Introduction
The bimanual examination involves a simultaneous internal and external examination, attempting to feel for a bulky uterus, and cervical tenderness.
- 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