Physical Exam

Pelvic Speculum Exam

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Video coming September 2026

How to Perform

With consent, a chaperone, and the patient in lithotomy, select and warm an appropriately sized speculum and lubricate it with warm water or water-based gel. Separate the labia and insert the closed speculum along the posterior vaginal wall at a slight downward angle, then open the blades to bring the cervix into view and lock it. Inspect the cervix and vaginal walls for color, discharge, and lesions; obtain any indicated samples (cytology, swabs); then unlock and withdraw the speculum while inspecting the walls.

How to Interpret

Bacterial Vaginosis

Appearance of vaginal discharge on speculum examination as an isolated sign in a woman

Rule in

—

Rule out

Helpful

Evidence:Limited

References

Simões JA, Discacciati MG, Brolazo EM, Portugal PM, et al. Clinical diagnosis of bacterial vaginosis. Int J Gynaecol Obstet. 2006;94(1):28-32. doi:10.1016/j.ijgo.2006.04.013 (cross-sectional study, 135 women, UNICAMP, Brazil; Nugent score gold standard; BV prevalence 22%). [Anchoring single primary cohort: vaginal discharge as a single Amsel criterion had sensitivity ~97% and specificity ~26% (the lowest specificity of the four criteria) versus the Nugent score. Verified at ScienceDirect + Wiley; PMID not located but volume/issue/pages and DOI confirmed at source. Corroborated by Vieira-Baptista P, et al. 2022 (Epub 2021), PMID 34160078, for the Amsel-set-versus-microscope contrast.]
Bickley LS, Szilagyi PG, Hoffman RM, Soriano RP. Bates' Guide to Physical Examination and History Taking. 13th ed. Philadelphia, PA: Wolters Kluwer; 2021.
Swartz MH. Textbook of Physical Diagnosis: History and Examination. 9th ed. Philadelphia, PA: Elsevier; 2025.