Gynecologists rely on a surprisingly wide range of instruments, from simple handheld tools used in routine exams to advanced optical systems for diagnosing cervical abnormalities. Some you’ll encounter at a standard annual visit, while others only come out for specific procedures like biopsies, IUD insertions, or surgery. Here’s what each tool does and when you’re likely to see it.
The Speculum: The Tool You’ll See Most Often
The speculum is the defining instrument of a gynecological exam. It’s a two-bladed device that gently holds the vaginal walls apart so your provider can see the cervix clearly. Without it, a Pap smear or visual exam of the cervix would be nearly impossible.
There isn’t just one type. The Graves speculum has the widest blades and is the standard choice for most adult exams. It comes in multiple sizes, including a larger version for patients with a longer vaginal canal. The Pederson speculum has narrower blades and is typically used for younger or smaller patients. A third type, the Huffman speculum, has the narrowest blades of all and is reserved for adolescents or patients who haven’t been sexually active.
Speculums come in both metal and plastic versions. A study published in BJOG compared the two and found that plastic speculums scored significantly higher on comfort, with an average comfort rating of 8.0 out of 10 compared to 7.3 for metal. The biggest difference was temperature: plastic doesn’t conduct cold the way stainless steel does, so it feels less jarring on contact. Metal speculums, however, are reusable and must be sterilized between patients using steam autoclaves at temperatures of 121°C to 132°C. Plastic versions are single-use and discarded after each exam.
Tools for Cervical Screening
During a Pap smear, your gynecologist collects cells from the surface of your cervix using a small brush or spatula. The brush looks like a tiny bottle brush and is rotated gently against the cervix to pick up a thin layer of cells. Those cells are then sent to a lab to check for precancerous changes.
If your Pap results come back abnormal, the next step is often a closer look using a colposcope. This isn’t inserted into your body. It’s a magnifying instrument mounted on a stand that sits outside and gives the provider a magnified view of the cervix, typically at 10x or 18x power. The colposcope also has a green light filter that makes blood vessel patterns on the cervix much easier to see. Abnormal blood vessel patterns can signal areas where precancerous or cancerous cells are developing, and they’re often invisible under normal white light.
If the colposcope reveals a suspicious area, your provider may take a small tissue sample using biopsy punch forceps. The Tischler forceps are among the most common, with a small jaw that takes a bite of tissue roughly 7 by 3 millimeters. The procedure is quick, though most patients feel a sharp pinch or cramp when the sample is taken.
The Tenaculum: Holding the Cervix Steady
A tenaculum is a slender forceps with a small hook at the tip, and it’s one of the tools patients ask about most, particularly those getting an IUD. Its job is straightforward: it grips the cervix to hold it still and in position while your provider works. During an IUD insertion, for example, the tenaculum pulls the cervix into alignment so the IUD can be guided accurately through the cervical opening and into the uterus.
The grip works by slightly puncturing the surface tissue of the cervix with the hook. That sounds more dramatic than it feels for most people, though it does cause a brief, sharp sensation. The cervix has relatively few nerve endings compared to other tissues, so the discomfort is typically short-lived. Tenaculums are also used during biopsies, endometrial sampling, and other procedures where the cervix needs to stay still.
Endometrial Sampling Devices
When a gynecologist needs to examine the tissue lining the uterus, often because of abnormal bleeding or to check hormone-related changes, they use a thin, flexible suction device called a Pipelle. It’s a narrow plastic tube that’s inserted through the cervix into the uterus. A small internal plunger creates suction, pulling a sample of the uterine lining into the tube.
The Pipelle is popular because it’s minimally invasive and can be done in the office without anesthesia. In a large clinical evaluation of nearly 1,400 women, the Pipelle successfully obtained an adequate tissue sample in about 92% of cases. For the small percentage where it couldn’t collect enough tissue, providers switched to a slightly larger instrument called a Novak curette, which works on a similar suction principle but has a stiffer, wider tip. The procedure typically causes cramping similar to a strong menstrual cramp, lasting a minute or two.
The Hysteroscope: Looking Inside the Uterus
A hysteroscope is a thin, lighted telescope that allows your gynecologist to look directly inside the uterus. It has three main parts: an eyepiece (or video connection), a barrel, and an objective lens at the tip. Modern hysteroscopes connect to a video monitor so the provider can see the uterine cavity on a screen in real time.
To get a clear view, the uterus needs to be gently expanded. This is done by flowing fluid (usually saline) or carbon dioxide gas through channels built into the scope. The fluid opens up the uterine walls enough to see the entire lining, locate polyps, identify fibroids, or find the source of abnormal bleeding. Providers carefully track how much fluid goes in versus how much comes back out, because absorbing too much fluid into the bloodstream can cause complications. The recommended upper limit for fluid deficit is 2,500 mL when using saline.
Some hysteroscopes also have working channels that allow tiny surgical instruments to pass through, so your provider can remove a polyp or small fibroid during the same procedure without needing a separate surgery.
Fetal Monitoring Devices
During labor, gynecologists and obstetricians use devices to track the baby’s heart rate. The most common is a handheld Doppler or an external ultrasound transducer strapped to the abdomen. These are completely noninvasive and work by bouncing sound waves off the baby’s heart.
External monitoring works well in most situations, but it can lose the signal frequently, particularly in patients with obesity. International guidelines recommend that the heart rate tracing be clearly readable at least 80% of the time, a target external monitors don’t always hit. When the signal is unreliable and the membranes have already ruptured, providers may switch to a fetal scalp electrode. This is a tiny wire that attaches directly to the baby’s scalp and picks up the heart’s electrical signal, similar to how an EKG works. It provides a more consistent reading but carries a small risk of infection or minor bleeding at the attachment site.
Instrument Sterilization
Every reusable metal tool in a gynecologist’s office, from speculums to tenaculums to biopsy forceps, goes through steam sterilization in an autoclave between patients. The CDC requires that each sterilization cycle be verified using biological indicators, specifically heat-resistant bacterial spores that confirm the autoclave reached a high enough temperature for a long enough time to kill all microorganisms. Cycle conditions are monitored with temperature charts and pressure gauges. Disposable plastic instruments skip this process entirely, since they’re designed for single use and discarded immediately after the exam.