Specula
A vaginal speculum (duckbill speculum) is used for spreading the vaginal walls, which allows for the internal inspection or diagnostic procedure [Figure 3]. There are many different types of specula and all have their own advantages and disadvantages. The choice of speculum depends on the situation, preference and experience. The most common ones are discussed below.
Figure 3
Seyffert
This speculum has a pistol grip, which is easy to handle, however, the heaviness of the grip, makes it prone to tilting [Figure 4]. It must always be held properly to prevent this. If both hands are required to hold it, it is possible to ask the patient to hold the top of the speculum. The lower blade of the Seyffert speculum is longer than the upper blade. This makes it easier to gain a view of the vaginal portion of the cervix, particularly when it is deep-lying. However, this speculum can only be used with the grip facing downwards (dorsally). It can only be fixed in a few positions, making it difficult to find the right balance between spreading too wide and having an insufficient view.
Figure 4
Cusco
This speculum is more lightly-equipped, looks ‘friendlier’ and is easier to handle [Figure 5]. The front and rear blade are of equal length, so the speculum can be inserted both with the grip facing forward and backward. If the vaginal portion of the cervix is deep-lying, it may be hard to gain a view without a longer lower blade. Fixing the speculum can be carried out in a stepless manner using a finger wheel.
Figure 5
Semm
This is another lightly-equipped speculum that looks ‘friendlier’ and is easier to handle [Figure 6]. This one has a lower risk of tilting because of the lighter handle. The front and rear blade are of equal length. A deeper-lying vaginal portion of the cervix may be harder to see because of this, but this speculum can be inserted with the handle either facing forward or backward. Fixing the speculum can only be done in a number of fixed positions, as with the Seyffert speculum.
Figure 6
PVC Speculum
This speculum is disposable and sterile-packaged. It is portable and light, but also less sturdy [Figure 7]. Additionally, these speculums can sometimes have sharp edges. However, they never feel cold and appear less bulky. The blades may be layered with lubricant, which is activated once the blades are dampened with water. If the blades of the speculum are transparent, the inspection of the vaginal walls is easier.
Figure 7
An alternative to this speculum is the Welch Allyn speculum, to which a lamp can be fitted inside. Unfortunately, this makes the speculum heavier.
The Cusco speculum is available with many different types of blades, whereas the Seyffert and the Semm are available only in a ‘normal’ and a narrow variant [Figure 8].
Figure 8
After use, the specula and other metal instruments must be ‘domestically’ cleaned (washed thoroughly). Prior to using the instruments again, they will have to be sterilised.