Chapter 20: The pelvic exam
Note: If the woman is on a bed
or a flat table and the speculum
handle will not fit facing down,
you can insert it with the
handle pointing up.
5. Open the bills of the speculum by gently
pushing the thumb-rest with your thumb.
When you see the cervix between the bills,
tighten the screw on the thumb-rest to
keep the speculum open.
If you open the speculum but you do not
see the cervix, close the speculum and
remove it partway.
Then try again,
repeating step 4.
(opening of womb)
The cervix may be off to
one side a little. This is
normal. Sometimes the
cervix will come into
view more clearly if the
woman coughs or
The cervix is usually
about this big.
pushes down as if she is
passing stool while the
speculum is open inside her.
6. Look at the cervix — it should be smooth and pink, or, if the woman is
pregnant, a little blue.
Small, smooth bumps on the cervix are usually normal, but sores or warts
are signs of infection.
Notice if there is discharge or blood coming out of the cervix. Thin, white, or
clear discharge is usually normal and healthy. Green, yellow, gray, lumpy, or
foul-smelling discharge can be a sign of infection.
7. If the woman wants to look at her own cervix, you can hold
a mirror and a light to help her see. This is a chance for a
woman to learn more about her body.
8. T est the cervix for signs of cancer by using either the
vinegar or Pap test (see page 379).
A Book for Midwives (2010)