OBJECTIVES: To determine if a standardised method of leg positioning without stirrups reduces the physical discomfort and sense of vulnerability and increases the sense of control among women undergoing speculum examination as part of a routine gynaecological examination. DESIGN: Randomised clinical trial. SETTING: Family medicine outpatient clinic. PATIENTS: 197 adult women undergoing routine gynaecological examination and cervical smear. INTERVENTION: Examination with or without stirrups. MAIN OUTCOME MEASURES: Women's perceived levels of physical discomfort, sense of vulnerability, and sense of control during the examination, measured on 100 mm visual analogue scales. RESULTS: Women undergoing examination without stirrups had a reduction in mean sense of vulnerability from 23.6 to 13.1 (95% confidence interval of the difference - 16.6 to - 4.4). Mean physical discomfort was reduced from 30.4 to 17.2 (- 19.7 to - 6.8). There was no significant reduction in sense of loss of control. CONCLUSION: Women should be able to have gynaecological examinations without using stirrups to reduce the stress associated with speculum examinations. TRIAL REGISTRATION: US Army Central Investigation Regulatory Office. Trial No DDEAMC 05-11.