Goals

The purpose of the bimanual examination is to determine the size and nature of the uterus and the presence or absence of adnexal masses in a symptomatic female.

Background

In a symptomatic female, the cervix should be palpated first with the examiner noting its shape, form, and consistency. An especially soft cervix (consider pregnancy), hard cervix (consider cancer), or tender cervix (consider STI) should be noted.

Uterine mobility and tenderness is assessed by the palpation of the vaginal fornix above the cervix to feel the uterine fundus when the uterus is anteflexed. In cases of retroversion, the fundus is palpable through the posterior fornix. The position, size, shape, consistency, amount of mobility, and any discomfort during the examination should be noted.

The adnexal area is palpated by moving the abdominal hand to the lateral lower quadrant and the pelvic hand to each ipsilateral side, each adnexal region can be palpated, feeling for the ovary. The presence of a mass or any adnexal tenderness or lack of mobility can be determined. It is important to note that studies have shown that bimanual examination is better at evaluating the uterus than the ovaries.

Contraindications

None in a healthy sexually active client.