Performing Speculum Examination During Menstruation
Yes, you can perform a speculum examination while a patient is menstruating, though the specific indication matters. For most clinical situations requiring speculum examination, menstruation should not delay the procedure, but conventional cytology Pap testing should be postponed if possible.
When to Proceed with Speculum Exam During Menstruation
Symptomatic Presentations (Always Proceed)
Any woman with gynecologic complaints requires appropriate pelvic examination regardless of menstrual status 1. This includes:
- Persistent symptomatic vaginal discharge - speculum examination is indicated to collect cervical or vaginal specimens, which may be more sensitive than urine-based testing 2
- Lower abdominal pain - complete pelvic examination is always indicated to identify sources such as pelvic inflammatory disease, ovarian pathology, or ectopic pregnancy 2
- Suspected or reported sexual assault - pelvic examination must be performed to document trauma and collect forensic specimens 2
- Abnormal bleeding patterns - examination helps differentiate sources and identify pathology 1
- Pelvic pain or dyspareunia - speculum and bimanual examination are necessary for diagnosis 1
STI Testing During Menstruation
The presence of menstrual blood or mucopurulent discharge should not delay the speculum examination 2. The test can be performed after careful removal of discharge with a saline-soaked cotton swab 2. Cervical or vaginal specimens for STI testing remain valid during menstruation 2.
When to Postpone Speculum Exam During Menstruation
Cervical Cytology Screening
If a woman is menstruating, a conventional cytology Pap test should be postponed, and the woman should be advised to have a Pap test at the earliest opportunity 2. This is the primary exception where menstruation affects timing.
However, this applies specifically to:
- Conventional cytology only - liquid-based cytology may be less affected by menstrual blood 2
- Asymptomatic screening - not symptomatic evaluations requiring visualization 2
Practical Technique Considerations
Managing Blood During Examination
- Remove pooled blood carefully with a saline-soaked cotton swab before collecting specimens 2
- Visualize the vaginal walls and cervix after clearing blood to note any discharge or lesions 3
- Avoid contaminating specimens with excessive menstrual blood when possible 3
Patient Preparation
- Ask the patient to empty her bladder before examination to minimize discomfort 2
- Explain the procedure thoroughly, as anxiety can increase muscle tension and discomfort 3
- Use appropriate lubrication (warm water only for speculum) to facilitate insertion 3
Common Pitfalls to Avoid
Do not assume menstruation invalidates all examination findings - most pathology remains identifiable, and symptomatic presentations require evaluation regardless of cycle timing 2, 1.
Do not delay urgent evaluations for menstruation - conditions like pelvic inflammatory disease, ectopic pregnancy, or sexual assault require immediate assessment 2, 1.
Do not confuse the Pap test postponement recommendation with all speculum examinations - only conventional cytology screening should be rescheduled, not diagnostic examinations 2.
Avoid forcing the speculum if resistance is encountered - this applies regardless of menstrual status and can cause trauma 3.