Locking the speculum open.

I can't stand plastic speculae. They pinch, they are harder to insert and the glare of the vaginal mucosa through the translucent blades blinds me. The metal can be prewarmed in a heated drawer and thus are as comfortable.

Yes liquidsky plastic speculums are not nice but its all about the cost and the increase in profit margins. As the Doctor rightly stated

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.

In the UK I have also noted the trend of the GP's option for plastic speculums as most of them had to send their metal speculum to the local hospital for autoclaving, thus increasing their cost. I think most hopsitals still use a metal speculum as their are "in housed autoclaved", in addition some speculum sizes and shapes are available only in metal.

The choice of metal versus plastic specula relates primarily to provider familiarity and opinion; there are no studies comparing patient comfort. Plastic speculae allow direct connections to lamps; their transparent bills also facilitate visualization. The audible and sensible clicks in locking plastic speculae position can be distressing, but one can avoid this by lifting the lock with one’s thumb.

From an environmental perspective, the argument for metal versus plastic resembles the debate between cloth versus disposable diapers; we have not seen an analysis comparing the landfill impact of plastic versus the resources required to sterilize and reuse metal speculae. ( Taken from The Challenging Pelvic Examination J Gen Intern Med. 2011 Jun; 26(6): 651–657. )

. . . . the trend of the GP's option for plastic speculums as most of them had to send their metal speculum to the local hospital for autoclaving, . . . .

You have got to be kidding me ! ! ! ! !

How can a doctor's office not have an autoclave?

Welcome to the 21st Century Susie. I'm afraid the autoclave in the private office has gone the way of the needle sharpening stone.

I'm going to skip sharpening needles for some folks. It should look good in the injection section of Med Fet 2. Nice, not so sharp 18G needles.

You have got to be kidding me ! ! ! ! !

How can a doctor's office not have an autoclave?

Susie the majority of GP surgeries in the UK in the past were single GP practices with just the GP and their receptionist, there were no nurses present at all so it was simpler to have their metal instruments autoclave at the local hospital .

Recently within the last 5-10years we have seen the formation of Surgeries which have a number of GP's as well as Practice Nurses ( most PAPs are done by them) . But even with the additional staff they are moving towards the disposable plastic speculum because of cost , it much cheaper to use that having to autoclave the metal speculums at the CSSD ( Central Sterile Services Department) at the local hospitals.

Sterilization has changed a lot in the past 25 years, the era of AIDS and HIV. At the same time, economy and efficiency of operation have become more important. Gone are the days of a doctor's office or dentist's office autoclaving their own instruments. Now everything is disposable, or shipped out for sterilization off premises.

Much the same in almost any line of business. The business concentrates on its core, and contracts out other things.

. . . Gone are the days of a doctor's office or dentist's office autoclaving their own instruments. Now everything is disposable, or shipped out for sterilization off premises. . . .

Dentist's offices DEFINITELY sterilize all their own instruments in house and everything they use is definitely NOT disposable.

The exams I have observed have been with the screw tightened into place - only once was it a plastic one that clicked into place.

All properly operating bi-valve specula have some method of locking open that I have ever seen. That should tell you something right there. There is no way I would ever NOT utilize this feature. The risk of quick closing and pinching is too great and I am all about comfort. If you were to use a speculum and while fully inserted just held it open manually and it slipped and proceeded to quickly close back, the two blades would most likely grasp the vaginal sidewalls (depending on the patient's anatomy in there) and she would indeed feel some discomfort--not a killer if it accidentally happened but I have never taken the chance. The worst thing that could happen would be the ends grasp the cervix and that would result in cramping more than likely. Either way, you're going to get a rise out of your patient I am sure. I always am utilizing the locking feature at each stage of examination. Think of it as a mountain climber that uses extra grappling hooks for safety as a backup. Of course there is also the convenience aspect also but I think that is beyond the scope of this topic.

I believe my obgyn holds it open and looks for my cervix. I've had him close and reposition it in the past. (I've been told I have a high cervix.) Once he finds it he will usually click it open which I believe is when it locks and then do all his tests.

As Alex2 said its always prudent to lock the speculum , as it can be very painful it it accidentally closes and pinches the walls of the vaginal or catches the cervix. Its precisely for that reason that the speculum is withdrawn partly open and not fully closed while in the vagina.

Tkdgurl yes in some patients it is indeed a bit difficult to visualize the cervix and so they well may hold it open while manipulating it to catch sight of that elusive cervix, before locking it open.

Well I can't speak for all doctor's offices here in the states but my old doctor Dr. John and his staff have their own autoclave and Doc does as well. But then he should know better than to use a plastic speculum on me anyway, lol.

Mashie

All of my wife's pelvic exams that involved the use of a speculum, the blades were always locked open. A few years ago the practice we go to switched from metal to plastic specula. They still have metal ones in the warming drawer, but those are used only if the patient requests the metal instead of the plastic. My wife has no preference so plastic is used. It is cool how it lights up.

My wife says she can feel each click of the plastic speculum as it is opened, and the clicks are pretty loud. She told me maybe next time she will request a metal speculum be used instead.

I’ve always had it locked in

My gynecologist doesn’t lock the speculum and doesn’t open it fully just as little as he needs to do the pap.

@Creekstone I am not trying to be a wise ass but unless it is a plastic speculum that makes that ratcheting sound, it is hard to tell if the thumbscrew on a metal speculum has been spun to keep it locked or not, and from a practical perspective once it is open, you do not want to allow it to close all the way as it will pinch, and generally dealing with the speculate and the sample collection swabs and brushes requires that the doctor have 3 hands or the speculum be locked open to some extent. Does your doctor have as assistant aht hands them al the things they need? That would allow them to keep it unlocked, but I really do not see the advantage of it.

It must make it kind of awkward if the speculum is not locked into place. The doctor only has two hands, one holding the speculum open and inside the vagina, and the vagina does have a tendency to push the speculum back out if pressure is not maintained on it. And the other hand holding the sample while avoiding touching anything with it. It is perfectly possible of course, although you would have to take the speculum out with one hand before dealing with the sample unless you had an assistant. I know the average appointment time for a smear test in the UK is 5 minutes, and the woman is only on the bed for 2 minutes, so perhaps the practice nurses use that technique themselves for speed.

I’ve always had it locked.

I've had it locked open a few times and didnt like it much. I always felt sore and loose afterwards.