View source for Medicine:Speculum

{{Short description|Medical device for investigating body orifices by direct vision}}
[[File:Spéculum en plastique.jpg|thumb|250px|The disposable bivalved plastic vaginal speculum is used in office gynecology]]

A '''speculum''' (Latin for 'mirror'; {{plural form}}: '''specula''' or '''speculums''') is a medical tool for investigating body orifices, with a form dependent on the orifice for which it is designed.  In old texts, the speculum may also be referred to as a '''diopter''' or '''dioptra'''.<ref>"diopter" in ''The Compact Edition of the Oxford English Dictionary'', Oxford University Press, 1971</ref> Like an [[Medicine:Endoscope|endoscope]], a speculum allows a view inside the body; endoscopes, however, tend to have [[Physics:Optics|optics]] while a speculum is intended for direct vision.

==History==
[[File:Ancient Roman Speculum.jpg|thumb|Three types of ancient Roman specula c. 50 AD.]]
[[File:5 Speculum, 14th 15th and 16th century. Wellcome M0008374.jpg|thumb|right|14th, 15th and 16th century specula]]
Vaginal and anal specula were used by the {{wipe|Ancient Greece}} and [[History:Ancient Rome|Romans]],<ref>{{cite web |date=2023-05-19 |title=Surgical Instruments from Ancient Rome |url=http://exhibits.hsl.virginia.edu/romansurgical/ |url-status=live |archive-url=http://archive.today/bfKkS |archive-date=2023-05-19 |access-date=2023-05-19 |website=Virginia.edu |publisher=University of Virginia}}</ref><ref>{{Cite journal |date=2023-05-19 |title=Vaginal Speculum, Roman, 100 BCE-400 CE |url=https://www.jstor.org/stable/community.26431718 |access-date=2023-05-19 |website=Jstor.org |jstor=co85154}}</ref> and speculum [[Social:Artifact (archaeology)|artifacts]] have been found in Pompeii.<ref>{{cite book |author=Cecilia Mettler |title=History of Medicine |publisher=The Blakiston Co (1947) |asin=B0006FF3UQ |author-link=Cecilia Mettler}}</ref><ref>{{Cite book |last=Milne |first=John Stuart |url=https://www.gutenberg.org/files/40424/40424-h/40424-h.htm#CHAPTER_IX |title=Surgical Instruments in Greek and Roman Times |publisher=Oxford at the Clarendon Press |year=1907 |pages=150–152 |access-date=2023-05-19 }}</ref> The modern [[Biology:Vagina|vagina]]l speculum, developed by J. Marion Sims, consists of a hollow cylinder with a rounded end that is divided into two hinged parts, somewhat like the beak of a [[Biology:Duck|duck]]. This speculum is inserted into the vagina to dilate it for examination of the vagina and [[Medicine:Cervix|cervix]].

The modern vaginal speculum was developed by J. Marion Sims, a plantation doctor in Lancaster County, South Carolina. Between 1845 and 1849, Sims performed dozens of surgeries, without anesthesia, on at least 12 enslaved women. In these experiments, Sims developed a technique to repair fistula and in the process invented the duckbill speculum. These experiments, and the development of the modern specula, led some to regard Sims as the "father of modern gynaecology."<ref>{{Cite web|url=https://www.theatlantic.com/technology/archive/2018/03/women-redesigning-speculum/555167/|title=Women Are Reinventing the Long-Despised Speculum|first=Daniela|last=Blei|date=March 8, 2018|website=The Atlantic}}</ref>

By the 1860s, specula were integrated into criminal justice practices in the UK. In Great Britain, examinations of the cervix were made mandatory for all women convicted of prostitution by the country's Contagious Disease Act.<ref>{{Cite web|url=https://www.fff.org/explore-freedom/article/contagious-disease-acts/|title=The Contagious Disease Acts|first=Wendy|last=McElroy|date=March 1, 2000|website=The Future of Freedom Foundation}}</ref>
In the 19th century, the vaginal speculum became a cultural symbol of the tenuous relationship between women and their physicians. Use of the speculum was generally avoided in medical practices, and most vaginal conditions were diagnosed through symptoms or palpating the abdomen. Many practitioners had moral concerns about the use of the speculum, and preferred to diagnose through palpating the abdomen. As late as 1910, physicians believed the vaginal speculum to be inferior to the "educated touch."<ref name="auto">{{cite journal|last=Sandelowski|first=M.|title=This most dangerous instrument: propriety, power, and the vaginal speculum|journal=J Obstet Gynecol Neonatal Nurs|date=January–February 2000|volume=29|issue=1|pages=73–82|doi=10.1111/j.1552-6909.2000.tb02759.x|pmid=10660279}}</ref>

These concerns continued into the early 20th century as the speculum became  commonplace in gynecology practices. Often, nurses played a major role in ensuring the proper use of the speculum during medical exams.<ref name="auto"/> The 1946 and 1956 editions of a multi-volume gynecology text for nurses required that nurses remain present during examination to protect both the patient and physician from "blackmail by designing persons."<ref>Crossen & Campbell, 1956, p. 53; Crossen & Hoffert, 1946, p. 175</ref>

{{asof|2015}}, 85% of gynecologists are women.<ref>{{Cite web|url=https://www.ama-assn.org/residents-students/specialty-profiles/how-medical-specialties-vary-gender|title=How medical specialties vary by gender|date=February 18, 2015|first=Lyndra|last=Vassar|website=American Medical Association}}</ref> As a result of this demographic shift, the procedures around speculum use have also changed.

==Construction==
[[File:Glasspekula.jpg|right|thumb|upright|Two cylindrical-shaped glass specula]]
[[File:Vaginal speculum 1.png|thumb|Position of the opened speculum during vaginal examination]]
Specula have been made of glass or metal. They were generally made of [[Chemistry:Stainless steel|stainless steel]] and sterilized between uses, but particularly in the 21st century, many — especially those used in emergency departments and doctor's offices — are made of plastic, and are disposable, [[Medicine:Single-use medical devices|single-use]] items.  Those used in surgical suites are still commonly made of stainless steel.

==Types==
[[File:Specula.pdf|thumb|Different Sizes and Shapes of Specula Commonly Used in Gynecology]]
Specula come in a variety of shapes based on their purpose, and a variety of sizes;<ref>{{cite web|url=http://www.m-e-dical.com/english/vs.htm|title=Comparison chart of speculum types, with line images|access-date=2014-05-03}}</ref> in any case the cylinder or bills(s) of the instrument allow the operator a direct vision of the area of interest and the possibility to introduce instruments for further interventions such as a biopsy.

===Vaginal===

The most common specula used in gynecologic practice are varying sizes of bivalved vaginal speculum; the two bills are hinged and are "closed" when the speculum is inserted to facilitate its entry and "opened" in its final position where they can be arrested by a screw mechanism, so that the operator is freed from keeping the bills apart.<ref>{{Cite book |last=Berek |first=Jonathan |title=Berek and Novak's Gynecology |date=2020 |publisher=Wolters Kluwer |year=2020 |isbn=9781496380333 |edition=16th |location=Philadelphia, PA, USA |pages=Chapter 1 |language=English}}</ref>



A cylindrical-shaped speculum, introduced in 2001, the dilating vaginal speculum (also known as the Veda-scope<ref>{{cite journal|pmid=15089838|year=2004|last1=Longmore|first1=P. G.|title=Veda-scope: More comfortable than the bivalve speculum and cytologically equivalent|journal=The Australian and New Zealand Journal of Obstetrics and Gynaecology|volume=44|issue=2|pages=140–5|doi=10.1111/j.1479-828X.2004.00180.x|s2cid=22103276}}</ref>) invented by Clemens van der Weegen,<ref>van der Weegen, Clemens (2000) "Vaginal speculum with seal" {{US Patent|6719687}}</ref> inflates the vagina with filtered air.<ref>{{cite journal|pmid=11787909|year=2001|last1=Thomas|first1=A|title=A randomised controlled trial comparing a dilating vaginal speculum with a conventional bivalve speculum|journal=The Australian & New Zealand Journal of Obstetrics & Gynaecology|volume=41|issue=4|pages=379–86|last2=Weisberg|first2=E|last3=Lieberman|first3=D|last4=Fraser|first4=I. S.|doi=10.1111/j.1479-828x.2001.tb01313.x|s2cid=39928557}}</ref> (see diagram) The device has two main functions: a) to take a normal Pap smear with a cervical brush or a cytology brush; and b) as an internal colposcope so that the operator can pivot the Veda-scope to view any part of the vagina barrel and cervix facilitated by an internal light source that can illuminate the vaginal wall and cervix with multi-coloured light filters, which can detect pre-cancerous cells with the aid of [[Chemistry:Acetic acid|acetic acid]] solution and [[Chemistry:Iodine|iodine]] solution. It also has a facility to attach a digital camera for viewing and recording.<ref>[http://pacificei.com/how_work.html How it works]. pacificei.com</ref> [[File:Dilating vaginal speculum inflating vagina and light illuminating.jpg|right|thumb|Dilating vaginal speculum inflating vagina and light illuminating (cervical brush inserts through top inlet)]]

A specialized form of vaginal speculum is the weighted speculum, which consists of a broad half tube which is bent at about a 90 degree angle, with the channel of the tube on the exterior side of the angle. One end of the tube has a roughly spherical metal weight surrounding the channel of the speculum. A weighted speculum is placed in the vagina during vaginal [[Medicine:Surgery|surgery]] with the patient in the lithotomy position. The weight holds the speculum in place and frees the surgeon's hands for other tasks.
A vaginal speculum is also used in fertility treatments, particularly artificial insemination, and allows the vaginal cavity to be opened and observed thereby facilitating the deposit of semen into the vagina.

;Cylindrical shape
{|
| valign="top"|
* Ferguson
* Glass speculum
* Veda-scope (dilating vaginal speculum)
|}

[[File:Sims.Speculum.jpg|right|thumb|upright|The single-billed Sims speculum is still in use today.]]
;One bill
{|
| valign="top"|
* Auvard
* Breisky
* Doyen
* Eastman
* Jackson
| valign="top"|

* Kallmorgen
* Kristeller
* Landau
* Martin
* Mathieu
| valign="top"|
* Polansky
* Samuel
* Scherbak
* Sims
* Weissbarth
|}

[[File:Speculum of Polansky.jpg|thumb|Medical instrument]]
[[File:Speculum en métal.jpg|thumb|right|upright|Duckbill shape of a two-billed speculum]]
;Two bills (bivalved)
{|
| valign="top"|
* Collin
* [[Engineering:Cusco's speculum|Cusco]]
* DeVilbiss
| valign="top"|
* Graves
* Huffman
* Pederson
* Semm
| valign="top"|
* Seyffert
* Trelat
* Winterton
|}

;Three bills
{|
| valign="top"|
* Guttmann
* Nott
| valign="top"|
* O'Sullivan-O'Connor
* Polansky (veterinary use)
|}

===Rectal===
Vaginal specula are also used for [[Biology:Human anus|anal]] surgery, although several other forms of anal specula exist.  One form, the [[Medicine:Anoscopy|anoscope]], resembles a tube that has a removable [[Engineering:Bullet|bullet]]-shaped insert.  When the anoscope is inserted into the anus, the insert dilates the anus to the diameter of the tube.  The insert is then removed, leaving the tube to allow examination of the lower rectum and anus.

This style of anal speculum is one of the oldest designs for surgical instruments still in use, with examples dating back many centuries. The sigmoidoscope can be further advanced into the lower intestinal tract and requires an endoscopic set-up.

;Tubal shape
{|
| valign="top"|
* Aniscope
|}

;One bill
{|
| valign="top"|
* Czerny
|}

;Two bills
{|
| valign="top"|
* Barr
* Bodenhamer
* Killian
| valign="top"|
* Pratt
* Ricord
* Roschke
| valign="top"|
* Sims
* Smith-Buie
|}

;Three bills
{|
| valign="top"|
* Alan Park
* Cook
* Mathieu
|}

===Nasal===
[[File:Examples_of_nasal_speculum,_both_ancient_and_modern._Wellcome_M0000167.jpg|thumb|upright=0.7|Two examples of nasal specula: ancient and modern]]
[[Medicine:Human nose|Nasal]] specula have two relatively flat bills with handle.  The instrument is hinged so that when the handles are squeezed together the bills spread laterally, allowing examination.
{|
|-
| valign="top"|
* Killian
*Cottle
* Vienna
| valign="top"|
* Voltolini
* Yankauer
|}

Additionally, the Thudichum nasal speculum is commonly used in the outpatient examination of the nose.

===Aural===
[[File:Aural Speculum ENT Instrument Medical.jpg|right|thumb|Ear specula are funnel-shaped.]]
[[Medicine:Ear|Ear]] or aural specula resemble a [[Engineering:Funnel|funnel]], and come in a variety of sizes.
{|
|-
| valign="top"|
* Aural Speculum
*Farrior Ear Speculum
| valign="top"|
|}

===Eyelid===
[[File:Cataract surgery.jpg|thumb|Eyelid speculum (right) in use during cataract surgery]]
For opthalmic surgery such as [[Physics:Cataract surgery|cataract surgery]], a speculum designed to retract the eyelids is used.

===Oral===
In veterinary medicine, a McPherson Speculum can be used for oral examination. The speculum helps keep the mouth open during the exam and helps avoid biting injuries.

==Non-medical use==

Specula are used for sexual pleasure, both vaginally and anally.<ref>{{cite journal |title=Sensual, Erotic, and Sexual Behaviors of Women from the "Kink" Community |author=Jennifer Eve Rehor |date=2013-04-24 |journal=Archives of Sexual Behavior |doi=10.1007/s10508-015-0524-2 |volume=44 |issue=4 |pages=825–836 |pmid=25795531 |pmc=4379392 }}</ref>

==See also==
* {{annotated link|Medicine:Endoscope}}
* {{annotated link|Medicine:Vaginal dilator}}

==References==
{{Reflist}} Rediker, Marcus
Slave Ship:a human history
Penguin Group, 2007, Page 33, graph 2 : " The man had attempted to cut his own throat and had succeeded in " dividing only the external jugular vein." (To force feed him (the slave) the ships doctor would need to use the speculum oris, "...the long thin mechanical contraption used to force open unwilling throats to receive gruel and hence sustenance."

== External links ==

{{Surgical instruments}}

{{DEFAULTSORT:Speculum (Medical)}}
[[Category:Gynaecology]]
[[Category:Medical equipment]]

{{Sourceattribution|Speculum (medicine)|1}}