Advanced Physical Assessment of Breast and Axilla, Female and Male Genitalia

Breast cancer is the most common cancer in women worldwide, with an estimated 2.3 million new cases diagnosed in 2020 alone. Early detection through screening and advanced physical assessment is crucial for successful treatment outcomes. A comprehensive breast and axilla assessment should be part of a routine physical examination for women, regardless of age. In this article, we will discuss the advanced physical assessment of the breast and axilla.

1. Inspection:

The first step in the breast and axilla assessment is inspection. The patient should be in a seated position with their arms at their sides. The examiner should visually inspect the breasts and axilla for any asymmetry, contour changes, or skin abnormalities, such as rashes, puckering, or dimpling. The nipple and areola should also be examined for any discharge or inversion.

2. Palpation:

After inspection, the next step is palpation. The examiner should use the pads of their fingers to palpate the breast tissue, starting from the axilla and moving in a circular motion towards the nipple. The palpation should be systematic, covering the entire breast and axilla, and assessing for any lumps, nodules, or areas of tenderness.

It is essential to note that breast tissue is typically lumpy and may feel different at different times in the menstrual cycle. Thus, it is crucial to conduct a breast exam at the same time each month for women who are still menstruating.

3. Clinical Breast Exam:

The clinical breast exam (CBE) is a comprehensive breast examination conducted by a healthcare provider. During a CBE, the examiner will inspect and palpate the breasts and axilla, as well as examine the lymph nodes for any enlargement or tenderness. A CBE should be conducted every 1-3 years for women aged 20-39 and annually for women aged 40 and above, along with regular mammograms.

4. Imaging:

Imaging tests, such as mammograms, ultrasounds, and MRI, are essential for detecting breast cancer in its early stages. A mammogram is a low-dose X-ray of the breast that can detect abnormal growths or calcifications in the breast tissue. Ultrasound uses sound waves to create images of the breast tissue and is often used in conjunction with a mammogram to provide a more detailed view. MRI is a powerful imaging technique that uses a magnetic field and radio waves to create detailed images of the breast tissue.

Advanced Physical Assessment of Female and Male Genitalia:

Genitalia assessment is an essential part of the routine physical examination for both males and females. The assessment can provide early detection of sexually transmitted infections (STIs), reproductive health issues, and cancers of the reproductive system. Here we discuss the advanced physical assessment of female and male genitalia.

Female Genitalia Assessment:

1. Inspection:

The first step in the female genitalia assessment is inspection. The examiner should ask the patient to lie on their back with their legs spread apart. The examiner should visually inspect the external genitalia, including the labia majora, labia minora, clitoris, and vaginal opening, for any abnormalities, such as redness, swelling, or lesions.

2. Palpation:

After inspection, the next step is palpation. The examiner should use their gloved fingers to palpate the vulva, including the labia majora, labia minora, and clitoris, for any tenderness or masses. The examiner should also perform a bimanual exam by inserting one or two fingers into the vagina and palpating the cervix, uterus, and ovaries.

3. Speculum Exam:

A speculum exam is a pelvic exam that uses a speculum, a medical tool that is inserted into the vagina to hold it open, allowing the examiner to visualize the cervix and perform any necessary tests, such as a Pap smear. The examiner should choose the appropriate size and type of speculum based on the patient’s age, anatomy, and comfort level. The speculum should be inserted gently and slowly, and the examiner should ensure that the patient is comfortable throughout the exam.

Male Genitalia Assessment:

Inspection:

The first step in the male genitalia assessment is inspection. The examiner should ask the patient to stand or lie down with their legs slightly apart. The examiner should visually inspect the external genitalia, including the penis, scrotum, and perineum, for any abnormalities, such as redness, swelling, or lesions.

Palpation:

After inspection, the next step is palpation. The examiner should use their gloved fingers to palpate the scrotum, testes, epididymis, and vas deferens for any tenderness or masses. The examiner should also inspect the penis for any abnormalities, such as Peyronie’s disease or a penile fracture.

Rectal Exam:

A rectal exam may be necessary to assess the prostate gland in men over the age of 50. During a rectal exam, the examiner will insert a lubricated, gloved finger into the rectum to feel the prostate gland for any abnormalities, such as enlargement or nodules.

In conclusion, a comprehensive physical examination of the breast and axilla and the genitalia is essential for the early detection and treatment of various health issues, including breast cancer, STIs, and reproductive system cancers. Healthcare providers should conduct regular physical examinations and imaging tests, along with providing patient education on self-examination and risk reduction strategies.