Source:

Alexandra Duncan, GTA, Praxis Clinical, New Haven, CT

Tiffany Cook, GTA, Praxis Clinical, New Haven, CT

Jaideep S. Talwalkar, MD, Internal Medicine and Pediatrics, Yale School of Medicine, New Haven, CT

A bimanual exam is a thorough check of a patient's cervix, uterus, and ovaries. It can tell an experienced provider a great deal, as it may lead to the discovery of abnormalities, such as cysts, fibroids, or malignancies. However, it's useful even in the absence of such findings, as it allows the practitioner to establish an understanding of the patient's anatomy for future reference.

Performing the bimanual exam before the speculum exam can help relax patients, mentally and physically, before what is often perceived as the "most invasive" part of the exam. A practitioner already familiar with the patient's anatomy can insert a speculum more smoothly and comfortably. However, lubrication used during the bimanual exam may interfere with processing certain samples obtained during the speculum exam. Providers must be familiar with local laboratory processing requirements before committing to a specific order of examination.

This demonstration begins immediately after the end of the speculum exam; therefore, it assumes the patient has provided a history and is in the modified lithotomy position.

A rectovaginal exam is not always necessary, but it may be performed to fully assess a retroverted uterus and ovaries (this may be the only way to accomplish full assessment depending on uterine position) or to assess the rectum.

1. Bimanual Exam

Figure 1. Bimanual exam. Correct positioning of the examiner's hands for the bimanual exam.

1. Prepare the patient by saying, "I will now place two gloved fingers in your vagina and use my other hand to press on your abdomen to assess your uterus and ovaries."
2. Fully coat the first two fingers of your dominant hand with lubricant.
3. Sit and tell the p

This video reviewed the techniques for performing a comfortable bimanual and rectovaginal exam. When first performing the exam, it can be hard to know what both normal structures and abnormalities should feel like, but familiarity develops with practice. Experienced practitioners can determine the structure and location of the patient's anatomy and discover polyps, cysts, and malignancies; the potential of pelvic inflammatory disease; and more. The rectovaginal exam can be a good way to gather information about a retrove