Female Pelvic Exam: Speculum Examination

by Stephen Holt, MD, MS

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    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.

    About the Lecture

    The lecture Female Pelvic Exam: Speculum Examination by Stephen Holt, MD, MS is from the course Examination of the Male and Female Genitourinary System.

    Included Quiz Questions

    1. After locating the cervix with the speculum, insert the brush or broom, rotate it 5 times, and then place it in the collection jar.
    2. Collect the cells from the vagina with the cervical brush then put them in the collection jar.
    3. A speculum is not needed for collecting a Pap smear.
    4. After locating the cervix with the speculum, insert the brush or broom and rotate it twice then put it in the collection jar.
    5. Use a cotton swab to collect cervical cells for the Pap smear.
    1. To visualize the cervix
    2. To collect cells for a Pap smear
    3. To evaluate for sexually transmitted infections
    4. To evaluate for uterine cancer
    5. To evaluate for uterine prolapse

    Author of lecture Female Pelvic Exam: Speculum Examination

     Stephen Holt, MD, MS

    Stephen Holt, MD, MS

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