Clinical exam · Kidney, genitourinary, breast and obstetric exam

Gynecologic examination: speculum and bimanual exam !

Exam technique

A check of the external genitals, of the cervix with a speculum, and of the uterus and ovaries with two hands, always with consent and a chaperone.

Updated 2026-11-01

See it in 3D: Cervix · Body of uterus · Ovaries · Vagina · Vaginal fornix · Labia majora · Labia minora · Rectouterine pouch

What it is

The pelvic exam has three parts: inspection of the external genitalia, the speculum exam (viewing the vagina and cervix and taking a cervical sample) and the bimanual exam (feeling the uterus and adnexa between a vaginal hand and an abdominal hand). It is central to cervical cancer screening and to the work-up of pelvic pain, bleeding and discharge. It is done with informed consent, explaining each step, with a chaperone, and the patient may stop it at any time.

Landmark anatomy

The cervix projects into the vault of the vagina, surrounded by the anterior, posterior and lateral fornices.
The external os is small and round in women who have not had a vaginal birth, and a transverse slit in those who have.
The uterus is usually anteverted (tilted toward the bladder); a retroverted uterus is felt better through the posterior fornix or on rectovaginal exam.
The ovaries lie beside the uterus near the pelvic wall; after menopause they are normally not palpable.
The rectouterine pouch (of Douglas) is the lowest point of the peritoneal cavity, where blood, pus or fluid collects.

Technique, step by step

Explain, obtain consent and offer a chaperone; ask her to empty her bladder; ask permission before each step; she may pause or stop at any time.
Lithotomy position, feet in the supports, a drape over the abdomen and thighs; warm hands and instruments, gloves.
External inspection: hair, labia majora and minora, clitoris, urethral opening, introitus and perineum; look for lesions, discharge, inflammation.
Ask the patient to bear down or cough: watch whether the vaginal wall or uterus descends (prolapse) or urine leaks.
Speculum: right size, warmed and lubricated with water; insert it closed, angled down and back, rotate to horizontal and open until the cervix is seen.
Look at the cervix: colour, external os, lesions, bleeding and discharge; take the cytology or HPV sample if indicated.
Withdraw the speculum slowly while closing it, looking at the vaginal walls.
Bimanual exam: one or two gloved, lubricated fingers in the vagina and the other hand on the lower abdomen; move the cervix and ask whether it hurts.
Feel the uterus between both hands (size, position, shape, consistency, mobility), then each adnexa in the lateral fornices.
Rectovaginal exam if the rectovaginal septum or posterior cul-de-sac must be assessed; at the end, offer tissues and privacy to dress.

Abnormal findings

Cervical motion tenderness with adnexal tenderness: pelvic inflammatory disease or ectopic pregnancy.
A tender adnexal mass with a positive pregnancy test: ectopic pregnancy until proven otherwise.
An enlarged, irregular, firm uterus: fibroids; a large, soft uterus: pregnancy.
A palpable ovary after menopause is abnormal and needs work-up.
An exophytic, friable cervical lesion that bleeds on contact: suspected cervical cancer.
Thick white discharge with itching suggests candidiasis; thin grey, malodorous discharge suggests bacterial vaginosis.

Common errors

Skipping consent, the chaperone or the explanation of each step; the exam is adapted to the patient (smaller speculum, position, pauses) and to any history of trauma.
Using too much lubricant before cytology, or a cold speculum.
Inserting the speculum pressing upward on the urethra instead of toward the posterior wall.
Feeling the adnexa without an active abdominal hand, so the organs are never trapped between the hands.
Not asking first about pregnancy, bleeding or an intrauterine device.

Test yourself

Think of the answer, then tap the question to see it.

What are the parts of a complete pelvic exam?

Inspection of the external genitalia, the speculum exam with sampling, and the bimanual exam; the rectovaginal exam is optional.

What does severe pain on moving the cervix suggest?

Pelvic inflammation, such as pelvic inflammatory disease, or blood in the pelvis, as in ectopic pregnancy.

Why is a palpable ovary abnormal in a postmenopausal woman?

Because the ovary shrinks after menopause and is normally no longer felt; if it is, there may be a mass.

Which measures of respect and safety go with the exam?

Explanation, consent, a chaperone, privacy, permission before each step and the option to pause or stop.

Add to my cards (4)

See it in 3D

The structures of Durgical's 3D anatomy where it is found.

← All of the clinical exam

Educational content on the clinical exam; it is learned and practised under supervision. It does not replace assessment by a health professional and is not for self-diagnosis.

Sources: 3.4 Well-Person Care - Maternal Newborn Nursing | OpenStax (OpenStax, 2024); Urination - painful (MedlinePlus (U.S. National Library of Medicine), 2024).

Spotted a mistake?We are always improving for the community. Tell us what is wrong and our team will review it.Report a mistake

Representative model, for educational purposes only.