Speculums Are Not One-Size-Fits-All

Are you one of those “hard-to-fit” types when it comes to jeans? Rest assured that thinking your thighs look fat and sending numerous sales people back to the racks is painless compared to being a “hard-to-fit” type when it comes to speculums.

 

The problem is, much like those skinny jeans, speculums are not one-size-fits-all. The speculum I use for a 16-year-old virgin is a completely different instrument than I would use for a 40-year-old with 3 kids, the 70-year-old who is well into menopause, the 4”10’ woman, or the 6" woman. My choice of speculum is not only dependent on the size of the vaginal opening, but also on variables such as the length of the vagina, the elasticity of the vaginal walls, the position of the uterus, and what I need to accomplish while up there. For example, the amount of exposure I need to swab vaginal discharge is different than what I need to do a Pap test, a uterine sampling or a major procedure.

 

The modern speculum was invented (yes, by a man) in 1845. You would think that by now someone would have come up with something better than 2 metal duck bills to allow visualization of the cervix, but other than the brief appearance of a one-size-fits-all soft inflatable speculum a few years ago, there haven’t really any better options for vaginal viewing.

 

So while that metal speculum is not going to go away, and never going to feel good, it shouldn’t be excruciating. If your pap test goes beyond “a little pressure,” and it pinches, bites or hurts, don’t be shy. Say something! Sometimes a minor readjustment or changing instruments can make a world of difference. But unless you tell your gyne, he or she won’t know that the speculum is digging or pulling on something it shouldn’t. Not to mention if the speculum part of the exam hurts, the rest of the exam is likely to be painful as well since your pelvic muscles will involuntary contract into ‘keep out mode” to protect themselves from further agony.

 

I know it’s never intentional, but clamping your knees together and lifting your bottom off the table, makes it really difficult for the doctor to get a speculum in and see what needs to be seen. It will also make the exam take longer, and yes, hurt more. It helps to take your mind off the fact that a large metal object is about to enter your vagina by deep breathing or talking to your gynecologist about something unrelated. I had one woman who instead of talking to me, talked to her sister on her cell phone during her Pap smear to take her mind off what I was doing! I also have a patient who precedes her annual exam with a 2-martini lunch.


If you are not an easy fit, I would skip the martinis, but you’re probably better off seeing a gynecologist as opposed to a general doctor for your annual Pap. Gynecologists are not only the most experienced at inserting speculums, but have multiple sizes that vary in length, width and how far they open. If only the jean store could be so accommodating.

Added to Women's Health, Gynecology on Mon 10/04/2010