VAGINAL SPECULUM

Abstract: A vaginal speculum comprises two elements (1, 2) having on one hand a spoon part possible to insert in a woman's vagina (3, 5) and on the other hand an oblique handle part (4, 6). After insertion in the vagina, the spoon parts are movable through displacement of the handle parts so that said parts may widen the vagina. There is an aperture of inspection in one handle part (4), the handle parts (4, 6) having co-operating locking means for locking the parts (1, 2) in relation to each other. The upper as well as the lower spoon part (3, 5) have a longitudinally curved shape. More precisely, said spoon parts have such a shape that they diverge with at least 30 DEG from concavely curved intermediate portions (17, 17') towards convexly curved portions (18, 18'), the distance between the convexly curved portions (18, 18') being considerably larger than the corresponding distance between the concavely curved portions (17, 17'). In such a way, the pinching muscle of the opening of the vagina reliably retains the spoon parts inside the vagina.

Description: VAGINAL SPECULUM Technical Field of the Invent-.ion This invention relates to a vaginal speculum comprising two mutually separable, upper and lower elements, each of which has a spoon part which is insertable in the woman's vagina, said spoon part being integral with a handle part directed at an angle thereto, and which elements from an initial position, in which said spoon parts are approached to each other, are displaceably movable in relation to each other so as to widen the vagina after insertion of the spoon parts therein and thereby enable inspection and/or insertion of instruments in the interior of the vagina, more precisely through an aperture in the handle part of the upper speculum element, said handle parts having co-operating locking means by means of which the elements may be locked in the desired adjustment positions in relation to each other, and the upper as well as the lower spoon part having a longitudinally curved shape, more precisely such a shape that said spoon parts diverge from concavely curved intermediate portions towards convexly curved portions. Vaginal specula of the above-mentioned kind are used on one hand in connection with gynaecological examinations in which the interior of the vagina, e.g. the mouth of the womb, is ocularly inspected, and on the other hand also in connection with more or less complicated operations of the interior of the vagina, e.g. in order to remedy cancer diseases or to take vaginal smear tests. Such operations may be performed with con¬ ventional surgical knives as well as by the use of modern laser operational technology, and also with diathermy. Prior Art. A vaginal speculum of the kind initially related to is disclosed in DK 125 056. In this known speculum, the spoon parts are, in the main, equally long and only slightly curved. Apart from the fact that the two spoon parts have cross-sec¬ tion-wise vaulted or rounded shape, the lower spoon part is thus substantially straight, while the upper one has an oblique wall portion between the concave and the convex portions, said portions converging in their distal, free end portions in the direction towards each other. The angle between the straight lower spoon part and the oblique wall portion of the upper spoon part is less than 10°. For reasons which are clear from below, this geometrical shape is disadvantageous. The interior of the woman's vagina extending between the opening of the vagina and the mouth of the womb or the portio is surrounded by muscles which certainly are weaker than the powerful pinching muscle in connection with the opening of the vagina, but which nonetheless may exert considerable contrac- tion force. These vaginal muscles may be activated already by the fact that the woman is tense, faced with an examination or operation being close at hand. At times said muscles may also be activated and contract the vagina as a consequence of such trivial a circumstance as an attack of coughing. When the vagi- nal muscles for one reason or another, without the woman's con¬ scious control, are activated and contract the vagina, the above-mentioned geometrical shape of the speculum disclosed in DK 125 056 entails that said speculum unintentionally is ejected from the vagina. In practice, this is something which to a great extent obstructs the physician's work. Thus, in most situations, the physician's two hands are engaged by handling various instruments and that is why it is inconceivable to use one of the hands only to hold the speculum device in place. If an unintentional ejection occurs in this connection, the instruments must be removed and the speculum device be put back in place before the operation and the examination respectively can be continued. At worst, the work has to be completely interrupted after an ejection. Another disadvantage is that the upper spoon part, or duckbill part, as well as the lower one are, in the main, equally wide the whole way backwards from the front end or tip of the spoon part. This equally wide shape may in practice cause pains or inconvenience for the woman in con¬ nection with the squeezing in of the spoon parts through the opening of the vagina and the vagina, in that the tissues are initially hit by front portions of the spoon parts which are, in the main, as wide as the rear ones. One further disadvantage of the known speculum device is that the upper spoon part, by the geometrical design thereof, exerts a considerable pressure on the urethra which is squeezed in between the upper spoon part and the hard pubic bone when the spoon parts are maximally distanced from each other for the purpose of maximally widening the vagina. Further, a disadvantage is that the interior of the vagina can not be widened much more than what the maximum wid- ening of the pinching muscle or the opening of the vagina admits . A similar vaginal speculum is also known in SE 9002345- 8. In this case, however, the two spoon parts are, in the main, completely straight and parallel to each other, and therefore the risk of ejection is even more explicit than in the speculum according to DK 125 056. objects and Features o the Invention The present invention aims at obviating the above-men- tioned disadvantages and shortcomings of the specula disclosed in DK 125 056 and SE 9002345-8 and at creating an improved speculum. Thus, a primary object of the invention is to provide a speculum which is automatically retained in the vagina in a reliable way as soon as the spoon parts are maximally distanced from each other and locked in the desired adjustment position. Furthermore, a reliable retention should be guaranteed even if the speculum is drawn out a bit from the very inner position thereof in the vagina. Another object of the invention is to create a speculum which may be smoothly inserted in the vagina in such a way that the woman' s pains and inconvenience are reduced to a minimum. A further object of the invention is to create a speculum which does not exert a considerable pressure on the urethra during usage. An object is also to create a speculum which admits larger widening of the interior of the vagina than previously. Other objects of the invention are to create a speculum which is easy to use, in particular consider¬ ing the possibilities to displace and lock the spoon parts in relation to each other, and which is easy and cheap to manufac¬ ture. According to the invention, at least the primary object is attained by the features defined in the characterizing clause of claim 1. Preferred embodiments of the invention are furthermore defined in the dependent claims . Further Elucida ion of the P ior Art In DE 514 195 and US 4 807 600 vaginal specula are dis¬ closed the spoon parts of which have a slightly vaulted or rounded basic shape. However, in these two cases, the spoon parts are pivotable in relation to each other by the fact that the upper spoon part is articulatedly connected to the appurte¬ nant handle part and adjustable in different positions by means of a mechanical lock device. However, such lock devices are inappropriate in connection with gynaecological work inasmuch as the woman's very delicate tissues in the area of the vagina may get jammed in connection with manipulation of the lock device. Unlike these specula, the present invention is based on the use of angular speculum elements each of which having the spoon part thereof integral with the appurtenant handle part . It may also be mentioned that a vaginal speculum with a hinged upper spoon part is disclosed in US 3 815 585. However, in this case, the spoon parts are, in the main, completely straight . Brief Description of the Appended Drawings In the drawings : Fig 1 is a perspective view of a speculum device according to the invention, Fig 2 is a schematic picture illustrating the woman's anatomy in connection with the vagina, the speculum according to fig 1 being shown inserted in the vagina, Fig 3 is a longitudinal section through the two elements of which the speculum is composed, Fig 4 is a partial end view showing an aperture of inspection in the handle part of the upper speculum element, the two spoon parts of the speculum elements being maximally approached to each other, Fig 5 is a corresponding end view showing the aperture of inspection when the spoon parts of the speculum elements are far distanced from each other, Fig 6 is an analogous end view showing the aperture of inspec¬ tion when the spoon parts are adjusted in an intermedi¬ ate position, Fig 7 is an exploded view showing the two elements of the speculum spaced-apart, Fig 8 is a side view illustrating the displaceability between the two elements of the speculum, Fig 9-11 are side views showing the two elements of the specu¬ lum in different positions during insertion in a vagina, and Fig 12-14 are planar views from above corresponding to the side views according to figures 9 to 11. Detailed Description of a Preferred Embodiment of the Invention The speculum shown in fig 1 comprises two mutually dis- placeably movable and separable elements, generally designated 1 and 2 respectively. The element 1 comprises a first or upper spoon part 3 and a handle part 4 directed at an angle thereto. In an analogous way, the element 2 comprises a spoon part 5 and a handle part 6. As may be clearly seen in fig 7, the two speculum elements are, in the main, L-shaped, each spoon part being integral with the appurtenant handle part. In practice, the two elements may advantageously be made of moulded, stiff plastic. Before the invention is described in more detail, refer¬ ence is made to fig 2 schematically illustrating the anatomy in connection with a woman's vagina. The vagina 7 itself consists of a hollow surrounded by muscles extending from the outer opening of the vagina to the mouth or the portio 9 of a womb 10. The main part of the vagina 7 is located inside of the pel¬ vic floor muscle 11 and above the colon 12. Above the vagina there is the urinary bladder 13 and the urethra 14. Above the opening of the vagina 8, surrounded by a strong pinching mus¬ cle, there is the firm and hard pubic bone 15. Although the anatomy of the womb and the portio may vary to a great extent, it can generally be noted that the portio of the womb is loca¬ ted in the area of the inner end of the vagina 7. Reference is now made to figures 1 and 3 simultaneously, in which it may be seen how a wide aperture 16 is recessed in the upper part of the handle part 4 of the element 1. This aperture is henceforth denominated an aperture of inspection, although the same also serves the purpose of inserting various instruments in the vagina. As may be most clearly seen in fig 3, the upper spoon part 3 as well as the lower spoon part 5 have a longitudinally curved shape. More precisely, the spoon parts have such a shape that said spoon parts diverge from the concavely curved intermediate portions 17, 17' in the direction towards the convexly curved portions 18, 18' near the free ends of the spoon parts. In relation to the imaginary axial line A extending, in the main, perpendicularly to the handle parts 4, 6, oblique, slightly arched wall portions 19, 19' thus extend between the concavely curved wall portions 17, 17' and the con¬ vexly curved wall portions 18, 18' . In the example, the obliq¬ uity angle between the wall portion 19 and the axial line A is about 23°, while the obliquity angle between the wall portion 19' and the axial line A amounts to about 13°. In other words, the total angle between the wall portions 19, 19' amounts to about 36°. Tests made have shown that this total angle between the oblique wall portions of the spoon parts should amount to at least 30°. In the preferred embodiments, this angle should be within the range of 33-45°, preferably within the range of 35-40°. The relatively large angle in which the wall portions 19, 19' jointly diverge becomes, in this way, large enough to locate the convexly curved wall portions 18, 18' at a mutual distance (across the line A) being considerably larger than the corresponding distance between the concavely curved wall por- tions 17, 17' . In the example, the largest cross-distance bet¬ ween the portions 18, 18' is more than twice as large as the smallest cross-distance between the portions 17, 17' . The con¬ cavely curved intermediate portion 17 of the upper spoon part transforms at the back into a wall portion 20 diverging back- wards in relation to the axial line A. In a similar way, the concavely curved intermediate portion 17 ' of the lower spoon part 5 transforms into the handle part 6 via a transition por¬ tion 21 being concavely curved in an angle sharply diverging in relation to the line A. As may be clearly seen in fig 3, the lower spoon part is longer than the upper one. In a prototype designed in practice, the lower spoon part has a length of 145 mm (counted from the tip 22 to the back edge 23 of the handle part) , while the cor¬ responding length of the upper spoon part is 130 mm (counted from the tip 24 to the back edge 25 of the handle part) . The length difference between the two spoon parts should in prac¬ tice be within the range 10-20 mm. In the lower part of the handle part 6, a number of elongate apertures 26 are recessed. The lower end of the handle part 4 has an oblique wall portion 27 which at the free end thereof has a hook-like projection 28. The apertures 26 and the hooks 28 constitute a locking means, by means of which the two speculum elements 1,2 may be kept locked in relation to each other in a desired adjustment position. More precisely, these locking means co-operate in such a way that the hook 28 inter¬ locks towards the lower edge defining the individual aperture 26 through which the oblique wall portion 27 is brought. The handle part 6 has two rounded bulges 29, 29' forming shoulders for the hand's fingers (index finger and little fin¬ ger) so as to facilitate the hand's grip of the handle part 6. An analogous shoulder for the same hand's thumb has the shape of an oblique and rounded wall portion 30 on the handle part 4. This wall portion 30 is located immediately below the aperture of inspection 16. As may be clearly seen in figures 4 to 6, the aperture of inspection 16 transforms at the bottom into two countersinks 31, 31' on both sides of a central wall portion 32. Separately, these countersinks 31, 31' may receive an instrument or tool, e.g. a homeostatic forceps, inserted in the vagina, the later¬ ally adjusted position of the countersink guaranteeing that the tool is held aside, out of the way for manipulations in the centre of the aperture of inspection. As may be further seen in figures 4 to 6 in combination with fig 3, the upper spoon part 3 is made with a central flute 33 for location below the woman's urethra extending between the aperture of inspection 16 and the concavely curved intermediate portion 17. A duct 34 for e.g. a fibre optic cable for lighting purposes is provided be¬ side the flute 33. Also in the lower spoon part 5, there is a duct 35 through which a tube may be inserted for the suction of blood and other body liquids which may be accumulated on the lower spoon part . In the transition between the spoon part 3 and the han¬ dle part 4 of the upper speculum element 1 there may be holes 36 recessed for the insertion of instruments and tools from the side instead of through the aperture of inspection 16. The upper spoon part 3 has side walls 3 extending, in the main, vertically downwards from the opposite long side edges of the central part of the spoon part. In other words, these side walls and the intermediate central part constitute a flute-like configuration. In an analogous way, the upper spoon part 5 includes two side walls 38 extending, in the main, ver¬ tically upwards from an intermediate central part. Thus, cross- section-wise, also the lower spoon part is flute-formed. In accordance with a characteristic feature, the upper spoon part is wider in the area of its rear end than the corresponding rear end of the lower spoon part, more precisely inasmuch as the distance between the side walls 37 of the upper part is larger than the distance between corresponding rear portions of the side walls 38 of the lower spoon part. As may be clearly seen in fig 3, the height of the side walls 37 is drastically reduced in connection with the front end or tip of the upper spoon part. As is furthermore evident from figures 12 to 14, the upper spoon part is provided with a tapering front end sec¬ tion 39. More precisely, this tapering front end section is narrower than the front end section designated 40 of the lower spoon part 5. Although the upper spoon part 3 , along the main part of the length thereof, is wider than the lower spoon part, the front tip and end section of the upper spoon part may thus be brought down in the flute-like configuration which is de¬ fined between the two side walls 38 of the lower spoon part 5. From figures 12 to 14 it is furthermore evident that the upper spoon part as well as the lower one generally taper in the direction of the front end or tip thereof. Thus, in the immedi¬ ate adjacency to the front section 40 the lower spoon part has a section 41 having mainly parallel side walls, and then the side walls and the intermediate central part are somewhat wid¬ ened in a rear wedge-shaped section 42. The front end section 39 of the upper spoon part immediately transforms into a wedge- shapedly diverging section 43 which, in turn, via a section 44 with parallel side walls, in conclusion transforms into another wedge-shapedly diverging section 45. The section 44 as well as the section 45 have a larger width than the rear, wide end sec¬ tion 42 of the lower spoon part. The function of the Invention The speculum as described above functions in the follow¬ ing way. The two spoon parts 3, 5 may be inserted in the vagina either simultaneously or separately; however, in both cases the upper spoon part 3 should be pivoted with the tip 24 pointing downwards to the lower spoon part at the passage of the opening of the vagina. When the two spoon parts have been inserted in the vagina via the opening of the vagina, the handle part 4 is pivoted towards the handle part 6 so that the handle parts are located, in the main, mutually in parallel. In this state, the adjustment of the spoon parts 3 , 5 is set in dependence on the size of the woman's vagina and the opening of the vagina. This is done by the operator bringing the handle part 4 in the direction upwards with the thumb of the hand (see figures 7 and 8) along the handle part 6 (which is held by the hand's index finger and little finger) until it can be felt that the vagina and ' the opening of the vagina have been maximally widened. In this position, the hook member 28 is brought into engagement with the nearest aperture 26. By the fact that the muscles of the vagina applies a force to the spoon parts 3 , 5 aiming at pivoting the spoon parts in the direction towards each other, forces are applied to the handle parts 4, 6 aiming at pivoting the spoon parts in the direction from each other. However, by the fact that the hook member 28 engages towards the lower edge of the appurtenant aperture, a separation of the handle parts from each other is made impossible. Instead, the handle parts are kept together by a locking force which increases with an increasing force in the muscles of the vagina. Owing to the fact that the spoon parts 3, 5 have the explicit arch-shape characteristic for the invention, said shape implying that the angle between the oblique wall portions 19, 19' is larger than 30° (and as a consequence it follows that the distance between the convexly curved portions 18, 18' is considerably larger than the distance between the concavely curved portions 17, 17 ' ) , a reliable retention of the spoon parts inside the vagina is guaranteed as soon as the handle parts are locked in rela- tion to each other. Thus, the woman's pinching muscle in con¬ nection with the opening of the vagina is so strong that it is able to hold back the spoon parts widening inwards themselves, even if forces are applied thereto by the muscles of the vagina themselves, said forces aiming at ejecting the spoon parts from the vagina. Of course, the retention ability becomes larger, the larger the angle between the spoon portions 19, 19' is and the wider the spoon parts are spaced apart in the area of the convexly curved portions 18, 18' . Estimations have shown that a good retention ability is obtained already when the distance between the portions 18, 18' in the initial position according to fig 3 is 50 % larger than the distance between the portions 17, 17 ' . A very good retention ability is obtained when the distance between the portions 18, 18', as shown in fig 3, is more than twice as large as the distance between the portions 17, 17' . In all circumstances, the angle between the spoon por¬ tions 19, 19' should be at least 30°. By the fact that the lower spoon part 5 is longer than the upper spoon part 3 , it is further obtained that the portio 9 is located in a very visible and easily accessible position in the whole anatomic area around the portio. Among elderly women and multipara, the portio is in most cases resting against the bottom of the vagina. By the fact that the lower spoon part is longer than the upper one, it is possible for the physician to "raise up" the portio on the lower spoon part before the upper spoon part meets the portio and obstructs further insertion of the spoon parts in the vagina. Especially among multipara, the portio may be enlarged or prolapsed implying that the spoon parts may be inserted furthest into the vagina only with problems . Never- theless, by its geometry, the speculum according to the inven¬ tion may, in an advantageous way, be held in a not fully inser¬ ted intermediate position in which said speculum is reliably retained inside of the pinching muscle of the opening of the vagina, thanks to the large angle between the spoon portions 19, 19' . Another advantageous functioning of the speculum device according to the invention is that the urethra 14 may be located in the flute 33 and be housed therein without squeezing pressure being applied thereon between the upper spoon part 3 and the hard pubic bone 15. Furthermore, the tapering shape of the upper spoon part as well as the lower one entails that the insertion of the speculum in the woman's vagina becomes ergo¬ nomically lenient in that the tissues successively are pushed aside without being abruptly exposed to extreme pressure forces. ■ Feasible Modifications of the Invention The invention is not limited solely to the embodiment described and shown in the drawings. Thus is it is feasible to make the speculum device with other locking means than those shown in the drawings. Further, the spoon parts may be made with considerably wider or higher side walls than those exem¬ plified in the drawings.

Claims: Claims 1. Vaginal speculum comprising two mutually separable, upper and lower elements (1, 2) , each of which has a spoon part (3, 5) which is insertable in a woman's vagina, said spoon part being integral with a handle part (4, 6) directed at an angle thereto, and which elements from an initial position, in which said spoon parts (3, 5) are approached to each other, are dis- placeably movable in relation to each other so as to widen the vagina after insertion of the spoon parts therein and thereby enable inspection and/or insertion of instruments in the inte¬ rior of the vagina, more precisely through an aperture (16) in the handle part (4) of the upper speculum element (1) , said handle parts (4, 6) having co-operating locking means (26, 28) by means of which the elements may be locked in the desired adjustment positions in relation to each other, and the upper as well as the lower spoon part (3, 5) having a longitudinally curved shape, more precisely such a shape that said spoon parts (3, 5) diverge from concavely curved intermediate portions (17, 17') towards convexly curved portions (18, 18') c h a r a c t e r i z e d in that the angle between oblique wall portions (19, 19') extending from the concavely curved intermediate portions (17, 17') to the convexly curved portions (18, 18') amounts to at least 30°, and that the distance bet- ween the convexly curved portions (18, 18') of the spoon parts is at least 50 % larger than the corresponding distance between the concavely curved portions (17, 17'), when the spoon parts are in an initial position close to each other. 2. Vaginal speculum according to claim 1, c h a r a c t e r i z e d in that the upper spoon part (3) on one hand, in the area of the rear end, is wider than the corre¬ sponding rear end of the lower spoon part (5) inasmuch as the distance between rear side walls (37) of the upper spoon part is larger than the distance between corresponding rear side walls (38) of the lower spoon part (5), and on the other hand, in the area of the front end, is narrower than a front section (41) of the lower spoon part (5) , whereby the upper spoon part (3) may, in spite of the larger width at the rear end thereof, be brought down with its front end or tip in the flute-like configuration which is defined between the two side walls of the lower spoon part in the front section. 3. Vaginal speculum according to claim 1 or 2, c h a r a c t e r i z e d in that both the upper spoon part (3) and the lower one (5) taper in the direction of the front end or tip thereof. 4. Vaginal speculum according to any one of the preceding claims, c h a r a c t e r i z e d in that an aperture of in¬ spection (16) in the handle part (6) of the upper speculum ele¬ ment (3) has two laterally spaced-apart countersinks (31, 31') .

Inventors: NORELL NILS-ERIK, NORELL, NILS-ERIK
Applicants: NORELL NILS ERIK, NORELL, NILS-ERIK
Application year: 1996
Main classification: A61B1
IPC codes: A61B1