your gloves again if necessary. (See note on using lubricant p._.) Then slowly reintroduce your index finger into the vagina, your middle finger into the rectum. Ask the patient to strain down as you do this so that her anal sphincter will relax. Tell her that this examination may make her feel as if she has to move her bowels but that she will not do so. Repeat the maneuvers of the bimanual examination, giving special attention to the region behind the cervix that may be accessible only to the rectal finger.
Impaired strength may be due to age, vaginal deliveries, or neurologic deficits. Weakness may be associated with urinary stress incontinence.
^^ Retroverted uterus
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