Learning Objectives #
1. To understand the purpose and indications of a rectovaginal examination and its specific advantages
2. To be able to perform a rectovaginal examination using proper technique
Introduction #
A pelvirectal examination is not usually done in a routine Gynecologic assessment. This exam can be helpful in assessing suspected pathology in the posterior cul-de-sac and rectovaginal septum. One can often reach 1-2 cm higher into the pelvis with the rectal finger.
Tell the patient that you will now examine the vagina and rectum. Explain to the patient that the examination will make her feel as if she was going to have a bowel movement, but she will not do so. Lubricate the gloved index and middle fingers. As you ask the patient to bear down, introduce your index finger into the vagina and your middle finger into the rectum. The examining right index finger is positioned as far up the posterior surface of the vagina as possible. If the uterus is retroverted or retroflexed it may be palpable only by the rectal finger. The rectovaginal septum is palpated for nodules or tenderness.
The patient is told that the internal examination is completed and that you are about to remove your fingers. Withdraw your fingers gently. When you withdraw your fingers, inspect them for discharge or blood.
The physician must then help their patient back into a comfortable sitting position. Make sure the patient is ok and words of encouragement upon completing the examination successfully are helpful. Once again clear instructions for dressing are needed. The physician must be sure there is adequate tissues present to wipe off any excess lubricant. Make sure the patient knows to get fully dressed and where she is to wait.
Finally the physician must finish the examination with a clean technique by removing their gloves and washing their hands.