The prevention of disease and the promotion of good health for women have gone through a transformation during the last ten years. This includes new recommendations for mammography screening, introduction of the HPV (Human Papillomavirus) vaccination, HPV testing, Papanicolaou smear, and pelvic examinations. A lot has been written about these topics. But one area that has been neglected in the literature is the RVE (rectovaginal examination).

Below we provide insights into exactly what this type of examination involves and under which circumstances it would be recommended. We also cover two related procedures, the pelvic exam and the rectal exam , in more depth.

When Is a Rectovaginal Examination Performed?

Your doctor will recommend a rectovaginal examination if he or she wants to examine the rectal and/or vaginal areas for possible abnormalities. Typically this type of exam is performed to assess rectal symptoms, pelvic pain, or a pelvic mass. It can also be used to get a sample for fecal occult blood testing.

Apart from the above reasons, it may be performed as part of a scheduled gynecologic examination. The doctor will most likely also do a Pap test during the same consultation.

What a Rectovaginal Examination Involves

A Gynecologist Holds in His Hand a Transvaginal Ultrasound Scanner With a Gel for Vaginal Examination of a Woman.

While this procedure might be somewhat uncomfortable, it should not cause any significant pain. Let the doctor know if you experience any pain. Similar to a pelvic examination, it will deliver a more accurate result if you could relax your muscles. Deep breathing exercises could also help.

A rectovaginal exam is similar to a vaginal exam where the physician inserts either a single or two fingers into the vagina while at the same time gently pressing the lower part of the abdomen. In this case, however, the rectum is also involved.

The first step is that the doctor inserts a gloved finger that has been well lubricated into your vagina and at the same time another finger of the same hand into your rectum. During the procedure, he or she will also press on the lower part of your abdomen with the other hand.

While performing a rectovaginal examination, your physician can evaluate the tissue between the vagina and the uterus, as well as the alignment and tone of the pelvic organs (including the fallopian tubes and ovaries) and also the ligament holding the uterus in position. He or she will look for any signs of masses or scarring that could point to cancer or other diseases. You should tell them if it hurts when they touch or move any of these organs.

The examination normally doesn’t take much more than a minute but it could take longer if the doctor finds something out of the ordinary.

Generally speaking, no preparation is needed for a rectovaginal examination. As with any pelvic examination, you should refrain from sexual intercourse (regardless of whether that is vaginal or anal) during the 24-hour period leading up to your appointment. If you are prone to constipation, the doctor could also ask you to use a laxative the day before the examination.

Why Is a Rectovaginal Examination Performed?

A rectovaginal examination enables your physician to identify and examine abnormalities in your pelvic area, particularly those of the ovaries and uterus. It makes it possible for him or her to feel deep into your pelvis to inspect the pelvic organs, feel exactly where they are and how big they are.

The rectovaginal exam is typically used in a situation where the patient is complaining of pelvic or rectal pain or suffering from symptoms of the genitourinary tract. These can include urinary urgency, pain, or abnormal bleeding.

Other reasons why the doctor might perform this examination include:

  • To identify a mass or scarring that could indicate a disease, including cancer
  • Blood in the patient’s stool that requires the doctor to obtain a fecal blood sample
  • Diagnosing any abnormalities in the ovaries
  • Limitations of the rectovaginal exam

A rectovaginal exam is not the test to replace all other tests. In the hands of an experienced gynecologist it can be an excellent screening tool but despite the controlled circumstances under which it is performed it does have certain limitations.

One specific study, for example, found that the sensitivity of the RVE is low. This limits its effectiveness as a screening test. On the other hand, its specificity is high because of the relatively low disease prevalence. Both the positive predictive value and the sensitivity of an RVE for identifying the existence of uterosacral nodularity were, however, negligible.

PELVIC EXAMS

How Often Is a Pelvic Examination Recommended?

As we mentioned above, a rectovaginal exam can be performed as part of your regular pelvic examination if the doctor thinks there is a good reason for this. As part of its Well-Woman Visit initiative, the ACOG American Congress of Obstetricians) recommends that women go for a pelvic exam once a year.

The organization also issued the following guidelines:

  • A yearly pelvic examination is recommended for all females over the age of 21
  • A bimanual pelvic examination that includes the use of a speculum is highly recommended
  • A rectovaginal examination should only be scheduled when deemed necessary by the doctor
  • STI cultures should be collected from the cervix, either through urine examples, a pelvic examination, or vaginal swab specimens

RECTAL EXAMS

What Does a Female Rectal Exam Involve?

Back View Portrait of Female Gynecologist During Pelvic Exam

Let’s mention right at the start that it typically does not hurt, although it might make you feel uncomfortable. You could also develop a strong need to urinate.

The gynecologist will request that you lie on your back on the examination table, with your feet in raised stirrups. You will then be asked to take a deep breath and relax. Next, the doctor will insert a gloved and lubricated finger into your rectum. He or she will also press on the lower part of your abdomen with the other hand.

Why Does Gynecologist Do a Rectal Exam?

Your gynecologist may recommend a female rectal exam as part of a routine checkup because it is regarded by many doctors as the best way to feel the female organs. You might also need one if you have one of the following symptoms:

  1. Bowel habits that changed without any obvious reason
  2. Blood in your stool or rectal bleeding
  3. An unexplained change in the way your urine flows
  4. Bleeding or a discharge from your urethra, i.e. the tube through which urine is taken out of the body

What Is the Purpose of a Rectal Exam?

A rectal exam at obgyn involves an examination of a patient’s pelvis, lower rectum, and lower belly. This test can assist the physician when he or she is checking for problems such as an abnormal mass in the rectum or the anus, ovarian cancer, or uterine cancer.

Sometimes a Rectovaginal exam can pick up a mass like ovarian cancer that the pelvic exam might miss. Ovarian cancers are often diagnosed when it has already spread, thus an RV exam may aid in early detection. While there may be some discomfort, the RV exam should be a part of the annual exam for women beginning at age 40.

Note: A rectal examination is not recommended for finding signs of colon cancer. This is because the doctor can only access a small part of the lower colon during this procedure. A rectal examination could, however, be used to get a blood sample that can then be tested in a laboratory.

If these tests find blood in the stool it might be a sign of colon cancer, although it could also simply be caused by a bacterial or viral infection in the intestines or the stomach. Further tests might be necessary.

Blood in your stool can not always be seen by the naked eye, so your gynecologist might want to perform a fecal occult blood test to confirm.

We hope the information in this article has answered most of your questions about rectovaginal exams. If there is anything that’s still unclear to you, please reach out to us. Dr. Andrew Krinsky is committed to improving women’s health in South Florida and he’d be more than happy to see you. Feel free to make an appointment, today!