Pregnant Speculum

Pregnant Speculum
A speculum is a device used to look inside the vagina and check the cervix and do a Pap Papanicolaou smear. There are a number of shapes and sizes of speculums they may use. The two major types are called Graves and Pederson. The Graves are wider in the bill than the Pederson, and the Pederson is more tapered. Before inserting the speculum, the doctor should alert you that the speculum examination is about to begin. Take a breath and exhale.
The doctor will now perform the speculum exam. There are a number of shapes and sizes of speculums they may use. The two major types are called Graves and Pederson. The Graves are wider in the bill than the Pederson, and the Pederson is more tapered. The Graves is generally used for sexually active women and the Pederson is preferred for the woman with a "relatively small introitus, such as a virgin or an elderly woman, and is often more comfortable for other patients as well" (Bates Guide to Physical Examination, 7th edition). Both Graves and Pederson come in metal and plastic and in small, medium and large sizes. A fiber optic light can be inserted into a plastic speculum to optimize visibility of the vaginal walls. There are also some special products for pediatrics and for obese patients.
Once the doctor has chosen the appropriate speculum, they should check it mechanically. The screw at the handle adjusts the height of the opening. This should be adjusted and tightened before insertion. The lever can be depressed to open the bills, and the screw at the lever holds them in place in the open position. This screw at the lever should be loose when inserting the speculum and the bills should be closed.
If this is your first pelvic exam, the doctor should show you the speculum. If they do not you can still ask to be shown the speculum. The doctor always holds the speculum with their index finger over the top of the bills, their other three fingers underneath and around the handle, and the thumb underneath the lever. Most doctors check to see that the speculum is not too cold. The temperature of the speculum can be checked by touching it against the inside of your thigh. If it is too cold, the doctor can run it under warm water. Some doctors keep their speculums in warm water.
Before inserting the speculum, the doctor should alert you that the speculum examination is about to begin. Take a breath and exhale. The doctor should re-establish the tactile signal and insert it at a 45-degree angle. As they slowly insert the speculum more fully, they rotate it to a flat position so that the handle is perpendicular to the floor. The bills should remain closed as they insert the speculum. The doctor will then push the speculum in gently until they feel some resistance. They should not force it in, but they also want it to be deep enough that they are able to see the cervix when they open the bills. Once the speculum is in far enough, they hold the handle with one hand to hold it in place. They slowly depress the lever to open the bills with the other hand until they are able to see the cervix. You may feel your cervix fall into place as the speculum is opened. It is not painful but slightly uncomfortable.
Once they have the cervix in view, they tighten the screw on the lever enough that it holds the bills open. At this point, with the bills open, the speculum will stay in place and the doctor should have the cervix in view and visually examine it, size, color, and configuration of the OS (center/opening). If all appears normal then the doctor should reassure you. This is an opportune time to use the hand held mirror to view your own cervix.
This is when the doctor takes cultures for the Pap smear, they should alert you that you will feel some pressure and discomfort, but no pain as they gently swipe off the cultures from your cervix. They will now remove the speculum with bills open until it is free of the cervix. Then they will allow it to close partially and rotate it to a 45-degree angle, observing the vaginal walls. The speculum will close completely as it is fully removed
Dr. Amos Grunebaum, MD, FACOG is a Professor of Obstetrics and Gynecology, and among the world's leading authorities on fertility and pregnancy. Read Dr. Amos' full bio , the book about him " Lessons in Survival: All About Amos ," and a fictionalized account of his father's life in the novel, " Through Walter's Lens ."
In addition to his current work, Dr. Amos is using his vast experience to launch Obie, a science-based app that offers personalized fertility advice. Learn more about Obie here.
© 2001-2022 BabyMed.com - All Rights Reserved.
Obie gives you personalized expert guidance, helping you improve your fertility and reproductive health.
By using this website, you agree to our use of cookies. We use cookies to provide you with a great experience and to help our website run effectively. View our cookie policy .

A speculum is a device used to look inside the vagina and check the cervix and do a Pap Papanicolaou smear. There are a number of shapes and sizes of speculums they may use. The two major types are called Graves and Pederson. The Graves are wider in the bill than the Pederson, and the Pederson is more tapered. Before inserting the speculum, the doctor should alert you that the speculum examination is about to begin. Take a breath and exhale.
The doctor will now perform the speculum exam. There are a number of shapes and sizes of speculums they may use. The two major types are called Graves and Pederson. The Graves are wider in the bill than the Pederson, and the Pederson is more tapered. The Graves is generally used for sexually active women and the Pederson is preferred for the woman with a "relatively small introitus, such as a virgin or an elderly woman, and is often more comfortable for other patients as well" (Bates Guide to Physical Examination, 7th edition). Both Graves and Pederson come in metal and plastic and in small, medium and large sizes. A fiber optic light can be inserted into a plastic speculum to optimize visibility of the vaginal walls. There are also some special products for pediatrics and for obese patients.
Once the doctor has chosen the appropriate speculum, they should check it mechanically. The screw at the handle adjusts the height of the opening. This should be adjusted and tightened before insertion. The lever can be depressed to open the bills, and the screw at the lever holds them in place in the open position. This screw at the lever should be loose when inserting the speculum and the bills should be closed.
If this is your first pelvic exam, the doctor should show you the speculum. If they do not you can still ask to be shown the speculum. The doctor always holds the speculum with their index finger over the top of the bills, their other three fingers underneath and around the handle, and the thumb underneath the lever. Most doctors check to see that the speculum is not too cold. The temperature of the speculum can be checked by touching it against the inside of your thigh. If it is too cold, the doctor can run it under warm water. Some doctors keep their speculums in warm water.
Before inserting the speculum, the doctor should alert you that the speculum examination is about to begin. Take a breath and exhale. The doctor should re-establish the tactile signal and insert it at a 45-degree angle. As they slowly insert the speculum more fully, they rotate it to a flat position so that the handle is perpendicular to the floor. The bills should remain closed as they insert the speculum. The doctor will then push the speculum in gently until they feel some resistance. They should not force it in, but they also want it to be deep enough that they are able to see the cervix when they open the bills. Once the speculum is in far enough, they hold the handle with one hand to hold it in place. They slowly depress the lever to open the bills with the other hand until they are able to see the cervix. You may feel your cervix fall into place as the speculum is opened. It is not painful but slightly uncomfortable.
Once they have the cervix in view, they tighten the screw on the lever enough that it holds the bills open. At this point, with the bills open, the speculum will stay in place and the doctor should have the cervix in view and visually examine it, size, color, and configuration of the OS (center/opening). If all appears normal then the doctor should reassure you. This is an opportune time to use the hand held mirror to view your own cervix.
This is when the doctor takes cultures for the Pap smear, they should alert you that you will feel some pressure and discomfort, but no pain as they gently swipe off the cultures from your cervix. They will now remove the speculum with bills open until it is free of the cervix. Then they will allow it to close partially and rotate it to a 45-degree angle, observing the vaginal walls. The speculum will close completely as it is fully removed
Dr. Amos Grunebaum, MD, FACOG is a Professor of Obstetrics and Gynecology, and among the world's leading authorities on fertility and pregnancy. Read Dr. Amos' full bio , the book about him " Lessons in Survival: All About Amos ," and a fictionalized account of his father's life in the novel, " Through Walter's Lens ."
In addition to his current work, Dr. Amos is using his vast experience to launch Obie, a science-based app that offers personalized fertility advice. Learn more about Obie here.
© 2001-2022 BabyMed.com - All Rights Reserved.
Obie gives you personalized expert guidance, helping you improve your fertility and reproductive health.
By using this website, you agree to our use of cookies. We use cookies to provide you with a great experience and to help our website run effectively. View our cookie policy .

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The vaginal speculum is one of the most commonly used apparatuses by gynecologists. We have a wide selection of vaginal specula in all sizes from small to large. We also have surgical vaginal specula and disposable one-time use as well. There are specula with attached lights as well as metal.

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Introduction

Introduce yourself to the patient
Wash your hands
Explain to the patient what the examination involves and why it is necessary

For example: “I will be passing a speculum, which is a plastic/metal instrument, through the vagina to visualise the neck of the womb.”
Reassure them that this should not be painful, but you will stop immediately if it becomes too uncomfortable

Obtain verbal consent
Request a chaperone

By Sarindam7 [CC BY-SA 4.0], via Wikimedia Commons
Abdominal Examination

Inspect the abdomen for scars and ascites
Palpate the abdomen for masses and tenderness
Palpate the groin for inguinal lymphadenopathy

Adapted from work by Gynpath.ru [CC BY-SA 4.0], via Wikimedia Commons
[caption id="attachment_15334" align="aligncenter" width="1024"] Fig 1 - Types of speculum. A - Cusco's speculum. B - Sim's speculum[/caption]
[caption id="attachment_15337" align="aligncenter" width="905"] Fig 2 - Speculum examination. A - Normal cervix. B - Cervical ectropion.[/caption]

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Original Author(s): Grace Fitzgerald Last updated: 11th July 2017
Revisions: 6
Original Author(s): Grace Fitzgerald Last updated: 11th July 2017
Revisions: 6
A speculum is a device used to look inside in the vagina and observe the cervix. A speculum examination is often performed alongside a bimanual examination , as part of a complete gynaecological workup.
In this article, we shall look at how to perform an speculum examination in an OSCE-style setting.
Fig 1 – Types of speculum. A – Cusco’s speculum. B – Sim’s speculum
The patient should be laid on their back, with legs bent at the hip (feet towards their buttocks), and asked to flop their knees apart.
Fig 2 – Speculum examination. A – Normal cervix. B – Cervical ectropion.
A Sim’s speculum can be used to assess prolapse:
Swabs often required in cases of suspected infection:
The cervical smear is used to detect precancerous changes in the cervix:
A speculum is a device used to look inside in the vagina and observe the cervix. A speculum examination is often performed alongside a bimanual examination , as part of a complete gynaecological workup.
In this article, we shall look at how to perform an speculum examination in an OSCE-style setting.
The patient should be laid on their back, with legs bent at the hip (feet towards their buttocks), and asked to flop their knees apart.
A Sim's speculum can be used to assess prolapse:
Swabs often required in cases of suspected infection:
The cervical smear is used to detect precancerous changes in the cervix:
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