MultimediaPlayer.aspx?MultimediaID=18563281
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Resources
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Thank You!
Anatomic variations
Hypospadias is a condition in which the opening of the urethra is on the underside of the penis instead of at the tip. The location of the opening can vary and can be anywhere from underneath the tip of the penis (more common) to the base of the penis (less common)
Vary by material, length, and shape of bill
Anatomic variations
Hypospadias is a condition in which the opening of the urethra is on the underside of the penis instead of at the tip. The location of the opening can vary and can be anywhere from underneath the tip of the penis (more common) to the base of the penis (less common)
Benign features: Smooth, well-defined borders, anechoic, posterior echoic enhancement
Ways to ask about practices
USPSTF Regarding PSA Testing
Before deciding whether to be screened, men should have an opportunity to discuss the potential benefits and harms of screening with their clinician and to incorporate their values and preferences in the decision. Screening offers a small potential benefit of reducing the chance of death from prostate cancer in some men. However, many men will experience potential harms of screening, including false-positive results that require additional testing and possible prostate biopsy; overdiagnosis and overtreatment; and treatment complications, such as incontinence and erectile dysfunction. In determining whether this service is appropriate in individual cases, patients and clinicians should consider the balance of benefits and harms on the basis of family history, race/ethnicity, comorbid medical conditions, patient values about the benefits and harms of screening and treatment-specific outcomes, and other health needs. Clinicians should not screen men who do not express a preference for screening.
Lab Panel for AUB
Structural causes
Malignant features: irregular borders, hypoechoic, sometimes with posterior acoustic shadowing or microcalcifications
This may include a moveable light source, a headlamp, a light inside the speculum, etc.
Non-structural causes