The speculum exam
9. To remove the speculum, pull it toward you a little until the bills are away
from the cervix. Loosen the screw on the thumb-rest and gently let the bills
close while pulling the speculum down and out of the vagina. The
bills should be closed all the way as you finish pulling it out.
10. Give the woman a clean cloth or tissue to wipe
any discharge from her genitals.
11. Be sure to clean the speculum
after you use it.
Tests for infections and cancer
An important reason to do a speculum exam is to test the health of the
cervix. The cervix can be tested for infections (see Chapter 18) and for
cancer. Your local health authority may be able to provide you with kits to
test for chlamydia, gonorrhea, or other STIs and can recommend how
often to test women for infections and cancer. Women who have had
normal exams may be tested every 3 years or when you see them during
pregnancy. Women whose exams were not normal should be tested more
often. Women with signs of illness should be tested right away.
There are 2 tests for cancer of the cervix. You do not need to do both
tests. Choose the test that you can use most easily in your area.
The vinegar test
The vinegar test is easy to do,
it is not expensive, and you do
not need to have a laboratory
to know the results. If a
woman has cancer on her
cervix, the vinegar test
is very likely to find it.
But the vinegar test cannot
tell how severe a cancer is, and
sometimes it shows a problem
that is not cancer.
The Pap test
The Pap test can give you much
more information than the
vinegar test. The Pap test can tell
you whether a problem on the
cervix is an infection or cancer. It
may tell you what type of
infection a woman has, or
how severe a cancer is.
But the Pap test is expensive,
and you need a laboratory to
know the results.
If either test is positive, the woman needs medical attention as soon
You can do these tests for a woman at almost any time, including
when she has her monthly bleeding or during pregnancy. During a
woman’s monthly bleeding is not the best time to do the Pap test, because
the blood can make the test less clear. But it is better to do the test during
a woman’s monthly bleeding than not to do the test at all. If the woman
is having her monthly bleeding, use a long swab to gently wipe the blood
away from her cervix before you do the test.
A Book for Midwives (2010)