How does the gynecologist decide which speculum to use?

I just had a routine exam at a new gynecologist and he used a kristeller speculum which he asked me to hold. I was never examined with one of those and I was wondering if it’s decided which speculum to use based personal preference or if there are guidelines? What do you think?

I was definitely weirded out a bit by holding the upper blade myself lol

I have no real idea, never experienced that before but maybe the gyno wanted you to feel more involved and in control? Is it more comfortable than a regular speculum?

@Patientlywaiting could be! But no, I definitely felt more pressure than usual

@Lina98 I had never heard of that type, went online to see pictures and don't even understand how they work!

@Jacana how I learned today it’s two blades that are being inserted one after the other. The first one is pulled down (towards the anus) and the other one up. I was holding the upper one

@Lina98 Maybe this choice is motivated by putting the patient more in control?

Kristeller Vaginal speculum is a hand held speculum used to examine the walls of the vagina during pelvic examination, cervical examination, pap smears, cervical cytology and vaginal biopsy. It allows better visualization and manipulation than a traditional metal or plastic speculum.

So in answer to your question , its partly personal choice as a sims speculum could also have been used, but as stated it does allow better visualization of the walls of the vaginal canal than a traditional speculum so its fit for purpose ( well equipped or well suited for its designated role or purpose.)

@Jacana The Kristeller vaginal speculum and retractor is a single blade not self-retaining speculum. The advantage of Kristeller vaginal Speculum is that it gives more exposure of the vaginal cavity than self-retaining specula and therefore is preferred for gynecological procedure. The disadvantage of Kristeller vaginal speculum is that, being it not self-retaining, one assistant's help is need to keep the speculum in place.

@Lina98 For a routine exam the health care provider decides which speculum to use based in personal preference. I prefer for gynecological routine exams the self-retaining Cusco vaginal speculum.

All I know is that from now on, I’m reminding drs that both of my babies were born via c-section and I have a tight pelvic floor. No thank you to big speculums.

Brings a whole new perspective to the phrase "I want you to open wide for me" @Lina98

To be honest I was never curious enough to ask. I prefer plastic ones just because it isn’t as cold as the metal one, and that’s the one she always uses.

They decide by the body type and shape of a woman

To be honest I was never curious enough to ask. I prefer plastic ones just because it isn’t as cold as the metal one, and that’s the one she always uses.

I always thought women preferred metal speculums...

@HunnyBuns The use of disposable vaginal specula is associated with increased greenhouse gas equivalents compared with reusable alternatives with no significant difference in clinical utility.

I believe they had a favourite, a routine Speculum for everybody except special patients like virgins or teens. My gynecologist uses a disposable medium Collin, my GP have examined with a metal Collin.

I found the plastic ones are a little more comfortable than the metal ones, but I’m sure providers have their personal choices.

No personal experience but anything right out of the freezer should do!

😇😇😇😇😇

I would imagine that is why the do the bi manual first. To evaluate the size and tightness of the vagina.

I have to say that a few years ago I was working for a OB/GYN group. And they were starting to use disposable plastic vaginal speculums.

I was a medical assistant but also I was working as a financial analyst for the group. There is a lot of money in practicing GYN/OB. So the doctor wanted me to do a cost comparison between using metal or plastic vaginal speculums and the same with anal speculums.

Well it turned out that the plastic speculums were a little less expensive so that is what the practice used and the metal speculums went into a box and into my storage.

So the all mighty dollar won that battle.

P.S. Most doctors will look at the size of the female. Age, height and weight and if they have had any babies or other pertinent medical information and choose which speculum they will use. Pediatric, S, M, LG or X-LG. And will also put it into their notes about which speculum. And if it is too big or too small he will ask for a different size. And after the first month or so they are batting probably 97% correct on what size speculum they use.

My doctor uses a plastic lighted one.

Until recently it's always been a plastic disposable type. At my last visit it was steel. The doctor even explained that the health service was trying to reduce plastic waste, and I imagined all these plastic speculum floating around in the ocean..lol

It felt larger and colder and I didn't like the sound it made

Did you notice it sliding in more easily?

Did you notice it sliding in more easily?

No, it felt really cold and I felt a lot more pressure and pushing until the blades were fully inside

@Lina98 the Kristeller system is not actually a speculum. There are 2 separate valves, one to pull upwards, the other downwards. This system is rather used when it is necessary to perform an surgical procedure to open the vagina more widely. In this practice, it is most often the assistant who holds the upper valve, rarely the patient.

Concerning the model used, it is indeed the doctor's practice which makes him prefer this or that reference. We also tend to keep habits learned during studies, personally I'm more Collin.

As for the plastic or metal debate, for some it is an economic question.

In several regions of Europe, the doctor asks the patient to buy her speculum in a pharmacy before the consultation, so plastic models are used and then thrown away (bad for the carbon footprint)

In France some have done it but it is against the rules of the Health Insurance Fund. The consultation with the gynecologist is reimbursed but it is up to the doctor to provide the equipment he uses. The disposable system is therefore much more expensive than re-sterilized stainless steel instruments.

The argument that they are colder is not true; many pedestal tables are equipped with drawers allowing them to be brought to the correct temperature.

I find that the plastic models are less easy to introduce because they stick a little, however I think that you should always have some in advance in case you suspect a resistant infection (hepatitis C for example see HIV)

Concerning the size of the valves, it is the art of the gynecologist to have an eye to know which one will best correspond to the anatomy of his patient. To answer @bedwetter_bobby No, we do not do the bi-manual touch before because this would pollute the samples that we have to take during the smear once the speculum is in place.

I would really like to learn