Bimanual Examination - Podcast Version TeachMeObGyn 0:00 / 0:00 1x 0.25x 0.5x 0.75x 1x 1.25x 1.5x 1.75x 2x Introduce yourself to the patient Wash your hands Explain to the patient what the examination involves and why it is necessary Reassure that it should not be painful but you will stop immediately if it becomes too uncomfortable Obtain verbal consent Request a chaperone Preparation Patient should have an empty bladder Ask the patient to remove clothing from the waist down and any sanitary protection Cover with a sheet when appropriate When ready, ask the patient to lie on the couch on their back, with knees bent and apart. Note that any abdominal inspection and palpation should be performed before this step. Abdominal Examination Inspect the abdomen for scars and ascites Palpate the abdomen for masses and tenderness Palpate the groin for inguinal lymphadenopathy External Examination Put on gloves Inspect the external genitalia and perineum for: Deficiency associated with childbirth Abnormal secondary sexual characteristics – hair distribution, cliteromegaly (associated with hyperandrogenism) Skin abnormalities – lesions, warts, erythema Discharge – colour, consistency Bleeding Swellings of the vulva – tumours, cysts (sebaceous, Bartholin’s) Ask the patient to cough to observe any incontinence or prolapse Palpate the labia majora with the index finger and thumb Adapted from work by De Vita and Giordano and Indian Journal of Sexually Transmitted Diseases and AIDS [CC-NC-SA 3.0] Fig 1Signs on external inspection during the bimanual examination. A) Uterine prolapse, b) Genital warts, c) Bartholin’s cyst. Bimanual Examination Use lubricating gel to lubricate the right index finger and middle finger Ensure the patient is still happy to proceed, and gently insert fingers into the vagina Enter with the palm facing sideways, then rotate so the palm is facing upwards In practice, you can use one finger for the whole examination. However, for OSCE/examination purposes, two fingers should be used (unless the presenting complaint is that partner cannot enter / pain during sex). Move along the posterior wall of the vagina and locate the cervix and feel for: Smoothness, clots, mobility and firmness Place fingers in the posterior fornix to lift the uterus whilst simultaneously pushing the fundus down by placing the left hand above the symphysis pubis. Assess uterus size (a normal uterus is approximately the size of a plum) Determine if anteverted or retroverted Note tenderness, mobility and shape Place the fingers in the lateral fornix and press lateral to the umbilicus to feel for any adnexal tenderness or masses (repeat on the other side) Gently move the cervix from side to side to check for cervical tenderness (important sign with ectopic pregnancy or pelvic inflammatory disease). Remove fingers gently and inspect for discharge or blood By TeachMeSeries Ltd (2026) Fig 2The bimanual examination. One hand lifts the uterus, whilst the other pushes the fundus down. Completing the Examination Thank the patient and allow them to get dressed in private Remove your gloves and wash your hands Summarise findings and suggest further investigations (usually a pelvic ultrasound +/- bloods depending on the history and findings) Rate This Article