Finding the elusive cervix...

Trauma Columnist · Mar 31, 2017

When I worked ER, (doing STD exams not PAPs), I sometimes had to remove the speculum and completely reinsert it - have you tried that?

Ladycards · Mar 31, 2017

Yes and then I would re-direct it more posteriorly or anteriorly but no cervix

Trauma Columnist · Mar 31, 2017

Ugh. Sorry I can't help further. Hopefully some of our WHnP colleagues will answer.

ndnursepract · Apr 2, 2017

Try doing the bimanual exam first. If you can manually feel the cervix, you'll have a better idea which direction to direct the speculum.

BirkieGirl · Apr 3, 2017

ask the patient to cough. always works in the ER.

YoutubeTheNP · Apr 4, 2017

go deeper. It's there. :sarcastic:

Rnis, BSN, DNP, APRN, NP · Apr 6, 2017

Aim down and deep. when I was a new grad I was required to do one with the dr I work with, I had done lots of paps but struggled with finding the cervix on occasion. That one tip from him changed everything... I find it every time. (if someone is large and there is collapsing going on, I use the biggest speculum)

HealthEnthusiast · Apr 8, 2017

Hi! The best advice I ever got was the following:

Don't open the speculum until it's fully inserted. When you start opening it a bit, if the cervix doesn't pop right into view, take note of the texture of the lady partsl wall you're visualizing. If it has rugae, it's more than likely the anterior wall and you need to proceed more posteriorly before opening the spec fully. If the wall you can see is smooth, it's likely the posterior wall and you need to retract somewhat/angle up before fully opening the spec.

That approach works for me at least nine times out of ten. When it doesn't, I remove the spec and ask the patient to place her fists (one hand cupped over the other) under her sacrum if she is able, and I try again. It can make the exam more uncomfortable for her to prop herself in that way, so I try to minimize the time she stays in this position.

I hope this helps! :)