Assessing Uterine Tenderness

Proper Bimanual Examination Technique

The American Academy of Pediatrics recommends inserting 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
The cervix should be assessed for consistency, which is firm in a non-pregnant state and softer in pregnancy 1
Gently moving the cervix can assess for cervical motion tenderness, indicating pelvic infection or inflammation 1
The uterus should be palpated between the vaginal and abdominal hands to assess size, tenderness, and position, with a non-pregnant uterus being small and firm, and a pregnant uterus being larger, softer, and more globular 1

It is essential to distinguish between true pain and discomfort during the examination, as patients may mistake movement or pressure for pain 1
Adnexal tenderness or masses should be documented, along with cervical motion tenderness 1

Transvaginal ultrasound can provide additional information about uterine position and mobility, presence of fibroids or other pathology, and relationship between the uterus and surrounding structures 3
The American College of Radiology recommends a combined transabdominal and transvaginal ultrasound approach for a comprehensive evaluation 4, 5

The American Academy of Pediatrics recommends referring to a gynecologist for acute pelvic pain with possible ovarian torsion, ectopic pregnancy, or tubo-ovarian abscess, as well as pelvic inflammatory disease, chronic pelvic pain, and abnormal vaginal bleeding with severe anemia 1

The American College of Obstetricians and Gynecologists recommends using therapeutic language during the examination, explaining the procedure, and providing clear expectations about potential sensations 6
Having a chaperone present during the examination is also recommended 7