Chapter 04 bimanual exam 

• Now stand to perform a bimanual examination.
• Lubricate the index and middle fingers of your examining hand
• “Now I’m going to continue the internal examination; you’re going to feel me insert two fingers into the vaginaâ€�
  
• palpate the vaginal wall posteriorly, laterally, and anteriorly, including urethra and bladder region. Note nodulatiiest and tenderness 
• palpate the cervix as well. Should be nontender and mobileNote size shape consistency, etc. *
  
• Feel the fornix around the cervix *
  
• Press down towards the intrauterine hand as it raises the uterus upwards. Note size shape consistency, etc. *
  
• Identify any masses or tenderness *
  
• In a non pregnant woman, you may feel an antiverted uterus above the symphysis, it is usually firm and mobile *
  
• To palpate the ovary, put your hand in right lower quadrant and your intravaginal hand in the right lateral fornix. *
  
• Press abdominal hand in and down to move the ovary within reach of the intravaginal hand *
  
• Palpate the right ovary or any adnexal mass within the two hands *
  
• Note its size shape consistency tenderness *
  
• Repeat bimanual examination on left sides *
  
• Ovaries are active and somewhat tender in non pregnant women