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No two women are shaped the same, and many women change shape over time. Recognizing this, the medical field has invented several different speculum sizes and shapes to make gynecological exams as comfortable as possible for all patients. Pediatric specula are the smallest, Pederson specula are next in size, and Graves specula feature the largest speculum sizes. Pederson and Graves specula also come in several different sizes. Nasal specula, used for examining the sinuses, are the smallest variety of specula.
Pediatric specula are very rarely used in pediatric medicine. Rather, doctors use them for women who have never had intercourse or have biologically narrow vaginal canals. The arms of a pediatric speculum are often less than 1 inch (about 2 cm) wide and rounded at the tip. Doctors often choose this speculum size for young women receiving their first pelvic exam.
Pederson specula are the next size up from pediatric. The arms of a Pederson speculum taper slightly toward the rounded tips. These specula are often used for women with narrow vaginal canals, such as women older than middle age, or fully mature women who have never had intercourse. Speculum sizes in the Pederson class include small, medium, and large. The smallest size is only about 1 inch (about 2 cm) wide and the other two sizes are less than 0.5 inch (about 1 cm) wider than the smallest size.
Graves specula feature the largest speculum sizes. They feature arms that are flatter and wider than the pediatric and Pederson varieties. The tips of the arms are still rounded, but the edges of them flare out slightly, creating a subtle oval shape. Medical practitioners generally reserve these specula for women who have had sexual intercourse or have given birth.
Like the Pederson variety, Graves specula also feature three speculum sizes. The smallest is used for women who have had intercourse, but not frequently. The second is for women that engage in regular intercourse. The third size is often used for women who have given birth vaginally at least once.
Though they keep these guidelines in mind, doctors often examine each patient before choosing among the available speculum sizes. A woman who has given birth may have a narrow vaginal canal and require a smaller size than normal. Conversely, a woman who has never had intercourse may be able to accept a slightly larger speculum size.
Nasal specula, as their name indicates, are used for gently opening the nasal passages for in-depth examination. Patients with intense allergies, sinus blockages, or infections may be familiar with nasal specula. The arms of these tools are less than 0.25 inch (about 0.5 cm) wide, including the slightly flared tips. Doctors usually only require one standard size of nasal speculum.
My doctor uses a disposable plastic speculum, which I think is far preferable to a metal one. The exam beds in her office have warmers for the metal kind, because, let me tell you: a cold speculum is *no* fun! But she uses the plastic kind now, and they are much easier.
Pap smears are so wonderful anyway, so it's always nice to have a doctor who cares enough to check a patient carefully to see which size is most appropriate. Personally, I prefer a woman doctor for this procedure. They know how it feels, so they're more apt to take care to check a woman's size.
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