Speculum examination frequently appears in OSCEs. You’ll be expected to competently perform the procedure and demonstrate appropriate communication skills with the patient or mannequin. This speculum examination OSCE guide provides a clear step-by-step approach to performing the procedure.
IntroductionÂ
- Wash your hands
- Introduce yourself
- Confirm the patient’s details (name and date of birth)
- Ask if the patient could currently be pregnant
- Explain the procedure (as shown below)
Explanation
Assess the patient’s current understanding:
- “I’ve been asked to perform a speculum examination.”
- “Do you understand what this procedure involves?”
Explain the procedure:
- “What the procedure will involve is me inserting a small plastic device called a speculum into the vagina. This will allow me to visualise the neck of the womb.”
- “The procedure shouldn’t be painful however it will feel a little uncomfortable.”
- “If at any point you want me to stop the procedure, please let me know. You may also experience some light vaginal bleeding after the procedure.”
Explain the need for a chaperone:
- “For this examination, another staff member will be present, acting as a chaperone.”
- “Are you happy for a chaperone to be present?”
- “Do you have any preference on the gender of the chaperone?”
Check the patient’s understanding and gain consent:
- “Do you understand everything I’ve explained?”
- “Do you have any questions?”
- “Are you happy for me to perform the procedure?”
Ask if the patient would like to go to the toilet to empty their bladder before the examination.
Gather equipment
- Gloves
- Lubricant
- Speculum
- A light source for the speculum
Position
The patient should be positioned supine on a bed with their underwear removed and their abdomen exposed (a modesty cloth should be provided):
- “I need you to go behind the curtain and remove your underwear. Could you please then get onto the bed and cover yourself with the cloth provided.”
Position the patient in the modified lithotomy position:
- “Bring your heels towards your bottom and then let your knees fall to the side.”
Inspection
Preparation
- Don gloves
Inspect the vulva
- Ulcers (e.g. genital herpes)
- Abnormal vaginal discharge (e.g. chlamydia or gonorrhoea)
- Scars from previous surgery (e.g. episiotomy)
- Vaginal atrophy (secondary to post-menopausal changes)
- Masses (e.g. Bartholin’s cyst)
- Varicosities (varicose veins secondary to venous disease/obstruction in the pelvis)
Inserting the speculum
1. Warn the patient you are about to insert the speculum
2. Use your left hand (index finger and thumb) to separate the labia
3. Gently insert the speculum sideways (blades closed, angled downwards and backwards)
4. Once inserted, rotate the speculum back 90 degrees (so that the handle is facing upwards)
5. Open the speculum blades until an optimal view of the cervix is achieved
6. Tighten the locking nut to fix the position of the blades
Gently insert the speculum sideways with the blades closed
Once inserted rotate the speculum back 90 degrees
Open the speculum blades gently to obtain optimal view of the cervix
Fix the position of the speculum using the locking nut
Visualising the cervix
Inspect the cervix
- External os (note if open or closed)
- Cervical erosions (e.g. ectropion)
- Masses (e.g. cervical malignancy)
- Ulcers (e.g. genital herpes)
- Abnormal discharge (e.g. bacterial vaginosis)
Inspect the cervix
Removing the speculum
1. Loosen the locking nut on the speculum and partially close the blades
2. Rotate the speculum 90 degrees, back to its original insertion orientation
3. Gently remove the speculum, inspecting the walls of the vagina as you do so
4. Re-cover the patient
5. Dispose of the speculum and gloves
6. Wash hands
Loosen the locking nut
Gently remove the speculum, with the blades partly closed, inspecting the vaginal walls as you do so
Dispose of your equipment into an appropriate clinical waste bin
Wash hands.
To complete the procedure…
- Thank the patient
- Allow the patient time to get re-dressed
- Label the sample
- Document the procedure in the medical notes including the details of the chaperone
Summarise findings
“On examination of Mrs Smith, a 29-year-old female, there were no abnormalities of the vulva noted on inspection. Speculum examination revealed a healthy cervix, with the external os closed and no abnormal masses or discharge present.”
Suggest further assessments and investigations
- Swabs – microbiology /virology (e.g. STI screening)
- HPV testing
Markscheme
nstructions - “Perform a speculum examination on this patient” 1 Washes hands 2 Introduces themselves & confirms patient details 3 Explains procedure & gains consent 4 Requests a chaperone 5 Positions patient appropriately 6 Dons gloves 7 Inspects the vulva 8 Lubricates speculum 9 Warns patient of speculum insertion 10 Inserts speculum with blades closed 11 Opens speculum blades once fully inserted & tightens locking nut 12 Inspects the cervix 13 Removes speculum 14 Disposes of speculum and gloves 15 Re-covers patient and allows them privacy to get dressed 16 Washes hands 17 Thanks patient 18 Summarises salient findings 19 Suggests further assessments & investigations
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Speculum examaintion:
Introductory stuff
Position
inpection 6
Enter
Cervix 5
Withdraw while inspect
Fuirther investigation