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The bimanual exam (2-hand exam)
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HealthWiki > A Book for Midwives > Chapter 20: The Pelvic Exam: how to examine a woman's vagina and womb > The bimanual exam (2-hand exam)
Feel the womb with 2 hands to check for infections or growths, or to learn how long a woman has been pregnant. To feel the womb, you will need:
|very clean or sterilized plastic gloves||water-based lubricating jelly like K-Y Jelly, or clean water (do not use oil or petroleum jelly)|
Ask the woman to urinate before you start.
- Have the woman lie on her back with a pillow under her head. As you examine her, explain everything that you are going to do before you do it, remind her to relax, and stop the exam if she is in pain.
When the woman is ready, put on gloves and put some lubricating jelly on the first 2 fingers of your right hand (or your left hand if you are left-handed). Ask the woman to take a deep breath to help her relax. Gently open the lips of her genitals with your left hand. With the palm of your right hand facing up, put your two lubricated fingers all the way into the woman’s vagina.
Feel the cervix with your fingertips.
The cervix should be firm, round, and smooth. Normally, it feels about as hard as the tip of a nose. In the last months of pregnancy it feels soft, like lips. Sometimes at the end of pregnancy the cervix is a little open. If the woman has just had a miscarriage or an abortion, her cervix might be open.
The cervix can be hard to find. If you cannot feel the cervix, ask the woman to cough or push down as if she were passing stool until the cervix touches your finger. It may also help if the woman lies more flat.
Take care not to touch the woman’s clitoris, which is sensitive, or her anus, which has germs on it. Your thumb can easily touch the clitoris accidentally, so keep it to one side.
Check for pain in the cervix.
Put one of your fingers on each side of the cervix and move it side to side. This might feel strange to the woman, but it should not hurt. If it hurts, she might have an infection in her womb or a tubal pregnancy. These are both very dangerous. If the cervix feels soft and is easy to move, the woman may be pregnant.
- Put your left hand on the woman’s belly, below her navel (bellybutton) and above the hair around her genitals.
Feel the womb.
Put the 2 fingers that are in the vagina under the cervix. Lift up the cervix and womb with those 2 fingers. At the same time, press down on the woman’s lower belly with your left hand. Try to feel her womb between your hand and your 2 fingers. You will know that you are pressing on the womb when you feel the cervix move. If you do not feel the womb at first, try moving your hand around on her belly and pressing down in different places.
Feeling the womb takes practice. It is especially difficult to feel a woman’s womb if she has strong belly muscles or if she has a lot of fat on her belly.
Feel the size and shape of the womb.
Usually the womb feels firm, smooth, and smaller than a lemon (about 6 to 10 centimeters). In pregnancy the womb grows larger.top of womb at 11 to
12 weeks pregnant11 to 12 weeks pregnant
(just above the pubic bone)8 to 9 weeks pregnant6 to 7 weeks pregnantnot pregnant
6 to 10 cm long
(about the size of
a lemon or a chicken egg)actual size of wombcervixwomb inside the body
See how to measure the womb after 12 weeks.
You might feel lumps or growths on the womb. Some growths are not dangerous, but they may cause pain, heavy monthly bleeding, or bleeding between monthly bleedings. They are called fibroids. Other growths may be cancer of the womb. You cannot be sure the growths are not dangerous until the woman has more tests. If you feel growths on the womb, get medical help.
Feel the ovaries.
Finding and feeling the ovaries can be very difficult. It takes a lot of practice.
Put both your inside fingers on one side of the cervix and lift up the ovary. Move your outside hand to the same side of the woman’s body as the inside fingers and slide your outside fingers down her belly. When you press hard, you can feel her ovary slip between your fingers.
You must push down deeply with your outside hand, so ask the woman to take a deep breath and let it go before you feel her ovary. Stop pushing if she is in pain!wombtubesovaryAn ovary is usually about this big.
After checking one side, move your hands to check the other ovary.
If you feel something bigger than 3 centimeters long and 2 centimeters wide, or if this exam hurts her a lot, she might have a growth on her ovary, or she might have a tubal pregnancy. Get medical help.Note: It is normal for a woman's ovary to get bigger and smaller every month. If you are not sure of the cause of a large ovary, try checking again in 6 weeks. It may be small again.
- Take your fingers out of her vagina. Hold the lips of her genitals open and ask her to cough or push down as if she were passing stool. Watch her vagina to see if anything bulges out. If it does, she could have a fallen womb or bladder, or part of her bowel could be bulging into the vagina. Get medical advice.
After the bimanual exam, give the woman a clean cloth or paper to wipe off the jelly. Explain to her that she will have some extra discharge (the jelly) or a little blood after the exam.
Tell the woman what you found during the pelvic exam. Make sure to answer any questions the woman has.