Female doctor with patient

How Wide Do Speculums Expand Inside You

If you have ever wondered how a speculum works during a pelvic exam, you may have thought about how it expands. Speculum insertion can be intimidating to many people and can prevent them from getting potentially life-saving diagnostic exams like pap smears and STI screenings.

Learn about what a speculum does, how far it can expand and how you can work with your OB/GYN to make your next visit more comfortable. 

The Role of Speculums in Medical Examinations

Speculums are basic gynecological instruments that, although they may appear a bit daunting initially, are necessary for doctors to obtain a clear view of the cervix and vagina.

Specula are a crucial tool in gynecology, enabling doctors to conduct necessary examinations and procedures such as pap smears, which are critical for the early detection of conditions like cervical cancer. Speculum tools are essential for monitoring women’s health, as they help identify potential issues early when treatment is often more manageable.

Understanding Speculum Sizes and Expansion

Every woman’s body is unique, and our bodies constantly fluctuate in size and shape.

This means your doctor needs to have a range of speculum types and sizes for different bodies and stages of life. There are typically three types of specula designs: pediatric, Pederson, and Graves. 

  • Pediatric specula aren’t just used for pediatric exams; they’re also suitable for women who have not engaged in intercourse or those with anatomically narrow vaginal canals. 
  • The Pederson also has a narrow bill but comes in with longer blade sizes in small, medium and large sizes. The smallest size widens to approximately an inch, while the other two open to around 1.5”. 
  • Graves-style specula have a rounded, slightly flared bill. They are most often used on women who are having regular intercourse or those who have given birth vaginally at least once. They also come in three sizes, small, medium and large, with an expansion range between 1” and 2”. 

The degree of expansion is influenced by several factors, the most crucial being patient comfort. The speculum should never cause pain. If you do experience any discomfort, inform your healthcare provider. They can make adjustments, such as using a different size or reducing the width of expansion, to ensure comfort.

The speculum is expanded only to the extent medically required. It needs to be opened wide enough to enable your doctor to perform a comprehensive and effective examination or procedure. For instance, during a pap smear, the speculum must expand adequately to provide a clear view of the cervix.

Can a Speculum Damage My Vagina?

Specula are designed to be safe and should not damage your vagina. You may feel pressure or a slight stretching sensation, but it should not pinch or tear. However, certain conditions might lead to discomfort during a pelvic exam using a speculum. It’s essential to let your OB/GYN know if you have any of the following conditions:

  • Vaginal atrophy. This condition is characterized by thinning of the vaginal walls due to decreased estrogen levels. It leads to a shorter, tighter vaginal canal and symptoms like irritation, dryness and soreness. These changes can make a speculum exam uncomfortable.
  • Vaginismus. In vaginismus, the muscles around the vagina involuntarily contract due to fear of penetration, including the insertion of a speculum. This muscle tension can make the vagina contract, increasing the pain during a speculum exam.
  • Lichen sclerosus. Lichen sclerosus is a skin disorder that affects the skin’s elasticity, making it less stretchy and more prone to tearing. This can cause additional challenges during a speculum exam, as the skin may be more susceptible to tears.
  • Vulvodynia. Vulvodynia refers to chronic pain in the vulva, which can extend into the vagina. This ongoing pain can make the insertion and presence of a speculum during an exam particularly painful.

How Can I Make a Speculum Exam More Comfortable?

If you have anxiety about what is done during a pelvic exam that is preventing you from getting the care you need, there are several simple strategies you can try to help make your experience at the OB/GYN more comfortable. 

  • Communicate with your healthcare provider. Open and honest communication with your healthcare provider is essential. Inform them about any concerns, past discomfort or medical conditions that might affect the exam. They can adjust their approach accordingly.
  • Relaxation techniques. Practice relaxation techniques such as deep breathing or meditation before the exam. Reducing anxiety and muscle tension in your pelvic area can make insertion of the speculum less uncomfortable.
  • Request a smaller speculum. If you have concerns about the size of the speculum, ask for a smaller one. A properly sized speculum can reduce discomfort during insertion.

    You can also ask for an alternative to a traditional metal speculum, like the Nella disposable speculum. The Nella is made from smooth, temperature-neutral polycarbonate and best of all, it is only the size of a regular tampon.
  • Use lubrication. Some healthcare providers use a water-based lubricant on the speculum to ease insertion. If it's not offered, you can ask if it can be used to improve your comfort. Water-based lubricants do not interfere with cellular cytology, so they’re ideal for Pap smears and STI tests.
  • Positioning matters. The best position for a pelvic exam is typically the lithotomy position, where the patient lies on their back with knees bent and feet in at the corners of the table or in the stirrups. This position allows your healthcare provider optimal access to the pelvic area while ensuring your comfort.
  • Distraction techniques. Bring headphones and listen to music or an audiobook during the exam to divert your attention. Focusing on something other than the procedure can help reduce anxiety.

Choose Nella for More Comfortable Pelvic Exams

Nella offers you a more comfortable alternative to traditional metal specula. While it still expands your vaginal canal, the smooth polymer construction, slim, rounded design and near-silent operation make it a more comfortable experience.

Purchase the Nella Comfort Kit for your next visit or talk to your doctor about switching to Nella today. 

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