The wonders of women's work

I had a stuck speculum at work tonight. I wonder how many times that has been the opening sentence to a blog post? No, I am not going to bore you with a dissertation on how to fold fitted sheets or the best way to get purple texta out of doona covers. We're talking paid women's work here. Allow me to explain.

I work with a fantastic group of women who teach medical students how to perform women friendly (can anyone think of a better way to describe it??) pap smears and breast checks. We come from all walks of life and bring a diversity of experience to our work. We are well trained and provide an invaluable teaching service to students.

We demonstrate the procedure to the students in groups (one of us performing the examination and one modelling usually with about six students) then split into groups of two students and two teaching associates (TAs). One of us is examined by a student while the other TA provides support and then we swap. It means the students get to perform this intimate and important examination for the first time in a supportive learning environment where they receive useful clinical information and a different insight from us into the true meaning of a partnership in care. Many people find the very idea of this work confronting and associated with a major ick factor. I love it and think its a great opportunity for these students.

So...on to stuck speculum's...Most women and many clinicians never hear about this issue. We believe that its one of the reasons that women find pap smears painful and don't reappoint at the 2yr mark. Basically what happens is the bills of the speculum create a vacuum against the vaginal walls and the speculum literally becomes stuck. The telltale sign is that when you start to remove the speculum it draws the cervix with it. This can be visualised as the cervix bulging forward as the speculum is removed causing resistance for the clinician and pain (cramping) for the woman. If it is not recognised and the speculum is removed without addressing the problem this pain can be persistent over many days. If a few simple measures are used at the time (getting the woman to cough, lower and raise one leg or dismantling the spec) this significant problem can be averted. Its something that all med students and beginning clinicians should be aware of and know how to deal with...I hope this means they will have the capacity and motivation to teach others. If we can get the word out there clinical practice will improve and women will be more likely to come back.

On that note all the students we taught tonight gave us brilliant feedback and even a round of applause at the end of the session. They were all brilliant, attentive and respectful. A group of 5th years on their way to becoming excellent doctors. Now that makes me all warm and fuzzy!