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. While it is not generally a standard part of a medical or gynecological evaluation, it may be done if there are concerns about issues such as rectal involvement of endometriosis, a rectovaginal fistula (an abnormal connection between the rectum and vagina), or rectal or vaginal cancer.

It is different than a pelvic exam. A pelvic exam is typically recommended to evaluate 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 rejctovaginal exam.

Read on to learn more about the rectovaginal exam and everything it entails.

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

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

The rectovaginal 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.

Can a Rectovaginal Exam Detect Cancer?

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.

Why It Is Performed

Your healthcare provider might consider doing a rectovaginal exam if you have pain, discomfort, or pressure that seems like it 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 medical professional will discuss this part of the exam and why it is being done.

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 an individual and practitioner.
  • 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 the prescription of other forms of birth control.

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

What a Rectovaginal Examination Involves

Usually, 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 before your appointment. Sometimes, your healthcare provider may want you to take a laxative and will advise you beforehand.

A rectovaginal exam typically lasts for less than a minute, but it may last longer if your medical professional finds something concerning.

There are no risks involved with a rectovaginal exam. It can be a little uncomfortable but should not produce any real pain. Deep breathing and relaxing your pelvic muscles can help. If you feel any pain, let your healthcare provider know.

To do your rectovaginal exam, your practitioner 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 healthcare provider 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.

Other Rectal Exams

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

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.

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 healthcare provider would do a rectal exam to check your anal sphincter tone, which can affect your control over your stool.

Summary

A rectovaginal exam is an exam in which the rectum and vagina are manually examined. It can also provide valuable information for your healthcare provider about your pelvic structure and if any issues are going on. If you're nervous about the rectovaginal exam, talk about what it involves and your concerns with your provider. They may be able to provide you with relaxation techniques, use extra lubricant, or even possibly do an alternative exam.

A Word From Verywell

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

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

Frequently Asked Questions

  • When is a rectovaginal exam indicated?

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

  • What is a healthcare provider checking for during a rectovaginal exam?

    During this exam, your healthcare provider checks for tenderness, structural irregularities, discharge, blood, and altered muscle tone.

  • Do I have to let my gynecologist perform a rectovaginal exam?

    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 rectovaginal 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.

Originally written by Lisa Fayed
4 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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  2. American College of Obstetricians and Gynecologists. The utility of and indications for routine pelvic exam, 2020

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

  4. Elfassy L, Lasry A, Gil Y, Balayla J. Prevalence threshold of screening tests in obstetrics and gynecology. Eur J Obstet Gynecol Reprod Biol. 2021 Apr;259:191-195. doi:10.1016/j.ejogrb.2021.02.015