A comparison of two techniques for vaginal speculum placement to reduce patient pain.

Abstract

Vaginal examination with a speculum is uncomfortable and painful, with approximately 35% of women reporting pain [1-3]. The present study was a longitudinal, prospective, comparative study to compare pain experience after vaginal speculum placement with either a horizontal or vertical technique. For the horizontal technique, the inferior blade of the speculum was placed on the posterior wall of the vagina, at a 90° angle with respect to the antero-posterior axis of the vaginal introitus, and slid forward into the interior of the vagina. With regards to the vertical technique, the superior blade was applied in contact with the right vaginal wall and the inferior blade with the left vaginal wall. The speculum was then slid into the vagina (up to two thirds of the total length of the vagina) and rotated to a horizontal position. In each patient, both techniques were evaluated. Pain was graded on a visual analog scale from 0-10, where 0 indicated no pain and 10 indicated "most intense" perceived pain. Comparison between groups was done by Mann-Whitney U test, and differences between frequencies were calculated by Chi-squared test. The protocol was approved by the Local Ethics in Research Committee 36068 and the Research in Health Committee 3606 with the number R-2020-3606-038. All patients signed an informed consent form for participation in this study.