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Pederson Speculum

Bivalve vaginal speculum with relatively narrow, flat blades. A Pederson or extra-narrow Pederson can be useful when the introitus is narrow or a wider speculum is uncomfortable, but selection should follow the individual's anatomy, indication and preference. There are no universal industry size standards and no parity- or age-only rule for choosing a speculum.[7]

Design​

  • Narrow, flat blades. Thinner and flatter than the Graves, producing a slim closed profile that fits through a tight introitus.
  • Minimal blade curvature. Less concavity than the Graves' duckbill shape; the trade-off is somewhat less vaginal distension at the apex.
  • Thumbscrew lock. At the handle; opens and locks at the chosen separation for hands-free cervical visualization; self-retaining.
  • Multiple sizes (small, medium, long) and both metal (reusable) and plastic (disposable) versions.[2][3]

Reconstructive-Urology and Urogyn Uses​

The Pederson is one option for a patient whose vaginal caliber will not comfortably accept a wider bivalve speculum. An extra-narrow Pederson is specifically described in clinical-examination guidance for a narrow introitus related to atrophy, prior surgery or radiation, absent prior vaginal penetration, or discomfort; the goal is the smallest instrument that still provides necessary visualization.[7]

Office urogyn examination​

  • Postmenopausal atrophy, vaginal stenosis, or prior surgery or radiation. Consider an extra-narrow speculum, lubrication and stopping if the examination is not tolerated; width alone does not guarantee comfort.[7]
  • Adolescent reproductive-health visit. ACOG's initial-visit guidance emphasizes development, confidentiality, autonomy and trauma-informed care; it does not require a routine internal speculum examination or prescribe Pederson/Huffman selection.[4]
  • Any patient with a narrow introitus or prior painful examination. Select size by anatomy and the minimum exposure required rather than parity labels.[7]
  • Trauma-informed care. Consent, control, communication and willingness to stop are central; a smaller instrument may help some patients but does not itself make an examination trauma-informed.[4][7]
  • Cervical-cytology and HPV sampling, colposcopy and IUD management in patients in whom the Graves does not fit.
  • Mesh-exposure / suture-extrusion inspection in atrophic vaginas after prior pelvic reconstruction.
  • Urethral / anterior-wall examination for diverticulum, caruncle, fistula in narrow-caliber vaginas.

Office procedures​

  • Periurethral bulking-agent injection, vestibular and periurethral biopsy, and pessary fitting in nulliparous or atrophic patients.
  • Office cystoscopy adjunct. Exposing the urethral meatus in narrow-introitus patients before flexible cystoscope passage.

Pederson vs Graves — The Choice​

FeaturePedersonGraves
Blade profileNarrow, flatWider, more concave (duckbill)
Vaginal distensionLessGreater
Common fitNarrow introitus, atrophy/stenosis, prior pain or limited toleranceWider canal or redundant sidewalls when greater distension is needed
Cervical visualizationAdequate; may be limited in multiparous patients with redundant wallsExcellent in multiparous patients
Patient comfortMay be better tolerated when a wider profile is painfulMay be less tolerated in a narrow or atrophic introitus
Selection principleSmallest size that permits the needed viewWider profile when sidewall retraction is otherwise inadequate

For a patient with postmenopausal atrophy, anatomy and tolerance may favor an extra-narrow Pederson despite prior parity. This is an individualized examination choice rather than a categorical default.[7]

Pederson vs Other Specula​

FeaturePedersonGravesHuffmanSims
Blades2 narrow flat2 wide curved2 very narrow (longer, narrower than Pederson)1 (single-blade retractor)
Self-retainingYes (thumbscrew)Yes (thumbscrew)YesNo (handheld)
Common fitNarrow introitus / atrophyWider canal / redundant sidewallsVery narrow canal in selected patientsLateral-position exam, operative vaginal retraction
PositionLithotomyLithotomyLithotomyLeft lateral decubitus / operative

For operative vaginal surgery, the Auvard weighted speculum, Breisky-Navratil, or Heaney retractor replace the bivalve specula.

Practical Tips for Use​

Evidence-based techniques for maximizing comfort during Pederson examination:

  • Lubrication. A small amount of suitable water-based gel can improve comfort without reducing cytology adequacy in studied settings; avoid formulations known to interfere with the laboratory's collection system.[7]
  • Warm the speculum before insertion (warm water or speculum warmer).
  • Oblique-angle insertion with gentle rotation. Insert at approximately 45° relative to vertical, rotate as the speculum advances.
  • Verbal coaching. Communicate each step before performing it; especially important in trauma-informed and adolescent exams.
  • Vaginal estrogen may be considered when otherwise clinically indicated for genitourinary syndrome of menopause, but it has not been directly studied as a pre-examination analgesic; one clinical review describes benefit as experience rather than trial evidence.[7]
  • Sheathed speculum modification. In Hill's 136-patient RCT of a plastic speculum with a flexible sheath, mean cervix visualization was 95.1% versus 78.2%, while the entire cervix was seen in 61.8% versus 16.4%; pain scores were not significantly different.[6]

Patient-Comfort Evidence​

Patient discomfort during speculum examination is a substantial and well-documented barrier to gynecologic care:

  • Thomas 2001 RCT. Comfort responses varied by question or operator: 38–62% found the Pederson bivalve examination comfortable; 94% preferred the Veda-scope for comfort. These are different endpoints and do not form a direct 62%-versus-94% comfort rate.[1]
  • Kalaskey 2026. In a survey of 203 patients, the speculum was identified as the most uncomfortable aspect of the pelvic exam by 34.4% of respondents; temperature and positioning were also frequently cited.[2]
  • Plastic versus metal. Plastic specula were preferred by 49.8% of patients versus 17.7% for metal (32.5% had no preference) in Kalaskey 2026, and comfort was the predominant factor; concern about plastic waste was higher among younger respondents and those preferring metal. In the Ten Buuren 2024 Dutch survey (n = 196), a biobased plastic speculum scored slightly higher on comfort than metal (8.03 vs 7.26 of 10; the authors questioned clinical relevance), and most patients were willing to compromise on comfort for sustainability.[2][3] A 2026 urogynecology sustainability review lists reusable specula among suggested operating-room measures; it is reported to cite life cycle analyses finding fossil-based plastic specula to have about four times the carbon footprint of stainless steel, and bio-based plastic and metal about half that of fossil-based plastic.[8]

Limitations​

  • Limited cervical visualization in multiparous patients with lax or redundant vaginal walls. The narrow blades do not retract redundant tissue; switch to a Graves.
  • Inadequate for operative vaginal work. Narrow profile and short blade length; switch to operative retractors.
  • Do not infer need or size from sexual history alone. Internal examination is often unnecessary in asymptomatic adolescents; when clinically required, use consent, anatomy, the least invasive adequate method and specialist or vaginoscopic alternatives as appropriate.[4][7]

Historical Context​

The Pederson speculum is the narrow-blade counterpart to the Graves design and entered routine gynecologic practice in the mid-20th century. It evolved alongside the Graves bivalve and the Huffman (even narrower; pediatric or virginal) speculum as the bivalve family diversified to fit the full range of vaginal calibers, in contrast to the single-bladed lever speculum genealogy descended from J. Marion Sims' bent pewter spoon, now represented by the modern Sims retractor.[5]

See also: Graves Speculum, Sims Retractor, Auvard Weighted Speculum, Breisky-Navratil, Nasal Speculum.

References​

1. Thomas A, Weisberg E, Lieberman D, Fraser IS. "A randomised controlled trial comparing a dilating vaginal speculum with a conventional bivalve speculum." Aust N Z J Obstet Gynaecol. 2001;41(4):379–86. doi:10.1111/j.1479-828x.2001.tb01313.x

2. Kalaskey TA, Quillen KG, Knutsen KR, Bushko KR, Dueñas-Garcia OF. "Comfort or conservation? Investigating patient choices between plastic and metal speculums." PLoS One. 2026;21(4):e0346819. doi:10.1371/journal.pone.0346819

3. Ten Buuren AAA, Poolman TB, Bongers MY, et al. "Patient preferences for disposable and reusable vaginal specula and their willingness to compromise in the era of climate change: a cross-sectional study." BJOG. 2024;131(5):684–9. doi:10.1111/1471-0528.17733

4. Committee on Adolescent Health Care. "The initial reproductive health visit: ACOG Committee Opinion No. 811." Obstet Gynecol. 2020;136(4):e70–80. doi:10.1097/AOG.0000000000004094

5. Wall LL. "The Sims position and the Sims vaginal speculum, re-examined." Int Urogynecol J. 2021;32(10):2595–601. doi:10.1007/s00192-021-04966-w

6. Hill DA, Cacciatore ML, Lamvu G. "Sheathed versus standard speculum for visualization of the cervix." Int J Gynaecol Obstet. 2014;125(2):116–20. doi:10.1016/j.ijgo.2013.10.025

7. Bates CK, Carroll N, Potter J. "The challenging pelvic examination." J Gen Intern Med. 2011;26(6):651–7. doi:10.1007/s11606-010-1610-8

8. Chen CCG, Andiman S, Long J, et al. Health Care Sustainability: Strategies for Operating Rooms and Urogynecologic Procedures. Urogynecology (Phila). 2026;32(6):569-577. doi:10.1097/SPV.0000000000001835