Using Human Papillomavirus (HPV) detection tests for cervical cancer screening and managing HPV-positive women – a practical guide / Activity 5

Procedure to collect samples for HPV testing – Steps for insertion of the speculum and exposure of the cervix

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Use a self-retaining bivalve speculum for exposure of the cervix. These specula are available in different sizes (small, medium, and large) and designs (e.g. Cusco speculum, Collin speculum, Graves speculum). Select a speculum of the appropriate size, and dip it in normal saline or lubricate the blades with a lubricating jelly. This helps with easy insertion of the speculum to minimize discomfort to the woman. In most women, a medium-sized speculum usually provides adequate exposure of the cervix. Do not use lubricating jelly if the same sample may be used for cervical cytology (e.g. for triage if the sample is positive for HPV). Insert the speculum gently, and open the blades until the cervix is fully visualized. Care should be taken not to open the speculum blades too much, because that may cause painful stretching of the vaginal walls and lead to injury. If there is difficulty in locating the cervix, withdraw the speculum slightly and re-insert it with the speculum blades directed posteriorly. Open the blades slowly until the cervix comes into view. The cervix should be exposed in such a way that the external os is positioned at the centre of the open speculum blades. Fix the blades in the open position by tightening the screw, so that the speculum remains in place and the cervix is visualized adequately. In multiparous women, exposure of the cervix may be difficult because of lax vaginal walls. In such situations, use a large speculum to expose the cervix properly. Alternatively, you can slip a non-lubricated condom or the finger of a large glove (with its end cut off) over the speculum blades and then insert the speculum. This holds the lateral vaginal walls between the speculum blades out of the line of vision and enables proper visualization of the cervix. In postmenopausal women, use a small speculum to avoid discomfort. In some women, the cervix is deviated, leading to difficulty in adequate exposure. Manipulate the speculum carefully to ensure good exposure. Adjust the light source to view the cervix clearly. The next section discusses sample collection for HPV testing.