b"External Iliac Nodes Supercial and DeepUterus, cervix, vagina,Inguinal Nodesclitoris, penis, prostate, vasUterus, clitoris, vagina, penis, deferens, seminal vesicles,anus, rectum, urethra, skin bladder, external genitalia of the external genitaliaLumbar/Preaortic Nodes Common Iliac NodesTestis, epididymis, kidney, Cervix, vagina, prostate,LymphEdovaries, fallopian tubes, ovaries, bladder, rectum, uterus anusInternal Iliac Nodes Sacral NodesUterus, cervic, vagina,Pelvic organs, rectum, anus, prostate, seminal vesicles,cervix, vagina, prostate, bladder, rectum, anus,coccygeal regionurethraFigure 7. Drainage Routes of the Pelvic Lymph Nodes The pelvic cavity and genitalia consist of severalarea and the presence of microbes, urine, sweat, and redundant lymphatic drainage pathways, such as twofeces 227229 . The risk of infections, skin breakdown,separate ones to drain the scrotum's internal andand a quick stretch, or fill, of the skin are all reasons external portions, to limit edema damage to theearly intervention is crucial with GLE. The signs and organs or systems, and to protect the ability forsymptoms associated with GLE are listed in Figure 8.procreation 208,224,225 . This redundancy can be seen inIndividuals with lower extremity or lower trunk Figure 7. When there is a dysfunction in the pathway,lymphedema, along with anyone who has undergone through excision, trauma, overload, or other means totrauma or cancer treatments in the pelvic region, the lymphatic system, lymphedema will typically resultshould be evaluated for GLE. Individual HCPs must in the regions directly drained by the areas ofcheck with their states practice acts for guidelines or involvement and those distal to the damage. Edemarules involving evaluating and treating the genital with GLE can be seen unilaterally or bilaterally in theregion. Individuals not formally trained in internal external genitalia, the mons pubis, inner thighs, andvaginal or rectal evaluations should refer to the buttocks of both sexes and the vagina. The penis canappropriate providers, such as physicians, physician be engorged by the scrotum or, as previouslyassistants, nurse practitioners, or PT/OT pelvic health described, buried by the scrotum 226 . The layers of thespecialists. The evaluation contains all the components body's skin and tissues are altered in design to meetpreviously mentioned in the Standardized Approach the needs of an area, and the genitalia are nofor the Diagnosis and Management of Lymphedema exception. The skin of the external genitalia is highlyand Lymphatic Diseases, Section 1: Primary and elastic to allow for fluctuations in size with intimacySecondary Lymphedema and Lipedema, and a few and traumas, such as childbirth. This, with theadditional pieces. Please refer to Figure 9 for the assistance of gravity, allows for quick and extensiveadditional subjective components when evaluating enlargement of the labias, scrotum, and penis 227229 .GLE. The key to this portion is that a medical The genital region is also prone to infections and skinpractitioner cannot show uneasiness when asking these breakdown due to the warmth and moisture in thequestions, which will increase the likelihood of less-Figure 8. Signs and Symptoms Associated with Genital Lymphedema| Standardized Approach for the Diagnosis and Management of Lymphedema (LE) and Lymphatic Diseases (LD)|21"