Pelvic Exam

Now stand to perform a bimanual examination. Lubricate the index and middle fingers of your examining hand. I'm going to continue the internal exam now. You're going to feel me insert two fingers into your vagina. And insert them into the vagina, exerting pressure posteriorly. Palpate the vaginal wall posteriorly, laterally, and anteriorly, including the urethra and bladder region. Note any nodularity or tenderness. Palpate the cervix, noting its position, size, shape, consistency, regularity, mobility, and tenderness.

The cervix is normally rounded and firm with a consistency similar to the cartilage at the tip of the nose. It should be non-tender and mobile. Feel the fornix around the cervix. Press down toward the intravaginal hand as it raises the uterus upward. Note the size, shape, consistency, and mobility of the uterus. Identify any masses or tenderness. In a non-pregnant woman, you may feel an antiverted uterus above the symphysis. It is normally firm and mobile. To palpate the right ovary, place your abdominal hand on the right lower quadrant

and your intravaginal hand in the right lateral fornix. Press your abdominal hand in and down to move the ovary within reach of the intravaginal hand. Palpate the right ovary, or any adnexal mass between your hands. If possible, note its size, shape, consistency, mobility, and tenderness. Repeat the bimanual examination on the left side. Ovaries are palpable in women with active ovarian function. They may be somewhat tender normally. Palpation is often difficult in ovies or poorly relaxed women.