Speculum ‘self‐insertion’: a pilot study

Wright, Deborah; Fenwick, Jennifer; Stephenson, Pam; Monterosso, Leanne

doi:10.1111/j.1365-2702.2005.01205.x

Cited by 36 publications

(15 citation statements)

References 31 publications

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“…Alternative positions,10 alternative speculums,11 alternative foot rests,12 self insertion of the speculum,13 and different types of gowns14 have shown varying degrees of improvement in pain, embarrassment, or anxiety. Reduction of physical discomfort and psychological distress are part of the motivation for the recent attempts to validate self collection methods for cervical cancer screening to eliminate the need for smears.…”

Section: Discussionmentioning

confidence: 99%

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Improving women's experience during speculum examinations at routine gynaecological visits: randomised clinical trial

Seehusen

Johnson

Earwood

et al. 2006

BMJ

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Objectives To determine if a standardised method of leg positioning without stirrups reduces the physical discomfort and sense of vulnerability and increases the sense of control among women undergoing speculum examination as part of a routine gynaecological examination. Design Randomised clinical trial. Setting Family medicine outpatient clinic. Patients 197 adult women undergoing routine gynaecological examination and cervical smear. Intervention Examination with or without stirrups. Main outcome measures Women's perceived levels of physical discomfort, sense of vulnerability, and sense of control during the examination, measured on 100 mm visual analogue scales. Results Women undergoing examination without stirrups had a reduction in mean sense of vulnerability from 23.6 to 13.1 (95% confidence interval of the difference − 16.6 to − 4.4). Mean physical discomfort was reduced from 30.4 to 17.2 ( − 19.7 to − 6.8). There was no significant reduction in sense of loss of control. Conclusion Women should be able to have gynaecological examinations without using stirrups to reduce the stress associated with speculum examinations.

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Section: Discussionmentioning

confidence: 99%

“…Reduction of physical discomfort and psychological distress are part of the motivation for the recent attempts to validate self collection methods for cervical cancer screening to eliminate the need for smears. 15 16 Some studies have shown that beliefs about pain during the procedure can influence screening behaviours for some women 13…”

Section: Discussionmentioning

confidence: 99%

Improving women's experience during speculum examinations at routine gynaecological visits: randomised clinical trial

Seehusen

Johnson

Earwood

et al. 2006

BMJ

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“…A study of 354 women in Moshi, Tanzania revealed that key factors for cervical cancer screening were significant concerns about embarrassment and pain due to screening from the speculum as well as physician gender [7]. In Australia, a study seeking to determine women’s attitudes towards physician versus self–insertion of the standard speculum found that 91% of 133 women would choose self-insertion over physician insertion, and that women have indicated discomfort, embarrassment and vulnerability from having another person insert a device and examine their cervix [8]. In the U.S., even though there is greater access to health care, compliance rates to cervical cancer screening vary, and embarrassment and fear of pain during examination have been reported as potential barriers to screening [7, 9–11].…”

Section: Introductionmentioning

confidence: 99%

Design and preliminary analysis of a vaginal inserter for speculum-free cervical cancer screening

et al. 2017

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ObjectiveCervical cancer screening usually requires use of a speculum to provide a clear view of the cervix. The speculum is one potential barrier to screening due to fear of pain, discomfort and embarrassment. The aim of this paper is to present and demonstrate the feasibility of a tampon-sized inserter and the POCkeT Colposcope, a miniature pen sized-colposcope, for comfortable, speculum-free and potentially self-colposcopy.Study designWe explored different designs using 3D computer-aided design (CAD) software and performed mechanical testing simulations on each. Designs were rapid prototyped and tested using a custom vaginal phantom across a range of vaginal pressures and uterine tilts to select an optimal design. Two final designs were tested with fifteen volunteers to assess cervix visualization, comfort and usability compared to the speculum and the optimal design, the curved-tip inserter, was selected for testing in volunteers.ResultsWe present a vaginal inserter as an alternative to the standard speculum for use with the POCkeT Colposcope. The device has a slim tubular body with a funnel-like curved tip measuring approximately 2.5 cm in diameter. The inserter has a channel through which a 2 megapixel (MP) mini camera with LED illumination fits to enable image capture. Mechanical finite element testing simulations with an applied pressure of 15 cm H2O indicated a high factor of safety (90.9) for the inserter. Testing of the device with a custom vaginal phantom, across a range of supine vaginal pressures and uterine tilts (retroverted, anteverted and sideverted), demonstrated image capture with a visual area comparable to the speculum for a normal/axial positioned uteri and significantly better than the speculum for anteverted and sideverted uteri (p<0.00001). Volunteer studies with self-insertion and physician-assisted cervix image capture showed adequate cervix visualization for 83% of patients. In addition, questionnaire responses from volunteers indicated a 92.3% overall preference for the inserter over the speculum and all indicated that the inserter was more comfortable than the speculum. The inserter provides a platform for self-cervical cancer screening and also enables acetic acid/Lugol’s iodine application and insertion of swabs for Pap smear sample collection.ConclusionThis study demonstrates the feasibility of an inserter and miniature-imaging device for comfortable cervical image capture of women with potential for synergistic HPV and Pap smear sample collection.

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“…An Australian study of women attending family planning clinics found that 67% (133/198) agreed to insert their own speculum, and of these, 90% would choose to do it again. The main barrier was women feeling unsure how to self insert a speculum 6. In future, screening might be based on detection of specific human papillomavirus (HPV) subtypes and additional biomarkers for risk of cervical cancer.…”

mentioning

confidence: 99%

Commentary: Best practice in primary care

Oakeshott

Hay

2006

BMJ

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Speculum ‘self‐insertion’: a pilot study

Abstract: Speculum self-insertion may encourage women's attendance at clinics for regular screening. Early diagnosis and treatment will result in better health outcomes for women, families and the community at large.

Cited by 36 publications

References 31 publications

Improving women's experience during speculum examinations at routine gynaecological visits: randomised clinical trial

Improving women's experience during speculum examinations at routine gynaecological visits: randomised clinical trial

Design and preliminary analysis of a vaginal inserter for speculum-free cervical cancer screening

Commentary: Best practice in primary care

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