A complete gynecologic exam must include a thorough physical examination, a visualization of the vulva to look out for abnormal lesions. An internal examination to palpate for masses and the possibility of tenderness in the vaginal walls or cervix. This involves inserting two adequately lubricated fingers into the vaginal orifice and assessing the anatomy through palpation or feeling. A bimanual exam must also be performed to rule out masses in the vagina and the rectum. An adequately lubricated finger is inserted into the vagina (usually the forefinger) and another finger (usually the middle finger) is inserted into the rectum. The examiner’s other hand is then used to feel the reproductive organs through the abdomen. Most importantly, the visualization of the cervix and the vaginal walls to ensure the sexual health of the patient. This also allows the physician to obtain samples of the discharges from the cervix and vagina.

This is achieved using a vaginal speculum which dilates the vaginal vault and allows visualization of the cervix. There are different types of vaginal specula. It usually consists of two blades and a handle that can be locked by fastening a screw once the blades click into place. The most common specula is the Graves vaginal speculum, otherwise known as the duckbill speculum. Its blades range from 1/2 inches to 1.5 inches in width. Its length ranges from three (3) inches to four and three fourths inches. The superior blade is usually shorter than the inferior blade. This is usually used in women who have had children or are sexually active. The Pederson vaginal speculum is similar to the Graves vaginal speculum, however, its blades are more narrow and flatter. Their small size makes them popular for use in pediatric patients. The first two specula types dilate the vaginal vault anteroposteriorly, which means it makes the opening taller. Another type of vaginal speculum called the side opening vaginal speculum dilates the vagina laterally, or it makes the vagina wider. The dimensions of this speculum are one and one fourth inches in width by four inches in length. To insert a vaginal speculum, the introitus or vaginal opening must be stretched open by two moistened fingers. The speculum must then be warmed and moistened with lubricant or warm water, afterwhich it is inserted laterally into the vaginal opening so as not to cause pain or discomfort. Once the speculum passes over the fingers holding the introitus open, they are turned horizontally. Insertion is continued to the back of the vagina, the speculum must be held at a 45 degree angle to the examination table. The speculum blades are then opened to reveal the cervix and the vaginal sidewalls. The blades are secured by compressing them moving the top one forward until a click is heard. Then the speculum is locked by rotating the mechanism clockwise. The examination and sampling of the cervix and vaginal sidewalls may then be performed. Examinations with the speculum are dreaded by women visiting their gynecologist, yet this tools of torture as most call them, have saved more than its fair share of patients from cervical cancer thru vigilant screening.