Bimanual (vaginal) examination
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Introduction

  • Explain to patient – I would like to perform an internal examination of the vagina, uterus, and tubes.
  • This will involve placing two fingers into the vagina and feeling for the cervix, uterus and the tubes. There will be another person in the room at all times, it may be a little uncomfortable but should not be painful.
  • Consent

Inspect Vulva

  • Ask the lady to bring her feet up to her buttocks and push her bottom in to the bed. Gently relax the knees apart.
  • Inspect vulva
  • Look for tears, discharge, prolapse, skin tags, erythema, warts, swellings and check perineal area.

Bimanual examination

Part labia with left hand
With lubricated gloved hand insert index and middle finger with palm facing laterally and then rotate so palm upwards.

Cervix

  • Usually points downwards in the upper vagina
  • Assess motility by moving it side to side
  • Note any cervical excitation

Uterus

Use external hand to push down on pelvic area abdomen
Assess:

  • Size – Big = pregnancy, fibroid, endometrial tumour
  • Shape – lobulated ? fibroids
  • Position – anteverted or retreverted
  • Mobility  – fixed ?endometriosis, adhesions for PID

Addenexae

Position internal fingers towards each lateral fornix

  • Ovaries – firm, ovoid, often palpable
    • Enlarged = ? benign ovarian cysts or malignant
    • Tumours
  • Fallopian tubes usually impalpable
  • ?Tenderness due to salpingitis

 

To Finish

  • Withdraw fingers from vagina
  • Inspect glove for blood or discharge
  • Re-drape genital area and allow patient to dress in private

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Dr Tom Leach

Dr Tom Leach MBChB DCH EMCert(ACEM) currently works as a GP Registrar and an Emergency Department CMO in Australia. He is also a Clinical Associate Lecturer at the Australian National University. After graduating from his medical degree at the University of Manchester in 2011, Tom completed his Foundation Training at Bolton Royal Hospital, before moving to Australia in 2013. He started almostadoctor whilst a third year medical student in 2009. Read full bio

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