Graves Speculum
The Graves is a bivalve vaginal speculum with curved blades that separate the vaginal walls for examination of the vagina and cervix. A locking mechanism maintains the selected opening. It is useful for office examination, sampling and selected procedures; an operative vaginal retractor may provide a less obstructed working channel during reconstruction.[1][2]
Design and configurations
Blade width, blade length and the yoke all affect access. CooperSurgical's Euro-Med range includes standard and open-sided Graves configurations; examples include 19 × 82 mm, 33 × 114 mm and 35 × 127 mm blade dimensions. Longer blades and wider-opening yokes are separate choices, not interchangeable descriptions of the word large.[1]
Inspect the hinge, locks and blade edges before use. For reusable models, confirm that cleaning and sterilization followed the specific IFU. A speculum designed for LEEP or laser work has additional requirements; an ordinary uncoated metal Graves is not a universal substitute.[2]
Choosing the speculum
Choose according to the required view, vaginal length and caliber, tissue sensitivity and the patient's prior examination experience, rather than assigning a size solely from age, parity or sexual history. A narrower Pederson may be useful when insertion or opening is uncomfortable; a longer instrument may help when the apex lies beyond a shorter blade. Wider blades can support lax lateral walls but may be poorly tolerated in a narrowed introitus.[3]
The smallest instrument that gives the required view is a useful starting principle, not a reason to persist with inadequate visualization. Reposition or change the instrument when needed.
Urogynecologic uses
- Assessing vaginal mucosa, discharge, bleeding, mesh exposure or exposed sutures.
- Inspecting the vaginal cuff after hysterectomy or prolapse surgery.
- Visualizing the cervix when indicated sampling or a cervical procedure is planned.
- Inspecting vaginal tissue during pessary follow-up.
- Initial assessment before switching to a Sims, Heaney or Breisky for focused exposure.
A bivalve speculum retracts the walls it contacts. For compartment-by-compartment prolapse assessment or inspection behind a blade, change the exposure rather than assuming one locked view displays the entire vagina.
Graves compared with other specula
| Speculum | Blades | Common use |
|---|---|---|
| Graves | Two wide, curved | Routine adult examination, wide cervical window, colposcopy, pessary and cuff inspection |
| Pederson | Two narrow, flat | Narrow introitus, atrophic tissue, nulliparous patients |
| Huffman | Two very narrow | Adolescent or pediatric examination |
| Sims | Single handheld blade | Lateral-position examination, surgical vaginal retraction |
| Auvard weighted | Single weighted blade | Operative vaginal work with an unobstructed anterior channel |
These are typical uses from practice, not rules. In postmenopausal patients with vaginal atrophy, a Pederson is often more comfortable even when the patient is parous. When the Graves blade obstructs cervical instrument passage, or the apex lies beyond the blade, change to a Sims, a longer speculum or an operative retractor.
Examination technique
- Explain the purpose and sequence; agree that the patient can ask to pause or stop. Arrange privacy, support and a chaperone according to preference and local policy.
- Check the instrument's temperature and function. Use a comfortable position and avoid forcing insertion.
- Advance gently along the vaginal axis, avoiding pressure on the sensitive anterior structures. Open only enough to achieve the intended view, then secure the lock without excessive tension.
- If pain, guarding or resistance occurs, pause and reassess size, position and whether the examination should continue.
- Release the locks and withdraw under control, avoiding entrapment of vaginal tissue between the blades.[2][3]
Water-soluble lubricant can improve comfort, but compatibility depends on the intended sample and product. The Euro-Med IFU restricts lubrication when cytology or colposcopy is planned, while examination literature supports compatible lubricants in many circumstances. Follow the actual device and laboratory instructions; do not assume every lubricant is suitable for every test.[2][3]
Telling the patient about instrument contact before it happens, generous lubricant at the introitus and careful speculum selection all reduce discomfort. In atrophic or irradiated tissue, an ultra-narrow speculum with liberal lubricant is suggested.[3] In a randomized trial of 136 women, a plastic speculum modified with a flexible polypropylene sheath showed 95.1% of the cervix versus 78.2% with a standard plastic speculum (P<0.001), with no significant difference in pain scores. That trial used a modified disposable speculum, not a metal Graves.[4]
References
1. CooperSurgical. Euro-Med Graves Specula. Manufacturer configurations and dimensions.
2. CooperSurgical. Vaginal Reusable Specula Instructions for Use, 34158-IFU Rev A. Complete four-page IFU text checked September 20, 2026.
3. Bates CK, Carroll N, Potter J. The challenging pelvic examination. J Gen Intern Med. 2011;26(6):651–657. doi:10.1007/s11606-010-1610-8. Open article. Practical examination guidance; historical screening recommendations are not used here.
4. Hill DA, Cacciatore ML, Lamvu G. Sheathed versus standard speculum for visualization of the cervix. Int J Gynaecol Obstet. 2014;125(2):116–120. doi:10.1016/j.ijgo.2013.10.025.