Intended for healthcare professionals


Vaginal speculum examinations without stirrups

BMJ 2006; 333 doi: (Published 20 July 2006) Cite this as: BMJ 2006;333:158
  1. Wendy Brooks Barr (, assistant professor of family and social medicine
  1. Beth Israel Residency in Urban Family Medicine, Institute for Urban Family Health, Albert Einstein College of Medicine, New York, NY 10003, USA

    US clinicians wonder if it will work

    The pelvic examination using a vaginal speculum is one of the most common medical procedures performed by doctors and experienced by women. About 55 million smear tests are performed in the United States every year.1 The article in this issue by Seehusen and colleagues is a provocative one for US clinicians, raising basic questions about how pelvic examinations are performed.2 American medical schools uniformly teach a single way to position a woman for pelvic examinations—in the dorsal lithotomy position with feet in stirrups.34 The article raises the possibility that the standard use of stirrups may not be best for patients, and that other positioning options should be considered. Most clinicians I spoke with (admittedly, an unscientific sample) shared my initial reaction to the article's suggestion of performing a speculum exam without stirrups—how would that work? Given this reaction among providers of family medicine in the northeastern part of the United States, it is interesting—and somewhat surprising—to …

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