Is the Pubic Bone Palpable via the Vagina?
Yes, the pubic bone is palpable via vaginal examination—it serves as a critical anatomical landmark during both transvaginal palpation and ultrasound examination.
Anatomical Basis for Palpability
The pubic bone (specifically the pubic symphysis and ischiopubic ramus) is directly accessible through the anterior vaginal wall and serves as a fundamental reference point during pelvic examination:
- During digital vaginal examination, a finger inserted into the vagina with anterior pressure allows palpation of structures from the pubic bone extending posteriorly 1
- The pubic bone serves as the origin point for the levator ani muscles (specifically the pubococcygeus), which attach at or near the pubic bone and are routinely assessed during pelvic examination 2
- Complete pelvic and perineal examination requires specific palpation of structures at the ischiopubic ramus, including the adductor magnus origin, confirming the pubic bone's accessibility 3
Clinical Applications
During Routine Pelvic Examination
- The anterior vaginal wall examination involves palpating from the pubic bone posteriorly to assess for masses, tenderness, or structural abnormalities 1
- Paravaginal defect assessment requires identifying the relationship between the vaginal wall and the arcus tendineus fascia pelvis, which attaches to the pubic bone 4
- Pelvic organ prolapse evaluation involves assessing the descent of vaginal walls relative to fixed bony landmarks, including the pubic symphysis 5
During Ultrasound Examination
- Transvaginal ultrasound technique requires the transducer to be positioned relative to the pubic bone to properly visualize pelvic structures 1
- The transabdominal approach specifically places the transducer just above the symphysis pubis, using it as an anatomical reference point 1, 6
Clinical Pitfalls to Avoid
- Inadequate anterior pressure during examination may fail to appreciate the pubic bone and associated pathology, such as enthesopathy at the adductor magnus origin 3
- Failure to systematically palpate from the pubic bone to the cervix can miss important anterior wall defects or masses 1
- Not recognizing that levator ani muscle tears occur at or near the pubic bone origin in primiparous women, making this area particularly important to assess 2
Specific Examination Technique
When performing vaginal examination to palpate the pubic bone:
- Insert a single finger along the posterior vaginal wall, then apply anterior pressure to locate the cervix and assess anterior structures 1
- Palpate systematically from the pubic symphysis posteriorly to evaluate the full length of the anterior vaginal wall 1
- Assess for localized tenderness at the ischiopubic ramus where muscles and ligaments attach to bone 3
- Evaluate the relationship between the bladder base and pubic bone to identify paravaginal defects or prolapse 4