Are the “duckbill forceps” used for gynecological examinations really “modern female torture devices”?

If you were to ask what examination is the most terrifying in a hospital, a gynecological examination would definitely be on the list.

Recently, a netizen began to learn about the process of gynecological examinations because of illness. When looking up the process, she found that many routine gynecological examinations require the use of "duckbill forceps", but the use of "duckbill forceps" made her feel a little uncomfortable. After further understanding, she found that many women had the same feelings as her, "'Duckbill forceps' caused a great psychological shadow", "made people afraid of gynecological examinations", "it would feel painful"...

Image source: Screenshot from a social platform

Why does such a routine gynecological examination leave psychological trauma on so many people? Why are there no more comfortable and humane alternatives to gynecological examination tools?

This is an issue that deserves serious discussion.

Vaginal speculum (duckbill forceps)

The reason why it is still used

The tool used by gynecologists to examine the vagina and cervix is ​​called a vaginal speculum. Because its two blades are very similar to duck bills, it is also called duckbill forceps.

The earliest duckbill forceps were invented in the mid-19th century by the controversial "Father of Gynecology" James Marion Sims. They have been improved several times and are still in use today.

After so many years, the appearance and performance of many daily necessities in life have undergone tremendous changes. However, when it comes to vaginal speculum for gynecological examinations, whether it is Chinese and foreign textbooks, the operating guidelines of various authoritative institutions, or teaching demonstration videos on the use of speculum in various gynecological examinations and gynecological surgeries, they all still default to using this duckbill speculum - there may be differences in details, but the essence is the duckbill structure.

Why? Because its functions are stable and reliable, ensuring that clinical needs can be met most of the time.

The vagina we see in various illustrations is shaped like a cylindrical tube. In fact, under normal circumstances, the front and back walls of the vagina are naturally fitted together, and tools are needed to push them open to observe the health of the inside.

The posterior vaginal wall is usually one or two centimeters longer than the anterior vaginal wall, so the two "duck bills" of the vaginal speculum are usually one long and one short. After entering the vagina, the duck bill is opened, the short blade is used to prop up the anterior vaginal wall, and the long blade is used to push open the posterior vaginal wall, so that the vagina and cervix can be clearly exposed for inspection and operation.

Schematic diagram of the working process of the vaginal speculum. There are two main usage scenarios for the vaginal speculum, one is during gynecological examinations, and the other is during transvaginal surgical operations.

When gynecological patients complain of abnormal vaginal discharge, vulvar and vaginal discomfort, abnormal vaginal bleeding, etc., they need to be examined with a speculum. Disposable plastic specula are generally used in outpatient clinics. The speculum can help medical staff see the situation in the vagina and make preliminary judgments on whether there are special inflammatory manifestations, abnormalities of the cervix, vegetation or other special lesions, or foreign bodies are retained.

If there is bleeding, it can be preliminarily determined whether the bleeding comes from the vagina, cervix or uterus. At the same time, the sampling site must be correct to ensure the accuracy of the results.

Disposable plastic speculum. Copyright image from the gallery. Reproduction may lead to copyright disputes.

During gynecological surgery, if it is a transvaginal operation or a pelvic operation that may come into contact with the vagina, the vulva and vagina need to be cleaned and disinfected to prevent infection. In this case, a metal speculum with a bolt is generally used. Using a speculum to expose the vagina and cervix can ensure that the disinfection is sufficient and thorough to avoid omissions.

During the operation, the metal speculum can be adjusted to a suitable angle and position, and the bolt can be rotated to fix the speculum. In this way, the surgeon does not need to use one hand to operate the opening and closing of the speculum, but can free both hands to concentrate on the operation.

Metal speculum. Copyright image. Reproduction may cause copyright disputes.

Experience using a vaginal speculum

Why it's so bad

Many people have a psychological trauma from gynecological examinations, and one important reason is that the process of using a speculum is extremely uncomfortable. Some people even experience pain long after the examination is over.

Why is the experience of using vaginal speculum so bad? There are many reasons.

The objective reason is that the perineum itself is rich in nerves and more sensitive than most other parts of the body, so it is more likely to cause discomfort during the operation. If the speculum is not fully lubricated, it will pull and rub against local tissues during insertion, which is more likely to cause foreign body sensation and pain.

The shape of the human vagina does not completely match the speculum. When the speculum is opened, in order to fully expose the cervix, some parts will be subjected to excessive expansion pressure, causing pain.

There are specula of different sizes on the market, but small specula are generally used more for patients with vaginal atrophy or congenital stenosis, and they often have the disadvantages of insufficient length and insufficient exposure. In outpatient gynecological examinations, medium-sized specula are generally used by default because they can meet the examination needs of most people. However, although the specifications of the tools are uniform, the human body is not the same. Therefore, it is inevitable that many people have a poor experience when using them.

Some diseases or symptoms, such as inflammation, vaginal atrophy caused by decreased estrogen, etc., will increase local sensitivity to pain and discomfort, and are also one of the causes of pain and discomfort during gynecological examinations.

Subjectively, gynecological examination itself is a very private examination. Especially when exposing private parts to unfamiliar medical staff, it is inevitable to feel nervous and ashamed. Therefore, when facing a strange and invasive examination tool such as a vaginal speculum, the muscles will unconsciously contract to resist, which will significantly increase the discomfort of the examination. If there have been unpleasant gynecological examination experiences, painful childbirth experiences, or uncomfortable sexual life experiences in the past, the examination will be more painful due to psychological trauma.

In addition, the medical staff's operating techniques are also very important to the examination experience. In my personal experience, if the speculum is fully lubricated before the examination, the discomfort when inserting the speculum can be significantly reduced. On the premise of being able to see the internal conditions clearly, opening the speculum as little as possible can also greatly reduce the patient's discomfort.

In addition, when facing particularly nervous patients, informing or explaining the next operation before each operation so that the patient can be mentally prepared can effectively calm many people's nervousness and help the examination go smoothly. At the same time, fully prepare all the tools to be used before each examination, so that the examination can be completed as quickly as possible and reduce the patient's pain.

Is there a better tool to replace it?

Whether out of empathy for patients or the need to complete their work, the vast majority of doctors have summarized how to improve their skills in the process of growing from students to doctors, including how to make the examination process achieve the purpose while avoiding causing discomfort to patients to the greatest extent possible.

In clinical practice, there are often dozens of different tools used in daily examinations and surgical operations, each of which corresponds to a specific purpose. Even the shape of the needle tip of the suture needle corresponds to the suture requirements of different tissues. Therefore, vaginal speculum, a tool that often seems to be not easy to use and easily causes discomfort to patients, naturally makes many doctors think: Is it possible to improve it? Is it possible to replace it with other shapes?

Many people have tried it, and some new tools have indeed briefly entered clinical use, but unfortunately, there is still no better tool to replace the mainstream vaginal speculum.

Some people have tried to improve their vision by using the ideas of gastroenteroscopy and laparoscopic surgery, replacing the speculum with a speculum, that is, using a thin camera instead of the naked eye, and using only the lens for inspection without stretching the vaginal wall. The discomfort caused by this method will definitely be significantly reduced. If the lens is clear, many details that cannot be seen by the naked eye can be seen clearly, and the specific pathological status can be recorded, which is very helpful for the continuous observation of some diseases. However, the clearer the lens, the higher the cost. If the cost control leads to insufficient clarity, the accuracy will be difficult to guarantee, so it is difficult to benefit all patients.

A medical gynecological speculum

Some people have also tried to improve the shape of the speculum, using designs similar to tampon push tubes or petal shapes to try to reduce the discomfort caused by the speculum. These designs may not be able to replace all the functions of traditional speculum, but if they can ensure the comprehensiveness of gynecological examinations and the accuracy of specimen collection, even if they are only used for outpatient gynecological examinations and specimen collection, countless women will benefit from them.

A new type of speculum changes the traditional two-leaf speculum into a five-leaf speculum. When the dilator is inserted and opened, the five "petals" can gently support the cervix, ensuring that only the cervix is ​​visualized, avoiding the collapse of the vaginal wall.

Many medical operations sacrifice the comfort of the operation process for the sake of accuracy, safety and other medical purposes of examination and treatment. Gynecological examinations for women are a very typical example. Fortunately, more and more people are beginning to pay attention to this and are actively promoting the advancement and innovation of tools. I hope that more people will participate and brainstorm, and perhaps a better alternative to the traditional speculum will appear soon.

Author: Doctor Feidao Duanyu

Reviewer: Lan Yibing, deputy chief physician, Department of Obstetrics and Gynecology, Zhejiang University School of Medicine