Intended for healthcare professionals


Improving women's experience during speculum examinations at routine gynaecological visits: randomised clinical trial

BMJ 2006; 333 doi: (Published 20 July 2006) Cite this as: BMJ 2006;333:171
  1. Dean A Seehusen (dseehusen{at}, research director1,
  2. Dawn R Johnson, staff physician1,
  3. J Scott Earwood, staff physician1,
  4. Sankar N Sethuraman, professor of statistics2,
  5. Jamie Cornali, family nurse practitioner1,
  6. Kelly Gillespie, staff physician1,
  7. Maria Doria, staff physician1,
  8. Edwin Farnell IV, resident physician1,
  9. Jason Lanham, resident physician1
  1. 1 Department of Family and Community Medicine, Eisenhower Army Medical Center, Fort Gordon, GA 30905, USA,
  2. 2 Mathematics and Computer Science Department, Augusta State University, Augusta, GA 30904, USA
  1. Correspondence to: D A Seehusen
  • Accepted 22 May 2006


Objectives To determine if a standardised method of leg positioning without stirrups reduces the physical discomfort and sense of vulnerability and increases the sense of control among women undergoing speculum examination as part of a routine gynaecological examination.

Design Randomised clinical trial.

Setting Family medicine outpatient clinic.

Patients 197 adult women undergoing routine gynaecological examination and cervical smear.

Intervention Examination with or without stirrups.

Main outcome measures Women's perceived levels of physical discomfort, sense of vulnerability, and sense of control during the examination, measured on 100 mm visual analogue scales.

Results Women undergoing examination without stirrups had a reduction in mean sense of vulnerability from 23.6 to 13.1 (95% confidence interval of the difference - 16.6 to - 4.4). Mean physical discomfort was reduced from 30.4 to 17.2 (- 19.7 to - 6.8). There was no significant reduction in sense of loss of control.

Conclusion Women should be able to have gynaecological examinations without using stirrups to reduce the stress associated with speculum examinations.

Trial registration US Army Central Investigation Regulatory Office. Trial No DDEAMC 05-11.


  • Contributors DAS was responsible for conception and design of the study, collected and interpreted data, drafted the manuscript, and is guarantor. DRJ was responsible for conception and design of the study, collected data, and edited the manuscript. JSE collected data and drafted the manuscript. SNS carried out the statistical analysis, interpreted data, and critically edited the manuscript. JC, KG, MD, EF, and JL collected data and edited the manuscript.

  • Funding Uniformed Services Academy of Family Physicians.

  • Competing interests None declared.

  • Ethical approval This study underwent review for ethical considerations by the Institutional Review Board of Eisenhower Army Medical Center.

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