From the Guidelines
To properly use a speculum for a vaginal examination, the speculum should be lubricated with warm water and inserted with the blades closed, avoiding anterior pressure to prevent pain along the urethra, as recommended by the American Academy of Pediatrics 1. When performing a speculum examination, it is essential to prioritize patient comfort and minimize discomfort. The examination should be performed after completion of the external examination, and a single finger can be inserted along the posterior vaginal wall to locate the cervix if necessary. Key steps to follow include:
- Lubricating the speculum with warm water to facilitate insertion
- Inserting the speculum with the blades closed to avoid causing pain
- Avoiding anterior pressure during insertion to prevent pain along the urethra
- Opening the speculum once it is fully inserted to visualize the cervix
- Inspecting the vaginal walls for discharge and lesions
- Completely visualizing the cervix to note any lesions or abnormalities, such as an ectropion, which is a normal developmental finding in adolescents 1. During the speculum examination, samples can be obtained for laboratory and office-based analysis, including wet prep, potassium hydroxide examination, and vaginal pH testing, to diagnose conditions such as yeast infection, bacterial vaginosis, or trichomoniasis 1. It is crucial to handle the speculum gently and respectfully, prioritizing patient comfort throughout the examination, and to communicate clearly with the patient to reduce anxiety.
From the Research
Preparation for Speculum Examination
- The use of lubricant for speculum insertion is recommended to reduce discomfort during routine pelvic examination 2, 3, 4, 5.
- Applying a small amount of lubricating gel to the blades of a speculum before insertion can reduce patient discomfort without altering test results 3, 4.
Speculum Insertion Technique
- A standardized method of leg positioning without stirrups can reduce physical discomfort and sense of vulnerability among women undergoing speculum examination 6.
- The use of a medium-sized plastic speculum with a standardized technique can help minimize discomfort during vaginal speculum examination 4.
Lubricant Options
- Water-soluble gel lubricant can be used on the outer inferior blade of the plastic vaginal speculum without changing cervical cytology results 5.
- Lubricating gel can significantly decrease patient pain during vaginal speculum insertion compared to using water 4.