Objective. To compare pelvic examination under anesthesia to transvaginal sonography (TVS) as a method for ovarian detection and measurement. Methods. Two hundred and eighty-nine ovaries from 151 women were evaluated. After induction of anesthesia, a complete pelvic examination and TVS were performed, and the ovaries were removed surgically. Ovarian dimensions generated sonographically and estimated on clinical examination were compared to those obtained from the measured surgical specimen. Results. Forty-four percent of ovaries were palpable clinically whereas 85%were visualized sonographically (P < 0.001). Right ovaries were palpable more frequently than left ovaries (P < 0.01). Ovaries were detected clinically in 30%of women >55 years of age versus 51%of women < 55 years of age (P < 0.05), in 9%of women weighing >200 lb versus 55%of women weighing < 200 lb (P < 0.001), and in 12%of women with a uterine weight >200 g versus 51%of women with a uterine weight < 200 g (P < 0.001). TVS was significantly more accurate than clinical examination in detecting ovaries in women with these high risk characteristics. Conclusions. TVS is significantly more accurate than clinical examination in detecting ovaries and in defining their dimensions. Ovaries frequently are not palpable in women ≥55 years of age, women who weigh >200 lb, or women with an enlarged uterus ( > 200 g). The addition of TVS to annual pelvic examination may be beneficial in women >55 years of age who are overweight and therefore at high risk to develop ovarian cancer. To compare pelvic examination under anesthesia to transvaginal sonography (TVS) as a method for ovarian detection and measurement. Methods. Two hundred and eighty-nine ovaries from 151 women were evaluated. After induction of anesthesia, a complete pelvic examination and TVS were performed, and the ovaries were removed surgically. Ovarian dimensions generated sonographically and estimated on clinical examination were compared to those obtained from the measured surgical specimen. Results. Forty-four percent of ovaries were palpable clinically and 85% were visualized sonographically (P <0.001 Ovaries were detected clinically in 30% of women> 55 years of age versus 51% of women <55 years of age (P <0.05), in 9% of women weighing> 200 lb versus 55% of women weighing <200 lb (P <0.001), and in 12% of women with a uterine weight> 200 g versus 51% of women with uterine weight <200 g TVS w as significantly more accurate than clinical examination in detecting ovaries in women with these high risk characteristics. Conclusions. TVS is significantly more accurate than clinical examination in detecting ovaries and in defining their dimensions. Ovaries frequently are not palpable in women ≥55 years of age, women who weigh> 200 lb, or women with an enlarged uterus (> 200 g). The addition of TVS to annual pelvic examination may be beneficial in women> 55 years of age who are overweight and therefore at high risk to develop ovarian cancer.