Speculum (medicine)

The disposable bivalved plastic vaginal speculum is used in office gynecology

A speculum (Latin for "mirror") (plural specula or speculums) is a medical tool for investigating body cavities, with a form dependent on the body cavity for which it is designed. In old texts, the speculum may also be referred to as a diopter or dioptra. Like an endoscope, a speculum allows entry into a body cavity; endoscopes, however, tend to have optics while a speculum is intended for direct vision.

History

Vaginal and anal specula were used by the ancient Greeks and Romans, and speculum artifacts have been found in Pompeii. A vaginal speculum, developed by J. Marion Sims, consists of a hollow cylinder with a rounded end that is divided into two hinged parts, somewhat like the beak of a duck. The speculum is inserted into the vagina to dilate it for examination of the vagina and cervix.

Construction

All specula were formerly made of metal, and sterilized after use. However, many, especially those used in emergency departments and doctor's offices, are now made of plastic, and are sterile, disposable, single-use items. Those used in surgical suites are still commonly made of metal.

Types of specula

Two tube-shaped glass specula

Specula come in a variety of shapes based on their purpose, in any case the tube or blade(s) of the instrument allow the operator a direct vision of the area of interest and the possibility to introduce instruments for further interventions such as a biopsy.

The best-known specula are the bivalved vaginal specula; the two blades are hinged and are "closed" when the speculum is inserted to facilitate its entry and "opened" in its final position where they can be arrested by a screw mechanism, so that the operator is freed from keeping the blades apart.

Vaginal use

A specialized form of vaginal speculum is the weighted speculum, which consists of a broad half tube which is bent at about a 90 degree angle, with the channel of the tube on the exterior side of the angle. One end of the tube has a roughly spherical metal weight surrounding the channel of the speculum. A weighted speculum is placed in the vagina during vaginal surgery with the patient in the lithotomy position. The weight holds the speculum in place and frees the surgeon's hands for other tasks.

Tubal shape

• Fergusson
• Glass speculum

One blade

The single-bladed Sims speculum is still in use today

Auvard Breisky Doyen Eastman Jackson Kallmorgen Kristeller

Landau Martin Mathieu Samuel Scherbak Sims Weissbarth

Two blades (bivalved)

Duckbill shape of a two-bladed speculum

Collin Cusco DeVilbiss Grave

Pederson Semm Seyffert Trelat Winterton

Three blades

Guttmann Nott

O´Sullivan-O´Connor Polansky (veterinary use)

Rectal use

Vaginal specula are also used for anal surgery, although several other forms of anal specula exist. One form, the anoscope, resembles a tube that has a removable bullet-shaped insert. When the anoscope is inserted into the anus, the insert dilates the anus to the diameter of the tube. The insert is then removed, leaving the tube to allow examination of the lower rectum and anus.

This style of anal speculum is one of the oldest designs for surgical instruments still in use, with examples dating back many centuries. The sigmoidoscope can be further advanced into the lower intestinal tract and requires an endoscopic set-up.

Tubal shape

• Aniscope

One blade

• Czerny

Two blades

Barr Bodenhammer Killian Pratt

Ricord Roschke Sims Smith-Buie

Three blades

• Alan Park
• Cook
• Mathieu

Nasal use

Nasal specula have two relatively flat blades with handle. The instrument is hinged so that when the handles are squeezed together the blades spread laterally, allowing examination.

Killian Vienna

Voltolini Yankauer

Aural use

Ear specula are funnel-shaped

Ear or aural specula resemble a funnel, and come in a variety of sizes.

Aural speculum

Oral use

In veterinary medicine, a McPherson Speculum can be used for oral examination. The speculum helps keep the mouth open during the exam and helps avoid biting injuries.

Non-medical uses

Some health centers and feminist organizations sell plain specula, to allow women to better understand their body and improve how they view their vulva and vagina.

Vaginal and anal specula are also sometimes used as sex toys.

See also

• Endoscope
• Luce Irigaray, writer of Speculum of the Other Woman (1974)

External Links

• Bimanual Pelvic Exam Of A Female