New Speculum or Old Problem?
We usually associate a speculum with discomfort or pain. For some women it can spark awful memories and for others simply awkward laughter.
The speculum is a useful tool: it’s a duck-bill-shaped device that doctors use to see inside a hollow part of your body to diagnose or treat disease. Most of the time it’s used by gynecologists to open the walls of the vagina and examine the vagina and cervix. Without a speculum we couldn’t perform many gynaecological exams.
The first speculum was most likely invented during Roman times - the oldest was found in Pompeii. During this time, the tool had not been updated, as they believed “it did the job”. However, the painful “speculum experience” that women endured had been completely disregarded.
If we compare the “Pompeii” speculum (discovered around the1800’s) to the one we use today, there have been a few improvements. The speculum we use today was invented by Dr Sims. Sims’s idea came from a rudimental speculum he created with 2 spoons; he was inhumanely experimenting on female slaves, to find a way to reach the cervix and treat problems.
Have we made any progress since the 1800’s? In the 60s, the brand Welch Allyn created the more hygienic plastic speculum; thanks to its transparency, it can be used to better illuminate the vaginal canal. Plus, there is no cold sensation like the metal model. The second innovation was creating different sizes (today they range from extra small to large) because all vaginas vary in shape and size and gynaecological examinations can happen at any age.
We have come a long way since Sims’ time, where looking at female intimate parts was inappropriate for a male doctor (a time where only midwives dealt with vulvas) and people thought performing medical examinations could lead women into prostitution.
The plastic speculum is also an important feminist symbol; in the 70s, a few years after its invention, Carol Downer was the first woman to do a self-analysis and invite women to do the same. This involved using a speculum and a mirror to look at their vulvas and see up to the cervix. This act of empowerment and reappropriation of the female body, spread across Europe.
The speculum has always been a hostile, noisy, invasive tool. But has anyone ever tried to change it? Finding a different shape would be the first step. In 2005 an American company created a speculum called FemSpec. Their particular model worked by inflating, but the idea failed rapidly, just like the others who tried to free us from the duck-bill shape.
What if the speculum was not the problem itself? What if the reason we find it so uncomfortable is because of the way we used it? What if the procedure to insert it in our vaginas was consensual, informed and not something that happens when you are suddenly naked on an examination table? What if doctors paid more attention to the dimensions of the speculum or the feedback of discomfort or pain from the patient?
When a doctor uses the speculum everyday it becomes a daily routine for them, but this is not the same for the patient. The doctor should always ask for consent before inserting the speculum or performing any other procedure on a person. If consent has not been given it is gynaecological/obstetric violence.
Many doctors are not updated on the most recent guidelines when talking about consent, relationship with the patient and the right dimensions of the speculum to use, during a gynecological exam. If you find a doctor that pays attention, is well-informed and up to date with the latest guidelines, the exam can work out well, but that’s not always the case.
It is important to know that the width of the vaginal opening must also be taken into consideration when choosing a speculum - there is not one speculum that fits all. The smallest size (also know as “for virgins” for people who have never had penetrative sex) is as long as a finger. The medium sizes are like a finger and a half. The large sizes, for specific or surgical situations, are larger than two fingers.
Always remember that if you are uncomfortable or in pain you have the right to ask for a smaller speculum or to ask how it was chosen.
In order to insert anything in your vagina during an exam, doctors should use a lube - and remember that water does not lubricate.
If you think about your gynaecological examinations, how did the procedure go? How was the relationship between you and the doctor? Let’s think about it: how about if the hated design of the speculum was just a really small part of the issue? What if the elephant in the room was the doctor/patient relationship that needs modernising?