If you have had a pelvic exam, you have most likely encountered a vaginal speculum. Health care providers use speculums to look inside the vagina and see the cervix. It is an important tool to check for abnormal growths, take samples (such as for a Pap smear) and perform surgery. Speculums come in different sizes, styles and colors. Some have lights, some have wings.  

Medical conditions or personal experiences can make speculum exams scary, uncomfortable or painful. Research shows that these concerns can be so severe that they cause people to avoid gynecologic care altogether.  

Learn more about how the speculum came to be, options you have to ease speculum pain or anxiety, and ways you and your provider can work together make pelvic exams go smoothly.   

A brief history of the vaginal speculum

Evidence shows there were versions of a speculum used in ancient Greece and Rome. Early versions were made of bone or wood. However, most people credit the development of the “modern” metal speculum to James Marion Sims, a controversial plantation doctor who learned to treat gynecologic conditions by performing surgeries on enslaved women. As part of this process, he designed a speculum in the 1840’s that continues to be in use today.  

Speculum use grew from there. In the 1860’s, the British government passed the Contagious Disease Acts to reduce sexually transmitted infections (STIs) in the military and navy. British doctors began using the speculum to examine women suspected of prostitution. Many opposed these acts, which were ultimately repealed in 1886. However, speculum use continued. 

Over 170 years later, the basics of the device remain unchanged. However, innovators are now trying to find ways to better the experience for anyone with a vagina. New designs boast some improvements such as making the speculum less noisy, covering the blades in silicone for a warmer touch and making the instrument slimmer and easier to insert. 

Different speculums for different bodies

You can feel some discomfort or pressure when your health care provider inserts the speculum, but it should never hurt. Your provider will usually use the smallest speculum they can for your exam. You may need a different size, style or other accommodations to find the right speculum for your body. 

Some of the ways that speculums can vary include: 

Material: Speculums can be made of glass, metal or plastic. 

Blades and wings: Vaginal speculums can have one, two or three blades. The most common type has two blades in a “duck-billed” shape. The doctor puts the speculum in the vagina and opens the blades to see the inside. Some versions have wings that help expand the walls more. 

Disposal and reuse: Some speculums are sanitized and reused while others are single-use only. 

Size: Your provider will use a speculum that best fits your body. Some factors include your age, anatomy, sexual activity and if you have given birth. 

Options for speculum exams

Some conditions, such as vaginismus, vulvodynia or vaginal atrophy, can make pelvic exams painful. Trauma, sexual or gender identity and muscle tension can also be factors in how you experience exams.  

Your provider will check in with you and make you comfortable by: 

• Beginning with the smallest speculum  
• Warming or lubricating the speculum before insertion 
• Describing the process as it happens so you can know what to expect. If you prefer, you can also choose to distract yourself by listening to music or an audiobook 

If you have further concerns, talk with your provider about pain management. The OHSU Center for Women’s Health offers a range of pain control options, from heating pads to deep sedation. We will meet you where you are so you can get the care you need.