Inspect the Patients External Genitalia Seat yourself comfortably and inspect the mons pubis labia and perineum Separate the labia and inspect

■ The labia minora

■ The urethral meatus

■ The vaginal opening, or introitus

Note any inflammation, ulceration, discharge, swelling, or nodules. If there are any lesions, palpate them.

If there is a history or an appearance of labial swelling, check Bartholin's glands. Insert your index finger into the vagina near the posterior end of the introitus. Place your thumb outside the posterior part of the labium

Labium Genitalia

■ The labia minora

■ The urethral meatus

PALPATING BARTHOLIN'S GLAND

PALPATING BARTHOLIN'S GLAND

Delayed puberty is often familial or related to chronic illness. It may also be due to abnormalities in the hypothalamus, anterior pituitary gland, or ovaries.

Excoriations or itchy, small, red maculopapules suggest pediculosis pubis (lice or "crabs"). Look for nits or lice at the bases of the pubic hairs.

Enlarged clitoris in masculinizing conditions

Urethral caruncle, prolapse of the urethral mucosa (p._)

Syphilitic chancre, epidermoid cyst. See Table 11-1, Lesions of the Vulva (p._).

A Bartholin's gland may become acutely or chronically infected and then produce a swelling. See Table 11-2, Bulges and Swelling of Vulva, Vagina, and Urethra (p._).

majus. On each side in turn, palpate between your finger and thumb for swelling or tenderness. Note any discharge exuding from the duct opening of the gland. If any is present, culture it.

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