The hated speculum is getting a redesign, and it’s about time.
The pelvic exam tool has remained essentially unchanged since it was invented 150 years ago, by a man, through experimental procedures performed on slave women.
Many have tried, but so far, no one has succeeded to replace the torturous device.
Now, several groups are in the running to reinvent not only the speculum, but the entire experience of going to the gynecologist.
The speculum was invented by James Marion Sims in the 1840s. The inventor of what looks like a medieval torture device is often referred to as ‘the father of modern gynecology.’
We can thank him for pioneering surgical methods for repairing vaginal tearing that sometimes occurs during childbirth, but he developed the technique by experimenting on slave women who were wide awake and experiencing a lot more than ‘a little pressure’ from a speculum.
Sims actually developed the speculum in order to help a white patient, but tested his ideas – beginning with a bent gravy spoon – on a slave woman, without anesthesia, or a medical reason to be manipulating her body.
The result was a device with two arms shaped a bit like miso soup spoons. That evolved into the metal or plastic duck-bill shaped contraception that patients still know and, mostly, hate.
Now, specula are available in various sizes, though not every doctor’s office is necessarily stocked with options, but attempts to improve the comfort of the device have largely been rejected by doctors as simply less effective.
For most women, the cold, lubricated prongs, ratcheting sound and ensuing dilation are a source of anxiety and discomfort. Studies have shown that, for some women who have been the victims of sexual trauma or abuse, a visit to the gynecologist can trigger bad memories and associations.
One study done in the 1980s even found that the speculum was one of the top reasons women gave for skipping their annual exams.
In 2014, the American College of Physicians recommended that pelvic exams not be performed on women that were not pregnant or presenting any symptoms of gynecological health problems, but seems to have since changed its mind.
Yona is a project that grew out of design firm Frog’s idea for a more comfortable speculum (left). Now, the women of Yona are developing an app (right), instructions for doctor. YONA
In 2016, the US Preventative Services Task Force suggested that a pelvic exam may not be appropriate for all women, and instead recommended an obstetrician-gynecologist ‘discuss’ the option with her.
But, the American College of Obstetricians and Gynecologists replied that there was not enough evidence on either side of the argument, and stuck to its recommendation that all women over 21 have an annual pelvic exam.
If it has to be done, a project known as Yona hopes it can be done more pleasantly.
Yona grew out of a speculum redesign project from New York design firm Frog. A team of designers has been 3D printing and testing a number of new speculum ideas, but realized that a lot more needs to change to make going to the gynecologist a comfortable experience.
The all-women team’s current design has three ‘leaves’ instead of two, which helps gynecologists get the good field of view, without creating as much stretching tension as the current, two-leafed device.
They also took a cue from the sex toy industry and covered their speculum in silicon that both feels and looks more pleasing. A new, wider angle on the handle allows doctors to sit further away from their patients, and hold the speculum more comfortably during exams.
Yona is also creating an app that allows women to fill out forms, has tools for ‘mental wellbeing’ provides secure access to test results, and a networking platform.
Women have reported that doctors’ clinical bedside manners and the discomfort of exam rooms also make their annual check-ups stressful. Yona has ideas for redesigning both to be more ‘patient-centered,’ according to its website.
In the age of laparoscopic everything, Duke University graduate student Mercy Asiedu is working on a design that would eliminate the need for a doctor to widen the vaginal opening.
She has designed a ‘vaginal inserter’ which a woman could place herself, which would allow the use of pen-sized camera to observe and take images inside her vagina. Of the fifteen volunteers in Asiedu’s pilot study, 92 percent preferred her vaginal inserter and camera system to a traditional speculum pelvic exam. For 83 percent of women, this method still gave a clear view of the cervix.
Asiedu’s research, published on PLOS one, even suggests that a woman could perform the entire exam herself.