Skip to main content

Single-Tooth Tenaculum

Ring-handled cervical traction instrument with one opposing tooth on each jaw (1 × 1), often called a Pozzi-style tenaculum. Its focal purchase stabilizes the cervix for transcervical instrumentation; gentle axial traction can align the cervical canal and uterine cavity. The puncture may cause bleeding or pain, and an alternative grasper may be suitable depending on the cervix and procedure. This page covers shared gynecologic work in urogynecology, not a mandate to use tenacula for every prolapse or reconstructive case.[1][8]

Design​

  • Two finger rings with a ratchet on many patterns, like a hemostat or ring forceps; jaw shape, curvature and lock differ by model.
  • Opposing single-point jaws (1 × 1) make a focal cervical grip. For example, Sklar's 96-2624TAA Schroeder/Pozzi-style disposable model is straight, 241 mm, sterile stainless steel; a reusable Sklar Kahn variant is angled and 241 mm. Neither establishes a universal 24-cm or reusable design.[8][9]
  • Processing is model-specific: do not autoclave a single-use device. Obtain the manufacturer instructions for the reusable pattern in service.[8][9]

The single-tooth design differs from the Jacobs 2 × 2 tenaculum or vulsellum, which offers multi-point toothed purchase; neither device is proved universally preferable for a friable cervix or vaginal cuff. Choose the least traumatic grip consistent with the needed traction.[10]

Reconstructive-Urology and Urogyn Uses​

Cervical stabilization for transcervical instrumentation​

  • Stabilizing the cervix for uterine sounding during preoperative endometrial assessment in the urogyn workup.
  • Straightening the cervico-uterine angle to ease passage through the internal os for Hegar dilator cervical dilation before hysteroscopy.
  • Maintaining cervical position during IUD placement, endometrial biopsy, hysteroscopy, and other in-office gynecologic procedures done as part of the urogyn workup or shared-clinic practice.[1][5]

At the time of pelvic-reconstruction operations​

  • Vaginal hysterectomy and selected uterine-preserving procedures. Cervical traction may aid exposure or descent; choose forceps or traction suture according to access and tissue quality rather than treating a single-tooth instrument as required for sacrocolpopexy.
  • Hysteroscopic evaluation at the start of a fistula or mesh-erosion workup when intracavitary pathology is suspected.

Pain and Bleeding​

Tenaculum placement is a recognized source of procedural pain and bleeding in the urogyn and RU patient population:

  • Bleeding after IUD placement: in one randomized 95-person IUD trial, bleeding after instrument removal occurred in 26/47 (55.3%) single-tooth versus 3/48 (6.3%) Allis applications. This is a study-specific immediate outcome, not the rate for all tenacula, all procedures or atrophic cervices.[1]
  • Pain at placement is a distinct procedural event; cervical sensory pathways include both pelvic and hypogastric afferents, not exclusively S2–S4 parasympathetic fibers. In the Andrews trial, overall IUD-procedure pain was similar between forceps arms; parity related to pain. These data do not establish a fixed age or dysmenorrhea predictor list for tenaculum pain.[1][2][11]
  • Lidocaine-prilocaine cream ranked highest for tenaculum-placement pain reduction versus placebo in a 38-RCT IUD-insertion network meta-analysis; paracervical lidocaine ranked next in that analysis. Rankings across heterogeneous trials do not set a universal product or dwell time.[4]
  • ACOG Clinical Consensus No. 9 (2025) advises shared decision-making on pain control for in-office uterine and cervical procedures. It cautions against extrapolating results from one procedure to another.[5]

Alternatives to the Single-Tooth Tenaculum​

InstrumentBleeding vs single-toothPain vs single-toothInsertion success
Allis clamp3/48 vs 26/47 after removal in a 95-person IUD RCTOverall IUD-procedure pain similar; tenaculum-step pain not separately compared47/48 vs 46/47, not an equivalence trial[1]
Atraumatic vulsellumShorter time to hemostasis (0.4 vs 1.1 min); count of maneuvers not significantly differentPlacement pain 35 vs 33.3 mm, no difference in 80-person IUD trialNo evidence here of superior insertion success[6]
Investigational vacuum traction deviceNo bleeding or only limited ecchymosis in a 13-patient single-arm pilotVery low pain on device application; no comparator7/13 (54%) IUD insertions succeeded with the study device[3]
No tenaculum when feasibleNo tenaculum punctureAvoids tenaculum-placement event, not all insertion painMay be appropriate in selected straightforward insertions; have a stabilization plan if needed[7]

The single-tooth tenaculum remains familiar and useful when focal cervical purchase is required.

Technique Pearls​

  • Apply to the anterior lip when suitable, generally near 12 o'clock; adapt to visible tissue and planned canal axis. A different device or traction suture may be safer than an unsupported two-point bite in fragile tissue.
  • Forewarn the patient and discuss analgesia before placement; consider a topical or injected local anesthetic according to the selected product and procedure. The 2019 network meta-analysis does not set a dwell time for lidocaine-prilocaine cream; follow the product label.[4]
  • Gentle steady traction along the canal axis; abrupt traction is the main cause of tenaculum tear-through.
  • Reassess purchase if tissue tears or slips; use a suitable multi-point or atraumatic grasper, a traction suture, or change the plan rather than repeatedly clamping fragile tissue.
  • Hold pressure with a sponge stick to the application site at the end of the case if oozing persists.

Safety Profile​

  • Cervical bleeding at the application site is the most common event; usually self-limited with sponge-stick pressure.
  • Tear-through. Particularly in atrophic or friable cervix; convert to broader-grip alternative.
  • Vasovagal response. Recognized risk with cervical instrumentation in the office; have the patient supine and counsel before placement.
  • Pain. Topical or paracervical local anesthesia ranked best for tenaculum-placement pain in the network meta-analysis.[4]

See also: Jacobs Tenaculum (multi-tooth), Ring (Sponge) Forceps, Allis Clamp, Hegar Dilators, Auvard Weighted Speculum, Graves Speculum.

References​

1. Andrews B, Quick K, MacLeod E, Edwards K, Rone BK. "Cervical bleeding with cervical stabilization during IUD placement: Allis clamp versus single-tooth tenaculum, a randomized control trial." Arch Gynecol Obstet. 2023;307(4):1015–9. doi:10.1007/s00404-022-06784-x

2. Lopez LM, Bernholc A, Zeng Y, et al. "Interventions for pain with intrauterine device insertion." Cochrane Database Syst Rev. 2015;(7):CD007373. doi:10.1002/14651858.CD007373.pub3

3. Legardeur H, Masiello-Fonjallaz G, Jacot-Guillarmod M, Mathevet P. "Safety and efficacy of an atraumatic uterine cervical traction device: a pilot study." Front Med. 2021;8:742182. doi:10.3389/fmed.2021.742182

4. Samy A, Abbas AM, Mahmoud M, et al. "Evaluating different pain lowering medications during intrauterine device insertion: a systematic review and network meta-analysis." Fertil Steril. 2019;111(3):553–561.e4. doi:10.1016/j.fertnstert.2018.11.012

5. Committee on Clinical Consensus–Gynecology. "Pain management for in-office uterine and cervical procedures: ACOG Clinical Consensus No. 9." Obstet Gynecol. 2025;146(1):161–77. doi:10.1097/AOG.0000000000005911

6. Doty N, MacIsaac L. "Effect of an atraumatic vulsellum versus a single-tooth tenaculum on pain perception during intrauterine device insertion: a randomized controlled trial." Contraception. 2015;92(6):567–71. doi:10.1016/j.contraception.2015.05.009

7. Ovsepyan V, Kelsey P, Evensen AE. "Practical recommendations for minimizing pain and anxiety with IUD insertion." J Am Board Fam Med. 2024;37(6):1150–5. doi:10.3122/jabfm.2024.240079R1

8. Sklar. 96-2624TAA Schroeder/Pozzi-style tenaculum. Manufacturer listing: sterile single-use straight 1 × 1 forceps, 241 mm.

9. Sklar. 91-1125 Kahn tenaculum forceps. Manufacturer listing: reusable angled 1 × 1, 241 mm; obtain its processing IFU.

10. B. Braun Aesculap. EO202R Jacobs tenaculum/vulsellum forceps. Manufacturer catalog: straight, 2 × 2, 215 mm; device comparison here is descriptive.

11. Jobling P, O'Hara K, Hua S. Female reproductive tract pain: targets, challenges, and outcomes. Front Pharmacol. 2014;5:17. doi:10.3389/fphar.2014.00017. Cervix is a sensory transition zone; this does not isolate tenaculum pain to one pathway.