geriatrics
Physical Examination of the Older Adult
Female Reproductive System
For bimanual pelvic examination, patients who lack hip mobility may lie on their left side. Postmenopausal reduction ofestrogenleads to atrophy of the vaginal and urethral mucosa; the vaginal mucosa appears dry and lacks rugal folds. The ovaries should not be palpable 10 years after menopause; palpable ovaries suggest cancer. Patients should be examined for evidence of prolapse of the urethra, vagina, cervix, and uterus. They are asked to cough to check for urine leakage and intermittent prolapse. Some health care practitioners recommend that patients ≥ 21 have screening Physical Examination annually. Others recommend an interval of 3 years until age 65. However, no evidence supports or refutes pelvic examinations for asymptomatic, low-risk patients. Thus, for such patients, the decision about how often these examinations should be done should be individualized. Neither a Papanicolaou (Pap) test nor a human papillomavirus (HPV) test is recommended for women ≥ age 65 who have had normal test results in the preceding 10 years. The genital area should be examined for signs of STIs, other infections, and abnormalities. 