The Half Speculum Exam to Diagnose the Bulge

I released this video for the Lay Public on June 16, 2024, on my Feminine Wellness Newsletter called “What is that Bulge?” Intended to educate the public. However, I realized that many Primary Care doc and nurses and PAs have never been introduced to the concept of the Half Speculum Exam taught to GYNs and Urogyns. So here it is. A brief primer on how to figure out easily if the bulge coming out of the vagina is from the Anterior Compartment (Cystocele), the Posterior Compartment (Rectocele and maybe Enterocele), the Apex of the vagina, or the Cervix and Uterus. Or a combination of these.

Can you tell what this bulge is below? Bladder or Rectum or both? Tough to tell unless you do a lot to these types of evaluations and surgeries. Most of you did not get the training in your residencies on how to differentiate the bulges from the separate compartments. I have been fooled myself. This video shows you the basics in just over a minute.

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On the left side are the Before pictures. On the right side are the After pictures. Notice the speculum used in the bottom row? That is called a Half Speculum Exam. It isolates the bulge.

Let me show you the steps on how I do the exams using a Half Speculum (the bottom of a standard speculum). You can even buy a specific Half Speculum I developed called the Alinsod O-Shot Speculum shown below. Works great for O-Shots and Clitoxin Shots. Made by Marina Medical in Florida.

I created this with the helpful input of Charles Runels, MD. Originally made to help do the O-Shots easier. A wonderful tool for the Half Speculum Exam.

Beautifully shaped to push the labia minora to the sides and give a great view of the mid urethral area where the O-Shots are given.

You get to see the mid urethra and the anterior compartment. Flip it over and you can view the entire posterior compartment.

Marina Medical makes the Alinsod O-Shot Speculum: LINK

Red Alinsod, MD (red@alinsodinstitute.com, www. alinsodinstitute.com,www.gynflix.com)

Isolation of the Bulge

When she bears down a large spongy ballon comes out. What is it? She lacks confidence in her appearance and thinks it is not sexy nor attractive. She wants the bulges repaired and to look like she did before babies.

She pushes and this round thing comes out. Like a baby’s head! Can you see a small slit across the very tip of the bulge? That is the cervix hanging out with the uterus behind it.

I put a Half Speculum on the floor of the vagina to cover the rectum. That isolates the bladder and prevents the rectum from bulging out. Can you see the slit across the cervix?

I put a Half Speculum on the roof of the vagina to cover the bladder. That isolates the rectum below and prevents the bladder from bulging out. No cervix here.

About to start surgery in the operating room with the patient asleep. My Lone Star Retractor is placed, a catheter is in the bladder, and at rest you can see the wavy reggae of the vaginal wall covering the bladder.

During surgery I have dissected the bladder and covered it with a patch made out of cadaver dermis (skin) and tacked it back to strong ligaments.

Immediately After Surgery. I have the catheter in place for a few days, the vaginal packing will be removed in a few minutes. You can see the sutures used to repair the vaginal opening and giving her the eventual look of never having had a baby. She gets her virginal look back.

Six weeks after surgery and she is healing quite well!

The Bulges are gone. The Vaginoplasty and Perineoplasty also done give her that beautiful youthful appearance and function.

That same Half Speculum exam shows that the Bladder bulge is gone!

That modest rectal Bulge is also gone and the floor if now firm and able to create friction during sex. The spongy waterbed-like floor has been repaired!

She is now 2 Fingers tight across just like before the babies!

The tightness and reduction in the diameter is full-length and not just the opening. She has friction from the entry to the top. Her angles have been returned to be like her pre-baby self!

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