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Single-Tooth Tenaculum

Ring-handled cervical traction instrument with a single sharp tooth on each jaw — the standard grasper for cervical stabilization and traction during transcervical procedures. The teeth pierce the cervical stroma to give a firm reliable grip; the operator uses gentle traction to straighten the cervico-uterine angle and align the canal for instrumentation. Daily-use instrument in urogyn and reconstructive-urology for any case that traverses the cervix — concomitant hysteroscopy / endometrial sampling during prolapse workup, cervical stabilization during vaginal hysterectomy / sacrocolpopexy, and IUD work in the gyn-shared urogyn clinic.[1][2]

Design​

  • Two ring handles with box-lock ratchet, like a hemostat or ring forceps.
  • Curved jaws terminating in a single sharp tooth on each jaw; the teeth interdigitate when the ratchet is engaged, piercing the anterior cervical lip.
  • Stainless steel, autoclavable; standard ~ 24 cm overall length.

The single-tooth design distinguishes it from the Jacobs (multi-tooth) tenaculum, which spreads grip across multiple smaller teeth and is preferred for the vaginal cuff after hysterectomy or for grasping a friable / atrophic cervix.

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 office gyn done as part of urogyn workup or shared-clinic practice.[2][3]

At the time of pelvic-reconstruction operations​

  • Vaginal hysterectomy and sacrocolpopexy with uterine preservation — the single-tooth tenaculum is the workhorse for cervical traction during pedicle development and uterine descent.
  • 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 — important context for the urogyn / RU patient population:

  • Cervical bleeding at the application site occurs in ~ 55% of placements with the single-tooth tenaculum (Andrews 2023 RCT).[1]
  • Pain at tenaculum placement is S2–S4 parasympathetic mediated and is a distinct pain event during IUD insertion. Predictors of greater pain include nulliparity, age > 30, longer interval since last pregnancy, and history of dysmenorrhea.[2]
  • Lidocaine-prilocaine cream was the most effective agent for reducing tenaculum-placement pain in the Samy 2019 network meta-analysis of 38 RCTs; lidocaine paracervical block was the second best option.[4]
  • ACOG Clinical Consensus 2025 endorses local anesthetic — particularly lidocaine — for pain management during IUD insertion and other in-office uterine / cervical procedures.[5]

Alternatives to the Single-Tooth Tenaculum​

InstrumentBleeding vs single-toothPain vs single-toothInsertion success
Allis clamp6.3% vs 55.3% (Andrews 2023 RCT)No differenceNo difference[1]
Atraumatic vulsellumLess bleeding, shorter time to hemostasisNo differenceComparable[6]
Vacuum (suction) tenaculumNo bleeding, minimal painLower54% insertion success — lower in pilot[3]
Valsalva maneuver (no tenaculum)NoneAvoids the event entirelySuitable in selected patients[7]

Despite these alternatives, the single-tooth tenaculum remains the most widely used cervical-stabilization instrument due to its reliable grip and procedural familiarity.

Technique Pearls​

  • Apply to the anterior lip at the 12 o'clock position; some operators grasp at 10-and-2 in nulliparous / friable cervix to spread the load.
  • Forewarn the patient before closing the ratchet; consider topical lidocaine-prilocaine cream 3–5 minutes before placement or paracervical block in anxious / nulliparous patients.[4][5]
  • Gentle steady traction along the canal axis — abrupt traction is the main cause of tenaculum tear-through.
  • Convert to Allis or Jacobs if the cervix is friable, atrophic, or repeatedly tears through with the single-tooth grip.
  • 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 — the most common event; usually self-limited with sponge-stick pressure.
  • Tear-through — particularly in atrophic / 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 — addressable with topical or paracervical local anesthesia per the network-meta and ACOG consensus.[4][5]

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