A pelvic exam is an important procedure that we, as women, need to go through at some point during our lives. It should be a part of our well-being check-ups in maintaining our reproductive health as well as when we are having related health problems. Most of us do not like them, but they are a "necessary evil" and a major part of our health care management. They help the midwife or health care provider to assess and diagnose any potential health issues such as infections, tumors, and lesions of the female reproductive system and are necessary for many contraceptive choices. During pregnancy, pelvic exams help midwives to assess maternal and fetal well being, fetal growth, and to diagnose and treat possible health issues that could have an impact, not only on the mother, but possibly on her baby too. During labor, they help the midwife to assess dilation and effacement, labor progression, fetal positioning and descent during birth.
A woman should have her first gynecological exam when she is first thinking about becoming sexually active, or as soon as she becomes sexually active, or by the time she is eighteen. There are many female gynecologists, nurse practitioners, physician's assistants and midwives (nurse-midwives as well as direct-entry homebirth midwives) that provide these services to women, pregnant or not, as part of their well-woman care. If a woman prefers a woman practitioner, which many do, to provide her with obgyn health care, it is usually easy to find one in the United States and Canada. Of course, many women still use male health care providers or gynecologists for their obgyn exams. This is a highly personal choice for each woman.
Whomever a woman chooses as her gynecological care provider, it is essential that she be comfortable and honest with her/him, and that she feels confident that she will receive quality, attentive care. If she is not satisfied with someone she has seen, she needs to find someone else. She can ask a friend or an older sister who they see for their pelvic exams. It does not hurt to shop around for the right practitioner until she finds someone in which she feels comfortable.
ETHICS & ABUSE
If a client/patient's examiner is a male and he does not have a female assistant in the room with him as he begins the exam, the client/patient needs to immediately stop the exam and request a female to be present in the room. If the male examiner disagrees or balks at this request, end the exam immediately and either reschedule for a time when there will be a female present or discontinue care with this practitioner. An option for the client/patient is to bring someone with them to the exam, such as a friend, a sister or other family member, or your partner/husband and request them to be present in the room during the exam. This is helpful if the practitioner is seriously understaffed and is not able to supply a female assistant.
The client/patient has the right to stop the exam at any time if their examiner makes them upset or uncomfortable (emotionally or physically).
If at any time the patient/client feels that her examiner has inappropriately acted in an unprofessional manner (which unfortunately does happen, most often with certain unscrupulous male practitioners - such as with inappropriate touching or sexual or abusive verbal comments, non-verbal gestures, rough physical treatment), she should consider either saying something immediately to the "abusing" examiner (which may be difficult to do or may be ignored by the examiner as over-reacting by the client/patient). If the client/patient feels that she is unable to confront the examiner, then she needs to consider reporting her "abuse" to the proper authorities AND the patient/client should discontinue care immediately with this practitioner. The examiner (male or female) should at all times be professional and courteous to his/her patients/clients. These are standard Patient/Client Rights!
GATHER MEDICAL HEALTH HISTORY INFORMATION
Before the appointment, the woman will need to be ready with some information about her family medical history, which she might be asked to provide. Among the most common questions are the following:
- When did your last period start? (Or, when was your LMP; LMP= last menstrual. period.)
- At what age did you start menstruating?
- How long does your period usually last?
- Are you sexually active?
- Are you currently using birth control at this time and if so, what method are you using?
- Have you had any pregnancies, miscarriages, or abortions?
- Do you have any problems or concerns you wish to discuss?
These questions are an important part of a woman's obgyn history and in the future may help her to get pregnant if and when that time comes or prevent unwanted pregnancy. The client/patient should also have a list of questions or concerns she would like to have discussed with her practitioner at the time of the exam. Communications are important between health care provider and client/patient. See Medical History for more information.
At the visit to her chosen health care provider she may have a short general physical exam which may include a breast exam. She may wear some sort of hospital gown and nothing else. In a home setting, a woman may feel comfortable wearing a bath robe or other similar garment that open in the front for breast examination.
For the actual pelvic examination in an office or clinic setting, the woman will lie down on an examining table with her feet resting in elevated "stirrups" -- props that support her legs in the air. Stirrups might look a little scary, but they are really just there to rest her feet in and keep her more comfortable. At home, the midwife may be able to examine her on her bed, propped up with pillows (see below). The woman's legs will be spread apart, with her knees falling to each side to expose her genitals. Almost everyone feels uncomfortable and vulnerable the first few times they are in this position... of course, who would not, but it is important for the woman to relax and realize that everyone goes through this, and soon it will not feel so uncomfortable. Even the health care provider/midwife who is examining her (if it is a woman) goes through the same exam.
The pelvic exam should not hurt and if at any point it does, the woman needs to make sure to let the practitioner know. If it is stressful or uncomfortable, the best way to help is to try to have the woman relax with some deep breaths. As with any other medical procedure, if she tenses up her muscles and goes stiff, the exam becomes more difficult. If she is informed ahead of time about what the exam involves, and she is comfortable with her practitioner, there is should be no reason for her to be nervous. The practitioner should tell the woman what they are doing when they are doing it. If this is a woman's first pelvic exam, the woman needs to make sure that the practitioner is informed about it.
SUPPLIES & EQUIPMENT
Exam table or bed (if done in client's home).
Exam gloves. These can be non-sterile, disposable exam gloves for general examination purposes. Have several pair available, just in case of tearing or contamination. In the event that a woman is pregnant and her amniotic bag has broken, be sure to use only sterile disposable gloves to prevent infection contamination. If the woman is allergic to latex, be sure to have alternative gloves available.
Flexible light source. This can be a portable table lamp, standing lamp, or even a head lamp (fits over the head like a miner's lamp). Good lighting is important.
Vaginal speculum in appropriate size for the client. These can be a metal speculum that has been previously sterilized between uses or a clear plastic disposable one. I personally prefer the disposable plastic specula for many reasons. The plastic ones are, after all, disposable and have not been previously used by other clients. This means there is less risk of infection contamination between clients. They are relatively inexpensive and easily obtained through many medical supply stores (I have some sources listed below). They usually come in a pack of 20-25 and come in a variety of sizes (small, medium, and large). For most women, a medium size is suitable. A small size may be needed for a teenage girl, a woman expecting her first pregnancy, or a very small and/or tight vaginal chamber. If the size is uncomfortable for the client, try a smaller size.
Warm water. This can be running water from a faucet or a bowl filled with warm water in which the speculum is placed to warm up. Another reason I like plastic over metal is that plastic is not as cold as metal, initially, and it does not heat up as intensely as metal either. Make sure the water is not too cold or too hot. About body temperature is good.
Lubricating jelly. If a pap smear is not being done, using a water-soluble lubricating jelly like K-Y Jelly is fine. Do not use mineral-oil based lubrication like petroleum jelly. If a pap smear is going to be performed, use warm water as a lubricant instead. Some debate has gone on whether or not lubricating jelly should be used and may cause interference with obtaining a pap smear. To be on the safe side, a midwife should consider not using a lubricating jelly for a pap test.
A NOTE ON USING LUBRICANT
When performing either a pelvic or rectal examination, you should never contaminate the tube of lubricant by touching it with your gloved hand after touching the client. Develop the following habit: always allow the lubricant to drop onto your gloved fingers without actually touching them. If you should accidentally contaminate the lubricant tube. Discard it.
A paper or cloth drape. This is nice for the client to maintain some feeling of modesty while laying with her genitalia exposed. It is especially important in an office setting where other people are around and where interruptions may occur and/or exposure to the hallway and strangers may be likely. (It seems whenever I have had an exam in a health care provider's office the exam table is always facing the door and my bottom tends to be exposed to the world.) At a client's home, it is less of an issue, but it can still be important if the client has other people in her home that can interrupt an examination. Privacy is always important. Plus, after the pelvic exam, it is nice to be able to cover the client's lower half while performing a breast exam. She feels less exposed this way.
Kleenex or paper towels. These are used for clean-up after the examination. The use of lubrication jelly can leave a messy feeling for the client. Either the midwife or the client will wipe the genitalia clean after the exam.
Soap and hot water for hand washing. It is important that the midwife always washes her hands and arms up to her elbows with a good surgical soap and hot water before beginning the exam. After the exam, repeated washing should also be performed. Proper hand washing is the best defense against infections and contaminations. A midwife should also keep her nails clean and trimmed short. No woman likes an examiner with long fingernails!
The client should not douche before the examination. A usual time period would be about 24 to 48 hours prior to the exam, depending on whether or not a culture will be taken.
The client must have an empty bladder before the exam. If this is a prenatal visit, or a urine sample is to be obtained, do the urine testing prior to the exam. This gives the client a chance to empty her bladder and it gives the midwife the urine she needs to run her dip-stick urinalysis.
The examination is usually performed in the examiner's office, but an examination may be performed during a client's home visit by a midwife or other health care provider. Decide ahead of time where the exam will take place and which would be more comfortable for the client.
ASSEMBLE ALL ITEMS: Make sure all items are assembled and within easy reaching distance of the client. This includes a good light source, a vaginal speculum of appropriate size, and materials for bacteriological cultures and Papanicolaou smears (Pap smears), if these are to be done.
EXAM TABLE: On the examination table the exam should start with the patient lying supine on the exam table with the head elevated 30 to 45 degrees, her thighs flexed and abducted (knees up), her feet resting in stirrups (or chairs) for support, and her buttocks extending slightly beyond the edge of the examining table. Assist the client in placing her heels in the stirrups. Adjust the angle and length to "fit" the client. Have the client slide her hips down until she contacts your hand at the edge of the table. Have the client relax her knees outward just beyond the angle of the stirrups. A pillow should support her head. If the exam table is a flat table, the client may need to in the lithotomy position (lying flat on back) with a pillow under her head. This will depend on the type of exam table the midwife has, adjustable or non-adjustable.
WITHOUT EXAM TABLE: In the home, without a exam table available, the client can be examined on her bed. She will still lay on her back with knees bent and legs apart and can bring her buttocks to the edge of the bed and instead of stirrups, two straight back chairs can be used for her feet, knees bent up. Pillows or other padding can be placed under the buttocks to raise the buttocks if internal visual examination must be made using a speculum.
Elevating the Buttocks
Another option for a in-home exam would be to have two midwife's assistants available, one holding each foot for support. A third option would be to have the client use a firm, surface, such as a table top with pillows and soft padding. Just make sure the table that is used will be able to hold the client's weight. We do not want any accidents to happen when an unstable table collapses.
The breast exam is usually done just before routine pelvic exam. The midwife should try to use this time to educate the client about the importance of doing regular breast self-exams and use this opportunity to teach her how they should be done.
The client must be appropriately gowned and draped. Drape her appropriately with a clean sheet or paper drape. Some clients are more comfortable when a drape is extended well over the thighs and knees. Others prefer to watch both the practitioner and the examination itself and object to drapes that obscure their view. Ask the client which method she prefers.
The client's arms should be at her sides or folded across her chest.
Use non-sterile gloves on both hands. Double-glove your dominant hand if you intend to perform a rectal or rectovaginal exam. (Discard the outer glove after the rectal exam before proceeding with the rest of the exam.)
Properly dispose of soiled equipment and supplies. Make sure a waste receptacle is close-by for throw-away items.
It is important that a male examiner be chaperoned by a female assistant. The female assistant should be in the room during the entire procedure. For a female examiner, this is suggested, but not entirely necessary. Some female examiners may or may not prefer to work alone. This should be up to the client or if a client is emotionally disturbed or upset, an assistant or someone else familiar with the client should be present. The client may want her husband or partner with her or a female friend or relative. This is fine.
Always tell the client what you are about to do before you do it. This helps to keep her relaxed, as well as informed. Explain in advance each step in the examination, avoiding any sudden or unexpected movements.
Have warm hands and a warm speculum. If the midwife does not, she may need to warm both under warm water before proceeding. Cold hands and a cold speculum can be very uncomfortable for the client and make her tense up.
The examiner should be sitting comfortably between the clients legs, low enough to obtain a good visual of the genitalia, but high enough to maintain visual eye contact with the client's face for communication. Monitor your examination when possible by watching your client's face. Have as much eye contact with your client as possible.
Pelvic exam by midwife
Checking Pelvic Diameters.
INSPECTING THE CLIENT'S EXTERNAL GENITALIA
The midwife should uncover the vulva by moving the center of the drape away from herself. She should try to avoid creating a "screen" with the drape pulled tight between the client's knees.
The midwife should announce what she is going to do and then touch the client on the thigh with the back of your hand before proceeding. This helps to calm the client and initiate touch.
The anatomy of the external female genitalia, or vulva, including the mons pubis, a hair-covered fat pad overlying the symphysis pubis; the labia majora, rounded folds of adipose tissue; the labia minora, thinner pinkish-red folds that extend anteriorly to form the prepuce; and the clitoris. The vestibule refers to the boat-shaped fossa between the labia minora. In its posterior position lies the vaginal opening or introitus, which in virgins may be hidden by the hymen. The term perineum, as commonly used clinically, refers to the tissues between the introitus and anus.
Cross Section, Side View
The examiner should sit comfortably and inspect the mons pubis, the labia and perineum. With a gloved hand, separate the labia and inspect the outer genitalia for redness, swelling, lesions, masses, or infestations:
1. The labia majora and minora. Gently palpate. Inspect the folds around them.
2. The clitoris. Enlarged clitoris in masculinizing conditions.
3. The urethral orifice.
4. The vaginal opening or introitus.
5. Note any redness, swelling, or discharge and Lesions of the vulva.
Reassure the client, if the exam is normal so far, say so.
Look for any itchy, small, red maculopapules. These suggest pediculosis pubis (pubic lice). Look for nits and lice at the bases of the pubic hair.
Checking for Discharge.
Note any inflammation, ulceration of Skene's glands (e.g., from gonorrhea) is suspected, insert your index finger into the vagina and milk the urethra gently from the inside outward. Note any discharge from or about the urethral orifice. If present, a culture should be taken.
Checking Bartholin's Glands.
MoonDragon's ObGyn Womens Health Information: Lesions of the Vulva
If there is a history or appearance of labial swelling, check Bartholin's glands. The midwife Inserts her index finger into the vagina near the posterior end of the introitus. She places her thumb outside the posterior part of the labia majora. On each side in turn she palpates between her finger and thumb for swelling or tenderness. Note any discharge exuding from the duct opening of the gland. If present, culture it. Note any surgical scars (episiotomy or other scars) and other abnormalities.
Inflammation commonly caused by gonorrhea and may be acute or chronic. Acutely, it is a tense, hot, very tender abscess. Look for pus coming out of the duct. Chronically, a non-tender cyst occupies the posterior labium. It may large or small.
Assess the support of the vaginal outlet. With the labia separated by her middle and index finger; ask the client to strain down. Note any bulging of the vaginal walls.
A cystocele is present when the anterior wall of the vagina, together with the bladder above it, bulges into the vagina and sometimes out the introitus. Look for the bulging vaginal wall as the client strains down. A rectocele is formed by the anterior and downward bulging of the posterior vaginal wall together with the rectum behind it. To identify it, spread the client's labia and ask her to strain down.
INTERNAL EXAM INSTRUCTIONS
Inspect the vagina and cervix next using a speculum. A speculum is placed inside the vagina and opened. The speculum is an instrument that holds the vaginal walls apart and allows the examiner to see the cervix and vagina and check for inflammation, infection, scars or growths. There may be some feeling of pressure on the bladder or rectum with the speculum in place. Select a speculum of appropriate size, lubricate it and warm it with warm water. (Other lubricants, such as K-Y Jelly, may interfere with cytological or other studies but they may be used if no such tests are planned.) By having the speculum ready during assessment of the vaginal outlet, the midwife can ease speculum insertion and increase the efficiency by proceeding to the next maneuver while the client is still straining down.
The midwife announces what she is going to do and then touches the client on the thigh with the speculum before proceeding.
Inserting the Speculum.
Expose the introitus by spreading the labia from below using the index and middle fingers of the non-dominant hand (peace sign).
Place two fingers just inside or at the introitus and gently press down on the perineal body. With the other hand introduce the closed speculum past the fingers at a 45-degree angle downward. The blades should be held obliquely and the pressure exerted toward the posterior vaginal wall in order to avoid the more sensitive anterior wall and urethra. Avoid contact with the anterior surfaces. Be careful not to pull on the pubic hair or to pinch the labia with the speculum.
After the speculum has entered the vagina, remove the fingers from the introitus. Rotate the blades of the speculum into a horizontal position maintaining the pressure posteriorly. Insert until the handle is almost flush with the perineum.
Rotating the Speculum.
Open the blades after full insertion of the speculum 2 or 3 cm using the thumb lever. Maneuver the speculum so that the cervix comes into full view. Position the "bills" so the cervix "falls" in between. Secure the speculum by turning the thumb nut (metal speculum) or clicking the ratchet mechanism (plastic speculum). Do not move the speculum while it is locked open.
Opening the Speculum.
Viewing The Cervix
When the introitus is retroverted, the cervix points more anteriorly than diagrammed. Position the speculum more anteriorly, i.e., more horizontally, in order to bring the cervix into view.
MoonDragon's ObGyn Womens Health Information: Uterine Abnormalities
Inspect the cervix and its os (opening). Note the color of the cervix, its position, any ulcerations, nodules, masses, bleeding or discharge. Inspect the vaginal walls for lesions and redness.
MoonDragon's ObGyn Womens Health Information: Cervical Abnormalities
A normal cervix will appear pinkish in color. The cervix will appear as purplish in color if a woman is pregnant.
The nullparous cervical os is small and either round or oval. The cervix is covered by smooth pink epithelium. Nullpara means a woman who has not borne children. After childbirth, the cervical os presents a slit-like appearance.
The trauma of difficult deliveries may tear the cervix, producing permanent transverse or stellate lacerations.
OBTAINING SPECIMEN SAMPLES
If the midwife is going to obtain specimens for cervical cytology (Papanicolaou smears, also known as a pap smear). Take these steps in order:
1. The Endocervical Swab: Moisten the end of a cotton applicator stick with saline and insert it into the os of the cervix. Roll it between the thumb and index finger, clockwise and counter clockwise. Remove it. Smear a glass slide with the cotton swab, gently in a painting motion. (Rubbing hard on the slide will destroy the cells.) Place the slide into the ether-alcohol fixative at once.
Obtaining a Cervical Swab.
2. Cervical Scrape: Place the longer end of the scraper on the os of the cervix. Press, turn and scrape. Smear on a second slide as before.
Obtaining Cervical Spatula Sample
3. Vaginal Pool: Roll a cotton applicator stick on the floor of the vagina below the cervix. Prepare a third slide as before. If the client has an infection or a discharge from the cervix or the vagina, this would be a good time to take a sample with a cotton swab for analysis.
If the cervix has been removed, do a vaginal pool and scrape from the cuff of the vagina.
MoonDragon's ObGyn Womens Health Information: Procedures - Pap Smear Pictorial
Do a vaginal examination. Withdraw the speculum slowly while observing the vagina. As the speculum clears the cervix, release the thumb screw and maintain the speculum in its open position with your thumb. Close the blade by releasing the screw with the thumb of the speculum and allow the "bills" to fall together as the speculum emerges from the introitus while rotating the speculum to 45 degrees, avoiding both excessive stretching and pinching of the mucosa. During the withdrawal, inspect the vaginal mucosa, noting its color, inflammation, discharge, ulcers or masses. Again avoid contact with the anterior structures.
MoonDragon's ObGyn Womens Health Information: Vaginal Inflammations
Replace the drape while you prepare for the rest of the exam. Reassure the client, if the exam is normal so far, say so.
Apply a small amount of lubricant to the index and middle fingers of the dominant hand.
Uncover the vulva and lower abdomen by moving the center of the drape away from the examiner.
The midwife announces what she is going to do and then touch the patient on the thigh with the back of the hand before proceeding.
Perform a bimanual examination. From a standing position, introduce the index and middle finger of the gloved and lubricated hand into the vagina, again exerting pressure primarily posteriorly. Avoid the anterior structures. The thumb should be abducted, the ring and little fingers flexed into the palm. Note any nodularity or tenderness in the vaginal wall, including the region of the urethra and bladder anteriorly.
Identify the cervix, noting its position, shape, size, consistency, regularity, mobility and tenderness. Palpate the fornix around the cervix. Note that during pregnancy, the cervix will be softer in consistency (like palpating the lips) as compared to non-pregnancy (like the end of the nose). If the woman is in the latter stages of her pregnancy, the cervix may be very "squishy" feeling and pliable. Dilation and/or effacement (opening and thinning) of the cervix may have already began.
Place the abdominal hand about midway between the umbilicus and symphysis pubis and press downward toward the pelvic/vaginal hand. The pelvic/vaginal hand should be kept in a straight line with the forearm, and inward pressure exerted on the perineum by the flexed fingers. Support and stabilize the arm by resting the elbow either on the hip or on the knee which is elevated by placing the foot on a stool. Continue to lift the cervix with the vaginal hand. Identify the uterus between the hands and note its size, shape, consistency, mobility, tenderness and masses. This procedure may cause some discomfort for the client. Uterine enlargement suggests pregnancy, benign or malignant tumors.
Palpating Uterine Fundus
Palpating Behind Uterus
Place the abdominal hand on the right lower quadrant, the pelvic hand in the right lateral fornix. Maneuver the abdominal hand downward 3 or 4 cm medial to the iliac crest, and using the pelvic hand for palpation, identify the right ovary and nay masses in the adnexa. Gently "trap" the ovary between the fingers of both hands (if possible). Three to five years after menopause, the ovaries have usually atrophied and are no longer palpable. If you can feel an ovary in a post-menopausal woman, suspect an ovarian tumor.
View from the right side.
Note the size, shape, consistency, mobility and tenderness of any palpable organs or masses. The normal ovary is somewhat tender. Repeat the procedure on the left side.
MoonDragon's ObGyn Womens Health Information: Adrenal Masses
Replace the drape and assist the client to remove her feet from the stirrups and sit up.
Reassure the patient, if the exam is normal, say so.
Leave the room and allow the patient to dress before continuing with the consultation.
VAGINAL-RECTAL EXAM: Withdraw your fingers, removing your gloves and throwing them away. Re-glove using fresh, clean gloves. Place lubricant (K-Y Jelly) on internal exam glove. Another method is to double glove and then remove the outer glove after the rectal exam before proceeding with the vaginal exam.
Then slowly reintroduce the index finger into the vagina, the middle finger into the rectum. Ask the client to strain down as the midwife/examiner does this so that her anal sphincter will relax. Tell her that this examination may make her feel as if she has to move her bowels - but, reassure her that she will not.
Repeat the maneuvers of the bimanual examination, giving special attention to the region behind the cervix which may be accessible only to the rectal finger. In addition, try to push the uterus backward with your abdominal hand so that your rectal finger can explore as much of the posterior uterine surface as possible. Check the rectum itself and other nearby structures for any abnormalities.
The risk of spreading infection between vagina and rectum should always be considered. Gonorrhea may infect the rectum as well as the female genitalia. This fact, together with the rising prevalence of gonorrhea, has led to the recommendation that gloves be changed between vaginal and rectal examination in order to avoid spreading of gonococcal infection. In order to avoid fecal soiling, gloves should always be changed if for some reason the practitioner examines the vagina after the rectum. Another helpful suggestion is to double glove (put one glove over another) so that after the exam, the used glove is easily removed and discarded while still having a clean glove underneath. It saves time for the examiner.
Pictorial Description of Rectal Exam
Pelvic Examination and Pap Smear (Cervical Smear)
Pictorial Description of Pap Smear (Cervical Smear)
Sister Zeus: Learning How to Use a Speculum (Do-it-yourself Cervical Exam)
After the examination, wipe off the external genitalia and anus or offer the client some tissue with which to do it herself. Throw away any used disposable items and clean up supplies.
Note: If I am using a disposable speculum for the examination, I will offer to give it to the client to keep. If she is interested, I teach her how to do her own self exam using a speculum, flashlight, and mirror. Sometimes this comes in handy to do your own self-exam. If she does not want the speculum then I will go ahead and toss it.
Tenderness with cervical motion is an important sign of pelvic disease. You should both observe the clients's face and ask her if the examination is painful in any way.
Your ability to palpate the uterus and ovaries will depend on the client's anatomy, the size of your hands, and your level of skill.
MEDICAL EXAM SUPPLIES: RESOURCES
It pays to shop around for supplies and equipment. Sometimes you can find good deals on supplies. These are a few suggestions and resources to check out:
Moore Medical Supply: Disposable Vaginal Specula by Moore Medical
Economical Pederson-type, self-locking with smooth rigid locks. Features 6-blade position with 2 distal openings. This is not used with a light source. Comes in three sizes in a box of 25. The large size is white in color; the medium and small come in clear. Price as of February 2006, $14.19. (Price is subject to change by supplier.)
Moore Medical Supply: Metal Pederson Vaginal Speculum by KMedic
Correct spring tension and size for optimum control and motion. Ideal handle dimensions for the right heft and feel. Silk matte hand-finished surface for corrosion resistance. Precise geometric design, precision milling and assembly. Comes in medium and small sizes. Price as of February 2006, $31.89 each. (Price is subject to change by supplier.)
Moore Medical Supply: Metal Graves Vaginal Specula by KMedic
Made of stainless steel. Comes in three sizes, small, medium, and large. Prices as of February 2006, range from $26.59 (Small) to $28.89 (Medium) and $34.99 (Large) for each speculum. (Prices subject to change by supplier.)
Moore Medical Supply: Kleenspec 586 Series Disposable Vaginal Specula by WelchAllyn
Pederson-style, 4 boxes of 25 per case. Features include: Halogen light for true tissue color and consistent, long lasting illumination. Disposable for economy, safety and convenience. Expendable light carrier for safety. Comes in small and medium sizes. Prices as of February 2006 are $114.00 (Medium) and $115.00 (Small) for a case of 100. (Prices are subject to change by supplier.)
Moore Medical Supply: KleenSpec Disposable Vaginal Specula System by WelchAllyn
KleenSpec disposable vaginal specula illumination system with integrated on/off switch and transformer. Features include reliable performance. The permanent illumination system comes complete with a light handle and transformer. New ergonomic design allows for easy cleaning. Unique integrated light source transmits superior illumination for a more accurate diagnosis. Eliminates positioning of an external light source and provides greater visualization of the exam area. Disposable sheaths come in a box of 125 for $142.00. The vaginal illumination system is $243.00 each. The bulb (4.6V) is $23.79 each. The specula comes in three sizes, large, medium and small. These come in a box of 20 (Large) and 25 (Medium and Small). The price for the specula is $46.39 for a box of any size. Prices given are for February 2006. (Prices subject to change by supplier.)
Moore Medical Supply: Exam Room Supplies from exam tables, stools, paper goods to scales and other exam supplies and equipment.
SUPPLIES FROM AMAZON.COM
Note; This only a small selection of available products.
PLASTIC DISPOSABLE SPECULUM IN ASSORTED SIZES
METAL SPECULUM IN ASSORT SIZES & TYPES
ASSORTED EXAM ROOM SUPPLIES
USED EXAM TABLES & MEDICAL EQUIPMENT
DealTime: Used Exam Tables
PEMED: Used Surgical & Exam Tables & Medical Equipment
EDUCATIONAL, MEDICAL & MIDWIFERY SUPPLIES & RESOURCES
Mayawrap.com: Wear Your Baby Website
Wear Your Baby specializes in Maya Wrap Baby Carriers.
Earth Mama Angel Baby
Natural Pregnancy, Labor, Postpartum, Breastfeeding, Baby Care Products.
Ace Graphics Midwifery Website
Ace Graphics is located in Australia and is an excellent resource of supplies and teaching aids for midwives, childbirth educators and other health care practitioners working with birthing couples.
Cascade Health Care Supplies, Inc.
Cascade has a great assortment of professional and parenting medical supplies, books, educational materials and much more.
Emergency Medical Products, Inc.
EMP has inexpensive medical surgical instruments (forceps, scissors, etc.) and umbilical cord scissors as well as first aid supplies, emergency medical supplies and clothing, emergency medical equipment along with much more.
Birth With Love
Birth With Love has birth and midwifery supplies with comparable prices to Cascade's and Moore Medical's. She has customized birth kits, a freebie list of free samples, and a swap meet page for used equipment.
WRS Health Education Products
Wonderful health oriented supplies for all aspects of health prevention & education, pregnancy, drug prevention, smoking prevention, alcoholism and more.
Arista Surgical Supplies
Medical, surgical, and home health care & supplies for medical professionals.
Henry Schein Medical Supplies
Medical, surgical, and dental equipment & supplies for medical & dental professionals.
Moore Medical Corp.
Medical, surgical supplies for medical professionals.
Anatomical Chart Company
Anatomical Educational Products.
Yalad Birthing Supply
Birth supplies & service for midwives, childbirth educators, doulas, home birth, home schooling and much more.
Spirit Led Childbirth/BirthSupplies.com
Birthing & parenting supplies.
MoonDragon's Birth Links: Midwifery Supplies & Resources
Amazon.com has many medical and surgical supplies available from a variety of vendors. Use the search box below to find specific items and do price comparisons.
HERBS, OILS, & SUPPLIES
MoonDragon's Health & Wellness: Manufacturers & Distributors
See all our merchant banners below for products, remedies and supplements recommended on this web site.
HELPFUL PRODUCTS & FURTHER EDUCATION
Prescription for Nutritional Healing: The A-To-Z Guide To Supplements
-- by Phyllis A. Balch, James F. Balch - 2nd Edition
Prescription for Nutritional Healing: The A-To-Z Guide To Supplements
-- by Phyllis A. Balch, James F. Balch - 4th Edition
Prescription for Herbal Healing: The A-To-Z Reference To Common Disorders
-- by Phyllis A. Balch
The Complete Guide to Natural Healing
This is only a small sample of educational materials and products available through Amazon.com. Use the search box provided below to search for a particular item.
If you see a suggested Amazon product "not there" as indicated by an orange box with the Amazon logo, this only means the specific product link has been changed by Amazon.com. Use the "click here" icon on the orange box and it will bring you to Amazon.com and you can do a search for a specific product using keywords and a new list of available products and prices will show. Their product and resource links are constantly changing and being upgraded. Many times there are more than one link to a specific product. Prices will vary between product distributors so it pays to shop around and do price comparisons.Educational materials and health products are available through Amazon.com. Use the search box provided below to search for a particular item.
For a full list of available products from Mountain Rose Herbs, click on banner below:
Mountain Rose Bulk Herbs Mountain Rose Herbs, Bulk Herbs A
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Mountain Rose Herbs, Bulk Herbs P
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Mountain Rose Herbs, Bulk Herbs V
Mountain Rose Herbs, Bulk Herbs W
Mountain Rose Herbs, Bulk Herbs Y
Mountain Rose Aromatherapy Oils Mountain Rose Herbs, Aromatherapy Oils A-B
Mountain Rose Herbs, Aromatherapy Oils C-E
Mountain Rose Herbs, Aromatherapy Oils F-L
Mountain Rose Herbs, Aromatherapy Oils M-P
Mountain Rose Herbs, Aromatherapy Oils Q-Z
Mountain Rose Herbs, Aromatherapy Oils: Oil Blends & Resins
Mountain Rose Herbs, Aromatherapy Oils: Diffusers, Nebulizers, & Burners
Mountain Rose Herbs, Aromatherapy Oils: Oil Kits
Mountain Rose Herbs.com: Order Online
GOLD CROWN PREMIUM NATURAL HEALTH PRODUCTS
MoonDragon's Nutrition Information Index
MoonDragon's Health & Wellness: Nutrition Basics Index
MoonDragon's Health & Wellness: Therapy Index
MoonDragon's Nutrition Therapy Index
MoonDragon's Alternative Health Information Index
MoonDragon's Aromatherapy Information Index
MoonDragon's Health & Wellness Index
MoonDragon's ObGyn Womens Health Information Index by Subject Order
MoonDragon's ObGyn Womens Health Information Index by Alphabetical Order
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