Why a Recto-Vaginal Exam Is Performed

Assessing the Benefits and Limitations of the Procedure

a gynecologist examining a patient
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An annual pelvic exam is recommended for all women and can consist of some or all of the following procedures: the external genital exam, the speculum exam, the bimanual exam, and the recto-vaginal exam.

Gynecologists will sometimes perform a rectovaginal exam in addition to a normal pelvic exam. To do this, your doctor will insert a gloved, lubricated finger into the vagina and another from the same hand into the rectum. He or she will then palpate (examine by feeling) the abdomen with the free hand.

It is similar to a bimanual exam wherein the doctor inserts one or two fingers into the vagina and gently presses the lower abdomen.

Purpose of a Recto-Vaginal Exam

A recto-vaginal exam allows doctors to examine and identify abnormalities in the pelvic area, most specifically those of the uterus and ovaries. It provides them the means to feel deep inside the pelvis to determine where and how large the pelvic organs are.

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

Other reasons can include:

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

Although a pelvic exam is considered vital to the identification and treatment of cancer, sexually transmitted infections (STIs), and other genitourinary tract disorders, a recto-vaginal exam offers uncertain benefits.

According to a 2016 review of studies in the Journal of the American Association of Nurse Practitioners, a recto-vaginal exam has a low sensitivity in detecting uterosacral nodules, rectal compression, the cervical involvement of endometrial cancer, and colorectal cancer.

How This Exam Is Performed

A recto-vaginal exam can be a little uncomfortable but should not produce any real pain. If you feel do feel any pain, let your doctor know. Deep breathing exercises can also help. Just like in a pelvic exam, relaxing your muscles will yield a more accurate result.

In performing the procedure, your doctor can evaluate tissue between the uterus and vagina, the tone and alignment of the pelvic organs (including the ovaries and fallopian tubes), and the ligaments that hold the uterus in place.

The exam typically lasts for less than a minute but may last longer if the doctor finds something suspicious. Aside from discomfort, there are no risks involved with the procedure.

Normally, there is no preparation needed. 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 beforehand.

Pelvic Exam Recommendations

The American Congress of Obstetricians and Gynecologists (ACOG) recommend an annual pelvic exam as part of its Well-Woman Visit initiative. The ACOG guidelines include the following recommendations:

  • The use of an external, speculum and bimanual exam is highly recommended, while a recto-vaginal exam should be performed when indicated.
  • An annual exam is recommended for all women over the age of 21.
  • Cultures for STIs should be obtained from the cervix, either as part of the pelvic exam or from urine samples or vaginal swab specimens.
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Article Sources

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  1. Nishikawa J. An evidence‐based review of the rectovaginal examination during well‐woman visits. J Am Assoc Nurse Practitioners. 2016 May; 28(5):237-40. doi:10.1002/2327-6924.12316

  2. American College of Obstetricians and Gynecologists. ACOG Statement on USPSTF Draft Recommendations on Pelvic Exams. June 28, 2016.