A resident physician is performing a pelvic examination on a young woman. The fingers of one of her hands is in the patient’s vagina and is palpating the cervix. The other hand is pressing on the abdomen. With the palm of this hand, the physician feels a bony structure in the lower midline. This structure is most likely the ?

**Core Concept**
During a pelvic examination, the examiner may use various techniques to assess the female reproductive organs and surrounding structures. One such technique involves palpating the cervix with one hand and applying pressure to the abdomen with the other to help locate and assess the position of pelvic structures.

**Why the Correct Answer is Right**
The bony structure felt in the lower midline of the abdomen during a pelvic examination is likely the **pubic symphysis**. This structure is a cartilaginous joint located at the front of the pelvis, where the two pubic bones meet. The pubic symphysis serves as a site of attachment for various muscles and ligaments, such as the inguinal ligament and the rectus abdominis muscle. When pressure is applied to the abdomen during a pelvic examination, the examiner can feel the pubic symphysis as a hard, bony structure.

**Why Each Wrong Option is Incorrect**
**Option A:**
This option is incorrect because the **sacrum** is a large, triangular bone located at the base of the spine and is not palpable in the lower midline of the abdomen during a pelvic examination.

**Option B:**
This option is incorrect because the **coccyx** (tailbone) is a small, triangular bone located at the very bottom of the spine and is not palpable in the lower midline of the abdomen during a pelvic examination.

**Option C:**
This option is incorrect because the **iliac crest** is a curved ridge of bone located on the sides of the pelvis and is not palpable in the lower midline of the abdomen during a pelvic examination.

**Clinical Pearl / High-Yield Fact**
It's essential to note that the pubic symphysis is a key landmark in pelvic anatomy, and its location and integrity are often used to assess the stability and mobility of the pelvis.

**Correct Answer:** A. Pubic symphysis.

✓ Correct Answer: D. Pubis