Asking for a Speculum That Works for You

Pelvic exams often include the use of a vaginal speculum.  Clinicians use vaginal speculums to view the vagina, cervix, any discharge or inflammation or abnormal growths, and take samples when needed.  Vaginal speculums are also used to perform select surgeries of the pelvic area.

Vaginal speculums come in different sizes, shapes, materials and even colors.  Some speculums even have a light attached. Speculum exams can range from awkward but not uncomfortable, to uncomfortable or painful and/or emotional/frightening.  Some exams are difficult due to the medical condition that requires the exam.  For some women, the memory of past exams or past traumatic experiences can cause them to avoid adequate gynecological health care.

The history of the vaginal speculum is fraught with mistreatment of women.  The modern speculum was invented from doctors’ experiences who experimented on enslaved women and imprisoned women in concentration camps.  The current design of the speculum dates back to Marion Sims who designed the speculum in the 1840s based on treating gynecological conditions and performing surgeries on enslaved women in the U.S.
The use of speculums grew from there, and in the 1860s was once again used by the British government to identify women suspected of prostitution and inspecting and testing for sexually transmitted infections.

Here we are, 180 years late, whereby the device is much the same although some inventors and entrepreneurs are trying to improve on things, making them less noisy, warmer materials rather than plastic or metal, and easier to insert.

There are several ways you can make a speculum exam easier, involving both the practitioner and the patient.

• Use the smallest speculum possible, that works for this body and the exam that is needed.
• If you have a history of knowing the size and shape of the speculum, this can be a request made.
• Speculums can be made of glass, metal, or plastic. Requests can be made.
• Speculums can have one, two, or three blades. The most common type is a duck-gilled two blade shape. Some versions have wings that help to expand the vaginal walls so that the cervix can be more easily viewed.
• Size matters here. Many women only need the smallest of speculums, even a pediatric speculum might work.  Others need larger/wider blades and/or long blades.
• The clinician can warm and/or lubricate the speculum before insertion, making it more comfortable
• The patient may want the clinician to talk through it, describing the process and communicating each step right before the next step. Other patients just want the clinician to do what is needed and no talking.   It is the clinician’s responsibility to inquire.
• The exam might be more comfortable with… music? Turning the lights down? Another person in the exam room – whether friend/relative/spouse/ professional assistant. Again, the clinician should inquire.

For women about to have an exam, my advice is to communicate your needs, your requests, and seek providers who are respectful of these and able to accommodate your requests.