Speculum 'self-insertion': a pilot study

Abstract

Aim: This paper reports phase II of a pilot study that aimed to determine whether self-insertion of a speculum by women undergoing a pap smear would be more comfortable and lead to an improvement in satisfaction and a decrease in anxiety associated with this procedure.

Background: Research demonstrates that pelvic examinations are considered by most women to be unpleasant and are routinely associated with embarrassment, apprehension, fear and often some level of discomfort and/or pain.

Design: The study used quantitative and qualitative data collection techniques. Phase I (described elsewhere) tested the newly developed Speculum Self-Insertion Satisfaction Questionnaire for content validity, internal consistency and clarity. Phase II pilot study tested the technique of speculum self-insertion. Women's general level of anxiety was measured using the State Trait Anxiety Inventory, both before and after they performed the self-insertion procedure. Women's satisfaction and acceptance of the procedure was measured using the Speculum Self-Insertion Satisfaction Questionnaire and explored through the use of qualitative research techniques.

Participants: A total of 198 women attending family planning clinics in Perth, Western Australia, between September and December 2003 were invited to participate in the study. One hundred and thirty-three women agreed to self-insert their own speculum.

Results: The study demonstrated that speculum self-insertion was acceptable to most women, especially younger women. Nearly 91% of women either agreed or strongly agreed that they were satisfied with the experience of self-insertion and would choose to self-insert the speculum again. This included the women who had not previously had a speculum examination. The quality of specimen collected was not detrimentally affected by speculum self-insertion.

Conclusions: The results of this pilot research, while needing to be replicated in a larger study, demonstrate that offering women the opportunity to self-insert a speculum during a routine pelvic examination is an acceptable, innovative, simple and cost-neutral change in clinical practice that increases women's comfort and satisfaction and potentially makes sexual health screening less threatening to women of all ages.

Relevance to clinical practice: Speculum self-insertion may encourage women's attendance at clinics for regular screening. Early diagnosis and treatment will result in better health outcomes for women, families and the community at large.