wheres the cervix?

[ACSlater]

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hi. i am currently an IM intern and am having some trouble with paps lately. having a hard time visualizing the os...the cervix always seems to be not clearly visualized...perhaps one part of it is tucked under the speculum. i moved the speculum around but without luck. this has happened on the last few paps. what am i doing wrong? 😕

 

[snowinter]

Hi,

I know sometimes the anatomy of someppl can be more difficult than others.
What I do is go down at an angle when i'm entering the vagina.. It gives me good success with a more posterior cervix (hey what is the plural of cervix?)

make sure they are relaxing all the way -- so you can fully enter the speculum..

anyway, why not ask one of your upperl levels for more guidance/tips?

I'd love to hear tips from other ppl too. I'm just starting to get comfortable with my exams.

snow

 

[monkey7247]

Phew...

The content of the OP is far less ridiculous than the title. I was going to say "open an anatomy book".

 

[grayce79]

hi. i am currently an IM intern and am having some trouble with paps lately. having a hard time visualizing the os...the cervix always seems to be not clearly visualized...perhaps one part of it is tucked under the speculum. i moved the speculum around but without luck. this has happened on the last few paps. what am i doing wrong? 😕

Which speculum are you using? I've had this happen if I happen to be using too small of a speculum.
Make sure you are using a large enough speculum and make sure you aren't shy about opening it as wide as you need to.

 

[Carbo/Taxol]

I use a medium sized Peterson standard on most patients for routine paps unless they are overweight or am having trouble visualizing (use Graves). Be gentle, but as said before you need to open the speculum wide in order to visualize -- this is better than getting an insufficient sample and having to repeat the test. The patient will dislike you more for the latter.

 

[tiredmom]

Aiming down helps too. It seems like it would hurt worse, but it really doesn't. Put pressure (gently) towards the posterior wall of the vagina, and if it's not there when you open, close it and try to push in further. I second the right speculum for the patient... down here in San Antonio - we don't see many we can use a pederson on!

 

[Diane L. Evans]

if i were you i would approach my mentor and let them know the problem. Perhaps you can spend a few days in the OB clinic with the residents. It is extremely embarassing to notknow how to do this especially when you have an urgent situation. And you should not feel bad it is an art.

To me an internist should be able to do a little of everything and gyn paps is without exception perhaps in your elective month you can opt for 2 weeks. You can get sued if you miss a cervical cancer and it mets to the lungs!

Good work communicating your concerns