The patient is in the dorsal position. To introduce the bivalve speculum, anoint the left forefinger with lubrichondrin and both valves of the speculum are smeared with it. The forefinger is introduced into the vagina as in making a digital examination, depressing the perineum, and introducing the speculum with its slit vertical. Before reaching deepest point, turn so that short blade is above and long behind. Separate blades until cervix is engaged, then secure with set-screw on handle. Care must be exercised to avoid pinching folds of vagina or labia minora between bases of blades.
<Callout type="important" title="Critical Step">Careful handling of the speculum is crucial to prevent injury and ensure a clear view.</Callout> Some bivalve specula, such as Graves, have an additional set-screw for increased spread at introitus vaginae. To bring cervix into view if it does not present readily, hook tenaculum in os and draw cervix downward. The Neugebauer bivalve speculum and Ferguson cylindrical speculum are also used but offer fewer advantages over the duckbill speculum.
<Callout type="gear" title="Essential Equipment">Equip yourself with a variety of specula to accommodate different patient needs.</Callout> For operative procedures, the Edebohls speculum is preferred due to its solid flattened weight and hook. The Sims speculum transforms gynecology when used in Sims or knee-chest position. An assistant holds labium majus on upper right side while operator introduces speculum blade into vagina.
<Callout type="risk" title="Safety Hazard">Using the wrong size speculum can cause unnecessary suffering and limit visibility.</Callout> The vaginal walls may require a depressor to push out obstructing folds. The Hunter depressor is recommended for its flexible copper shank and polished silver surface, which reflects light aiding in illumination of deep recesses.
Looking into vagina confirms tactile information, noting rugae, inflammation conditions, canal caliber, length, elasticity, shape abnormalities, discharge character, amount, reaction, cervix shape, size, location, lacerations, cervical discharge characteristics. Cover-glass specimens and cultures from discharge may be made if necessary.
Key Takeaways
- Correct handling of the speculum is essential to avoid injury and ensure a clear view.
- Different types of specula are suited for various conditions and patient needs.
- Depressors can be used to push out obstructing vaginal folds, improving visibility.
Practical Tips
- Use an assistant when using the Sims speculum to hold labium majus properly.
- Choose the smallest speculum that provides a good view to minimize discomfort.
- The Hunter depressor is highly effective for pushing out obstructing vaginal folds.
Warnings & Risks
- Incorrect handling of the speculum can lead to injury and poor visibility.
- Using an inappropriate size or type of speculum may cause unnecessary suffering.
- Failure to properly clean and sterilize instruments can result in septic infection.
Modern Application
While this chapter provides detailed historical techniques for gynecological examinations, modern medical practices have advanced significantly. However, the principles of careful handling, proper instrument selection, and thorough examination remain crucial. Understanding these foundational methods enhances contemporary medical practice by emphasizing patient comfort and safety.
Frequently Asked Questions
Q: What is the correct position for introducing a bivalve speculum?
The patient should be in the dorsal position with the left forefinger anointed and both valves of the speculum smeared. The forefinger introduces the speculum into the vagina, depressing the perineum.
Q: Why is careful handling important when using a bivalve speculum?
Careful handling prevents injury to vaginal folds and labia minora, ensuring a clear view without causing unnecessary suffering or obscuring necessary areas for examination.
Q: What equipment is recommended for pushing out obstructing vaginal folds during an examination?
The Hunter depressor with its flexible copper shank and polished silver surface is highly effective, as it reflects light aiding in illumination of deep recesses within the vagina.