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Narrator: Now stand to perform a bimanual examination.

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Lubricate the index and middle fingers

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of your examining hand.

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

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

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Narrator: And insert them into the vagina,

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exerting pressure posteriorly.

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Palpate the vaginal wall,

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posteriorly,

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laterally,

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and anteriorly, including the urethra and bladder region.

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Note any nodularity or tenderness.

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

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consistency, regularity, mobility, and tenderness.

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The cervix is normally rounded and firm

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with the consistency similar to the cartilage

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at the tip of the nose.

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It should be nontender and mobile.

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Feel the fornix around the cervix.

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Press down toward the intravaginal hand

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as it raises the uterus upward.

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Note the size, shape, consistency, and mobility

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of the uterus.

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Identify any masses or tenderness.

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In a nonpregnant woman, you may feel

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an anteverted uterus above the symphysis.

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It is normally firm and mobile.

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To palpate the right ovary,

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place your abdominal hand on the right lower quadrant,

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and your intravaginal hand in the right lateral fornix.

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Press your abdominal hand in and down

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to move the ovary within reach of the intravaginal hand.

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Palpate the right ovary, or any adnexal mass

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between your hands.

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If possible, note its size, shape and consistency,

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mobility, and tenderness.

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Repeat the bimanual examination on the left side.

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Ovaries are palpable in women with active ovarian function.

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They may be somewhat tender normally.

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Palpation is often difficult in obese or poorly relaxed women.