A speculum is a medical instrument used to open and hold open a body cavity. The most recognized application is the vaginal speculum, which is used during pelvic examinations and procedures like Pap smears. This tool gently separates the walls of the vagina, providing clear visibility of the vaginal canal and the cervix, the opening to the uterus. The ability to directly visualize these internal organs is fundamental for routine screenings, diagnosing infections, and detecting abnormalities or cancerous changes.
Understanding the Tool
The vaginal speculum is typically a bivalve device, consisting of two hinged arms or blades that resemble a duck’s bill. These blades are the part of the instrument inserted into the vagina, and they are responsible for widening the vaginal walls for examination. The speculum also includes a handle for the provider to grip and a locking mechanism, such as a screw or lever, to hold the blades open once the cervix is in view.
Specula are commonly made from either stainless steel or disposable medical-grade plastic, with the choice often depending on the provider’s preference and the clinic’s standard practice. Metal specula are reusable after sterilization, while plastic versions are single-use, offering guaranteed hygiene and sometimes featuring a built-in light source for improved visibility. They also come in various sizes, like Pederson for narrower canals and Graves for wider ones, allowing the practitioner to select the most appropriate size based on the patient’s anatomy and comfort.
Preparing for the Examination
The process begins with thorough communication between the patient and the healthcare provider to explain the procedure and obtain verbal consent. The patient is usually asked to empty their bladder beforehand. A patient is then positioned on the examination table in the lithotomy position, lying on their back with their knees bent, hips flexed, and feet resting in stirrups or on the table near the buttocks.
Once the patient is positioned and appropriately draped for privacy, the provider prepares the speculum. If a metal instrument is used, it may be warmed under running warm water or with a specialized warmer to prevent a cold sensation upon insertion. A small amount of water-based lubricant is applied to the outside of the speculum’s blades to facilitate smooth insertion, which does not interfere with collecting cell samples like Pap smears.
Step-by-Step Procedure for Use
The provider starts by gently separating the labia to expose the vaginal opening, or introitus. The closed speculum is then carefully inserted with the dominant hand, often at a slight downward angle toward the small of the back, which follows the natural curve of the vaginal canal. This initial insertion angle, approximately 45 degrees, helps to avoid contact with the sensitive tissues of the urethra and clitoris.
As the speculum is inserted to its full depth, it is rotated 90 degrees so the handle is pointing downward and the blades are oriented horizontally. The provider then begins to slowly open the blades until the cervix comes into clear view between the two blades. The goal is to open the speculum just enough to fully visualize the cervix without causing excessive distension of the vaginal walls, which can be uncomfortable.
Once the cervix is centered and fully visible, the provider engages the locking mechanism to hold the speculum securely in place, freeing both hands for any necessary sampling, such as a Pap test or swabbing. After the examination or sampling is complete, the locking mechanism is released, and the blades are allowed to partially close. The speculum is then gently withdrawn, maintaining the downward angle of insertion to prevent trauma to the anterior vaginal wall as it passes out of the introitus.
Patient Comfort During Visualization
During the examination, patients may experience sensations of pressure rather than sharp pain as the vaginal walls are gently separated by the speculum blades. A feeling of coldness is also common, especially with metal specula. Some patients report a mild cramping sensation when the speculum is opened or when samples are collected from the cervix, which is generally brief.
Providers employ several strategies to help maximize comfort and reduce muscular tension throughout the examination. Coaching the patient through deep, slow breathing exercises can promote muscle relaxation. It is also important for the provider to maintain open communication, describing each step before it occurs and reminding the patient that they can request the examination to be paused or stopped at any time. Selecting the smallest functional speculum size and using ample, warmed lubricant are practical ways to enhance the patient’s subjective experience during the visualization phase.