What the Provider Should Feel During Pelvic Exam When the Client Sits Forward
Understanding the Question Context
This question appears to be asking about bimanual examination technique and what anatomical structures should be palpable when the patient assumes a sitting-forward position during the pelvic examination.
Key Examination Findings
When performing a bimanual examination with the patient leaning forward, the provider should be able to trap the uterus between the internal vaginal fingers and the external abdominal hand, allowing assessment of uterine size, shape, position, and mobility. 1
Proper Bimanual Technique
Insert 1-2 lubricated, gloved fingers into the vagina while placing the other hand on the lower abdomen to trap the uterus between both hands 1
First identify and assess the cervix, noting its position and direction, then gently move upward from the cervix to feel for the uterine body 1
The sitting-forward position can help bring pelvic organs into better palpation range, particularly when assessing uterine mobility and adnexal structures 1
Specific Structures to Palpate
Uterine body: Should be palpable between the two examining hands, with assessment of size, contour, consistency, and mobility 1
Cervical position: The cervix position provides valuable information about uterine anatomy—90% of cases with posterior cervical position have anteverted uteri, while 64.2% with anterior cervical position have anteverted uteri 2
Adnexal structures: The ovaries are positioned lateral to the uterus, usually lying anterior to the internal iliac veins and medial to the external iliac vessels 3
Critical Pitfall to Avoid
Ensure the patient has an empty bladder before assessing uterine position, as a full bladder can artificially push a retroverted uterus into an anteverted position, leading to misdiagnosis. 1
Why This Matters
A distended bladder significantly alters pelvic anatomy and can mask true uterine position 4, 1
If the bimanual examination is inconclusive, transvaginal ultrasound provides definitive assessment of uterine position 1
Patient Comfort Considerations
The semi-sitting position may reduce patient anxiety compared to supine positioning, particularly when examined by male physicians 5
Patients should be informed that the examination may be uncomfortable but should not be painful in the absence of pelvic abnormality 6
Between 11-60% of women report pain or discomfort during pelvic examination, with a median of 35% 6