finding cervix

Specialties CNM

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Hi! I am a FNP student and no matter what technique I use, I can hardly ever visualize the cervix during speculum exam. I have tried angling the speculum downward on insertion, going back as far as possible and opening the speculum and gradually aiming upward, having patient put their fists under their buttocks, taking the speculum out and inserting at another angle, and I've tried feeling for the cervix first. Nothing works for me!! And for big women who have lots of fat in the lady partsl canal...is a condom on the speculum the best approach? Are there any techniques any of you can share?

Thanks so much!

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Specializes in L&D.

Have you also tried finding your own cervix with a speculum? Are you in clinicals right now?

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Specializes in Emergency Department.
And for big women who have lots of fat in the lady partsl canal...is a condom on the speculum the best approach?

Do you cut the end off the end of a condom? How is it stretchy enough to open with the speculum? I used the wide blade speculum (forget which one this is) to scoop up as much flesh out of the way.

Once when I had no luck finding a cervix I did a VE first and then went in with the spec. Lubricant has no bearing on the result of the pap so I didn't worry about it.

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Specializes in L&D.

I've had to have my own cervix manually palpated to locate it by the midwife doing my last pap, before she tried again with the speculum. I'm also a former "big girl" so I suppose I still have a lot of fatty skin folds in my lady parts, so I always need to have the large graves for my own exams.

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Hi! I am a FNP student and no matter what technique I use, I can hardly ever visualize the cervix during speculum exam. I have tried angling the speculum downward on insertion, going back as far as possible and opening the speculum and gradually aiming upward, having patient put their fists under their buttocks, taking the speculum out and inserting at another angle, and I've tried feeling for the cervix first. Nothing works for me!! And for big women who have lots of fat in the lady partsl canal...is a condom on the speculum the best approach? Are there any techniques any of you can share?

Thanks so much!

The ACNM have produced a great on-line speculum education, which will definately help you

http://www.obgyn.net/SpeculumEducation

I do not suggest that you "feel the cervix first", this will make specimen collection for Ffn inaccurate, also consider that if you suspect ruptured membranes this should be sterile procedure.

Performing SSE is a skill that needs to be practiced.

-Observe a skilled CNM, NP or MD

-Know the procedure

-Then have a skilled practioner observe you.

Remember that if the woman has a bad experience she may not return for important cervical health screening in the future

Good Luck

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Specializes in ER.

Great video!

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