Bimanual Examination
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.