Medical Student Tips - Using the Speculum
This started out as as reply to Graham's post, but as I got into it, I decided to make it a post of my own, and perhaps a series.
My most important tips for using the vaginal speculum:
- The patient's buttocks need to be extending a couple of inches beyond the end of the stretcher (particularly if the uterus is anteverted), otherwise you might not be able to maneuver the speculum into the proper angle to see the cervix. If it looks like they might not be scooted down far enough, then they aren't scooted down far enough. You can always have them scoot down more after you realize your mistake, but it's better to just position them properly before you begin.
- The patient has to be relaxed. If she's all tensed up and adducting her thighs, you shouldn't just try to force your way in. You've got to make her relax first. Act relaxed yourself, using gentle tones. Tell her to take a deep breath or two and let it out slowly. Take your time. Reassure her. If you can't gently separate her knees, she's not relaxed enough.
- Touch the inner thigh with your non-speculum hand before you touch the genital area, and tell her your intentions before you proceed. Don't just dive right in. A female instructor once asked me many years ago, "how would you like it if you were in that position and I just came up and grabbed your balls?" Hmmmm.
- You can push downward on the speculum with considerable force without causing unreasonable discomfort, but stay the heck away from the urethra. All the pressure should be directed inferiorly as you insert the speculum. I use my index finger to press down firmly on the inferior blade as I slide the speculum in. Torquing on the urethra with the speculum is as much of a no-no as using the upper incisors as a fulcrum for the laryngoscope. Just don't do it.
- You must find the cervix. If you don't, you're a failure.
Just kidding....sometimes it's not so easy. But don't give up, practice makes perfect.