A guide to performing pelvic speculum exams: a patient-centered approach to reducing iatrogenic effects

Current training in the United States for pelvic speculum examinations (PSEs) has a primary focus on the physician-centered goal of visualizing the cervix but may not inform practitioners of potential iatrogenic effects. Such oversight leaves trainees unprepared and unskilled in preventing and addressing adverse outcomes. This article incorporates a literature review into a step-by-step guide to aid the teaching of PSEs.

Iatrogenic effects of PSEs may include mild discomfort, extreme pain, anxiety, psychological (re)traumatization, and sexual pain disorders. A literature-based guide is presented to identify patients at risk for adverse outcomes, set up the exam room, set up the patient, perform the exam, calm distressed patients, and avoid exam-interfering behaviors.

Although PSEs can lead to adverse outcomes, awareness of the iatrogenic effects allows clinicians to utilize techniques to prevent or reduce negative effects. A method of incorporating techniques described in this article into teaching is provided.