Subsequent to a careful and thorough bimanual examination in the dorsal decubitus or genu-facial position Sims inserted a speculum of his own design to continue his evaluation and preferred that the patient be positioned in the left lateral semi-prone position.

“In 1845 I first used my speculum for fistula operations, placing the patient on the knees.....This method of exhibiting the parts is not only useful in these cases, but in all affections of the os and cervix uteri requiring ocular inspection. The speculum was a bent silver spoon. After 1853 Simsrarely resorted to this position except in cases of complex fistulas.”  Sims-Anniversary Discourse-1858