Finding the elusive cervix...

Specialties Advanced

Published

I am an adult-gero NP and I'm starting back into primary care. I am having a lot of trouble with pap smears. I just can't seem to find the cervix. I angle the speculum posteriorly and sometimes it comes right into view and sometimes I just can't find it! Any tips or advice?

Up Vote Up Vote ×
Specializes in Nephrology, Cardiology, ER, ICU.

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

Up Vote Up Vote ×

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

Up Vote Up Vote ×
Specializes in Nephrology, Cardiology, ER, ICU.

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

Up Vote Up Vote ×

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.

Up Vote Up Vote ×

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

Up Vote Up Vote ×
Specializes in ER, PCU, UCC, Observation medicine.

go deeper. It's there. :sarcastic:

Up Vote Up Vote ×

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)

Up Vote Up Vote ×

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! :)

Up Vote Up Vote ×
+ Add a Comment