Vaginal examination

Speculum Exam
  1. Warm and lubricate the speculum by holding it under running tap water.
  2. Announce what you are going to do and then touch the patient on the thigh with the speculum before proceeding. Vaginal examination
  3. Expose the introitis by spreading the labia from below using the index and middle fingers of the non-dominant hand (peace sign).
  4. Insert the speculum at a 45 degree angle pointing slightly downward. Avoid contact with the anterior structures.
  5. Once past the introitis, rotate the speculum to a horizontal position and continue insertion until the handle is almost flush with the perineum.
  6. Open the "bills" of the speculum 2 or 3 cm using the thumb lever. Position the bills so that the cervix "falls" in between.
  7. Secure the speculum by turning the thumb nut (metal speculum) or clicking the ratchet mechanism (plastic speculum). Do not move the speculum while it is locked open.
  8. Observe the cervix and vaginal walls for lesions or discharge. Obtain specimens for culture and cytology as indicated.
  9. Withdraw the speculum slightly to clear the cervix. Loosen the speculum and allow the "bills" to fall together. Continue to withdraw while rotating the speculum to 45 degrees. Again, avoid contact with the anterior structures.
  10. Replace the drape while you prepare for the rest of the exam.
  11. Reassure the patient, if the exam is normal so far, say so.



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