The Atlantic

Why No One Can Design a Better Speculum

The gynecological device may have an ethically fraught history, but it's hard to improve on the design.
Source: Morphart Creation / Shutterstock / The Atlantic

Few women enjoy pelvic exams: the crinkly paper dress, the awkward questions, the stirrups, the vague fear that can comes with doctors’s visits of any kind (what if they find something abnormal, something bad, something cancerous?). But perhaps no piece of the pelvic exam is as reviled as the vaginal speculum—the cold, clicking, duck-billed apparatus that lifts and separates the vaginal walls so a near-stranger can peer inside.

The speculum’s history is, like many medical histories, full of dubious ethics. Versions of the speculum have been found in medical texts dating back to the Greek physician Galen in 130 A.D. and shown up in archaeological digs as far back as 79 A.D. amidst the dust of Pompeii. (The artifact from Pompeii is a bit of a nightmare: two blades that open and close via a corkscrew-like mechanism.)

But the speculum most women experience today is largely credited to a man named James Marion Sims, often heralded as the father of American gynecology. He was a controversial figure even in his day, and should probably remain one now.

Sims’s early gynecological experiments were done on slave women who, in many cases, he purchased and kept as property in the back of his private hospital. Along with this violent legacy, Sims left behind a few medical advances and inventions—one of them being the vaginal speculum. While the design has been refined, the speculum women see today isn’t all that different from the one Sims used on his captive patients.

One might expect our modern spirit of innovation and disruption to turn its eye on the speculum. Surely something invented so long ago, under such dubious circumstances, could use an update. And many have tried. In the past 10 years, new designs for the speculum have continuously cropped up, only to fade away again. But while medical manufacturers continue to improve the design in little ways, there has been no real contender to displace the duck-billed model. The speculum’s history is inextricably linked to extreme racism and misogyny. But for all that, it just may be the best design we’re ever likely to have.

* * *

In 1845, Sims—a condition often caused by prolonged childbirth, in which a hole forms in between the bladder or rectum and the vagina. The tear causes urine and feces to pool in the vagina, creating infections, pain, and incontinence. Fixing it required a doctor to be able to look into the vaginal canal and see the hole.

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