What are the normal findings on a pelvic exam?

Normal Findings on Pelvic Examination

External Genitalia

Normal external genitalia appear pink, smooth, and without lesions, masses, or signs of inflammation. 1

• The vulva demonstrates significant anatomic variation among healthy women, making a single "normal" appearance difficult to define 2
• Skin should be intact without ulcerations, excoriations, or abnormal pigmentation 1
• Hair distribution varies based on age, ethnicity, and hormonal status 2
• Labia should be symmetric or mildly asymmetric without masses or nodules 2

Cervix

The normal cervix appears pink, smooth, and uniform in color and texture. 1

• Position may be anterior, mid-position, or posterior—all are normal variants 1
• Consistency ranges from soft to firm depending on hormonal status and menstrual cycle phase 1
• The cervical os may be round and small in nulliparous women or slit-like in parous women 1
• Ectropion (cervical eversion) is a normal developmental finding, especially in adolescents and young women, where the squamocolumnar junction is visible on the exocervix 1
• No friability, bleeding on contact, or discharge should be present 1

Uterus (Bimanual Examination)

The normal uterus measures approximately 50-80 mm in length during reproductive years and is mobile, smooth, and nontender. 3

• Position may be anteverted, retroverted, or midposition—all are normal variants 1
• Contour should be regular and smooth without masses 1
• Consistency is firm but not rock-hard 1
• The uterus should be freely mobile without fixation 1
• Size decreases in postmenopausal women 3

Adnexa (Ovaries and Fallopian Tubes)

Normal ovaries may be palpable or nonpalpable on bimanual examination, and when felt, should be smooth, mobile, and nontender. 1

• Ovarian size varies with age and hormonal status, with smaller volumes in postmenopausal women 3
• Normal ovaries in reproductive-age women are typically 3-5 cm in greatest dimension 3
• Fallopian tubes are typically not palpable on normal examination 1
• No masses, tenderness, or fullness should be appreciated 1

Cul-de-sac

The cul-de-sac (pouch of Douglas) should be free of masses, nodularity, and significant fluid. 1

• Minimal physiologic fluid may be present and is normal 1
• No tenderness should be elicited on palpation 1

Vagina

The vaginal walls should appear pink, moist, and rugated without lesions or discharge. 1

• Vaginal mucosa should be well-estrogenized in reproductive-age women 1
• Normal discharge is clear to white, minimal in amount, and without odor 4
• The vaginal walls should be nontender and without masses 1

Important Clinical Context

Routine screening pelvic examinations in asymptomatic, nonpregnant adult women are not recommended, as they have not been shown to reduce morbidity or mortality. 4

• Pelvic examination should be performed when indicated by symptoms or specific clinical indications 5, 6
• The examination may cause discomfort, anxiety, or embarrassment in approximately 30-35% of women 4, 1
• Normal findings do not exclude all pathology, as the sensitivity and specificity of pelvic examination for detecting conditions like ovarian cancer is limited 4, 7