Materials, software, and tools used in our experiments.

Materials, software, and tools used in our experiments.</p

Comparison of small, medium, and large glove sizes in preventing lateral vaginal wall collapse during speculum examinations.

The data shown is for nitrile gloves using the “middle finger” placement method.</p

Summary of findings and recommendations.

Pelvic exams are frequently complicated by collapse of the lateral vaginal walls, obstructing the view of the cervix. To overcome this, physicians frequently repurpose a glove or a condom as a sheath placed over the speculum blades to retract the lateral vaginal walls. Despite their regular use in clinical practice, little research has been done comparing the relative efficacy of these methods. Better visualization of the cervix can benefit patients by decreasing examination-related discomfort, improving cancer screening accuracy, and preventing the need to move the examination to the operating room under general anesthesia. This study presents a physical model that simulates vaginal pressure being exerted around a speculum. Using it, we conduct controlled experiments comparing the efficacy of different condom types, glove materials, glove sizes, and techniques to place gloves on the speculum. The results show that the best sheath is the middle finger of nitrile-material gloves. They provide adequate lateral wall retraction without significantly restricting the opening of the speculum. In comparison, condoms provide a smaller amount of retraction due to loosely fitting the speculum. They may still be a reasonable option for a different speculum size. However, vinyl-material gloves are an impractical option for sheaths; they greatly restrict speculum opening, occasionally even breaking the speculum, which overcome its retraction benefits. Glove size, condom brand, and condom material (latex vs polyisoprene) had minimal impact. This study serves as a guide for clinicians as they use easily accessible tools to perform difficult pelvic exams. We recommend that physicians consider nitrile gloves as the preferred option for a sheath around a speculum. Additionally, this study demonstrates proof-of-concept of a physical model that quantitatively describes different materials on their ability to improve cervical access. This model can be used in future research with more speculum and material combinations, including with materials custom-designed for vaginal retraction.</div

Comparison of various condom brands and no condom in preventing lateral vaginal wall collapse during speculum examinations.

Comparison of various condom brands and no condom in preventing lateral vaginal wall collapse during speculum examinations.</p

Comparison of the different methods of applying the glove onto the speculum in preventing lateral vaginal wall collapse during speculum examinations.

The palm method (inserting the speculum into the palm of the glove only and using the palm as the sheath), is not shown as those trials were abandoned because of clear inferiority. (see Fig 3).</p

Composite table of the mean and standard error for all the sets of trials performed.

Composite table of the mean and standard error for all the sets of trials performed.</p

Speculum photos.

(a) labeled diagram of the Welch Allyn plastic speculum used in our experiments; (b,c,d) the physician’s view through the speculum at varying vaginal pressures as represented by our physical model during an experimental trial with a Skyn condom: (b) 0 mmHg with excellent visualization, (c) 40 mmHg (5.3 kPa) with adequate visualization, and (d) 120 (16.0 kPa) mmHg with poor visualization due to lateral wall collapse.</p

Photo of experimental setup.

Pelvic exams are frequently complicated by collapse of the lateral vaginal walls, obstructing the view of the cervix. To overcome this, physicians frequently repurpose a glove or a condom as a sheath placed over the speculum blades to retract the lateral vaginal walls. Despite their regular use in clinical practice, little research has been done comparing the relative efficacy of these methods. Better visualization of the cervix can benefit patients by decreasing examination-related discomfort, improving cancer screening accuracy, and preventing the need to move the examination to the operating room under general anesthesia. This study presents a physical model that simulates vaginal pressure being exerted around a speculum. Using it, we conduct controlled experiments comparing the efficacy of different condom types, glove materials, glove sizes, and techniques to place gloves on the speculum. The results show that the best sheath is the middle finger of nitrile-material gloves. They provide adequate lateral wall retraction without significantly restricting the opening of the speculum. In comparison, condoms provide a smaller amount of retraction due to loosely fitting the speculum. They may still be a reasonable option for a different speculum size. However, vinyl-material gloves are an impractical option for sheaths; they greatly restrict speculum opening, occasionally even breaking the speculum, which overcome its retraction benefits. Glove size, condom brand, and condom material (latex vs polyisoprene) had minimal impact. This study serves as a guide for clinicians as they use easily accessible tools to perform difficult pelvic exams. We recommend that physicians consider nitrile gloves as the preferred option for a sheath around a speculum. Additionally, this study demonstrates proof-of-concept of a physical model that quantitatively describes different materials on their ability to improve cervical access. This model can be used in future research with more speculum and material combinations, including with materials custom-designed for vaginal retraction.</div

Comparison of speculum opening distance by the type of sheath applied.

Restriction of this value is the disadvantage of using a sheath. Because the condoms were looser than the gloves, opening the speculums to the same number of clicks leads to widely different speculum opening distances (distances between speculum blade apices) depending on the sheath used. To keep the speculum opening distances comparable, the speculums were opened to 3 clicks for condoms (a) and 5 clicks for gloves (b). However, when the speculums were opened to 5 clicks for the vinyl material gloves, the speculums often broke. To give a numeric value, the vinyl material gloves are shown at 3 clicks as well (a), which was the maximum amount of clicks that could be consistently attained without speculum breaking. All measurements shown are at baseline, before any external pressure was exerted (0 mmHg). The speculums can be inserted into the gloves via one of three methods: “middle finger” (1 finger), “two fingers”, and “palm” (see Fig 6). Trojan and LifeStyles condoms are composed of latex, and Durex and Skyn condoms are composed of synthetic polyisoprene.</p

Comparison of glove material type (nitrile vs vinyl) in preventing lateral vaginal wall collapse during speculum examinations.

Although the vinyl gloves seem better in this metric, they performed significantly worse overall because they restricted the speculum opening distance and occasionally even broke the speculum (see Fig 3). The data shown is for medium size gloves using the “middle finger” insertion method.</p