By Dr. Susan Rutherford, MD

The purpose of this blog is to share some details that women may like knowing about having a pelvic exam and Pap smear or other testing.

The term speculum is used to describe tools used to look into body orifices, such as the ear canal, nasal canal, vagina and others, each designed for their specific purpose.

A light is required to see into the vagina with the speculum in place, and that can be one attached to the speculum or an exam light from over the shoulder of the examiner.

A vaginal exam with a speculum is an opportunity to obtain specimens to look for:

• signs pointing to cervical cancer or pre-cancerous cells (the Pap smear and HPV virus testing)

• vaginitis, such as yeast infections, BV and trichomonas

• sexually transmitted infections, such as gonorrhea (GC) and chlamydia (CT)

Instruments that fit easily through the opening of the speculum, such as a small plastic spatula or small brushes, are used to sweep cells from the cervix and its opening.  Those instruments are then dunked in a small vial of solution where the cells then float free.  The vial is then sent to the lab.  That collection of cells can be used for the Pap, HPV and the GC/CT.

The GC/CT can be done separately, either by using a small Qtip type swab at the cervical opening, or from the walls of the vagina.

A swab of the vaginal walls, secretions or discharge can be sent to the lab to test for vaginitis.  This is the most sensitive test.  Alternatively, many cases of vaginitis can be diagnosed by looking through a microscope at the vaginal material collected by a swab and smeared on a glass slide to prep for the microscope.

We are explaining these steps because the portion of the exam using the speculum is usually the most intriguing for patients, and we hope that understanding will help women feel as comfortable as possible.

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You can also view our video of Dr. Rutherford explaining this below:

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