Speculum placement technique and perceived patient discomfort

Abstract

Many patients report discomfort associated with pelvic examinations, specifically upon placement of the speculum. This discomfort may discourage a patient from presenting for routine health maintenance and contribute to increase risk of preventable disease. There is a paucity in the literature describing techniques of speculum placement during pelvic examination and patient centered experiences. Over age and geographic strata, we compared vertical, oblique and horizontal speculum placement learned techniques versus those currently practiced. Additionally, we explored patient experience. We aim to apply outcomes to improve patient centered care and integrate findings to clinical skills labs/practicums of medical school reproductive health curriculum. Domestically trained physicians at an urban academic residency clinic completed a voluntary survey. Patients were surveyed after speculum placement during routine screening examination. The sample included physicians from each medical school region and across the age spectrum. The majority of providers identified oblique speculum placement as both learned and currently employed, with an increase in frequency of horizontal approach once in practice. Cohorts perceived discomfort at time of speculum placement and overall exam as comparable. Exploring patient experience during an examination commonly avoided due to perceived discomfort may be useful in promoting preventative health strategies. Inclusion of both vertical/oblique and horizontal techniques in medical school curriculum should be considered.