A speculum is a medical instrument designed to allow a clear, unobstructed view of the cervix and the walls of the vaginal canal during a gynecological examination. The tool is necessary because the flexible walls of the vagina naturally rest against one another, obstructing the view of the cervix. By gently separating and holding the vaginal walls apart, the speculum creates a pathway for medical professionals to perform examinations and procedures effectively.
What Medical Procedures Require a Speculum
The speculum is required for most routine and diagnostic procedures concerning the cervix and vagina. Its most frequent application is during a routine pelvic examination, providing the necessary visibility for the provider to visually inspect the health of the internal tissues. It is also required for a Pap test, a cervical screening procedure where a small sample of cells is collected to check for abnormal changes.
The speculum is essential for collecting samples used to diagnose infections, such as sexually transmitted pathogens or yeast. Beyond screening, it facilitates procedural interventions that require precise visual guidance, including the insertion or removal of an intrauterine device (IUD). It is also used during complex diagnostic procedures like a colposcopy, which requires a magnified view of the cervix to investigate abnormal Pap test results.
Understanding the Speculum Instrument
The speculum used for vaginal examinations features a design with two hinged blades, often compared to a duck’s bill, which are inserted closed. Once inside the vaginal canal, the blades are gently opened to separate the walls. The instrument is then secured in the open position using a lever or screw mechanism, locking the blades in place for the duration of the exam.
Speculums are made from reusable stainless steel or disposable plastic. Metal instruments are often warmed prior to use to increase patient comfort, while plastic versions may include a built-in light source. They are available in various sizes, such as small (Pederson) to large (Graves). The provider selects the appropriate size based on the patient’s anatomy to ensure the most effective examination with minimal discomfort.
Preparing for the Examination
To ensure accurate test results, patients should take several preparatory steps before the appointment. It is best to schedule the examination for a time when you are not menstruating, as blood can obscure cell samples needed for a Pap test. If rescheduling is not possible, check with the provider, as many modern tests can still be performed effectively during a period.
For 24 to 48 hours before the exam, avoid using vaginal products, such as douches, suppositories, or creams, as these can interfere with test accuracy. Patients should also refrain from sexual intercourse during this time, as semen or lubricants can affect the quality of a Pap smear sample. On the day of the exam, wearing clothing that is easy to remove from the waist down, such as a skirt or dress, can help reduce tension.
The Examination Process: Step-by-Step Expectations
The examination begins with positioning. You will be asked to lie on your back on the examination table, often with your feet placed in supports called stirrups. A sheet or drape is provided for coverage, and the provider usually positions the table to maintain eye contact. Before insertion, the provider applies a water-based lubricant to the speculum and warms metal instruments to minimize the sensation of cold.
The provider gently separates the outer labia and informs the patient before the instrument is inserted. The speculum is introduced into the vagina, often angled downward toward the tailbone for easier entry. The primary sensation felt upon insertion is pressure, not sharp pain, which increases slightly as the provider slowly opens the blades to visualize the cervix. If a plastic speculum is used, a soft clicking sound may be heard when the instrument is locked into place.
The provider should communicate each step, and the patient can request they pause at any time. If a Pap test is performed, a small brush or spatula collects cells from the surface of the cervix, which may cause a momentary sensation of mild pinching or cramping. Once the necessary steps are complete, the provider carefully unlocks the speculum, allowing the blades to close slightly before gently withdrawing the instrument. After removal, temporary pressure or a slight cramping sensation in the pelvic area is common but should quickly subside.