Speculum examination

Question 1

Speculum - Introduction

Answer 1

• Wash hands
• Introduce
• Check patient identity
• Explain procedure
• Gain consent
• Offer chaperone
• “Do you need to empty your bladder before the procedure?”
• Undress (offer privacy and sheet)
• Position
  
  • “Bring your heels towards your bottom and let your knees fall to the side”

Question 2

Speculum - General inspection

Answer 2

• Comfortable at rest? Well/unwell?
• Polycystic ovary syndrome
  
  • Hirsutism
  • Acne
  • Raised BMI
• Secondary sexual characteristics
  
  • Breast development
  • Pubic hair
• Pallor

Question 3

Speculum - Inspection

Answer 3

• Put on sterile gloves
• Part labia and observe area for:
  
  • Scars
  • Swellings
  • Discharge or blood
  • Ulcers or warts
  • Varicosities
• Ask patient to cough/bear down whilst looking for prolapse or involuntary leakage of urine (stress incontinence)

Question 4

Insert speculum

Answer 4

• Lubricate speculum
• Warn patient, may feel a bit uncomfortable
• Insert angled down with handles at 9 o’clock
• Angle up while turning the handles to 12 o’clock. Slide hand back at this point
• Open blades and position until cervix is in view, then fix in place
• Inspect cervix for:
  
  • External os (open/closed - parous/nulliparous)
  • Ectopy
  • Ulcers, polyps
  • Discharge
  • Erythema

Question 5

Speculum - Taking swabs

Answer 5

• 1. Cervical smear (dyskaryosis - pre-cancerous cells)
     * Insert into external os, rotate clockwise 5 times
     * Remove white head and place in sample pot
• 2. High vaginal swab (bacterial vaginosis)
     * Charcoal swab (remove cap first)
     * Swab posterior fornix
• 3. Endocervical swab (Chlamydia & Gonorrhoea)
• • Thinner swab
    
    • Clean area if any obvious discharge
    • Rotate swab in external os
    • Snap head off and place in sample pot

Remove speculum (draw back slightly before closing the blades to avoid catching the cervix)

Question 6

Speculum - Complete examination

Answer 6

• Dipstick urine
• Bloods (FBC, WBC etc)