Especially, I'm sure - as is Murphy's Law (or possibly Murray's law?) - when the one wielding the speculum is just a wee bit less confident than an NP or MD - or CNM - who may have been searching high and low for the small orbs for years and years. For example, a student nurse-midwife, early in her clinical hours (or, an FNP student, or even a SANE examiner, etc, etc).
Now, as a "good girl" - read that as, "guideline-fearing woman who gets a reminder letter in the mail and promptly grins and bears it"- I have had my share of annual gynecological exams. Honestly, girls... I know, they aren't fun, but really - I've had two kids now, so, I can't complain so much about a silly little plastic (or metal? Is it funny that I can't honestly say what my provider uses? I think it is, a little!) thingamabobber being inserted to allow for one spatula and one brush to gather a few simple cells from my cervix. You live, you learn - and you get scraped. Right?
That being said, I don't necessarily enjoy it when women know that I'm coming at them - as a student nurse midwife (gasp) - with a big, scary metal doodad. (That is, a "speculum"... go ahead, try it! And to tell the truth, the metal ones have really grown on me --- they are nice and warm, they don't 'click' -- eww, right? no one likes the 'click' -- and they don't snag or pinch like the plastic. Anyway, a different topic, for a different day. Back on track...) I know that I don't have the same finesse as the Midwife, and of course so do they. I am immensely grateful to each and every woman who has accepted me for this (by the way, for the few who I have visited with during their exams and mentioned they are nursing/NP students --- my offer still stands and my vagina/cervix are yours for pap/pelvic practice as needed), and I promise that my skills will become gentler and softer as time passes. Wait, wait! Back to the cervix.
(See?! Even NOW, when I'm simply trying to blog about the darn thing, it's avoiding me... what a knack it has!)
I've always thought of the cervix as a nice, perfectly smooth circle; the opening to the uterus. In labor, I know, it gradually opens to eventually - or at least hopefully, and in most cases - allow the baby to birth. It also dilates a slight amount each month around the time of the menses to allow for the shedding of the uterine lining.
All right. Got that. In my mind, when I imagined a cervix - prior to really beginning my SNM clinicals (and the whole tortellini alfredo scene, mind you) - I pictured a perfect, cherry-red LifeSaver. (Minus the "Life-Saver" imprint, I suppose - although that would add a certain comic charm to the whole thing...) The one or two cervices - there we go with that word again, darn plural terms - that I had peeked at throughout my time as an L&D nurse (every now and again we would be expected to do a speculum exam to check for pooled fluid around the cervix, or to do a swab near it to check for leaking amniotic fluid, etc, etc) seemed to cement that image. And, I got no real argument from the DVDs I popped in during childbirth prep classes that I taught, so.... everything seemed right in my little world!
Until, that is, I started with the Midwife.
And realized that cervices (cervixes? cervixi?) come in 103 different sizes, shapes, consistences, and colors. AND they hide. They love to play hide and seek! Who knew?! Up and around, underneath, way over to that corner there.... so many places, and such little area to maneuver the speculum. (And it didn't help that I was focused on looking for that little red Lifesaver for the first two weeks.) Flopsy, firm, red, white, pink, big, little, deep and shallow, innies and outies - I've seen 'em all, and I've barely just begun! I've seen cute, petite little cervices and some that I could care to forget, to tell you the truth. (Not really, I made that last part up --- a cervix really is just a cervix. Do you think a person would really "like" or dislike a cervix? Come on, now!) Sometimes, I've learned, I can play a little game of my own... when the little tricksters are hiding, they leave a little trail of blood and this can be followed; busted!
Now, the Midwife and I are still working on this, of course. We have a ways to go, but I think I'm getting there. I'm 3 for 3 on my last batch of exams, which if nothing else gets me excited. I've caught on to lower the stool right away. I finally figured out how to maneuver the spec with my left hand (not easy for me, at all!) and collect my swabs with my right. My brain and my hands are still playing a little quasi-queasy about how to make the motions that the Midwife explains and demonstrates on scooping and "flipping" the cervix into place. But - I think I'm getting there.