Ch 2. Speculum Examinations.

Posted: May 13, 2012 in Gynocology

Indications :

  1. Routine screening
  2. Prolapse
  3. Postcoital bleeding, intermittent menstrual bleeding
  4. Painful intercourse
  5. Presence of infection / discharge
Equipment :
  1. Gloves
  2. Speculum
  3. Lubricating jelly
  4. Examination couch and a ‘modesty sheet’
  5. Adequate lighting
  6. Ensure speculum is warmed and all equipment is in working order

Positioning :

  1. Patient should be supine.
  2. Place heels together with knees bent & allow legs to ‘fall’ apart.
  3. The light should be adjusted to allow a good view of the vulva and perineum
Inspection :
  1. Hair distribution
  2. Vulval skin
  3. Look at the perineum for scars/tears
  4. Gently part labia – inspect urethra
  5. Look for discharge, prolapse, ulcers, warts
Insertion :
  1. Hold speculum so blades are orientated in direction of vaginal opening
  2. Part the labia and slowly insert, rotating the speculum until its blades are horizontal
Visualisation of Cervix :
Inspect for:
  1. Discharge
  2. Warts
  3. Tumours
  4. Size of cervical os
  5. Bleeding
Univalve Speculum Positioning :
  1. Position patient in the left lateral position
  2. Knees drawn up to chest
  3. Hold back anterior vaginal wall with lubricated speculum
Findings :
Ask the patient to cough:
  1. Rectocele
  2. Cystocele
  3. Liquor
A speculum examination should be performed using minimal lubrication if a smear is to be performed.  For this reason, it is recommended the speculum examination is performed before the bimanual examination, to allow for extra lubricant during the bimanual procedure.
Taking a Cervical smear :
  • Rest point of spatula within the os and rotate clockwise 360° then rotate 360° anti-clockwise.
  • Exert light pressure (pencil).
  • Ensure contact with cervix throughout.
  1. Smear – this is done to analyse cells for any pre-cancerous changes. Under direct vision using the cervical brush, rotate 5 x 360 degree sweep around the centre of the cervix, then break the sample brush off into the liquid based cytology pot. For further information about smear tests see here.
  2. High Vaginal Swab – this will test for any bacterial infection for example bacterial vaginosis. A routine bacteriology swab is used to collect the sample, including any discharge present from the posterior fornix (upper vagina).
  3. Endocervical Chlamydial Swab – as chlamydia actually resides within cells, PCR is used. First a swab is used to clean away any discharge, then the endocervical swab is gently inserted into the centre of the cervix and gently rotated. The swab is then broken off into the liquid sample pot provided. An endocervical swab is also used for gonorrhoea.

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