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Use of a Tenaculum

Purpose of a Tenaculum

  • Stabilize the cervix to allow passage of sound and IUD through the os

  • Straighten any irregularities in the cervical canal

  • Straighten uterine curvatures or flexion

To Place 

  • Dominant hand in “palm-up” position

  • Thumb in one ring

  • Middle or ring finger in the other ring

Choose Site for Placement

  • Anterior lip

  • Posterior lip

  • Typically a horizontal bite, some prefer vertical

  • Do not occlude os!

Size of Bite

  • 1-1.5 cm wide

  • 1 cm deep

  • Not too shallow- may tear through

  • Not too deep- unnecessary

  • Do not occlude os!

Closing Ratchet

  • Once the teeth are in contact with the cervix, press into the tissue

  • Close the ratchet only 1-2 clicks

  • Close the ratchet silently

  • Once the ratchet is closed, test your application gently to be sure it is secure


  • Squeeze teeth together EXCEEDINGLY slowly

  • Have patient cough at application (hold onto speculum!)

  • 1 cc Local anesthetic to tenaculum site

Use When Sounding

  • Change hands; hold the tenaculum with the non-dominant hand while sounding and for IUD placement

  • OK to let tenaculum lay on speculum when picking up the sound or IUD

Tenaculum Hand Position While Sounding and for IUD Placement

  • Thumb on one side of ratchet and fingers on the other

  • Avoid the rings

  • Avoid inadvertent movements

  • USE the tenaculum

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