What Is Dr. McDonald Holding With That Glove. A speculum

Speculum Sizes: “One Size Does Not Fit All,” Says Your Friendly Neighborhood Gynecologist

I feel like Clarke Kent in this opening pic. On our Facebook page I recently shared a post about what percentage of women do not see their gynecologist every year. The startling number out of 1000 women was over 300. For some, the reason is misinformation about how often one should go to the gynecologist. Annual check ups are still recommended, even if the Pap test is not required. Also an annual Pap test is still covered by most insurance plans, so if you are someone who wants a yearly pap despite present guidelines, that is acceptable.

I am guessing that more than confusion about frequency of exams, more women don’t see their Lady Doctor regularly because the exams are uncomfortable, even often painful. Discomfort I expect. Pain, I don’t.

I have been told countless times over the years that my Pap tests don’t hurt. Women often marvel at how much better tolerated my exams are than with previous doctors. I don’t know why that is. I have never compared my technique to other physicians. I do want to use this moment, however, to highlight a difference in speculum sizes and types used.

At my practice, we are fortunate to have speculums from all around the world. Just kidding. We actually have multiple types of speculums for different types of women. I believe this plays a role in the tolerability of a Pap or other speculum exam.

Let’s back up for a moment. The speculum is a metal or plastic device that is used to open the vagina enough to see inside. A physician can evaluate the walls of the vagina, the cervix, perform STD testing, examine discharge quality and quantity, and even perform procedures and surgeries with the aid of visualization provided by the speculum. The are very helpful in the field of gynecology as a whole. What they are not is one-size-fits all.

Enter Bubba Gump:

You have your metal speculum, your plastic speculum, your pediatric speculum, your Graves speculum, your Pederson speculum, your disposable speculum, your reusable speculum, your bivalve speculum, your weighted speculum, your… okay enough.
Here are is a picture that highlights the differences:
Multiple speculums on a table
Pictured here are pediatric, large and small Pederson, large and small Graves, and the extra-large Pederson. What can I say? Women come in all shapes and sizes
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Don’t Laugh. I included this pic because you may need a quick pic to pan to if anyone walks behind your phone or computer. How do you explain looking at an assortment of speculums? These Succulents I purchased as a set on Amazon, though.

The Pederson speculums are designed for women with more narrow vaginas. I prefer these for my ladies who have never had children before.

The Graves are particularly useful in women who have delivered babies vaginally. The curvature allows for better visualization of the cervix.

The pediatric speculum is excellent for my patients who have not been sexually active. The population, however, that gets the most benefit from pediatric speculums is ironically the elderly and postmenopausal women.

I could get into more speculum history, but you’re not interested in those details. Much more fun are my many Gyne’s Angels pics taken in the office last week:

Thanks Arshi for capturing the essence of the pediatric, small Pederson, and extra-large Pederson specs in perfect light! It’s not just awesome recipes and food photography with you! Check out Arshi’s Instagram page for more.

If you don’t like visiting your gynecologist because of the sheer weirdness of the whole experience, I can accept that sentiment. Make an appointment anyway. If you avoid this vital screening primarily because of pain, you may need a more customized evaluation. Just a thought. Oh, and one final public service announcement for complete clarification. Every speculum exam is NOT a Pap smear. An exam with the formerly (until now) dreaded speculum can be performed to visualize the cervix, do STD testing, check for abnormal bleeding etc. The Pap smear is specifically screening for cervical cancer. Check out my What’s Pap-pening post for more on that.

Can’t leave my girl Shelly out of this one:
Shelly Small Speculum
Good morning Charlie… with a vagina
Dr. Wendy Goodall McDonald is a board certified OBGYN. She began practicing medicine in 2007 and now uses her extensive knowledge and growing following to increase health awareness in a fun and viral way. She is the founder of The Gyneco-blogic and an author of numerous books for adult and childhood health education and social growth. For more, check me, I mean her out at dreverywoman.com
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One comment

  1. Thank you for this really helpful explanation! I was wondering if you had any recommendations for patients with connective tissue disorders such as Ehlers-Danlos Syndrome and Epidermolysis Bullosa? I have the former and am not sexually active, because my skin and mucous membranes are so fragile that they tear, blister or bruise at the slightest pressure or friction.

    As you can imagine, pelvic exams have been hell, with deep perineal tears which required a trip to the ER in two cases, because stitches eventually just rip through my fragile skin as well. Unfortunately, most ob/gyns are unaware of this and do not believe me until they end up with a bloody mess and a sobbing patient. Thanks to EDS, I am also completely immune to local anaesthetics, which makes these experiences even worse.

    Do you know of any alternatives for patients with extreme skin fragility, when even the pediatric speculums have failed? And do you possibly have any suggestions about how to explain this to new doctors so they believe me?

    Thank you again for this helpful blog post!

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