Speculum

What is a speculum?

A speculum is a device a healthcare provider uses to examine hollow openings in your body, like your vagina, anus, ears or nostrils. The vaginal speculum used during pelvic exams is probably the most well-known type. During an exam, the speculum widens your vaginal walls just enough for your provider to see your vaginal canal and your cervix. Your cervix is the opening between your vagina and your uterus.

A speculum allows your provider to check abnormal growths, take fluid samples for testing, and even perform surgeries through your vagina.

What does a speculum look like?

Speculums come in different designs, depending on their purpose. During a gynecologist visit, the speculum you’ll most likely see has two arms that meet at a hinge. The arms resemble a duck’s bill. They’re the part of the speculum that goes inside your vagina. When the arms open, your vagina widens. When they close, your vagina returns to its regular size.

Speculums are either stainless steel or plastic. Some plastic speculums have built-in lights that make it easier for your provider to view your vagina and cervix.

What are the different types of vaginal speculums?

Just like vaginas, speculums come in different sizes. Factors like genetics, age, health and sexual activity determine your vagina’s size and how stretchy or elastic your vaginal walls are. It’s important for your comfort that your provider chooses a speculum that fits your vagina.

During an exam, your provider will use the smallest speculum that allows them to visualize your vagina and cervix. Some of the most common types of vaginal speculums include the following.

• A pediatric speculum is the smallest speculum. It’s narrower and shorter than other speculums. The name can be confusing, but a pediatric speculum isn’t commonly used on children. Instead, your provider may use it if you’ve never had sexual intercourse. Pediatric speculums are also widely used with people who are postmenopausal. Changes to your vaginal walls after menopause may make it difficult to tolerate a larger speculum.
• The Huffman speculum is bigger than a pediatric one but smaller than the commonly used Pederson one. It’s also designed for individuals who haven’t had penetrative sex.
• The Pederson speculum is one of the most commonly used speculums. Your provider may use this speculum if you’ve had intercourse or are sexually active but haven’t given birth. Pederson speculums come in a variety of sizes.
• The Graves speculum is also commonly used. It’s larger than the Pederson speculum, making it a good choice if you have a longer vaginal canal or vaginal walls with more elasticity. Your provider may use a Graves speculum if you’ve given birth vaginally. This type of speculum is also commonly used during procedures like colposcopy and biopsy. Graves speculums also come in a range of sizes.

What is a vaginal speculum used for?

You’ll most likely encounter a speculum during a pelvic exam or Pap smear. During a pelvic exam, your provider gently inserts the duck-billed part of the speculum into your vagina and opens the speculum to widen your vaginal walls. The widening makes it easier view your cervix and check for abnormal growths or other irregularities. During a Pap smear, your provider collects cells from your cervix that are later tested for signs of cervical cancer.

Getting familiar with a vaginal speculum during these routine exams can prepare you for procedures that you may need someday, which also use speculums. Some of these procedures include:

• Biopsy.
• Colposcopy.
• Dilation & Curettage (D&C).
• Endometrial ablation.
• In vitro fertilization (IVF).
• IUD placement.
• Loop electrosurgical excision procedure (LEEP).
• Vaginal hysterectomy.

For procedures where the speculum is in place for a long period of time (like a D&C and hysterectomy), you’ll be asleep.

Is a speculum safe?

Yes. Various speculum designs have been used for centuries to aid in diagnosing and treating gynecological conditions. Your healthcare provider will sterilize the speculum beforehand to ensure no bacteria enter your body when they insert it. You don’t have to be concerned about any long-term loosening of your vagina. Any widening during the procedure is temporary. Your vagina will return to its regular size after your exam.

Does a speculum hurt?

It’s common to feel discomfort or pressure when your healthcare provider inserts the speculum and widens it, but it should never hurt. Your provider may push down to relax the muscle at the opening of your vagina as the speculum goes in to reduce any discomfort.

If the speculum feels painful, you may be anxious and tense. Tense muscles can make the experience more painful than it has to be. Breathing and relaxation exercises can help.

Some conditions can make the experience painful if your provider doesn’t know about them beforehand. These conditions include:

• Lichen sclerosus: Lichen sclerosus is a skin disorder that may make your skin less stretchy and more susceptible to tears during a speculum exam.
• Vaginal atrophy: Vaginal atrophy occurs when decreases in estrogen thin your vaginal walls, causing your vaginal canal to shorten and tighten. This might make your vagina feel irritated, dry and sore. You may be more likely to experience discomfort during a speculum exam if you have this condition.
• Vaginismus: With vaginismus, the muscles around your vagina tense because you’re afraid of penetration. This fear includes being penetrated by a speculum. When your muscles tense, your vagina contracts, making a speculum exam more painful.
• Vulvodynia:Vulvodynia is chronic pain in your genitals, or vulva. This pain can extend to your vagina, making a speculum feel painful.

It’s important to let your healthcare provider know if you have any of these conditions so that they can take extra precautions to make the experience as comfortable for you as possible. Another option is to request that the provider who performs your exam has experience performing exams on people with your condition.

How can I make a speculum exam more comfortable?

Come to your appointment ready to communicate with your healthcare provider about your sexual history and your preferences so that they can deliver the best experience possible.

If you’re comfortable doing so, communicate with your provider about:

• Your gender identity and sexuality: Pelvic exams may feel especially unpleasant if the experience of penetration feels in opposition to your gender identity or sexuality. Communicate your concerns to your provider so that they can take these factors into account as they ease you through the exam step-by-step.
• Your sexual activity: Having a clear understanding of your history with vaginal penetration can help your provider choose a speculum that fits your vagina comfortably.
• How you tolerate penetration: Let your provider know if penetration is painful for you, including nonsexual penetration. For instance, if you know that you can’t tolerate tampons, let your provider know.
• Any history of sexual trauma or abuse: Pelvic exams may be difficult if you’ve experienced sexual trauma or abuse. Let your provider know about this history so that they can take additional care to ensure your comfort during the exam.

You can also ask that your provider take steps to create a more comfortable experience for you. For instance, you may request that they:

• Start by using the smallest speculum possible.
• Warm the speculum before the procedure.
• Lubricate the speculum before the procedure. This may not always be possible, however, especially if your provider is taking a fluid sample.
• Describe what’s happening during the procedure, alerting you of any sensations you can expect to feel.

You might also ask if listening to headphones during your exam is ok. Listening to calming music, a meditation or an audiobook may serve as a pleasant distraction.

Why does a speculum hurt so much?

Pain may be a sign that your muscles are overly tense or that you have a condition that’s making the experience painful. To prevent pain, communicate your concerns and relevant health information to your provider. Let them know at any point if you’re experiencing pain.

How wide does a speculum open you?

While many people imagine their vaginal walls getting stretched drastically, usually, the widening is only slight. For instance, it will only need to be widened an inch or less for a routine Pap smear.

Can a speculum cut you?

When a speculum is used correctly, it shouldn’t break any skin. Choosing the right size speculum for your vagina will prevent your hymen (tissue located near your vaginal opening) from tearing.

A note from Cleveland Clinic

No one enjoys the thought of having their vaginal walls widened while someone — even a medical professional — takes a closer look. Still, the benefits of enduring a speculum for a few minutes outweigh any discomfort. Both pelvic exams and Pap smears can detect conditions early so that you can receive the treatment you need. Early detection and treatment for cervical cancer may save your life. In the meantime, be proactive when it comes to your comfort. Tell your provider about your pain threshold. Don’t be afraid to ask for things you need, including a walk-through of what to expect.