A speculum (Latin for 'mirror'; pl.: specula or speculums) is a medical tool for investigating body orifices, with a form dependent on the orifice for which it is designed. In old texts, the speculum may also be referred to as a diopter or dioptra. [1] Like an endoscope, a speculum allows a view inside the body; endoscopes, however, tend to have optics while a speculum is intended for direct vision.
Vaginal and anal specula were used by the ancient Greeks and Romans, [2] [3] and speculum artifacts have been found in Pompeii. [4] [5] The modern 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. This speculum is inserted into the vagina to dilate it for examination of the vagina and cervix.
The modern vaginal speculum was developed by J. Marion Sims, a plantation doctor in Lancaster County, United States. Between 1845 and 1849, Sims performed dozens of surgeries, without anesthesia, on at least 12 enslaved women. In these experiments, Sims developed a technique to repair fistula and in the process invented the duckbill speculum. These experiments, and the development of the modern specula, led some to regard Sims as the "father of modern gynaecology." [6]
By the 1860s, specula were integrated into criminal justice practices in the UK. In Great Britain, examinations of the cervix were made mandatory for all women convicted of prostitution by the country's Contagious Disease Act. [7] In the 19th century, the vaginal speculum became a cultural symbol of the tenuous relationship between women and their physicians. Use of the speculum was generally avoided in medical practices, and most vaginal conditions were diagnosed through symptoms or palpating the abdomen. Many practitioners had moral concerns about the use of the speculum, and preferred to diagnose through palpating the abdomen. As late as 1910, physicians believed the vaginal speculum to be inferior to the "educated touch." [8]
These concerns continued into the early 20th century as the speculum became commonplace in gynecology practices. Often, nurses played a major role in ensuring the proper use of the speculum during medical exams. [8] The 1946 and 1956 editions of a multi-volume gynecology text for nurses required that nurses remain present during examination to protect both the patient and physician from "blackmail by designing persons." [9]
As of 2015 [update] , 85% of gynecologists are women. [10] As a result of this demographic shift, the procedures around speculum use have also changed.
Specula have been made of glass or metal. They were generally made of stainless steel and sterilized between uses, but particularly in the 21st century, many — especially those used in emergency departments and doctor's offices — are made of plastic, and are disposable, single-use items. Those used in surgical suites are still commonly made of stainless steel.
Specula come in a variety of shapes based on their purpose, and a variety of sizes; [11] in any case the cylinder or bill(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 most common specula used in gynecologic practice are varying sizes of bivalved vaginal speculum; the two bills 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 bills apart. [12]
A cylindrical-shaped speculum, introduced in 2001, the dilating vaginal speculum (also known as the Veda-scope [13] ) invented by Clemens van der Weegen, [14] inflates the vagina with filtered air. [15] (see diagram) The device has two main functions: a) to take a normal Pap smear with a cervical brush or a cytology brush; and b) as an internal colposcope so that the operator can pivot the Veda-scope to view any part of the vagina barrel and cervix facilitated by an internal light source that can illuminate the vaginal wall and cervix with multi-coloured light filters, which can detect pre-cancerous cells with the aid of acetic acid solution and iodine solution. It also has a facility to attach a digital camera for viewing and recording. [16]
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. A vaginal speculum is also used in fertility treatments, particularly artificial insemination, and allows the vaginal cavity to be opened and observed thereby facilitating the deposit of semen into the vagina.
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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.
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Nasal specula have two relatively flat bills with handle. The instrument is hinged so that when the handles are squeezed together the bills spread laterally, allowing examination.
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Additionally, the Thudichum nasal speculum is commonly used in the outpatient examination of the nose.
Ear or aural specula resemble a funnel, and come in a variety of sizes.
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For ophthalmic surgery such as cataract surgery, a speculum designed to retract the eyelids is used.
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.
Specula are used for sexual pleasure, both vaginally and anally. [17]
Dilationand curettage (D&C) refers to the dilation of the cervix and surgical removal of sections and or layers of the lining of the uterus and or contents of the uterus such as an unwanted fetus, remains of a non viable fetus, retained placenta after birth or abortion as well as any abnormal tissue which may be in the uterus causing abnormal cycles by scraping and scooping (curettage). It is a gynecologic procedure used for treatment and removal as well as diagnostic and therapeutic purposes, and is the most commonly used method for first trimester abortion or miscarriage.
In mammals and other animals, the vagina is the elastic, muscular reproductive organ of the female genital tract. In humans, it extends from the vulval vestibule to the cervix. The vaginal introitus is normally partly covered by a thin layer of mucosal tissue called the hymen. The vagina allows for copulation and birth. It also channels menstrual flow, which occurs in humans and closely related primates as part of the menstrual cycle.
Obstetrics and gynaecology is the medical specialty that encompasses the two subspecialties of obstetrics and gynaecology. The specialization is an important part of care for women's health.
Gynaecology or gynecology is the area of medicine that involves the treatment of women's diseases, especially those of the female reproductive organs. It is often paired with the field of obstetrics, which focuses on pregnancy and childbirth, thereby forming the combined area of obstetrics and gynaecology (OB-GYN).
Hysterectomy is the surgical removal of the uterus and cervix. Supracervical hysterectomy refers to removal of the uterus while the cervix is spared. These procedures may also involve removal of the ovaries (oophorectomy), fallopian tubes (salpingectomy), and other surrounding structures. The term “partial” or “total” hysterectomy are lay-terms that incorrectly describe the addition or omission of oophorectomy at the time of hysterectomy. These procedures are usually performed by a gynecologist. Removal of the uterus renders the patient unable to bear children and has surgical risks as well as long-term effects, so the surgery is normally recommended only when other treatment options are not available or have failed. It is the second most commonly performed gynecological surgical procedure, after cesarean section, in the United States. Nearly 68 percent were performed for conditions such as endometriosis, irregular bleeding, and uterine fibroids. It is expected that the frequency of hysterectomies for non-malignant indications will continue to fall given the development of alternative treatment options.
A pessary is a prosthetic device inserted into the vagina for structural and pharmaceutical purposes. It is most commonly used to treat stress urinary incontinence to stop urinary leakage and to treat pelvic organ prolapse to maintain the location of organs in the pelvic region. It can also be used to administer medications locally in the vagina or as a method of contraception.
In gynecology, a rectocele or posterior vaginal wall prolapse results when the rectum bulges (herniates) into the vagina. Two common causes of this defect are childbirth and hysterectomy. Rectocele also tends to occur with other forms of pelvic organ prolapse, such as enterocele, sigmoidocele and cystocele.
Vaginal bleeding is any expulsion of blood from the vagina. This bleeding may originate from the uterus, vaginal wall, or cervix. Generally, it is either part of a normal menstrual cycle or is caused by hormonal or other problems of the reproductive system, such as abnormal uterine bleeding.
Bloody show or show is the passage of a small amount of blood or blood-tinged mucus through the vagina near the end of pregnancy. It is caused by thinning and dilation of the cervix, leading to detachment of the cervical mucus plug that seals the cervix during pregnancy and tearing of small cervical blood vessels, and is one of the signs that labor may be imminent. The bloody show may be expelled from the vagina in pieces or altogether and often appears as a jelly-like piece of mucus stained with blood. Although the bloody show may be alarming at first, it is not a concern of patient health after 37 weeks gestation.
Vaginal hypoplasia is the underdevelopment or incomplete development of the vagina. It is a birth defect or congenital abnormality of the female genitourinary system.
A pelvic examination is the physical examination of the external and internal female pelvic organs. It is frequently used in gynecology for the evaluation of symptoms affecting the female reproductive and urinary tract, such as pain, bleeding, discharge, urinary incontinence, or trauma. It can also be used to assess a woman's anatomy in preparation for procedures. The exam can be done awake in the clinic and emergency department, or under anesthesia in the operating room. The most commonly performed components of the exam are 1) the external exam, to evaluate the vulva 2) the internal exam with palpation to examine the uterus, ovaries, and structures adjacent to the uterus (adnexae) and 3) the internal exam using a speculum to visualize the vaginal walls and cervix. During the pelvic exam, sample of cells and fluids may be collected to screen for sexually transmitted infections or cancer.
The endometrial biopsy is a medical procedure that involves taking a tissue sample of the lining of the uterus. The tissue subsequently undergoes a histologic evaluation which aids the physician in forming a diagnosis.
Osmotic dilators are medical implements used to dilate the uterine cervix by swelling as they absorb fluid from surrounding tissue. They may be composed of natural or synthetic materials. A laminaria stick or tent is a thin rod made of the stems of dried Laminaria, a genus of kelp. Laminaria sticks can be generated from Laminaria japonica and Laminaria digitata. Synthetic osmotic dilators are commonly referred to by their brand names, such as Dilapan. Dilapan-S are composed of polyacrylonitrile, a plastic polymer. The hygroscopic nature of the polymer causes the dilator to absorb fluid and expand.
The following is a list of instruments that are used in modern obstetrics and gynaecology.
A well-woman examination is an exam offered to women to review elements of their reproductive health. The exam includes a breast examination, a pelvic examination and a Pap smear but may include other procedures. Hospitals employ strict policies relating to the provision of consent by the patient, the availability of chaperones at the examination, and the absence of other parties.
Cervical agenesis is a congenital disorder of the female genital system that manifests itself in the absence of a cervix, the connecting structure between the uterus and vagina. Milder forms of the condition, in which the cervix is present but deformed and nonfunctional, are known as cervical atresia or cervical dysgenesis.
Pediatric gynaecology or pediatric gynecology is the medical practice dealing with the health of the vagina, vulva, uterus, and ovaries of infants, children, and adolescents. Its counterpart is pediatric andrology, which deals with medical issues specific to the penis and testes.
In gynaecology, Cusco's self-retaining bivalved speculum is a kind of speculums, used for vaginal and cervical examinations. It has a jaw that opens up like a duck bill.
In gynaecology, Sims' vaginal speculum is a double-bladed surgical instrument used for examining the vagina and cervix. It was developed by J. Marion Sims out of pewter spoon, but nowadays it is manufactured out of stainless steel or plastic. The plastic speculum is disposable, but the stainless steel one is not. Therefore, the stainless steel speculum should be sterilized before each use. Sims' speculum is inserted into the vagina to retract posterior vaginal wall. It gives more exposure of the vaginal walls than Cusco's Speculum and therefore is preferred for gynaecological surgeries. It is possible to slide the instrument around the vaginal wall to enable better visualization. The groove in the middle of Sims' speculum allows free flow of secretions and blood to the outside, thereby keeping the area dry. Sims' speculum is available in various sizes, and the size appropriate to the vaginal dimensions of the woman is chosen for use. The disadvantage of Sims' speculum is that it is not self-retaining. The examiner might want to use an anterior wall retractor in addition to Sims' speculum for better visualization of the cervix.
Warren operation is a surgery performed to correct anal incontinence. It is done by disrupting the anterior segment of the anal sphincter, perineal body and rectovaginal septum.
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