A speculum is an instrument used in gynecology, gastroenterology to view the cervix and vagina or anus, as well as by ENT physicians and general practitioners to examine the ear canal and nasal canal.

In this article, find out everything you need to know about the speculum.

A speculum is an instrument that is used to separate a cavity or a duct (uterus, rectum, nostril, ear canal) to visualize the interior of the cavity or duct.

In gynecology, the speculum is used to examine the internal part of the birth canal (vagina, cervix).

Composition according to specialties

• The gynecological speculum consists of two blades. It is either disposable and plastic and polystyrene or metal and autoclavable after each use.
  
• The anal speculum also consists of two blades but there are only metal models.
• The nasal speculum is made up of movable valves and is most often disposable and plastic.
• The ear speculum or ear otoscope is funnel shaped and made of plastic. It attaches to an otoscope.

The speculum is a medical instrument used to observe a cavity in the body: the vagina and the cervix, the rectum, the nostrils, the ear canals. It allows to examine the cavity or the duct by removing the orifice: appearance, color, presence of lesion. It is also used to take samples (biopsy) and perform therapeutic procedures.

The speculum is mainly used by gynecologists and midwives to perform gynecological examinations. There are many models.

Speculum in gynecology

The speculum maintains the walls of the vagina and allows you to see the vagina, the cervix (its appearance, does it show any discharge? Lesions?).

It also makes it possible to take samples (bacteriological, parasitological, virological vaginal and at the level of the uterine cervix), a vaginal smear, or a biopsy.

The speculum is also used to insert and remove an IUD, collect oocytes by puncture and transfer embryos in the context of assisted reproduction techniques such as IVF.

Finally, it is also used to perform therapeutic gestures:

• perform colposcopy of the cervix;
• make a conization of the uterine cervix;
• perform curettage in the context of termination of pregnancy;
• do an amnioscopy;
• perform a cerclage of the uterine cervix.

Speculum for anus and rectum

The speculum for the anus is called an anoscopic, the one for the rectum rectoscope. The anoscopy is used to perform an anoscopy, an examination that allows you to see the anal canal and to diagnose many pathologies: infections, hemorrhoids, anal fissures and fistulas.

Nasal and auricular speculum

The nasal speculum is an instrument used in otolaryngology to allow the extraction of foreign bodies located in the nasal cavity. It also allows the observation of the mucous membrane, the nasal septum.

The ear speculum allows you to observe the inside of the ear, to inspect the external auditory canal as well as the eardrum in order to detect possible abnormalities such as acute otitis externa or media, a plug or a lesion of the mucous membrane. .

Public concerned or at risk

We may all need a speculum examination from a general practitioner or specialist doctor.

Women under the care of a gynecologist have regular examinations with a vaginal speculum.

The stages of operation

The speculum used by gynecologists is introduced into the vagina (the woman is lying down, legs apart, feet in the stirrups) then the doctor pulls the blades apart which opens the walls of the vagina a little.

The anal speculum is gently introduced into the anal canal, while the person is either in a lateral decubitus position (lying on the left side, knees bent towards the chest and buttocks at the edge of the table) or in a knee-pectoral position. (on all fours, forearms bent so that the buttocks are raised). This small speculum keeps the anus open.

The spacing of the movable valves of the nasal speculum spreads the wings of the nose.

When is it used?

Use of the speculum according to the specialties

The vaginal speculum is used when gynecologists do a pelvic exam, but also to take samples, certain acts such as the insertion of an IUD or therapeutic acts.

The anal speculum is used during a proctological consultation, after a digital rectal examination, to diagnose a pathology of the anus or rectum.

The nasal speculum is used by ENTs to examine the nasal cavity or extract a foreign body from the nasal cavity.

The ear speculum is used by general practitioners and ENT physicians to diagnose possible pathology of the ear canal and eardrum.

Will I be in pain?

The introduction of a vaginal speculum is usually not painful. It can be unpleasant though. It is advisable to relax and focus on your breathing.

The introduction of a nasal speculum or an ear speculum is not painful, nor is that of the use of an anal speculum which can however be a little unpleasant.

The examination with a speculum does not require preliminary preparations.

Vaginal speculum

There are different vaginal specula for different uses.

The most commonly used specula are the Collin speculum (speculum with two removable valves) and the Cusco speculum (speculum with two non-removable valves).

Jayle’s speculum and Koogan’s speculum are rarer among gynecologists. The first works with a double movement, to spread both the vulva and the walls of the vagina. Koogan’s speculum is mainly used for colposcopies because it makes it easier to reach the cervix.

Dr COHEN Jonathan’s 4-valve speculum was designed in 2015 by this doctor. It is used for the management of bleeding during delivery.

Anal speculum

There is a very wide variety of rectal specula, in most cases they bear the name of their inventor:

• the Fansler;
• Floor hammer;
• Sims ;
• de Czerny, etc.

Nasal speculum

There are also different models of nasal speculum:

• the Killian Hartmann speculum, used during examinations and surgical procedures in ENT;
• the Vacher nasal speculum, made of steel, intended for ENT examinations;
• the Voltolini nasal speculum, an adjustable model, used in ENT to examine the nasal cavity, but also to remove foreign bodies.