Vaginal Speculum Examination

Question 1

What are the steps?

Answer 1

Introduction and Identification

Explanation

Exposure

Position the patient correctly

Put non-sterile gloves on

Inspection

Speculum Insertion

Remove speculum from vagina

Complete the examination

Dispose of gloves in clinical waste and clean your hands

Question 2

Clean your hands

Introduction and Identification

Answer 2

Give your name and status

Ask patient for their name and DOB

Question 3

Explanation

Answer 3

Explain to patient what you wish to examine and purpose of examination. Await the patient’s verbal consent

Inform the patient that a chaperone will be present and check if this is alright

Ask if patient would like to empty their bladder before you start

Question 4

Exposure

Answer 4

Request patient removes undercothes

Preserves modesty with sheet

Advises when ready

Question 5

Position the patient correctly

Answer 5

Instruct patient to lie on back, knees bent and apart or in leg rests; adjust lighting

Check patient comfort

Question 6

Put non-sterile gloves on

then

Answer 6

Ask patient to remove modesty sheet

Question 7

Inspection

Answer 7

Observe:

• Hair distribution
• Skin abnormalities
• Discharge
• Swelling
• Prolapse `

Question 8

Speculum insertion

Answer 8

Check with patient if any tenderness

Lubricate speculum with small amount water-based gel except if taking cervical cytology, ensure blades are closed

Separate labia with non-dominant hand to expose posterior introitus

Gently insert speculum with anterior blade anterior and posterior blade posterior to separate anterior and posterior wall of the vagina

Aim for posterior vault and insert the speculum fully, open blades 5mm and guide the speculum to view the cervix

Open speculum to view cervix but only secure if you are undertaking a procedure

Question 9

What do you comment on for cervix?

Answer 9

Note

• Appearance and colour of cervix
  
  • Ulcerations, polyps, blood?
• Amount and colour of any vaginal secretions

Question 10

Remove speculum from vagina

Answer 10

It may be necessary to open the speculum slightly to release the cervix

Remove slowly with blades closed

Question 11

Complete the examination

Answer 11

Inform the patient that you have completed the examination and ask her to get dressed

Thank the patient, explain that you will come back when she is ready to discuss findings

Dispose of gloves in clinical waste and clean your hands