Female Recto-vaginal Exam Video

The rectovaginal examination enables you to feel behind the cervix and perhaps a little higher. Now I'd like to do a rectovaginal exam. You'll feel one finger in your vagina and the other in your rectum. What I'd like you to do is bear down as I place my fingers. And you may feel as though you're going to have a bowel movement, but you won't. Okay. Okay, bear down. As you ask the patient to bear down, introduce your index finger into the vagina and your middle finger into the rectum.

Ask the patient to relax and reexamine the uterus, the right adnexa, and the left adnexa. Then palpate the region behind the cervix. If the uterus is retroverted or retroflexed as shown here, it may be palpable only by the rectal finger. Withdraw your fingers gently. You're going to feel me touch you once again. After changing your gloves, examine the anus and rectum. Inspect the perianal area for lesions, redness, rashes, or excretion. Palpate abnormal areas noting any tenderness. Can you bear down? Ask the patient to bear down and inspect the anal area for hemorrhoids or other lesions.

None are seen here. Relubricate your index finger and tell the patient what you're going to do. I'm going to feel me touch you. Again, ask the patient to bear down. Place the pad of your index finger over the anus. As the sphincter relaxes, gently insert your fingertip into the anal canal so that it points toward the umbilicus. Ask the patient to relax. Note the sphincter tone and any tenderness or nodules. To palpate as much of the rectal surface as possible, insert your finger fully and rotate your hand counterclockwise as far as you can.

Then, rotate it clockwise. Note any nodules, irregularities, or tenderness. Can you bear down? By asking the patient to bear down, you can sometimes bring a suspected lesion into reach. Normally, the cervix can be felt through the anterior rectal wall. Gently withdraw your finger. Wipe the vulva and anus to remove any lubricant or give the patient tissues to do so. If fecal matter is present on the glove, test it for occult blood. Finally, ask the patient to slide back on the examination table and sit up, assisting her if necessary.