Rookie
When using a speculum there are a number of points to consider:
1. Provide the patient with the opportunity to pass urine before the examination.
2. Position the patient in the modified lithotomy position: “Draw your ankles up towards your buttocks, keep your feet flat on the bed, and then let your legs fall open”. If you do not have leg rest or stirrups. Often overlooked by play doctors ....your patients needs to be comfortable .
Inserting the Speculum
1. While the vagina is not sterile ,its important to use a clean , non contaminated speculum.
2. Lubricate the speculum by dipping the speculum into the lubricant.
3. Carefully separate the labia using the thumb and index finger of your non-dominant hand.
4. With the blades closed, gently insert the speculum. Usually, the speculum is inserted with the handle pointing sideways (at 9 or 3 o’clock).
5. Once inserted, rotate the speculum so that the handle is facing upwards. If using a Collins speculum this rotation is not required.
6. Open the speculum blades until an optimal view of the cervix is achieved. Do this slowly, if the patient is tense encourage them to take a few deep breaths which will help to relax the vaginal muscles. As a beginner you do not need to open the blades to the maximum. Never force the speculum. If there is resistance, withdraw it and re-evaluate the angle and position.
7. Tighten the locking nut to fix the position of the blades.
8. If you need to move /adjust the speculum gently withdraw it slightly, reposition it at a better angle (e.g., more posterior if the cervix is anterior), and reinsert it.
Removing the Speculum
1. With your non-dominant hand, hold the blades of the speculum whilst you loosen the locking nut with your dominant hand. This ensures the blades do not snap shut when the locking nut is loosened.
2. Gently remove the speculum whilst slowly closing the blades and inspecting the walls of the vagina. Ensure you never fully close the blades before removal of the speculum. Closing the speculum full will pinch the vaginal walls, very painful and may end the future participation of your patient .
3. Clean the speculum, don,t allow the secretions to dry as it will be more difficult to remove.
Hope this helps. There is a lot of information and videos that show how to insert and remove a speculum. As with all things go slowly and take your time .