Some people place an upside-down bed pan to elevate the patient's buttocks slightly in order to create more space for the speculum. Not only is the position uncomfortable for the patient, it seems a waste of a perfectly good bed pan. Fortunately there is an alternative approach.
Trick of the Trade:
Rotate the pelvic speculum handle towards ceiling instead of floor
Caution: Do not lift the speculum anteriorly like you would a largynoscope blade. When widening the speculum view, err on the side of applying posterior pressure against the rectovaginal wall. This is much less painful than compressing the anterior structures.
Thanks to Dr. Siamak Moayedi (University of Maryland) for this trick!