Objectives: Pelvic exams are a cornerstone of gynecological care, necessary for both regular screenings and diagnostics. The collapse of lateral vaginal walls during a pelvic exam is a frequently encountered problem in clinical practice. Methods: Practitioners often utilize tools found in a typical clinical setting to counter this issue, such as a condom or glove over the speculum to prevent the lateral vaginal walls collapsing inward and obscuring cervical views. Results: These techniques have been passed down from mentor to mentee over the years, though scarcely described in literature. This article aims to provide instructions on how to use these two methods in clinical practice to improve pelvic exams for the practitioner and the patient. Conclusion: Utilizing a condom or glove to prevent lateral vaginal wall collapse has the potential to improve pelvic exams for both practitioners and patients.
PURPOSE Pelvic exams are frequently complicated by collapse of the lateral vaginal walls, obstructing the view of the cervix. To overcome this, physicians frequently repurpose a glove or a condom as a sheath placed over the speculum blades to retract the lateral vaginal walls. Despite their regular use in clinical practice, little research has been done comparing the relative efficacy of these methods. Better visualization of the cervix can benefit patients by decreasing examination-related discomfort, improving cancer screening accuracy, and preventing the need to move the examination to the operating room under general anesthesia. METHODS This study presents a physical model that simulates vaginal pressure being exerted around a speculum. Using it, we then compare the efficacy of different condom types, glove materials, glove sizes, and application methods onto the speculum. RESULTS The results show that the best sheath is the middle finger of nitrile-material gloves. They provide adequate lateral wall retraction without significantly restricting the opening of the speculum. In comparison, condoms provide a smaller amount of retraction due to loosely fitting the speculum. They may still be a reasonable option for a different speculum size. However, vinyl-material gloves are an impractical option for sheaths; they greatly restrict speculum opening, occasionally even breaking the speculum, which overcome its retraction benefits. Glove size, condom brand, and condom material (latex vs polyisoprene) had minimal impact. CONCLUSION This study serves as a guide for clinicians as they use easily accessible tools to perform difficult pelvic exams. We recommend that physicians consider nitrile gloves as the preferred option for a sheath around a speculum. Additionally, this study demonstrates proof-of-concept of a physical model that quantitatively describes different materials on their ability to improve cervical access. This model can be used in future research with more speculum and material combinations, including with materials custom-designed for vaginal retraction.
This work presents the design of a new protein based on the adenosine triphosphate-binding cassette (ABC) transporter solute binding protein (SBP). The Protein Data Bank in Europe's dictionary of chemical components was utilized to identify sorbitol and D-allitol. Allitol bound to an ABC transporter SBP was identified in the Research Collaboratory for Structural Bioinformatics Protein Data Bank (RCSB). Wizard Pair Fitting and Sculpting tools in PyMOL were used to replace bound allitol with sorbitol. PackMover Python code was used to induce mutations in the ABC transporter SBP’s binding pocket, and changes in free energy for each protein-sorbitol complex were identified. The results indicate that charged side chains form polar bonds with sorbitol in the binding pocket, thus increasing its stabilization. In theory, the novel protein can be used as a molecular sponge to remove sorbitol from tissue and therefore treat conditions affected by sorbitol dehydrogenase deficiency.
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