When the introitus is narrow, due to atrophy, the patient is tense, or virginal, the thin virginal speculum usually allows for a satisfactory exam.įor parous patients, the Graves speculum, with its’ broader blade, often gives better visualization of the vagina and cervix. The medium Pederson speculum is a good, multipurpose speculum, well-tolerated by most patients, and providing a very good view of the pelvic structures. With the patient lying on her side, raising the upper leg allows for good pelvic access. Some patients are unable to lie flat on their back. The bimanual examination can also be performed in this position. While the orientation of the pelvic structures is reversed, this is a manageable issue. The knee-chest position can be very useful, particularly with children.When the buttocks cannot be raised, turning the speculum upside down can still allow for a good exam.Elevating the buttocks with a pillow, rolled-up blanket, or bedpan facilitates the conventional placement of the speculum.A frog-leg position can provide for a very satisfactory exam.Others may need to be examined in alternative positions due to special circumstances or location.
The dorsal lithotomy position is generally used for pelvic exams, because it provides for good access to pelvis while inspecting the vulva, inserting a vaginal speculum, and performing a bimanual exam.īecause of illness or injury, some individuals cannot be examined in the conventional dorsal lithotomy position.
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