Gynecologic Simulator v3.0.jpg

The Sexual and Reproductive Health and Rights (STARS) - Cervical Cancer Screening and Treatment module's Gynecologic Simulator allows nurses, midwives, clinical officers, and medical officers to become confident and competent in performing visual inspection with acetic acid (VIA), and thermal ablation of cervical pre-cancer lesions as part of cervical cancer screening and treatment procedures performed in primary health care facilities and mobile units in resource-constrained settings. The Gynecologic Simulator contains 5 componentsː (1) base, (2) support pillars, (3) angled plane with triangular supports, (4) vaginal canal with augmented feedback, and (5) cervix models.

Gynecologic Simulator[edit | edit source]

Components[edit | edit source]

This section explains how to construct the 5 components of the Gynecologic Simulator.

The Gynecologic Simulator is designed with removeable cervixes so the learner can practice visual inspection with acetic acid (VIA), and thermal ablation of nulliparous and parous cervixes.

The Gynecologic Simulator is designed with a vaginal canal with augmented feedback for thermal ablation training.

The Gynecologic Simulator also contains aː (1) base, (2) support pillars, and (3) angled plane with triangular supports.

Cervix Dimensions and Appearance[edit | edit source]

The cervixes are designed to simulate the appearance of the os of nulliparous and parous cervixes.[1] The simulated cervixes also match the published dimensions on cervical width and length for nulliparous and primiparous women.[2]

The average cervix width for nulliparous women is 25.51 mm and average cervix length for nulliparous women is 29.18 mm.[2] The average cervix width for primiparous women is 28.18 mm and average cervix length for primiparous women is 31.89 mm.[2] 

The nulliparous and parous cervix models can have acetowhite lesions added to simulate a VIA positive cervix.

The features of VIA positive acetowhite lesions are:[3]

  • Distinct, opaque acetowhite area
  • Margins should be well-defined, may or may not be raised
  • Abnormality close to the squamocolumnar junction in the transitional zone and not far away from the os

Vaginal Dimensions[edit | edit source]

The upper range of linear vaginal length is 95.0 mm (9.5 cm) from the introitus to the cervix.[4] The Pederson medium vaginal speculum is 10.0 cm in length, and is an acceptable fit for many patients.

The diameter of the opening of a disposable pelvic speculum commonly used in an Ugandan hospital was measured by the Team Lead as 4.5 cm. The diameter of the opening of a medium sized Pederson vaginal speculum[5] is 6.0 cm at the handle and 3.0 cm at the ends of the speculum blades, which averages to 4.5 cm.

The vaginal canal is designed to be 4.5 cm in diameter, 14.0 cm in circumference, and 13.0 cm long (10.0 cm + 3.0 cm) to account for the vaginal length[4] and cervix length.[2]

Materials[edit | edit source]

  • Cardboard
  • Ruler
  • Pencil
  • 4 Tongue Depressors
  • Scissors
  • Knife or Blade
  • Tape
  • Paper
  • Aluminum Foil
  • Marker
  • Pink Clay (2 ounces)
  • White Clay
  • Red Clay
  • Jhpiego Flashcards

Gynecologic Simulator[edit | edit source]

Assembly Instructions[edit | edit source]

1
Collect Supplies

You will need the following materials:

  • Cardboard
  • Ruler
  • Pencil
  • Scissors
  • Knife or Blade
  • Tape
  • 4 Tongue Depressors
2
Supplies Used to Cut Out the 19.0 cm by 16.5 cm Base
Cut Out the Base
  1. Use scissors to cut out the base which is 19.0 cm long and 16.5 cm wide.
  2. Use knife to create two 5.0 cm long central slots 4.5 cm apart, 6.0 cm from each side, and 3.0 cm from the bottom.
3
Supplies Used to Cut Out the 13.0 cm by 16.5 cm Angled Plane
Cut Out the Angled Plane
  1. Use scissors to cut out the angled plane which is 13.0 cm high and 16.5 cm wide.
  2. Use knife tip to create one 0.5 cm wide, central horizontal slit 5.5 cm from the bottom.
4
Supplies Used to Cut Out the 9.0 cm by 9.0 cm Triangular Supports
Cut Out the Triangular Supports
  1. Use scissors to cut out two triangular supports which are 9.0 cm high and 9.0 cm wide.
  2. Use knife to create one 1.5 cm wide, central horizontal slot in each triangular support, 1.5 cm from the side and 2.0 cm from the bottom.
5
Supplies Used for Tongue Depressors
Cut the Tongue Depressors
  1. Use scissors to cut out one tongue depressor in half.
  2. Use scissors to cut second tongue depressor in half. Then cut one half piece length into a 0.5 cm high piece.
  3. Set aside two remaining tongue depressors for taping and use in triangular supports.
6
Taping Method to Attach Triangular Supports to Base
Attach Triangular Supports to Base
  1. Apply tape to two sides of each triangular support.
  2. Attach triangular supports to base as shown in the photo.
7
Taping Method to Attach Angled Plane to Base
Apply Tape to Angled Plane
  1. Apply tape to the bottom edge of the angled plane as shown in the photo.
8
Preparing to Attach Angled Plane to Base and Triangular Supports
Attach Angled Plane to Base and Triangular Supports
  1. Tape angled plane to base. Press tape of angled plane down firmly to base.
  2. Flip up the triangular supports to attach the angled plane to the triangular supports (as shown in the video below).
9
Taping Together Two Tongue Depressors Used to Strengthen Triangular Supports
Use Tongue Depressors to Strengthen Triangular Supports
  1. Insert one tongue depressor into each slot while leaving a small length projecting out of each slot.
  2. Tape the two tongue depressors together in the middle.
10
Tongue Depressor Piece Positioned Underneath the Two Taped Tongue Depressors Behind the Angled Plane.
Insert Tongue Depressor into Angled Plane
  1. Insert the tongue depressor piece into the 0.5 cm slot of the angled plane.
  2. Check the tongue depressor piece is positioned underneath the two taped tongue depressors behind the angled plane.
11
Support Pillars for Base
Prepare Support Pillars for Base
  1. Use scissors to cut out two rectangles 13.0 cm long and 3.0 cm wide.
  2. Use scissors to cut the tops of the rectangles at an angle.
  3. Use knife to create two vertical slots 1.5 cm wide in each support pillar. The lower slot should be 2.5 cm from the bottom and the upper slot should be 7.5 cm from the bottom of the support pillar.
12
Gynecologic Simulator with Support Pillars
Insert and Stabilize Support Pillars in Base
  1. Insert one support pillar in each slot of the base.
  2. Insert a half tongue depressor horizontally into the lower vertical slots of the two support pillars.
  3. Insert a half tongue depressor horizontally into the upper vertical slots of the two support pillars.

Vaginal Canal[edit | edit source]

Materials[edit | edit source]

Materials Used to Build the Vaginal Canal

You will need the following materials:

  • Paper
  • Ruler
  • Marker
  • Scissors
  • Tape
  • Aluminum Foil

Assembly Instructions[edit | edit source]

This section explains how to construct the Vaginal Canal of the Gynecologic Simulator. The Vaginal Canal provides augmented feedback to alert the learner if the heated Thermocoagulator Simulator probe shaft comes into contact with the vaginal sidewalls, and thereby, exposes the patient to a potential thermal injury.

1
Supplies to Cut Out Vaginal Canal
Cut Out Vaginal Canal
  1. Mark out a rectangle that is 13.0 cm high and 14.0 cm wide.
  2. Extend the rectangle with a diagonal line out to the edge on the unused part of the paper. This will help you line up the ends of the cylinder so the diameter is 4.5 cm.
  3. Mark out an area that is 3.0 cm from the top edge of the rectangle. This area will not be lined with aluminum foil.
  4. Cut out the 5-sided polygon.
2
Aluminum Foil Cut-Out Pattern
Prepare Aluminum Foil
  1. Mark out an area of aluminum foil that is 1.0 cm out from the paper edge of the Vaginal Canal.
  2. TIP: On the aluminum foil, mark out the line up against the paper edge of the Vaginal Canal also. This marking will be useful later on when you attach the aluminum foil to the Vaginal Canal.
  3. Cut out the aluminum foil rectangle which will be used to line the inside of the Vaginal Canal for the Augmented Feedback feature.
3
Please Tape Underneath and Not Over the Aluminum Foil to Avoid Insulating the Conductive Material.
Attach Aluminum Foil to Vaginal Canal
  1. Apply tape to the area of the Vaginal Canal that will be lined with aluminum foil (area below the dashed line) so the foil layer will lie flat inside the Vaginal Canal.
  2. IMPORTANT: One should avoid taping over the aluminum foil because this will insulate the conductive material and prevent the augmented feedback circuit from functioning.
  3. Press the aluminum foil over the taped area of the vaginal canal to attach the aluminum foil to the area below the dashed line on the vaginal canal.
4
Aluminum Foil Attached To and Folded Over On Vaginal Canal
Fold Aluminum Foil Over Vaginal Canal
Flip the vaginal canal over and fold and press down the remaining 1 cm border of aluminum foil on the vaginal canal as shown in the image.
5
Roll Vaginal Canal Into Cylinder of 4.5 cm Diameter.
Roll Vaginal Canal Into Cylinder
  1. Roll up the vaginal canal with the aluminum foil on the inside to form a cylinder of 4.5 cm diameter.
  2. Line up the two sides of the 13.0 cm lengths on the previously drawn rectangle to form a cylinder with a circumference of 14.0 cm.
6
Tape End of Cylinder v2.0.jpg
Tape End of Cylinder
  1. Apply a small amount of tape inside and outside the end of the cylinder that is not lined with aluminum foil to keep the top corners aligned. IMPORTANT: Tape should never cover the aluminum foil lining the inside of the cylinder.
  2. Carefully ensure the bottom edges of the cylinder remain aligned as you roll the remaining paper around the outside of the cylinder.
7
Tape Outside of Cylinder v2.0.jpg
Tape Outside of Cylinder
  1. Tape the outside end of the cylinder as shown. IMPORTANT: Be sure to leave a section of the folded aluminum foil exposed (untaped) where the alligator clip will be attached to allow the augmented feedback circuit to function.
  2. Use a ruler to check the diameter of the cylinder is 4.5 cm.

VIA Positive Cervix Models[edit | edit source]

Nulliparous Cervix[edit | edit source]

1
Materials Required for Making Nulliparous Cervix Model
Collect Supplies

You will need the following materials:

The clay should be a water-based soft clay, like Play-Doh.

Not shown in imageː

2
Dimensions For a Nulliparous Cervixː 2.5 cm in diameter and 3.0 cm in length.
Make a Nulliparous Cervix
Roll pink clay into a cylinder 2.5 cm in diameter and 3.0 cm long.
3
Creation of The Osː Press a pencil into the clay cervix to simulate the os of a nulliparous cervix.
Create the Os
Press a pencil tip into the center of the pink clay cylinder to simulate the smooth, rounded os of the nulliparous cervix. TIP: Cover the pencil tip with cellophane to prevent the pencil from discoloring the clay cervix.
4
Nulliparous Cervix Model (Pink Clay) with Squamocolumnar Junction (Red Clay)
Add Squamocolumnar Junction to Nulliparous Cervix
  1. Review the image of a VIA positive cervix on Flash Card No. 49 (pages 133-134) of the Jhpiego Flashcards and identify the squamocolumnar junction.
  2. The pink clay of the nulliparous cervix model simulates the squamous epithelium of the ectocervix.
  3. Add red clay to the cervix to simulate the columnar epithelium of the endocervix and define the squamocolumnar junction as a visible sharp border located near the external os.
5
Nulliparous Cervix Model (Pink Clay) with Squamocolumnar Junction (Red Clay) and Acetowhite Lesion (White Clay)
Add Acetowhite Lesion to Nulliparous Cervix
  1. Review the image of a VIA positive cervix on Flash Card No. 49 (pages 133-134) of the Jhpiego Flashcards and identify well-defined acetowhite lesions that are adjacent to the squamocolumnar junction.
  2. Add white clay to the cervix next to the squamocolumnar junction to simulate clinically significant acetowhite lesions.
6
Attach VIA Positive Nulliparous Cervix to Angled Plane of Gynecologic Simulator
Attach Cervix to Gynecologic Simulator
  1. Mount the VIA positive cervix model on the angled plane of the Gynecologic Simulator.
  2. IMPORTANT: Hold and stabilize the tongue depressor piece underneath the two taped tongue depressors behind the angled plane when mounting the cervix model on the angled plane.
7
Place Vaginal Canal Over the VIA Positive Nulliparous Cervix Model on the Gynecologic Simulator
Place Vaginal Canal Over Cervix Model
  1. Place the Vaginal Canal over the VIA positive cervix model on the angled plane of the Gynecologic Simulator.
  2. IMPORTANT: Ensure the end of the Vaginal Canal that is not lined with the aluminum foil is adjacent to the cervix model because the clay of the cervix model can conduct the Augmented Feedback circuit.
  3. Place the aluminum foil-lined end of the Vaginal Canal between the two support pillars so the Vaginal Canal rests on the half tongue depressor in the upper slots.
8
Connect (Red) Alligator Clip of Augmented Feedback Circuit to Vaginal Canal
Connect Augmented Feedback Circuit to Vaginal Canal
  1. Tape the bottom underside of the base of the Gynecologic Simulator to stabilize it during simulation training.
  2. Connect the alligator clip (attached to the exposed wire of the red insulated end of the buzzer) of the Augmented Feedback Circuit to the exposed aluminum foil of the Vaginal Canal.

Parous Cervix[edit | edit source]

1
Materials Required for Making Parous Cervix Model
Collect Supplies

You will need the following materials:

The clay should be a water-based soft clay, like Play-Doh.

Not shown in imageː

2
Dimensions For a Parous Cervixː 3.0 cm in diameter and 3.0 cm in length.
Make a Parous Cervix
Roll clay into a cylinder 3.0 cm in diameter and 3.0 cm long.
3
Creation of The Osː Use a pencil to simulate the "fish mouth" appearance of the os of a parous cervix.
Create the Os
Use the tip of the pencil to create the "fish mouth" appearance of the wider os of a parous cervix. TIP: Cover the pencil tip with cellophane to prevent the pencil from discoloring the clay cervix.
4
Parous Cervix Model (Pink Clay) with Squamocolumnar Junction (Red Clay)
Add Squamocolumnar Junction to Parous Cervix
  1. Review the image of a VIA positive cervix on Flash Card No. 97 (pages 229-230) of the Jhpiego Flashcards and identify the squamocolumnar junction.
  2. The pink clay of the parous cervix model simulates the squamous epithelium of the ectocervix.
  3. Add red clay to the cervix to simulate the columnar epithelium of the endocervix and define the squamocolumnar junction as a visible sharp border located near the external os.
5
Parous Cervix Model (Pink Clay) with Squamocolumnar Junction (Red Clay) and Acetowhite Lesion (White Clay)
Add Acetowhite Lesion to Parous Cervix
  1. Review the image of a VIA positive cervix on Flash Card No. 97 (pages 229-230) of the Jhpiego Flashcards and identify well-defined acetowhite lesions that are adjacent to the squamocolumnar junction.
  2. Add white clay to the cervix next to the squamocolumnar junction to simulate clinically significant acetowhite lesions.
6
Attach VIA Positive Parous Cervix to Angled Plane of Gynecologic Simulator
Attach Cervix to Gynecologic Simulator
  1. Mount the VIA positive cervix model on the angled plane of the Gynecologic Simulator.
  2. IMPORTANT: Hold and stabilize the tongue depressor piece underneath the two taped tongue depressors behind the angled plane when mounting the cervix model on the angled plane.
7
Place Vaginal Canal Over the VIA Positive Parous Cervix Model on the Gynecologic Simulator
Place Vaginal Canal Over Cervix Model
  1. Place the Vaginal Canal over the VIA positive cervix model on the angled plane of the Gynecologic Simulator.
  2. IMPORTANT: Ensure the end of the Vaginal Canal that is not lined with the aluminum foil is adjacent to the cervix model because the clay of the cervix model can conduct the Augmented Feedback Circuit.
  3. Place the aluminum foil-lined end of the Vaginal Canal between the two support pillars so the Vaginal Canal rests on the half tongue depressor in the upper slots.
8
Connect (Red) Alligator Clip of Augmented Feedback Circuit to Vaginal Canal
Connect Augmented Feedback Circuit to Vaginal Canal
  1. Tape the bottom underside of the base of the Gynecologic Simulator to stabilize it during simulation training.
  2. Connect the alligator clip (attached to the exposed wire of the red insulated end of the buzzer) of the Augmented Feedback Circuit to the exposed aluminum foil of the Vaginal Canal.

References[edit | edit source]

  1. International Agency for Research on Cancer. Atlas of Colposcopy: Principles and practice [Internet]. Colposcopy Digital Atlas. World Health Organization; 2021 [cited 2021 Nov 28]. Available from: https://screening.iarc.fr/atlascolpodetail.php?Index=13
  2. 2.0 2.1 2.2 2.3 Londero AP, Bertozzi S, Fruscalzo A, Driul L, Marchesoni D. Ultrasonographic assessment of cervix size and its correlation with female characteristics, pregnancy, BMI, and other anthropometric features. Arch Gynecol Obstet. 2011 Mar;283(3):545-50. doi: 10.1007/s00404-010-1377-5. Epub 2010 Feb 10. PMID: 20145939.
  3. Training of health staff in VIA, HPV detection test and cryotherapy - Facilitators' guide. New Delhi: World Health Organization, Regional Office for South-East Asia; 2017. Licence: CC BY-NC-SA 3.0 IGO. The World Health Organization (WHO) is not responsible for the content or accuracy of any translation. The original English edition shall be the binding and authentic edition.
  4. 4.0 4.1 Bates CK, Carroll N, Potter J. The challenging pelvic examination. J Gen Intern Med. 2011 Jun;26(6):651-7. doi: 10.1007/s11606-010-1610-8. Epub 2011 Jan 12. PMID: 21225474; PMCID: PMC3101979.
  5. Pederson Vaginal Speculum Medium [Internet]. PEDERSON VAG. SPEC. MED | Medical Supplies & Equipment. Surgo Surgical Supply; [cited 2021 Nov 28]. Available from: https://www.surgo.com/pederson-specs-german/pederson-vaginal-speculum-medium--3.  
Page data
Part of STARS - Cervical Cancer Screening and Treatment
Type Medical equipment
Keywords cervical cancer, screening, treatment, human papillomavirus testing, visual inspection with acetic acid, thermal ablation, cervical pre-cancer lesions
SDG Sustainable Development Goals SDG03 Good health and well-being
Authors Medical Makers
Published 2021
License CC-BY-SA-4.0
Impact Number of views to this page and its redirects. Updated once a month. Views by admins and bots are not counted. Multiple views during the same session are counted as one. 892
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