Author: A. Chandrasekhar, MD

Consultant: P. Tomich, MD

Technique
- Remove the gloves used for vaginal exam. Wear new pair of gloves and lubricate the gloved fingers.
- Slowly reintroduce the index finger into the vagina and the middle finger into the rectum.
- Ask the patient to bear down as the rectal finger is introduced.
- Sweep from side to side and use abdominal hand to bring utereus and adnexa towards vaginorectal hand
Feel:
- Examine the rectovaginal septum for thickening, nodularity or tenderness.
- While gently pressing your fingers as superiorly as possible, examine the rectouterine pouch.
- During this procedure, palpate laterally, identifying the right and left uterosacral ligaments and noting any masses or abnormal tenderness.
- Re-examine both the right and left adnexa with the rectovaginal technique.

Note: Occasionally, ovarian tumors or cysts may be palpated using this technique, but missed during the bi-manual exam.