Narrator: Now stand to perform a bimanual examination.

Lubricate the index and middle fingers

of your examining hand.

Practitioner: Okay, I'm going to continue the internal exam now.

You're going to feel me insert two fingers into your vagina.

Narrator: And insert them into the vagina,

exerting pressure posteriorly.

Palpate the vaginal wall,

posteriorly,

laterally,

and anteriorly, including the urethra and bladder region.

Note any nodularity or tenderness.

Palpate the cervix, noting its position, size, shape,

consistency, regularity, mobility, and tenderness.

The cervix is normally rounded and firm

with the consistency similar to the cartilage

at the tip of the nose.

It should be nontender and mobile.

Feel the fornix around the cervix.

Press down toward the intravaginal hand

as it raises the uterus upward.

Note the size, shape, consistency, and mobility

of the uterus.

Identify any masses or tenderness.

In a nonpregnant woman, you may feel

an anteverted uterus above the symphysis.

It is normally firm and mobile.

To palpate the right ovary,

place your abdominal hand on the right lower quadrant,

and your intravaginal hand in the right lateral fornix.

Press your abdominal hand in and down

to move the ovary within reach of the intravaginal hand.

Palpate the right ovary, or any adnexal mass

between your hands.

If possible, note its size, shape and consistency,

mobility, and tenderness.

Repeat the bimanual examination on the left side.

Ovaries are palpable in women with active ovarian function.

They may be somewhat tender normally.

Palpation is often difficult in obese or poorly relaxed women.