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Speculum examination frequently appears in OSCEs. You’ll be expected to competently perform the procedure and demonstrate appropriate communications skills with the patient or mannequin. This speculum examination OSCE guide provides a clear step-by-step approach to performing the procedure.

Check out the speculum examination OSCE mark scheme here.

 


Introduction 

  • 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)
  • Wash hands

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)
  • Don gloves

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

 


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

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

 


REVIEWED BY

Mr Isaac Magani

Consultant Obstetrician 


 

Assessment

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