The cervix is examined during a female genitourinary assessment
. During internal visual examination, its color and position, as well as any lesions or discharge, can be assessed, and cervical specimens can be obtained.
Assessment of cervical motion tenderness (CMT) is part of the bimanual examination. To assess for CMT, insert the index finger and middle finger into the vagina until they are at the posterior fornix of the vagina. Then use the other hand to place pressure on the abdominal wall, over the suprapubic region. Each hand applies pressure towards the opposite hand, allowing for complete examination of the size, position, shape, and mobility of the cervix, and to assess if there is any tenderness or palpable masses. Bimanual examination should continue to assess the uterus and ovaries, to distinguish the location of any acute tenderness, or identify if there is isolated CMT.
CMT is a significant clinical finding that often indicates peritoneal irritation. CMT, uterine and/or adnexal tenderness are defining characteristics of acute symptomatic pelvic inflammatory disease (PID) (Ross & Chacko, 2022). CMT is also a hallmark sign of ectopic pregnancy and appendicitis (Bickley et al., 2021) but can also add to the differential diagnosis of any process with peritoneal involvement, such as diverticulitis, inflammatory bowel disease, hernia, perforated abdominal viscus, abdominal wall hematoma, ureteral lithiasis, interstitial cystitis, endometriosis, endometritis, tubo-ovarian abscess, ovarian or adnexal torsion, chronic pelvic cellulitis, vaginitis, cervicitis, or pelvic thrombophlebitis (Cortes & Adamski, 2021).
Bickley, L. S., Szilagyi, P. G., Hoffman, R. M., & Soriano, R. P. (2021). Bate’s Guide to Physical Examination and History Taking (13th ed.). Wolters Kluwer Health: Philadelphia.
Cortes, E.G., Adamski, J.J. Chandelier Sign. [Updated 2021 Jul 15]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK545286/
Ross, J. & Chacko, M. (2022, April 20). Pelvic inflammatory disease: Clinical manifestations and diagnosis. UpToDate. https://www.uptodate.com/contents/pelvic-inflammatory-disease-clinical-manifestations-and-diagnosis