Reference Manual - IARC Screening Group

Performing Breast and Pelvic Examinations• Mobility: The uterus should be easy to move anteriorly orposteriorly. If it is fixed (not mobile), suspect adhesions or otherproblems.• Tenderness: Normally, the uterus is not tender with movement oron palpation. If tenderness is present, suspect infection in theuterine cavity (endometritis).• Locate the ovaries next. Remember that they usually are locatedbehind and to either side of the uterus.• To locate the right ovary, move the fingertips of the pelvic hand justunder and to the side of the cervix deep in the lateral fornix. Moveyour abdominal hand to the same side and just lateral to the uterus(Figure G-24). Press down (posteriorly) with this hand and reach up(anteriorly) with your vaginal fingers. Gently bring the fingers ofboth hands together and move them toward the symphysis pubis. Youshould feel the ovary slip between your fingers. Hold the ovary gentlybecause pressure on a normal ovary can cause pain.Figure G-24. Locating the OvaryIt is often easier to feel the ovary on the same side of the body as thehand that is in the vagina (i.e., right hand in vagina and the right ovary asshown above).Finding ovaries is a skill that takes much practice to develop. Keep thewoman’s comfort in mind. If you are just learning, you may not be ableto feel the ovaries of every woman. Not being able to feel the ovaries orother adnexal structures generally suggests that they are normal size(approximately 3 cm long, 2 cm wide and 1 cm thick), which is alsoimportant to know.• Record the size, shape, consistency, mobility and tenderness of anymasses.• Repeat the procedure for the other ovary.G-28 Cervical Cancer Prevention Guidelines for Low-Resource Settings