![Spéculum en plastique](https://upload.wikimedia.org/wikipedia/commons/7/78/Sp%C3%A9culum_en_plastique.jpg)
A speculum (Latin for 'mirror'; plural specula or speculums) is a medical tool for investigating body
orifices
A body orifice is any opening in the body of an animal.
External
In a typical mammalian body such as the human body, the external body orifices are:
* The nostrils, for breathing and the associated sense of smell
* The mouth, for eating, bre ...
, with a form dependent on the orifice for which it is designed. In old texts, the speculum may also be referred to as a diopter or dioptra. Like an
endoscope
An endoscope is an inspection instrument composed of image sensor, optical lens, light source and mechanical device, which is used to look deep into the body by way of openings such as the mouth or anus. A typical endoscope applies several modern t ...
, a speculum allows a view inside the body; endoscopes, however, tend to have
optics
Optics is the branch of physics that studies the behaviour and properties of light, including its interactions with matter and the construction of instruments that use or detect it. Optics usually describes the behaviour of visible, ultraviole ...
while a speculum is intended for direct vision.
History
![5 Speculum, 14th 15th and 16th century](https://upload.wikimedia.org/wikipedia/commons/5/54/5_Speculum%2C_14th_15th_and_16th_century._Wellcome_M0008374.jpg)
Vaginal and anal specula were used by the
ancient Greeks
Ancient Greece ( el, Ἑλλάς, Hellás) was a northeastern Mediterranean civilization, existing from the Greek Dark Ages of the 12th–9th centuries BC to the end of classical antiquity ( AD 600), that comprised a loose collection of cultu ...
and
Romans
Roman or Romans most often refers to:
*Rome, the capital city of Italy
* Ancient Rome, Roman civilization from 8th century BC to 5th century AD
*Roman people, the people of ancient Rome
*''Epistle to the Romans'', shortened to ''Romans'', a lette ...
, and speculum
artifacts have been found in
Pompeii
Pompeii (, ) was an ancient city located in what is now the ''comune'' of Pompei near Naples in the Campania region of Italy. Pompeii, along with Herculaneum and many villas in the surrounding area (e.g. at Boscoreale, Stabiae), was buried ...
. A
vagina
In mammals, the vagina is the elastic, muscular part of the female genital tract. In humans, it extends from the vestibule to the cervix. The outer vaginal opening is normally partly covered by a thin layer of mucosal tissue called the hymen ...
l speculum, developed by
J. Marion Sims
James Marion Sims (January 25, 1813November 13, 1883) was an American physician in the field of surgery. His most famous work was the development of a surgical technique for the repair of vesicovaginal fistula, a severe complication of obstruc ...
, consists of a hollow cylinder with a rounded end that is divided into two hinged parts, somewhat like the
beak
The beak, bill, or rostrum is an external anatomical structure found mostly in birds, but also in turtles, non-avian dinosaurs and a few mammals. A beak is used for eating, preening, manipulating objects, killing prey, fighting, probing for food ...
of a
duck
Duck is the common name for numerous species of waterfowl in the family Anatidae. Ducks are generally smaller and shorter-necked than swans and geese, which are members of the same family. Divided among several subfamilies, they are a form t ...
. This speculum is inserted into the vagina to dilate it for examination of the vagina and
cervix
The cervix or cervix uteri (Latin, 'neck of the uterus') is the lower part of the uterus (womb) in the human female reproductive system. The cervix is usually 2 to 3 cm long (~1 inch) and roughly cylindrical in shape, which changes during ...
.
The modern vaginal speculum was developed by
J. Marion Sims
James Marion Sims (January 25, 1813November 13, 1883) was an American physician in the field of surgery. His most famous work was the development of a surgical technique for the repair of vesicovaginal fistula, a severe complication of obstruc ...
, a plantation doctor in Lancaster County, South Carolina. Between 1845 and 1849, Sims performed dozens of surgeries, without anesthesia, on at least 12 enslaved women. In these experiments, Sims developed a technique to repair fistula and in the process invented the duckbill speculum. These experiments, and the development of the modern specula, led some to regard Sims as the "father of modern gynaecology."
By the 1860s, speculums were integrated into criminal justice practices in the UK. In Great Britain, examinations of the cervix were made mandatory for all women convicted of prostitution by the country's Contagious Disease Act.
In the 19th century, the vaginal speculum became a cultural symbol of the tenuous relationship between women and their physicians. Use of the speculum was generally avoided in medical practices, and most vaginal conditions were diagnosed through symptoms or palpating the abdomen. Many practitioners had moral concerns about the use of the speculum, and preferred to diagnose through palpating the abdomen. As late as 1910, physicians believed the vaginal speculum to be inferior to the "educated touch."
These concerns continued into the early 20th century as the speculum became commonplace in gynecology practices. Often, nurses played a major role in ensuring the proper use of the speculum during medical exams.
The 1946 and 1956 editions of a multi-volume gynecology text for nurses required that nurses remain present during examination to protect both the patient and physician from "blackmail by designing persons."
, 85% of gynecologists are women. As a result of this demographic shift, the procedures around speculum use have also changed.
Construction
![Vaginal speculum 1](https://upload.wikimedia.org/wikipedia/commons/6/64/Vaginal_speculum_1.png)
Specula have been made of glass or metal. They were formerly made of
stainless steel
Stainless steel is an alloy of iron that is resistant to rusting and corrosion. It contains at least 11% chromium and may contain elements such as carbon, other nonmetals and metals to obtain other desired properties. Stainless steel's corros ...
and sterilized after use. However, in the 21st century, many — especially those used in emergency departments and doctor's offices — are now made of plastic, and are disposable,
single-use
A disposable (also called disposable product) is a product designed for a single use after which it is recycled or is disposed as solid waste. The term is also sometimes used for products that may last several months (e.g. disposable air filter ...
items. Those used in surgical suites are still commonly made of stainless steel.
Types
Specula come in a variety of shapes based on their purpose, and a variety of sizes; in any case the cylinder or blade(s) of the instrument allow the operator a direct vision of the area of interest and the possibility to introduce instruments for further interventions such as a biopsy.
Vaginal use
The best-known speculum is the bivalved vaginal speculum; the two blades are hinged and are "closed" when the speculum is inserted to facilitate its entry and "opened" in its final position where they can be arrested by a screw mechanism, so that the operator is freed from keeping the blades apart.
A cylindrical-shaped speculum, introduced in 2001, the dilating vaginal speculum (also known as the Veda-scope) invented by Clemens van der Weegen, inflates the vagina with filtered air. (see diagram) The device has two main functions: a) to take a normal Pap smear with a cervical brush or a cytology brush; and b) as an internal
colposcope
Colposcopy ( grc, κόλπος, kolpos, hollow, womb, vagina + ''skopos'' "look at") is a medical diagnostic procedure to visually examine the cervix as well as the vagina and vulva using a colposcope.
The main goal of colposcopy is to prevent ...
so that the operator can pivot the Veda-scope to view any part of the vagina barrel and cervix facilitated by an internal light source that can illuminate the vaginal wall and cervix with multi-coloured light filters, which can detect pre-cancerous cells with the aid of
acetic acid
Acetic acid , systematically named ethanoic acid , is an acidic, colourless liquid and organic compound with the chemical formula (also written as , , or ). Vinegar is at least 4% acetic acid by volume, making acetic acid the main component ...
solution and
iodine
Iodine is a chemical element with the symbol I and atomic number 53. The heaviest of the stable halogens, it exists as a semi-lustrous, non-metallic solid at standard conditions that melts to form a deep violet liquid at , and boils to a vi ...
solution. It also has a facility to attach a digital camera for viewing and recording.
![Dilating vaginal speculum inflating vagina and light illuminating](https://upload.wikimedia.org/wikipedia/commons/b/b7/Dilating_vaginal_speculum_inflating_vagina_and_light_illuminating.jpg)
A specialized form of vaginal speculum is the weighted speculum, which consists of a broad half tube which is bent at about a 90 degree angle, with the channel of the tube on the exterior side of the angle. One end of the tube has a roughly spherical metal weight surrounding the channel of the speculum. A weighted speculum is placed in the vagina during vaginal
surgery
Surgery ''cheirourgikē'' (composed of χείρ, "hand", and ἔργον, "work"), via la, chirurgiae, meaning "hand work". is a medical specialty that uses operative manual and instrumental techniques on a person to investigate or treat a pat ...
with the patient in the
lithotomy position
The lithotomy position is a common position for surgical procedures and medical examinations involving the pelvis and lower abdomen, as well as a common position for childbirth in Western nations. The lithotomy position involves the positioning of ...
. The weight holds the speculum in place and frees the surgeon's hands for other tasks.
A vaginal speculum is also used in fertility treatments, particularly artificial insemination, and allows the vaginal cavity to be opened and observed thereby facilitating the deposit of semen into the vagina.
;Cylindrical shape
* Ferguson
* Glass speculum
* Veda-scope (dilating vaginal speculum)
;One blade
![Sims](https://upload.wikimedia.org/wikipedia/commons/9/95/Sims.Speculum.jpg)
;Two blades (bivalved)
![Speculum en métal](https://upload.wikimedia.org/wikipedia/commons/5/5c/Speculum_en_m%C3%A9tal.jpg)
;Three blades
Rectal use
Vaginal specula are also used for
anal
Anal may refer to:
Related to the anus
*Related to the anus of animals:
** Anal fin, in fish anatomy
** Anal vein, in insect anatomy
** Anal scale, in reptile anatomy
*Related to the human anus:
** Anal sex, a type of sexual activity involvin ...
surgery, although several other forms of anal specula exist. One form, the
anoscope
An anoscopy is an examination using a small, rigid, tubular instrument called an anoscope (also called an anal speculum). This is inserted a few inches into the anus in order to evaluate problems of the anal canal. Anoscopy is used to diagnose ...
, resembles a tube that has a removable
bullet
A bullet is a kinetic projectile, a component of firearm ammunition that is shot from a gun barrel. Bullets are made of a variety of materials, such as copper, lead, steel, polymer, rubber and even wax. Bullets are made in various shapes and co ...
-shaped insert. When the anoscope is inserted into the anus, the insert dilates the anus to the diameter of the tube. The insert is then removed, leaving the tube to allow examination of the lower rectum and anus.
This style of anal speculum is one of the oldest designs for surgical instruments still in use, with examples dating back many centuries. The
sigmoidoscope can be further advanced into the lower intestinal tract and requires an endoscopic set-up.
;Tubal shape
* Aniscope
;One blade
* Czerny
;Two blades
;Three blades
* Alan Park
* Cook
* Mathieu
Nasal use
Nasal specula have two relatively flat blades with handle. The instrument is hinged so that when the handles are squeezed together the blades spread laterally, allowing examination.
Additionally, the
Thudichum nasal speculum is commonly used in the outpatient examination of the nose.
Aural use
Ear
An ear is the organ that enables hearing and, in mammals, body balance using the vestibular system. In mammals, the ear is usually described as having three parts—the outer ear, the middle ear and the inner ear. The outer ear consists of ...
or aural specula resemble a
funnel
A funnel is a tube or pipe that is wide at the top and narrow at the bottom, used for guiding liquid or powder into a small opening.
Funnels are usually made of stainless steel, aluminium, glass, or plastic. The material used in its construct ...
, and come in a variety of sizes.
Oral use
In veterinary medicine, a McPherson Speculum can be used for oral examination. The speculum helps keep the mouth open during the exam and helps avoid biting injuries.
Non-medical use
Specula are used
for sexual pleasure, both vaginally and anally.
See also
*
*
*
References
Rediker, Marcus
Slave Ship:a human history
Penguin Group, 2007, Page 33, graph 2 : " The man had attempted to cut his own throat and had succeeded in " dividing only the external jugular vein." (To force feed him (the slave) the ships doctor would need to use the speculum oris, "...the long thin mechanical contraption used to force open unwilling throats to receive gruel and hence sustenance."
External links
*
{{DEFAULTSORT:Speculum (Medical)
Gynaecology
Medical equipment