OB/Gyn FREE Class

Lesson 4: The Pelvic Exam - The speculum and Your Cervix

Class Instructor: Dorrie Lane

First let's talk about your cervix. Check out the wonderful My Beautiful Cervix site to get comfortable if you've not looked at your own or if you want to see how very beautiful the cervix really is. I like to call the cervix the gateway to creation. Okay, back to the class...

I don't know of one woman who hasn't had her labia or pubic hair pinched by the speculum. At the very least, if your doctor says to you before inserting the speculum into your vagina, "this is gonna be a little cold", draw your knees together and ask that it be warmed in water first. There is no reason for not warming the speculum. Nor is there a reason for not using lubricant sparingly on the outside of the bills to assist insertion. The research regarding lubricant interfering with the reading of Pap smears is more than 20 years old and is not considered relevant. Remember you are in charge of your health care and comfort.

Once the speculum is inserted and opened, your doctor has to find your cervix and os. This should not be too difficult since a finger was just there. If there is a problem finding them, changing your position slightly will aid in their location. Your cervix and os change and are affected by births obviously, some std's, any type of invasive procedures and menopause. I am always curious to get a look at my cervix with a mirror when I'm getting a pelvic. And I always mention to my doctor that this is the entry of all creation. (Just to remind myself how sacred my body is.) Your doctor should tell you the shape, color, position and any ulcerations, bleeding or discharges she/he sees. This is also the time to take cell samples, you should barely feel this. If it creates noticible discomfort speak up and let your doctor know. Before the speculum is removed completely, your doctor should ask you to bear down and push out. This moves the bills away from your cervix before the speculum closes together. Then it can be removed without scraping your cervix.

The Rectovaginal Exam

Most women do not have a "medical textbook" uterus. Many have retroverted, retroflexed, anteflexed or antiverted placement of our uterus. This exam is important because it may be the only way a doctor can actually feel your uterus. I know, a finger in my rectum?? Just remember to relax, a big exhale of breath helps. A newly gloved and lubricated finger is inserted into your rectum, while another is inserted into your vagina. The free hand again presses downward on the abdomen to allow palpation of your uterus and ovaries. The doctor will also feel the septum (a thin wall of tissue that separates your rectum and vagina) for any abnormal masses. With this last swirl of a finger the exam is over. You should be offered a tissue to wipe away any excess lubricant. Voila!

You can purchase your very own plastic speculum here.

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