[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [Clinical exam](https://durgical.com/en/clinical-exam/) › [Kidney, genitourinary, breast and obstetric exam](https://durgical.com/en/clinical-exam/#a-renal) › Gynecologic examination: speculum and bimanual exam [Clinical exam](https://durgical.com/en/clinical-exam/) · [Kidney, genitourinary, breast and obstetric exam](https://durgical.com/en/clinical-exam/#a-renal) # 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](https://durgical.com/en/anatomy/cervix-of-uterus/) · [Body of uterus](https://durgical.com/en/anatomy/body-of-uterus/) · [Ovaries](https://durgical.com/en/anatomy/ovary/) · [Vagina](https://durgical.com/en/anatomy/vagina/) · [Vaginal fornix](https://durgical.com/en/anatomy/vaginal-fornix/) · [Labia majora](https://durgical.com/en/anatomy/labium-majus-of-vulva/) · [Labia minora](https://durgical.com/en/anatomy/labium-minus-of-vulva/) · [Rectouterine pouch](https://durgical.com/en/anatomy/rectouterine-pouch/) ## Key points - Three parts: external inspection, speculum exam with cytology, and bimanual exam. - Consent, chaperone, permission before each step and the right to stop. - Cervical motion tenderness: pelvic inflammatory disease or ectopic pregnancy. - A palpable ovary after menopause is abnormal. - A round cervical os means no previous vaginal birth; a transverse slit means previous vaginal births. - The pouch of Douglas is the lowest point of the peritoneum. ## 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)](https://durgical.app/estudiar/?add=/en/clinical-exam/gynecologic-examination-speculum-and-bimanual-exam/) ## See it in 3D The structures of Durgical's 3D anatomy where it is found. - [Cervix](https://durgical.com/en/anatomy/cervix-of-uterus/) - [Body of uterus](https://durgical.com/en/anatomy/body-of-uterus/) - [Ovaries](https://durgical.com/en/anatomy/ovary/) - [Vagina](https://durgical.com/en/anatomy/vagina/) - [Vaginal fornix](https://durgical.com/en/anatomy/vaginal-fornix/) - [Labia majora](https://durgical.com/en/anatomy/labium-majus-of-vulva/) - [Labia minora](https://durgical.com/en/anatomy/labium-minus-of-vulva/) - [Rectouterine pouch](https://durgical.com/en/anatomy/rectouterine-pouch/) ## Related - [Gynecologic and obstetric history](https://durgical.com/en/clinical-exam/gynecologic-and-obstetric-history/) - [Clinical breast examination](https://durgical.com/en/clinical-exam/clinical-breast-examination/) - [Leopold maneuvers](https://durgical.com/en/clinical-exam/leopold-maneuvers/) - [Digital rectal examination](https://durgical.com/en/clinical-exam/digital-rectal-examination/) - [Acute abdomen and peritoneal irritation](https://durgical.com/en/clinical-exam/acute-abdomen-and-peritoneal-irritation/) ## Related conditions - [Pelvic inflammatory disease](https://durgical.com/en/conditions/pelvic-inflammatory-disease/) - [Ectopic pregnancy](https://durgical.com/en/conditions/ectopic-pregnancy/) - [Cervical cancer](https://durgical.com/en/conditions/cervical-cancer/) - [Cervical intraepithelial neoplasia (cervical dysplasia)](https://durgical.com/en/conditions/cervical-intraepithelial-neoplasia/) - [Uterine fibroids (leiomyomas)](https://durgical.com/en/conditions/uterine-fibroids/) - [Ovarian cyst](https://durgical.com/en/conditions/ovarian-cyst/) - [Pelvic organ prolapse](https://durgical.com/en/conditions/pelvic-organ-prolapse/) - [Bacterial vaginosis](https://durgical.com/en/conditions/bacterial-vaginosis/) - [Vulvovaginal candidiasis](https://durgical.com/en/conditions/vulvovaginal-candidiasis/) [← All of the clinical exam](https://durgical.com/en/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](https://openstax.org/books/maternal-newborn-nursing/pages/3-4-well-person-care) (OpenStax, 2024); [Urination - painful](https://medlineplus.gov/ency/article/003145.htm) (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. --- Source: https://durgical.com/en/clinical-exam/gynecologic-examination-speculum-and-bimanual-exam/ License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/clinical-exam/gynecologic-examination-speculum-and-bimanual-exam/