Key Points

• Clinically significant leiomyomas may not be palpable on bimanual evaluation; relatively small submucous tumors often do not enlarge the uterine corpus, and larger tumors (example 4 cm diameter type 6 tumors) will be palpable have no current clinical significance ie, they don't cause AUB, RPL, or infertility and are unlikely to cause pressure symptoms unless impinging on the bladder.
• The body habits of the patient may impair (if obese) or facilitate (if thin) manual examination
• Types 6 and 7 leiomyomas may present as adnexal masses, difficult to distinguish from ovarian tumors
• Prolapsing Type 0 myomas may present as a vaginal mass, or visibly at the level of the external os
• Appropriate imaging is essential for the identification ad characterization of leiomyomas
• In many instances, the combination of bimanual examination and transvaginal or transabdominal ultrasound will be helpful