Reference Manual - IARC Screening Group

Performing Breast and Pelvic ExaminationsPerforming aRectovaginalExamination• Slowly insert the middle finger of your pelvic hand into the rectumand your index finger into the vagina (Figure G-25). As you do this,ask the client to breathe out through her mouth; this helps relax herrectal muscles (anal sphincter) and helps you feel where to insert yourfinger. Lubrication of both fingers with water also helps to insert thefingers.Figure G-25. Performing a Rectovaginal Examination• The tissue between your two fingers is called the rectovaginal septumand measures not more than 2–4 mm (one-quarter of an inch) inthickness along its length.• Press down firmly and deeply with the abdominal hand just above thepubic bone while the upper (vaginal) finger is pushing anteriorly onthe cervix.• Use the lower (rectal) finger to feel for the posterior surface of theuterus to determine if it is directed toward the rectum. The uterusshould feel smooth. Slide the rectal finger upward until the fundus isfelt.• Check for tenderness or masses between the posterior surface of theuterus and the rectum. This could suggest endometriosis.• When you have completed the rectovaginal examination, removeboth fingers slowly.G-30 Cervical Cancer Prevention Guidelines for Low-Resource Settings