The medical instrument used to hold open the vaginal walls during a pelvic exam is called a speculum. The pelvic examination is a routine health screening that allows a healthcare provider to visually inspect the vagina and the cervix. This tool is fundamental in gynecology, serving to gently separate the soft tissues of the vaginal canal so the provider can gain an unobstructed view of the internal structures.
Anatomy and Purpose of the Speculum
The speculum operates on a simple mechanical design, functioning like a duck’s bill with two hinged halves, or blades. These blades are inserted into the vaginal canal while closed and are then slowly opened by the clinician using an exterior handle and locking mechanism. The mechanism often involves a screw or lever that stabilizes the blades at a specific angle and width, maintaining the necessary separation of the vaginal walls.
The primary function of the speculum is retraction, pulling back the flexible vaginal tissue to expose the cervix. This retraction is necessary because the vaginal walls naturally rest against each other. By holding the walls apart, the instrument creates a clear viewing channel for the healthcare provider.
The speculum’s use is a prerequisite for subsequent procedures, including the collection of cells for a Papanicolaou test, commonly known as a Pap smear. During this process, the provider uses specialized tools to gently brush the surface of the cervix, gathering samples for laboratory analysis. The speculum also allows for procedures such as colposcopy and biopsies, where a magnified view and tissue samples are required. By locking the blades open, the instrument frees the provider’s hands to manipulate other instruments and collect necessary samples.
Variations in Design and Size
Specula are manufactured in two primary material types: reusable stainless steel and disposable plastic. The metal instruments are sterilized between uses and can be warmed before insertion to improve patient comfort. Disposable plastic specula are used once and discarded; these are often clear, which can slightly enhance the provider’s visibility of the vaginal walls.
The instruments also come in different sizes and designs to accommodate the wide variation in human anatomy. The two most common styles are the Graves and the Pedersen specula. The selection of the correct size and type is determined by the clinician based on the patient’s medical history and anatomical factors. Using the smallest size that permits an adequate view is standard practice to minimize potential discomfort during the examination.
Graves Speculum
The Graves speculum typically features wider, curved blades. It is often selected for patients who have given birth vaginally or have a generally wider vaginal canal.
Pedersen Speculum
In contrast, the Pedersen speculum has narrower, flatter blades. This design is frequently more appropriate for patients who are adolescents, have not been sexually active, or are post-menopausal, as these individuals may have a smaller or more sensitive introitus.
What to Expect During Insertion
The provider will first apply a small amount of water-based lubricant to the speculum blades to facilitate smooth entry into the canal.
The speculum is inserted with the blades in a closed, vertical orientation, often tilted slightly downward. This angle aligns the instrument with the natural slope of the vaginal canal, avoiding pressure on the urethra. Once fully inserted, the provider gently rotates the speculum and slowly opens the blades to gain visibility of the cervix.
Patients typically feel a sensation of pressure and fullness as the blades expand the vaginal walls. To help minimize this sensation, patients can focus on slow, deep breathing and consciously relax the pelvic floor muscles. It is important for the patient to communicate any acute or severe pain to the provider immediately, so adjustments can be made, such as repositioning the instrument or switching to a smaller size.