Clinical Question: Do women feel more comfortable and less vulnerable if stirrups are not used as part of a speculum examination?

Setting: Outpatient (primary care)

Study Design: Randomized controlled trial (nonblinded)

Allocation: Concealed

Synopsis: The embarrassment and fear of discomfort from the speculum examination often prevent women from seeking routine cervical cancer screening. One problem might be the use of stirrups to support the legs of women undergoing a pelvic examination. Stirrups are commonly used in the United States but are not routine in other countries. The authors of this study evaluated whether the use of stirrups increased pain and the feeling of vulnerability in 197 adult women presenting for a routine examination.

The women were randomized to a speculum examination using stirrups or one without stirrups. The stirrups were used to hold the legs at a 30- to 45-degree angle off the table. Women in the no-stirrup group were placed at the end of the table with their heels on the corners of the fully deployed extension of a standard examination table. Women in both groups were fully draped and underwent a standard pelvic examination with the examiner obtaining a cervical smear.

Physical discomfort and sense of vulnerability, measured following the examination using a 100-mm visual analog scale, were significantly lower in the no-stirrup group: the mean physical discomfort score was 43 percent lower (17.2 versus 30.4), and the sense of vulnerability was 44 percent lower (13.1 versus 23.6). Sense of loss of control was not significantly different between the two groups.

The quality of the smears was similar in the two groups. The researchers did not report the comfort of the examiner with either method or how they avoided having the speculum handle hit the table extension. The study was unblinded because the women knew whether they were in stirrups or not. Most of the women had already had one or more speculum examinations; the study would have been more effective had they enrolled women who had never had a pelvic examination using stirrups.

Bottom Line: To decrease discomfort and sense of vulnerability, women undergoing a routine pelvic examination should be offered the option of not using stirrups. On average, women will find this position more comfortable and will feel less exposed. (Level of evidence: 1b)