If you want to say that going to the hospital to do the most scary examination, the gynecological examination must be on the list.
Recently, a netizen began to understand the process of gynecological examination because he was sick. When reviewing the process, she found that many routine gynecological examinations require the use of "duckbill pliers", but the use of "duckbill pliers" made her feel a little uncomfortable. After learning more, she found that many women felt the same way as her, "'duckbill pliers' caused a great psychological shadow", "people are afraid of gynecological examinations", "they will feel pain", ......
Image source: Screenshot of a social platform
Why does such a routine gynecological examination leave a psychological shadow on so many people? Why is there no more comfortable and user-friendly alternative to the tools of gynecological examination?
This is an issue that deserves serious discussion.
Vaginal speculum (duckbill forceps)
The reason why it has been used
The tool used by gynecologists to examine the vagina and cervix is called a vaginal speculum, because its two blades are very similar to the duckbill, so it is also called duckbill pliers.
The first duckbill pliers were invented in the mid-19th century by James Marion Sims, the controversial "father of gynaecology", and have since been refined several times and are still in use today.
After so many years, the appearance and performance of many daily necessities in life have undergone earth-shaking changes, but when it comes to vaginal speculum for gynecological examination, whether it is Chinese and foreign textbooks or the operation guidelines of various authoritative institutions, as well as various gynecological examinations, teaching demonstration videos of speculum used in gynecological surgery, this duckbill type speculum is still used by default - the details may be different, but the essence is this duckbill structure.
Why? Because of its stable and reliable function, it can ensure that the clinical needs are met most of the time.
The vagina that we see in various illustrations is in the shape of a cylindrical tube, in fact, the anterior and posterior walls of the vagina under normal conditions are naturally fitted together, and it needs to be pushed open with a tool to observe the health of the inside.
The posterior wall of the vagina is often one or two centimeters longer than the anterior wall of the vagina, so the two "duckbills" of the vaginal speculum are often one long and one short. After entering the vagina, the duckbill is opened, and the short blades are used to support the anterior wall of the vagina, and the long blades are used to push the posterior wall of the vagina, so that the vagina and cervix can be clearly exposed for examination and operation.
Schematic diagram of the working vaginal speculum
There are two main scenarios for the use of vaginal speculum, one is for gynecological examination, and the other is for transvaginal surgical operation.
When gynecological patients complain of abnormal vaginal discharge, vulvovaginal discomfort, abnormal vaginal bleeding, etc., speculum examination is required. Disposable plastic speculums are generally used in outpatient clinics, which can help medical staff see the situation in the vagina and preliminarily determine whether there are special inflammatory manifestations, abnormalities in the cervix, vegetations or other special lesions, and whether there are foreign body retention.
If there is bleeding, it can also be preliminarily determined whether the bleeding is coming from the vagina, cervix, or uterus. At the same time, it is also necessary to confirm that the sampling site is correct to ensure the accuracy of the results.
Disposable plastic speculums. The stock copyright picture, reprinting and using may cause copyright disputes
In the case of gynecologic surgery, if it is a transvaginal surgery or a pelvic surgery that may come into contact with the vagina, it is necessary to clean and disinfect the vulva and vagina to prevent infection. In this case, a metal speculum with bolts is generally used. Exposing the vagina and cervix with a speculum ensures that the disinfection is adequate and thorough to avoid misses.
During the operation, the metal speculum can also be adjusted to a suitable angle and position, and the speculum can be fixed by rotating bolts. In this way, the surgeon does not need to have one hand to operate the opening and closing of the speculum, but can free both hands to concentrate on the operation.
Metal speculum. The stock copyright picture, reprinting and using may cause copyright disputes
Experience with the vaginal speculum
Why is it so bad
The reason why many people have a psychological shadow about gynecological physical examination is that the process of using speculum is extremely uncomfortable. Some people have pain that lasts long after the test is over.
Why is the experience of using a vaginal speculum so bad? There are many reasons for this.
The objective reason is that the perineum itself is rich in nerves and is more sensitive than most other parts of the body, so it is more likely to cause discomfort during operation. If the speculum is not adequately lubricated, it is more likely to cause foreign body sensation and pain if it is involved and rubbed against local tissues during inclusion.
The shape of the vagina does not match the speculum perfectly, and when the speculum is opened, there are areas that are subjected to excessive dilating pressure in order to fully expose the cervix, resulting in pain.
There are different specifications of speculum on the market, but small speculum is generally more used for patients with vaginal atrophy or congenital stricture, and often has the disadvantages of insufficient length and insufficient exposure. For outpatient gynecological examinations, a medium-sized speculum is generally used by default, because it can meet the examination needs of most people. However, while tool specifications are uniform, the human body is not the same. Therefore, it is inevitable that many people will have a poor experience when using it.
Some diseases or symptoms, such as inflammation, vaginal atrophy due to decreased estrogen, etc., will increase local sensitivity to pain and discomfort, and are also one of the causes of pain and discomfort during gynecological examinations.
Subjectively, the gynecological examination itself is a very private examination, especially in the face of unfamiliar medical personnel exposing the intimate parts, tension and shame are inevitable, so in the face of the unfamiliar and invasive examination tool of the vaginal speculum, the muscles will unconsciously contract to fight, which will obviously aggravate the discomfort of the examination. If you have had an unpleasant gynecological check-up, a painful childbirth, or an uncomfortable sexual experience, you will feel more painful about the examination due to psychological trauma.
In addition, the operation methods of medical staff are also very related to the examination experience. In my personal experience, if the speculum is sufficiently lubricated prior to the examination, the discomfort of speculum insertion can be significantly reduced. On the premise of being able to see the internal condition clearly, the opening of the speculum can be minimized, and the patient's discomfort can also be greatly reduced.
In addition, when facing a particularly nervous patient, informing or explaining the next operation before each operation can effectively calm the nervousness of many people and help the examination go smoothly. At the same time, all the tools needed are fully prepared before each examination, so that the examination can be completed as quickly as possible and the pain of the patient is reduced.
Is there a better tool to replace it?
Whether it's out of empathy for the patient or out of the need to get the job done, the vast majority of physicians have learned how to refine their skills as they grow from student to doctor, including how to make the examination process serve its purpose and minimize patient discomfort.
Clinically, there are often dozens of different tools in daily examination and surgical operations, each of which corresponds to a specific purpose, and even the needles used for sutures correspond to the suture needs of different tissues according to the shape of the needle tip. Is it possible to replace it with other shapes?
Many people have tried it, and it is true that some new tools have briefly entered the clinic, but unfortunately, there is still no better tool to replace the mainstream vaginal speculum.
Some people find a way to use the idea of gastrointestinal endoscopy and laparoscopic surgery to change the speculum to a speculum, that is, to use a slender camera instead of the naked eye, and only use the lens to inspect without opening the vaginal wall. The discomfort caused by this method will definitely be significantly reduced, and if the lens is clear, it can also see many details that are not clear to the naked eye, and record the specific lesion state, which is of great help for the continuous observation of some diseases. However, the clearer the lens, the higher the cost, and if the cost control leads to insufficient clarity, it is difficult to ensure accuracy, so it is difficult to benefit all patients.
A medical gynecological speculum
There are also some people who find a way to shape the speculum, using a design similar to a tampon push tube or petal shape to try to alleviate the discomfort caused by the speculum. These designs may not be able to replace the full functionality of traditional speculums, but if they ensure the comprehensiveness of gynecological examinations and the accuracy of specimen collection, even if they are only used for outpatient gynecological examinations and specimen sampling, countless women will benefit from them.
A new type of speculum that changes the traditional two-leaf speculum to a five-leaf speculum, and when the dilator is inserted and opened, the five "lobes" can gently support the cervix, ensuring that only the cervix is visualized, avoiding the collapse of the vaginal wall.
Many medical procedures sacrifice the comfort of the operation process for medical purposes such as accuracy and safety of examination and treatment, and women's gynecological examination is a very typical example. Fortunately, more and more people are beginning to pay attention to this, and are also actively promoting the progress and innovation of tools, hoping that more people will participate and brainstorm, and perhaps a better alternative than traditional speculum may appear as soon as possible.
Source: Popular Science China