title: Sheathed versus standard speculum for visualization of the cervix.
abstract: OBJECTIVE
  To determine whether modifying a plastic speculum with a flexible sheath would improve visualization and decrease pain during vaginal examination.
  
  
  METHODS
  We conducted a prospective randomized controlled trial of 136 women undergoing vaginal speculum examination at an outpatient obstetrics and gynecology faculty practice. Patients underwent examination via a standardized technique with either a medium-sized plastic speculum (standard) or an identical speculum modified with a flexible polypropylene sheath (sheathed). Investigators recorded the percentage of the cervix visualized. After speculum insertion, patients recorded pain using a 10-cm visual analog scale.
  
  
  RESULTS
  There were no substantial demographic differences between the standard (n=67) and the sheathed (n=68) groups. Investigators were able to visualize a significantly greater percentage of the cervix using the sheathed speculum compared with the standard speculum (95.1%±8.2% vs. 78.2%±18.4%; P<0.001), representing a 21.6% improvement in visualization, and were able to visualize the entire cervix in 42 (61.8%) patients when using the sheathed speculum compared with 11 (16.4%) patients undergoing standard speculum examination (P<0.001). Patients undergoing examination with the sheathed speculum reported a nonsignificant decrease in pain scores (1.0 vs 1.2; P=0.087).
  
  
  CONCLUSIONS
  A sheathed speculum significantly improves visualization of the cervix, without compromising patient comfort. ClinicalTrials.gov:NCT01670630.
authors.affiliation: Department of Obstetrics and Gynecology, Florida Hospital Graduate Medical Education, Florida Hospital Orlando, Orlando, USA; Department of Obstetrics and Gynecology, University of Central Florida College of Medicine, Orlando, USA. Electronic address: d.ashley.hill.md@flhosp.org.
authors.forename: David A
authors.initials: DA
authors.lastname: Hill
authors.affiliation: Department of Obstetrics and Gynecology, Florida Hospital Graduate Medical Education, Florida Hospital Orlando, Orlando, USA; Department of Obstetrics and Gynecology, University of Central Florida College of Medicine, Orlando, USA.
authors.forename: Michael L
authors.initials: ML
authors.lastname: Cacciatore
authors.affiliation: Department of Obstetrics and Gynecology, Florida Hospital Graduate Medical Education, Florida Hospital Orlando, Orlando, USA; Department of Obstetrics and Gynecology, University of Central Florida College of Medicine, Orlando, USA.
authors.forename: Georgine
authors.initials: G
authors.lastname: Lamvu
mesh_terms: D000328:Adult; D002584:Cervix Uteri; D004867:Equipment Design; D005260:Female; D058869:Gynecological Examination / Q000009:adverse effects / Q000295:instrumentation*; D006801:Humans; D010146:Pain / Q000209:etiology* / Q000517:prevention & control; D010147:Pain Measurement; D011446:Prospective Studies; D016037:Single-Blind Method; D013525:Surgical Instruments
keywords: Bivalve; Cervix; Gynecologic examination; Speculum; Vaginal sidewall