What Is a Rectovaginal Exam?

Assessing the Benefits and Limitations of the Procedure

A rectovaginal examination is a manual physical examination of the rectum and the vagina, It is not a standard part of a medical or gynecological evaluation, but you might need it if there is a concern about issues such as rectal involvement of endometriosis, a rectovaginal fistula (an abnormal connection between the rectum and vagina), or rectal or vaginal cancer.

A pelvic exam is typically recommended for females for the purpose of evaluating symptoms such as irregular bleeding or discharge, and for screening for malignancy (cancer). Components of a pelvic exam can include a speculum exam, bimanual exam, and rectovaginal exam.

Woman in doctor's office for a check up
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Purpose of a Rectovaginal Exam

A rectovaginal exam can allow your doctor to examine and identify abnormalities in your pelvic area, including the cervix, uterus, ovaries, fallopian tubes, anus, and rectum.

The recto-vaginal exam is not a particularly accurate screening exam and is usually reserved for people who either have rectal or pelvic pain or are experiencing symptoms related to the genitourinary tract (such as pain, urinary urgency, or abnormal bleeding).

Other reasons for the exam can include:

  • Identifying scarring or a mass that could indicate cancer or another disease
  • Obtaining a fecal blood sample (blood in the stool)
  • Diagnosing a tilted pelvis

Although a pelvic exam is considered important for identifying and treating cancer, sexually transmitted infections (STIs), and other genitourinary tract disorders, a rectovaginal exam offers uncertain benefits.

According to a 2016 review of studies in the Journal of the American Association of Nurse Practitioners, a rectovaginal exam has a low sensitivity in detecting uterosacral nodules, rectal compression, cervical involvement of endometrial cancer, and colorectal cancer. This means it misses many of these problems.

How a Rectovaginal Exam Is Performed

Normally, there is no special preparation needed before having a rectovaginal exam. As with any pelvic exam, you should not engage in sexual intercourse (including anal sex) for 24 hours prior to your appointment. In some cases, your doctor may want you to take a laxative and will advise you about this beforehand.

A rectovaginal exam typically lasts for less than a minute, but it may last longer if your doctor finds something concerning. Deep breathing and relaxing your pelvic muscles can help. It can be a little uncomfortable, but should not produce any real pain. If you feel any pain, let your doctor know.

There are no risks involved with the procedure.

To do your rectovaginal exam, your doctor will:

  • Insert a gloved, lubricated finger into your vagina
  • Insert another finger from the same hand into your rectum
  • Palpate (examine by feeling) your abdomen with the other hand

During this procedure, your doctor will evaluate the tissues in your rectum and vagina, the tone and alignment of your pelvic organs, including the ovaries and fallopian tubes, and the ligaments that hold the uterus in place.

When a Rectovaginal Exam Is Indicated

Your doctor might consider doing a rectovaginal exam if you have pain, discomfort, or pressure that you think is coming from the anal or rectal area. They might also do this exam if they detect a possible growth or abnormality in or near your rectum while they are doing other parts of your pelvic exam.

In general, a rectovaginal exam is considered when symptoms or other examination findings raise the possibility of a problem involving both the rectum and the vagina. You and your doctor will discuss this part of the exam and why it is being done.

Even if you have a rectovaginal exam, there is a high chance that you do not have a serious problem and that your symptoms can be effectively treated.

Other Female Rectal Exams

Besides a rectovaginal exam, there are other types of rectal exams, typically for evaluation of gastrointestinal problems.

  • Stool sample: Generally, one of the most common reasons for a rectal exam is testing for blood in the stool. This could be a concern if you have obvious blood streaks in the toilet, blood on the toilet paper, black tarry stools, unexplained weight loss, vomiting blood, or diarrhea.
  • Anal sphincter tone: Additionally, you might have a rectal exam if you have experienced stool incontinence or if you are unable to control your stool. In this case, your doctor would do a rectal exam to check your anal sphincter tone, which can affect your control over your stool.

Pelvic Exam Recommendations

The American Congress of Obstetricians and Gynecologists (ACOG) guidelines include the following recommendations:

  • The decision to have a pelvic exam should involve shared decision making between the patient and physician.
  • A pelvic exam is recommended for people who have symptoms of an STI or other pelvic conditions.
  • For people who do not have symptoms of illness, a pelvic exam is necessary before placement of an intrauterine device (IUD) but is not necessary before prescription of other forms of birth control.

Frequently Asked Questions (FAQs)

When is a rectovaginal exam indicated?

You may need to have a rectovaginal exam if you have an abnormal appearance, sensation, or control of your rectal and vaginal areas.

What is a doctor checking for during a rectovaginal exam?

During this exam, your doctor is checking for tenderness, superficial irregularities, discharge, blood, and altered muscle tone.

Do I have to let my gynecologist perform a rectovaginal examination?

You do not have to agree to any exam you don't want. Discuss alternate approaches that might help in diagnosing your problem.

Does a recotovaginal exam hurt?

It shouldn't hurt, but it can be uncomfortable or even painful if you have a medical problem affecting your rectum or vagina.

A Word From Verywell

Gynecological examinations are often needed for screening or to evaluate symptoms. These physical examination techniques can help your doctor decide about the next steps in your diagnostic evaluation or treatment plan.

If you have any questions or if you are hesitant about any part of your exam, be sure to talk about it either with your doctor or with someone else on your medical team until you feel that your concerns and questions have been addressed to your satisfaction.

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