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Stirrups: Because We Have Always Done It That Way?

Women reacted favorably to pelvic examinations without stirrups.

Many women feel both physical and psychological discomfort during pelvic examinations. This trial evaluated women’s experience during routine pelvic exams and cytology screening with or without the use of stirrups. The pelvic examination without stirrups was performed by placing the woman’s feet at the corners of the examining table. A total of 197 women were randomized to either type of examination and used visual analog scales to rate physical discomfort, sense of vulnerability and defenseless, and sense of control.

Women in the "non" stirrup group felt significantly less discomfort than those in the stirrup group. Moreover, women undergoing examination without stirrups felt a significant reduction in the sense of vulnerability. The authors note that once the woman’s feet are placed in stirrups, getting out can be awkward and changing hip or leg positioning due to discomfort is difficult. The quality of the Pap smears did not differ between the two groups.

Comment: Why do we use stirrups? Perhaps because we have always done it that way. Sometimes a pelvic examination is deferred in inpatient or outpatient settings because stirrups are unavailable or the patient cannot be moved from a hospital bed or gurney. This study demonstrates that at least cervical cytology can be successfully performed without stirrups. However, the study did not evaluate other important aspects of the pelvic examination: visibility of the external genitalia and vagina and quality of the bimanual examination.

— Ann J. Davis, MD

Published in Journal Watch Women's Health September 21, 2006

Citation(s):

Seehusen DA et al. Improving women’s experience during speculum examinations at routine gynaecological visits: Randomised clinical trial. BMJ 2006 Jul 22; 333:171-3.

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