Chapter 6: Genitourinary System

Problems with the urinary or reproductive systems can not only affect these systems but they can trigger problems in other body systems. In addition, difficulties with these systems can affect the patients quality of life and sense of well-being. The main function of the urinary system is to regulate fluid and electrolyte balance. The purpose of genitalia is to provide a route for excretion and for reproduction. Because of the function of these body systems, some people may have difficulty discussing problems they are experiencing. Ensuring the patients privacy and confidentiality is of utmost importance during the assessment.

Health History Assessment

Urinary: Hesitancy, frequency, urgency, dysuria, pyuria, polyuria, oliguria, nocturia, renal or urethral calculi, hematuria, incontinence, urinary retention, dribbling, testicular pain, poor stream, history of UTI, color and odor of urine, and history of urinary catheterization should be obtained. Female Genitalia: Infection, prolapse, leukorrhea, vaginal discharge, odor, pruritus, lesions, pain, date and result of last pap smear, and history of sexually transmitted diseases should be assessed. Male Genitalia: Lesions, pain, prostate problems, masses, infections, discharge, pruritus, hernia testicular pain, and history of sexually transmitted disease should be assessed. Sexual: Dyspareunia (painful intercourse in the female), birth control used, degree of sexual activity, and sexual preference should be obtained. Menstrual: Age of onset, regularity, menopause (date of onset), post-menopausal bleeding, last menstrual period (LMP) date, amount of flow (number of pads/tampons/day), duration of menses, PMS, and dysmenorrhea should be assessed. Obstetrical: Chronological sequence of pregnancies (weight and sex of each child), abortion, miscarriages, blood transfusions, stillbirths, complications of pregnancies, and rH sensitivity history should be obtained.

Physical Assessment
Pubic hair: Assess for normal hair distribution and presence of body lice. Penis/Testes: Note whether or not the patient is circumcised and if the foreskin retracts completely. Observe for smegma (a whitish substance under the foreskin). Note the appearance of the urethral meatus and whether or not there is a discharge. Palpate the testes for tenderness or masses. The testes are normally equal in size, however when the male is standing, it is normal for one testicle to be lower in the scrotal sac than the other. Observe the penis and testes for any lesions or rashes. Vulva/Urethra/Vaginal orifice: Observe for lesions. Note any discharge for the urethral meatus or vaginal orifice.