Locking the speculum open.

Ladies, when you have a pap smear and a metal speculum is used does your doctor lock open the speculum while they take the sample? I noticed during my wife's last pelvic exam that her doctor held the speculum open with one hand and took the sample with the other. She was very quick and my wife was not uncomfortable at all.

Not a lady, but I could see my ex's exam and her gyno did lock the metal speculum open every time to take the swabs.

Mike it could stem from the fact that her cervix is not difficult to find/ see and so the speculum does not need to be fully opened or locked into position. But as the doctor mention if its metal then you can just turn the screw , a few turns to open the blades. If the cervix pops into view then they would be no reason to fully lock the speculum and cause unnecessary discomfort.

Also could be that the Dr. is just that fast that they can insert the speculum and hold it open with one hand, and get the sample with the other hand, then remove the speculum immediately after the sample was obtained without needing to keep the speculum open for a longer time.

My wife saw a doctor that held the plastic speculum with one hand and swabbed with the other. He made a comment like "fast and simple, just as it should be". He also did a 10 second breast exam over the gown, and he skipped the external pelvic exam.

Well Dr Stiffler I hope that the wife no longer see that Doctor as it would appear that he is very superficial in his examination. I really cannot see the point of performing a "10 second breast exam over the gown" you would not be able to feel a lump even if it was there, I sure he did not even perform an exam of the lymph nodes in her armpits.

As for not performing an external pelvic exam there is really no excuse or justification for not performing one as skin abnormalities, swelling, ulcerations, growths such as external genital warts (EGW) or tumors, rashes, lacerations, bruising, and discharge would all require further investigations.

Its seems that its all about patient throughput these days, seeing as much patients a day as possible. Which can results in obvious problems being missed or developing into more serious conditions later on. Its a very sad reflection of Modern medicine.

Each time I've seen the speculum used on my wife her doctor turned the screw a little bit, which locked open the speculum. Regardless, the speculum exam is still relatively quick.

RN1993,

The doctor may have rushed through the breast exam and skipped the external pelvic, but he spent 15 minutes talking to her before the exam and 10 minutes after the exam, mostly about personal things like hobbies, her job, etc.

My doctor locks it open so he has both hands free to take the samples

I use a plastic speculum and always lock them open. This way I can visualize more and get what I need done quickly. I can also inspect the external genetalia from here before insertion, while inserted, and upon removal of the speculum. While doing a bimanual examination I also slide my thumb along the externals to Palpate. May look to someone like I didn't do it, but it has been done. If anything looks/feels abnormal I examine further.

There is also NO excuse to do any part of an examination over clothing or a gown. That was the first thing they taught us in 1st year Physical Assessment courses.

The doctors I've been to have locked open the speculum. With plastic I can hear it click into place and with a metal speculum I can feel the "tap tap" of a finger on the speculum as the screw is tightened, and then loosened before removal. This leaves the doctors hands free to get the swab, take samples, place in thein prep pap container, etc.

I know my doctor locks them open. The reason I know this is because she talks and I have seen at any time either hand and sometimes both. The nurse is always handing her things and passing things back.

My GYNs both use metal speculums and put them into locked position

Yep, my doctors always lock the speculum open so they have both of their hand free for other stuff.

Yes mine have always been locked into place

It's always been locked open in me I think. The doctor definitely has had hands free.

I've seen three OB-GYNs although all from the same practice. They all have locked the speculum when taking a pap smear.

My doctor always locks it in place - part of the thrill is that clicking sound as well. I don't see how you could do it otherwise unless it was super quick and not a detailed examination.

Every doctor I have been to always locks the speculum in place, i can hear the click once I have been spread open. It seems like most doctors go for the plastic spec over the metal these days. Kind of a shame because the spinning of the screw definitely turns me on.

My gynecologist locks it open

Most doctors do lock the speculum as it frees their hands for actually taking the sample without having to worry about the speculum accidentally closing before the procedure is completed. With plastic speculum you always hear the click as the speculum is open and locked at the same time.

With metal you don't have too but its much safer, you would not want to pinch any tissue. Also forgot to mention some women the cervix is a bit difficult to find so you need to adjust the speculum, so when you do locate it, you want to make sure the speculum remains in position and locked open.

My GP and GYN have always locked the speculum open. I prefer metal over plastic. Locking the speculum open allows for easy smears etc and decreases the chance of the smears being contaminated.

~Andie

Thanks Andie, yes that's the most important aspect of taking a smear, so as you rightly said:

Locking the speculum open allows for easy smears etc and decreases the chance of the smears being contaminated.

Mine locks it in place and take samples

The last but 1st smear test the doctor locked it open. It felt like ages it was open

When the doctor locks the speculum open, I'm wondering if you know this because of the clicking sound or if you can actually feel the lock engaging while the speculum is in you. Thanks for any replies on this.

The metal Pedersens and Graves specula have a threaded screw to open them. They do not lock open. The plastic specula do lock open. I don't personally care very much for the plastic ones because they can pinch.

My girlfriend has told me that her doctor only uses plastic speculums for her pap smears and she asked her doctor why he uses plastic ones and he told her its alot cheaper to buy plastic ones than the metal ones she wishes her doctor uses the metal ones but he doesnt

It's not only the initial cost of the metal Specula... but the ongoing cost of having to autoclave them after each use.

In today's society, use and dispose is the norm... despite what it is doing to our land-fill situation, not to mention the bio-hazard issue.

Doc Rob

We have noticed that the use of metal specula vs plastic is about 70% in favor of metal.

I've only seen the thumb screw not used once. In that case the doctor had a chaperone to assist and she used the broom method so only a single sample was needed. This also was a very rushed exam so hard to tell if the purpose was patient comfort or to save thirty seconds and get on to the next room in assembly line fashion

Regards

Greg