Providing Perineal – Genital Care

Purpose:
- To remove normal perineal secretions & colors
- To promote client comfort

Assess for:
- Irritation, excoriation, inflammation swelling
- Excessive discharge
- Odor, pain or discomfort
- Urinary or fecal incontinence
- Recent rectal or perineal surgery
- Indwelling catheter

Determine:
- Perineal-genital hygiene practices
- Self-care abilities

Equipment:
- In conjunction w/ bed bath
- Bath towel
- Bath blanket
- Washcloth
- Clean gloves
- Soap
- Bath basin w/ water 43-46 degree Celsius

Special perineal-genital care:
- Bath towel
- Bath blanket
- Clean gloves
- Cotton balls or swabs
- Solution bottle, pitcher or container filled w/ warm water or a prescribed solution
- Bed pan to receive rinse water
- Moisture-resistant bag or receptacle for used cotton swabs
- Perineal pad

Procedure:
1. Introduce self
2. Perform hand hygiene
3. Provide client privacy
4. Prepare the client
- Drape the client
- Fold the top bed linen to the foot of the bed & fold the gown up to expose the genital area.
- Place a bath towel under the client’s hips. – The bath towel prevents the bed from becoming soiled.

5. Position & drape the client & clean the upper inner thighs.
6. Provide the patient a bed pan.

For Females:
- Position the female in a back lying position w/ the knees flexed & spread well apart.

- Cover her body & legs w/ the bath blanket positioned so a corner is at her head, the opposite corner is at her feet & the other two on the sides. Drape the legs by tucking the bottom corners of the bath blanket under the inner sides of the legs.

– Minimum exposure lessens embarrassment & helps provide warmth. Bring the middle portion of the base of the blanket up over the pubic area.

- Start cleaning from the cleanest to dirtiest.

- Pour on water starting from the farthest thighs, to the upper

For Males
- Position the male client in a supine position w/ knees slightly flexed & hips slightly externally rotated.

- Put on gloves; wash & dry the upper inner thighs.

7. Inspect the perineal area.
- Note particular areas of inflammation, excoriation or swelling, especially between the labia in females & the scrotal folds in males.

- Also note excessive discharge or secretions from the orifices & the presence of odors.

8. Wash & dry the perineal-genital area.

For Females

- Clean the labia majora. Then spread the labia to wash the folds between the labia majora & labia minora. – Secretions that tend to collect around the labia minora facilitates bacterial growth.

- Use separate quarters of the washcloth for each stroke & wipe from the pubis to the rectum. For menstruating women & clients w/ indwelling catheters, use clean wipes. Take a clean wipe for each stroke. – Using separate quarters of the washcloth or new wipes prevents the transmission of microorganisms form one area tot the other. Wipe from the area of least contaminated (the pubis) to that of greatest contaminated (the rectum)

- Rinse the area well. You may place the client on a bed pan & use a periwash or solution bottle to pour warm water over the area. Dry the perineum thoroughly, paying particular attention to the folds to the labia. – Moisture supports the growth on many microorganisms.

For Males:
- Wash & dry the penis using firm strokes.

- If the client is uncircumcised, retract the prepuce (foreskin) to expose the glans penis for cleaning. Replace the foreskin after cleaning the glans penis. – Retracting the foreskin is necessary to remove the smegma (thick, cheesy secretion) that collects under the foreskin & facilitates bacterial growth. Replacing the foreskin prevents constriction of the penis which may cause edema.

- Wash & dry the scrotum. The posterior folds of the scrotum may need to be cleaned when the buttocks are cleaned. - The scrotum tends to be more soiled than the penis because of its proximity to the rectum; thus It is usually cleaned after the penis.

9. Inspect perineal orifices for intactness.

- Inspect particularly around the urethra in clients w/ indwelling catheters. – A catheter may cause excoriation around the urethra.

10. Clean between the buttocks.

- Assist the client to turn onto the side facing away from you.

- Pay particular attention to the anal area & posterior folds of the scrotum in males. Clean the anus w/ toilet tissue before washing it, if necessary.

- Dry the area well.

- For post delivery or menstruating females, apply a perineal pad as needed from front to back. – This prevents contamination of the vagina & urethra from the anal area.

11. Document any unusual findings such as redness, excoriation, skin breakdown, discharge or drainage & any localized areas of tenderness.

Evaluation
- Relate current assessments to previous assessments

- Conduct appropriate follow-up such as prescribed ointment for excoriation.

- Report any deviation from normal to the primary care provider.