Are you looking forward to your next gynaecology appointment? Neither am I… And we are not the only ones, visiting the gynaecologist is a source of anxiety for almost half of all patients. The most feared gynaecological practice is the pelvic exam, with discomfort and pain being common amongst many people with vaginas.

If you have ever had a pelvic examination, you may know what a speculum is: a medical instrument used by health professionals to examine the inside of the vagina and cervix. It is designed to spread the vaginal walls apart in order to allow a better visibility of the area. Or maybe you just know what it feels like, as it is not common for health professionals to explain what devices they use and/or how they function during the procedure. Many people with vaginas cite the invasive nature of the procedure, the lack of care by health workers, and how the device feels in their body as the main causes of their discomfort. 

This is not surprising, as modern gynaecology as a practice is built on inflicting pain on women, especially African-American women. The vaginal speculum was designed by James Marion Sims, a doctor who increased his expertise in gynaecology in the 1840s. During this period, he used the speculum to operate on enslaved African-American women to try to repair vaginal fistulas. At least three women died during this procedure, and there are no records of patients’ consent to the operation. Moreover, he avoided using anaesthesia, although it was commonly used at the time, based on the false and racist idea that African-American women felt less pain than white women. His medical diary describes how patients screamed and cried in pain for hours. The device was described by patients as a torture device.

The speculum used by gynaecologists today hardly differs from the one Sims designed in the 19th century. Why is this device still widely used in medicine, given its racist and sexist history? And why has it hardly improved as a tool, even though 80% of people with vaginas experience some form of discomfort on a simple and routine pelvic examination? 

Well you don’t have to look far to find a plausible answer. Medicine is not a neutral doctrine with its sexist and racist roots often remaining unchallenged. The doctrine is kept in place by the fact that patients often are not given the opportunity to communicate their discomfort to health workers, and if they do, this is responded to with gaslightingMedical gaslighting refers to behaviours in which health care professionals dismiss or downplay a patient's physical symptoms.× close. This creates a vicious cycle where the patient feels pain but does not feel comfortable expressing it, leaving them being forced to endure it.

Fortunately, researchers have begun to address this problem and developed new devices for gynaecological inspections that are safer, more accurate, and less painful. The research is based on their professional knowledge as well as their personal experiences as people with vaginas. They look not only at the function and performance of the instrument, but also at how it is perceived and felt by the patient. They examined what is painful and scary and why – think of the squeaking sound and the cold metal surface. They based their new designs on objects that are comfortable to vaginas, such as sex toys and Chinese balls. This brings about a shift in the way medicine is understood – not positioning the doctor’s needs above the patient’s, but addressing the psychological and physical well-being of the patient. 

So at your next visit to the gynaecologist, ask the doctor to purchase vagina friendly devices!