INTRODUCTION: The purpose of this study was to evaluate the accuracy of pelvic exam when compared to ultrasound measurements and pathology weight depending on BMI. To our knowledge, there are limited studies evaluating the effect of BMI on accuracy of bimanual examination and a more recent investigation is long overdue. METHODS: This was a retrospective chart review of patients over the age of 18 undergoing hysterectomy for benign indications between July 2010 and July 2015. Bimanual examination and ultrasound measurements of the uterus prior to surgery were compared to pathology weight and then their accuracy was compared based on BMI. Concordance correlation coefficients were used to estimate accuracy of these measurements. Bland-Altman plots were used to compare the weights from clinical exam and ultrasound to the actual pathology weight. RESULTS: 981 records were reviewed, of those 364 met inclusion criteria. Average weight of the uterus was 454.04 gm (+/-475.27). Average age and BMI of women undergoing hysterectomy was 45.5 years (+/-7.5) and 31.65 (+/- 7.09) respectively. Overall concordance between the three different methods of estimating uterine size ranged from 0.73 to 0.82. Concordance did not differ significantly between different BMI categories. CONCLUSION: The findings of pelvic exam are similar to ultrasound measurements when compared to pathology weight regardless of BMI whenever the uterine size can be estimated. These results suggest that if uterine size can be assessed, ultrasound may not be necessary for preoperative evaluation.