Vaginal Speculum: Medical Uses, Types, and Insertion
by Pharmchoices
A vaginal speculum is a medical instrument, used for visual examination of the cervix or vagina. Pelvic examination or vaginal examination helps in the diagnosis of intra-abdominal conditions in female patients with abdominal pain, and to obtain specimen to check for vaginal and uterine infections.
This visualization is helpful in treating vaginal/cervical lesions. The instrument traces its origin to J. Marion Sims, regarded as the “the father of gynecology” who developed the first design.
Though some modifications have been made with time, most vaginal specula still maintain the traditional, bi-valve design.
There are two types of vaginal speculum:
Disposable speculum, also called disposable vaginal speculum and,
Metal speculum. This type has styles such as Cusco’s speculum and Sim’s speculum.
Uses of Vaginal Speculum
To visualize the cervix or vaginal secretion and obtain cultures, wet smears
General pelvic examination, to visualize the cervix or vagina and obtain pap smears.
To perform follow-up examination in treating cervical or vaginal lesions.
To evaluate the source of vaginal, cervical or uterine bleeding.
For the post-operative evaluation of vaginal apex after abdominal or vaginal hysterectomy.
Evaluate the cervix or vagina in the presence of vulvar or perineal viral (Herpes or HPV) lesions.
For pre-operative evaluation of vaginal and uterine supports relating to descent and prolapse.
Conducted alongside biopsy, cryo or cold knife treatment methods.
Evaluate the vagina, cervix in the presence of vulvar or perineal viral (Herpes or HPV) lesions
Visualize the cervix in treatment of CIN; abnormal pap, VAIN, HPV or other cervical lesions
Disposable Vaginal Speculum vs. Metal Vaginal Speculum
Disposable vaginal speculum is for single use and prevents cross-contamination. It enhances safety and comfort in patients. It is also cost-effective.
Metal vaginal speculum is made from stainless steel, and reusable. However, they require resterilization with use of ethylene oxide (EtO) or sporicidal disinfectants. Reprocessing also involves the use of powerful detergents, disinfectants, solvents. These chemicals are not friendly to the environment.
How to use the Vaginal Speculum
Introduce yourself to the patient and wash your hands
Explain to the patient that you will pass the speculum through the vagina to visualize the neck of the womb
The patient should lie in a modified lithotomy position
Inspect the vulva for
Masses as in Bartholin’s cyst and vulval malignancy.
Ulcers, as in genital herpes.
Vaginal atrophy: common in postmenopausal women.
Scarring which happens in previous surgery like episiotomy, or lichen sclerosus
Female genital mutilation
Abnormal vaginal discharge in bacterial vaginosis, chlamydia, candidiasis, gonorrhea
Varicosities: varicose veins secondary to chronic venous disease.
Inspect for vaginal prolapse (a bulge visible protruding from the vagina). You can ask the patient to cough as you inspect. This can exacerbate the lump and help confirm if there is prolapse.
