Manual of gynecology . uteri, normal or enlarged from pregnancy EXAMINATION OF THE FEMALE PELVIC ORGANS. 101 or fibroid. There may be also inflammatory or blood effusion, or a tenderovary, but these are rare here. 7. Lateral Fornices.—Note cicatrices, prolapsed or cystic ovary, lateri-flexed uterus, inflammatory or blood effusion in broad ligament, dilatationof Fallopian tubes, fibroids placed laterally. The vaginal examination has now been completed. The studentshould keep in mind that he really learns very little from a vaginal exam-ination, just as he can learn very little as to the size an
Manual of gynecology . uteri, normal or enlarged from pregnancy EXAMINATION OF THE FEMALE PELVIC ORGANS. 101 or fibroid. There may be also inflammatory or blood effusion, or a tenderovary, but these are rare here. 7. Lateral Fornices.—Note cicatrices, prolapsed or cystic ovary, lateri-flexed uterus, inflammatory or blood effusion in broad ligament, dilatationof Fallopian tubes, fibroids placed laterally. The vaginal examination has now been completed. The studentshould keep in mind that he really learns very little from a vaginal exam-ination, just as he can learn very little as to the size and relation of anyobject by touching it with the fingers on a but limited area. Vaginalexamination is thus only the preliminary to the bimanual or abdomino-vaginal. BIMANUAL OR ABDOMINO-VAGINAL EXAMINATION. This method of examination is the all-important one in gynecologyand is the one which the student and practitioner will find most valuable,so that its practice should precede all other methods of internal investi-. Fig. hand as in bimanual examination. gation. As the practitioners experience increases, he will find that herelies more upon this and becomes less dependent on other means ofexamination. Method of performing Bimanual. Position of Patient.—The patientmust now be made to lie on her back. The head and shoulders shouldbe supported and the knees drawn up. Arrangement of Examiners Hands.—The internal hand (the right) isplaced as follows : two fingers (index and middle) are in the vagina, thethumb rests in the fold between a labium majus and the thigh, and theother fingers lie in the cleft of the nates, Fig. 71. The whole hand is 102 MANUAL OF GYNECOLOGY. then rotated backwards so as to bring its long axis as nearly as possibleinto the axis of the brim, and is then pushed up towards the brim of thepelvis. Thus the pubic segment, uterus with annexa, and posterior vagi-nal wall are lifted up towards the brim. The middle finger is placedover the os and the in
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