The examination of the uterus and other pelvic structures is often facilitated by dragging the uterus downward with a tenaculum while the vaginal or the bimanual examination is being made. Sensation in the cervix is so slight that little or no pain is experienced in this procedure. The anterior or posterior lip of the cervix is caught with the single or the double tenaculum (Fig. 4), guided along the vaginal finger or introduced through the speculum, and the uterus is drawn down by an assistant in case the bimanual examination is being made, or by the external hand of the examiner in case a simple vaginal examination is made. When this is done the utero-sacral ligaments are made tense, and can be felt like two cords extending from the sides of the cervix outward and backward to the pelvic wall. The posterior surface of the uterus can be palpated often as high up as the fundus. The method is especially useful when the examination is made by the rectum, and in this way the whole posterior surface and the fundus of the uterus may be palpated (Fig. 5). The contraindications to a vaginal examination are virginity, the presence of a hymen, and any acute inflammatory or painful condition of the vulva or vagina. None of these conditions, however, forbid an examination if an exact diagnosis is essential to the proper treatment of the case, and can be made only in this way. It may be that in these cases a rectal examination will be sufficient for diagnosis. [Illustration: FIG. 5.--Bimanual examination with one finger in the rectum. The uterus is drawn down with the double tenaculum.] Rectal examination of the pelvic structures is made in a way similar to that already described for the vaginal examination. Bimanual examination may be made by palpating the various organs between the rectal finger and the abdominal hand. _The Vaginal Speculum._--The speculum is an instrument through which a visual examination is made of the vagina, the external os uteri, and the vaginal cervix. A great number of specula have been invented. At the present day the best two instruments of this class are the bivalve speculum, such as Goodell’s (Fig. 6), and the duck-bill speculum (Fig. 7), or perineal retractor, invented by Sims. [Illustration: FIG. 6.--Goodell’s speculum.] [Illustration: FIG. 7.--Sims’ speculum.] [Illustration: FIG. 8.--Sims’ depressor for the anterior vaginal wall.]