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I was taught by my gentle Gynaecology professor 30 years ago to put
the lady in the Sims position to visualise the cervix, using either a
Sims, or my preferred Cusco speculum. It affords four great benefits:
firstly the patient lies in the comforting position of sleep, rather than
the position of sexual intercourse; second, the handle of the speculum
faces posteriorly, rather than banging against the clitoris; third, with
acutely angulated cervices, one has nearly 180 degrees of access, rather
than 90 (because of the couch, with the patient on her back); and finally,
the poor woman doesnt have to look at you with your head between her legs.
In 25 years of practice I have put my patients in the Sims position
for every IUCD insertion, smear and so forth, with uniform success, and
the patients only comments are mild surprise because these days it seems
an unexpected position. Aside from Sims position being less suitable for
bimanual pelvic examination, it is superior to the patient lying on her
back in every way.
The very thought of needing stirrups appals me and I suggest that
Sims' long overlooked and simple technique be resurrected before adopting
such medieval and humiliating methods.