Preparation

• Gloves (non-sterile)
• Lubricant

This procedure is non-sterile.

Obtain informed client consent. Ensure to advise the client to let you know immediately if they are having any discomfort.

Procedure Steps

Step 1: Use firm palpation from umbilicus to symphysis pubis

Start at the umbilicus and palpate firmly down to the symphysis pubis. Check for masses or tenderness. Keep one hand on the lower abdomen while inserting two fingers into the vagina (typically your index and middle finger of your dominant hand).

Large uterine masses can be palpated between the umbilicus and symphysis pubis.

Step 2: Locate cervix

Cervical motion tenderness is a common finding in pelvic inflammatory disease.

Move cervix gently side to side to check for cervical motion tenderness.

Step 3: Palpate for uterine masses

Place your index finger above the cervix and your and middle finger below cervix (anterior and posterior fornix). Use the hand on the patient’s abdomen to press uterus down to fingers in the vagina. Press vaginal fingers toward uterus.

You are best able to palpate uterine masses between your hand on the abdomen and your fingers within the vagina.

Step 4: Palpate adnexa

Adnexa (ovaries and tubes) are palpated directly to the right and left of the cervix.

Ovaries are often palpable in a premenopausal woman with a normal body habitus.

Aftercare

Document your findings and discuss any abnormalities with the client.

Patient Education

Follow-up

As per local cervical screening guidelines.

Saskatchewan Guidelines 

Key Takeaways

• The bimanual examination is better at examining the uterus than the adnexa.