00:00
We're now moving on to the more technical and invasive part of this exam and that is the
specular exam which allows for direct visualization of the cervix. Wherever you are practicing,
it's important to familiarize yourself with the type of speculum that they use in that facility.
00:16
This, again, is a disposable speculum as opposed to a metal speculum you would reuse and
you'll note that this one has a notched piece here such that when you're applying pressure
to the speculum and you close it, you'll go through different clicks as you're finding in a right
position for the patient and then to lift it you want to keep your thumb on the back of this tab
here such that when you release those clicks it doesn't immediately clamp shot. So you're
keeping pressure on there, lifting up the clicker, and then slowly lowering it for the comfort
of the patient. You also want to make sure that if you are in this position and you're further
adjusting that you're not pushing up on this piece which also widens the mouth of the
speculum. So be mindful of these different components before you're meeting the patient and
certainly before you meeting the speculum. Lastly, if you're fortunate enough to be in a
place where you have a speculum light, this can really help for direct visualization. This light
just goes in the back here and provides extra illumination. And then lastly of course, you're
going to want to liberally apply some lubricant to the top and the bottom of the speculum
itself. As I'm about to proceed with the speculum exam, take note that I already have my
collection vial for the Pap smear is already ready to go, the lid is loose and easy enough to
put my speculum brush into. My speculum brush is right at my fingertips, it's very handy
and you'll see in a moment how I take that off when I'm actually ready to perform the exam.
02:06
"Okay, Sophie I'm now going to insert the speculum in and again it's just going to be the bills
of the speculum. I encourage you to take a deep breath and as you're exhaling just push
down, bear down a little bit, it will help you a little bit easier because it opens up the end
of the vagina there." "Okay, I'm now feeling the outside. Perfect. Okay." Now I'm opening
the bill and perfectly in site, it was almost too easy. I can see the cervix, the endocervix,
the os of the endocervix is there. And the things that I'm looking for in the cervix are to look
for any friability or evidence of cervicitis which can be a marker of a sexually transmitted
infection. I'm looking for any nodularity or any abnormalities in the ectocervix which is the
area outside of the central os there and looking of course for any discharge as well. Now
that I'm in position with my speculum, I can move on and perform the Papanicolaou. First,
I'm going to take away any discharge that I need to if I wanted to do a sample. This is just a
brush gently on the sides here. If I wanted to collect this and send it off, I will now apply this
on to a slide, but in this case I'm just performing the brush itself and essentially this goes
into the cervix. I rotate it at least 5 times to make sure that I get an adequate sample.
03:40
Then I can withdraw it. Again, I've already loosened the lid of the collection vial, I can just
pop the brush into the vial and close it for now. And now as I'm withdrawing the speculum,
I'm just looking at the walls of the vagina to make sure there's no evidence of inflammation
or any lesions there. And I'm now going to withdraw the speculum, just allowing the bill of the
speculum to close on the way out. And that concludes the specular exam.