The exam table with its stirrups. The cold, metal instruments lying in wait. The drape-sheet hiding the patient from herself. The invasive poking and prodding. A routine trip to the gynecologist can elicit anxiety and dread.
One study attributed “negative affective, behavioral, and cognitive processes” to the pelvic exam, “unlike most other preventative care procedures.” Each year, some 60 million pelvic exams are performed in the United States. Providers use a speculum—the hinged, two-bladed instrument that looks like a duck bill—to inspect the cervix, test for STDs, and obtain pap smears.
For all its beneficial uses, the speculum has a sordid past, one connected to patriarchal authority and institutionalized racism. In the hands of professionalized medicine, the speculum became a tool for (mostly male) doctors to make public decisions about women’s private, reproductive organs. But today, product designers in San Francisco are taking aim at gynecology’s hated device. They’re rethinking the speculum’s jingling screws, materials, and uncomfortable angles to make the pelvic exam less unnerving for patients and providers.
In 1845, James Marion Sims, a 32-year-old surgeon in Montgomery, Alabama, was asked by a local slave owner to treat a young woman suffering from vesicovaginal fistula. This debilitating condition, a source of pain and incontinence, is usually caused by an obstructed labor: when the baby, stuck in the birth canal, crushes the soft tissues between the vagina and bladder. In the antebellum South, where black women had little health care or control over their bodies, rape and chronic infections were also often to blame. Sims, a plantation doctor, lacked relevant experience, but took an interest in finding a cure. Between 1845 and 1849, he performed dozens of surgeries, without anesthesia, on at least 12 enslaved women. In these experiments on human chattel, Sims developed a technique to repair fistula, the first of its kind. In the process, he invented the duckbill speculum so that he could better visualize the cervix.