Bimanual Examination

Definition - What does Bimanual Examination mean?

A bimanual examination is a pelvic examination technique in which two fingers, typically the middle and index fingers of one hand are inserted into the vagina while the opposite hand is used to apply gentle pressure on the abdomen to evaluate the uterus and adjacent organs. Since both the hands are used for this type of examination, it is referred to as 'bi-manual.'

FertilitySmarts explains Bimanual Examination

To perform a bimanual examination, the woman will be given an examination gown to wear and will be asked to get on the examination table and lie down on her back with her feet held in stirrups. Two fingers of a gloved hand are placed in the vagina whereas the other hand is used to feel the abdomen. The woman is asked to exhale as the doctor compresses the abdomen to facilitate muscle relaxation.

With the hand placed on the abdomen, the doctor can determine the size, mobility, and properties of the uterus as well as the presence or absence of any uterine masses. The uterus is also assessed for any tenderness. In addition, ovaries can be felt through the abdomen in females with a normal habitus. They should be mobile and have a size equal to an almond but can vary in texture. Obesity can impair a bimanual evaluation. Females who are past menopause have smaller ovaries, which are typically not felt.

The two fingers placed in the vagina are used to assess the mobility, shape, and consistency of the cervix as well as the presence of any lumps. By palpation (feeling) of the deepest portions of the vagina above the cervix, the doctor can also feel the upper portion of the uterus called fundus when it is bent forward in its normal position. If the fundus is tipped backward, it will be palpable through the rear recesses of the vagina. The doctor will notice the position, size, form, texture, and mobility of the uterus, along with any discomfort experienced during the examination. With the same two fingers, the doctor will also gently press down on the area between the anus and the vulva while asking the patient to strain down and cough. This will help determine the relaxation and support of the vaginal entrance, vaginal walls, and the uterus, thus, detecting the presence of a prolapsed pelvic organ.

At the end of the examination, the doctor will assess the cervix for any tenderness by moving it. Any excruciating pain during this maneuver can cause the patient to leap out as if reaching upward towards the ceiling for relief. This sign, known as the cervical motion tenderness or Chandelier sign, signals the presence of a pelvic inflammatory disease.

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