A speculum is a two-bladed instrument that gently holds the vaginal walls apart so the cervix can be seen. Using one correctly involves choosing the right size, inserting at the proper angle, opening the blades smoothly, and locking them in place to keep the view clear. Whether you’re a student learning the technique or a patient wanting to understand what happens during a pelvic exam, the steps below walk through the full process.
Choosing the Right Speculum
Speculums come in two main designs. The Pederson speculum has narrower, flatter blades and is the most commonly used type for people who are sexually active but have not given birth vaginally. The Graves speculum is wider and slightly longer, making it better suited for people who have delivered vaginally or who have a longer vaginal canal with more elastic walls. Graves speculums are also the standard choice during procedures like colposcopy or cervical biopsy because their wider opening gives a broader view.
Both types come in multiple sizes. The general rule is to use the smallest speculum that still gives a clear view of the cervix. Starting too large causes unnecessary discomfort, while starting too small may mean you can’t see what you need to and have to swap instruments mid-exam.
Speculums are either metal (stainless steel, reusable) or plastic (single-use, disposable). Metal speculums are sterilized between patients using an autoclave, which kills microorganisms with pressurized steam. Plastic speculums are discarded after one use. Functionally, both work the same way. Metal speculums feel cold, so warming them with warm water before insertion makes a noticeable difference in comfort.
Preparing the Speculum
Lubrication matters, but it depends on the purpose of the exam. If a cervical screening sample (such as a Pap test or HPV test) will be collected, lubricant should be avoided when possible. Residual gel can interfere with cell collection and may inhibit molecular-based tests, sometimes producing an unusable “unsatisfactory” result. For metal instruments, warm water alone is the safest option because it lubricates the surface lightly while presenting the least risk to sample quality.
When lubricant is genuinely needed for comfort, use a water-soluble, carbomer-free product. Apply a small amount, roughly the size of a five-cent coin, only to the outer surface of the blades. Keep the tip of the speculum clean so lubricant doesn’t transfer to the cervix before the sample is taken. Approved options include medical-grade K-Y Jelly, non-silicone Astroglide, and similar water-soluble gels that have been tested with liquid-based cytology systems.
Positioning the Patient
The standard position is lying on the back with knees bent and feet placed in stirrups or flat on the exam table with knees falling open. Hips should be at the very edge of the table so the pelvis tilts slightly, making the vaginal canal easier to access. A pillow under the lower back can help some people relax. Before anything touches the body, the examiner should explain each step out loud. Tension in the pelvic floor muscles is the single biggest factor that makes a speculum exam uncomfortable, and clear communication helps reduce it.
Inserting the Speculum
With the speculum fully closed (blades together), hold it in the dominant hand with the handle pointing upward or to the side, whichever feels more natural. Separate the labia with the other hand so the blades don’t pinch the skin on entry.
Insert the closed speculum at roughly a 45-degree angle, angled downward toward the small of the back. This follows the natural tilt of the vaginal canal. Apply gentle, steady, downward pressure as you advance it. Push forward until you meet resistance, then pull back just slightly. At this point the tip of the speculum is sitting near the base of the cervix in the deepest part of the vaginal canal (the posterior fornix). Now rotate the speculum horizontally so the handle points straight down or toward the floor, and the blades open side to side.
Once it’s in position, slowly open the blades using the thumb lever or screw mechanism. The cervix should come into view between the two blades. It looks like a smooth, pinkish dome with a small central opening (the os). When you have a clear view, tighten the thumb screw or click the ratchet to lock the blades open so you can work hands-free.
Troubleshooting a Difficult View
Sometimes the cervix doesn’t appear right away. The most common reason is that the vaginal side walls collapse inward and block the view. This is a well-known challenge, especially in patients with more lax vaginal tissue. A survey of colposcopy specialists found that 73% solve this problem by cutting the finger off a nitrile glove and sliding it over the speculum blades like a sheath. The glove material holds the side walls back without significantly restricting how far the blades can open. The middle finger of the glove tends to work best.
If the cervix still isn’t visible, it may be tilted. A retroverted (backward-tilting) uterus shifts the cervix higher and more anterior. Repositioning the speculum slightly, asking the patient to place fists under their hips, or gently adjusting the angle of entry can bring it into view. Patience and small adjustments work better than removing and reinserting the speculum repeatedly.
Removing the Speculum
To remove the speculum, first release the locking mechanism so the blades can close. Let them close slowly as you withdraw, but keep them slightly open until the blades have cleared the cervix to avoid pinching cervical tissue. Once past the cervix, allow the blades to come together fully and withdraw the speculum at the same 45-degree angle it went in. A slow, steady withdrawal is more comfortable than a quick pull.
Self-Examination at Home
Some people use a speculum at home to look at their own cervix, often with a mirror and flashlight or a phone camera. If you’re doing this, the same principles apply: use the smallest size that works, lubricate well (sample quality isn’t a concern outside a clinical setting, so water-based lubricant is fine), insert at a downward angle, and open slowly. A plastic, disposable Pederson-style speculum in a small or medium size is the easiest to manage solo. Lying on your back with knees bent and feet flat on the bed gives the most stable position. Go slowly, and if something feels sharp or pinching, close the blades and reposition before trying again.
When a Speculum Exam Is Needed
A speculum exam is performed when there’s a medical reason to look at the cervix or vaginal walls directly, such as cervical cancer screening, investigating abnormal bleeding, placing or removing an IUD, or evaluating discharge or lesions. Current clinical guidelines from ACOG note that a pelvic exam should be performed when indicated by symptoms or medical history, and that the decision should be shared between patient and provider. A speculum exam is not required before prescribing most forms of contraception (the exception being an IUD), and it is not needed just to screen for sexually transmitted infections, which can be done with urine or self-collected swabs.
Routine annual speculum exams for people with no symptoms and no increased risk are not strongly supported by current evidence. That said, an annual well-woman visit is still recommended, and cervical screening follows its own schedule based on age and prior results.