One of the things that you will often find doctors saying is, “Medicine is a constantly evolving field. It is hard to keep up with the daily new advances and constant research.” For the most part, of course, this is true. Hundreds of papers get published daily and with the birth of online journals, that number can only be guessed at. With the emphasis on evidence based medicine increasing, physicians have begun focusing on research and development much more in the past few years.

However, there are still fields of medicine that are left untapped. Technologies that are out of date, instruments that are taken for granted and philosophies that are followed from the dark ages are common place in medicine. Today’s story is about one such anachronism: the Sim’s gynaecological speculum.

Despite all the talk about gender equality and the rise of feminism, little encouragement is offered for the propagation of feminine hygiene and health. The state of health education about this topic is especially dismal in developing countries. It is usually a topic that is restricted to segregated health classes in high school and given in hushed undertones to an audience that is completely clueless about the whole idea. And if you think girls are ill prepared to handle the pubertal changes thrown at them by nature, imagine the plight of boys who are beyond confused about the mood swings of their girlfriends, sisters and mothers. But the scenario isn’t all bad. The world is slowly opening its eyes, and public education has dramatically improved. Screening for cervical cancer, one of the leading cancers of the female sex, has grown leaps and bounds, and stands testament to the increased awareness.

But, let’s talk a little about these screening processes.

According to the WHO, women are encouraged to undergo an annual screening for cervical cancer after the age of 40. For women who have a family history of cervical or breast cancer, the screening is recommended from the age of 20. And this process of screening is not comfortable by any stretch of the imagination and one of the most uncomfortable parts of this procedure is the introduction of the speculum into the vagina. In fact, the process is so uncomfortable that in 2014, The American College of Physicans recommended against pelvic exams because of the fear, harms and embarrassment they caused the patients.

So what is this speculum and why is it used at all? The purpose of this speculum is to hold the vaginal vault open in order to allow better visualisation of the cervix and the walls of the vaginal vault. Now, the speculum used today in most out-patient clinics is called the Sim’s speculum.

It was last modified in 1840. That is over a hundred and fifty years ago!

The Sim’s speculum was invented by J. Marion Sims, who is known as "The father of Modern Gynecology.” The history of the speculum is a bloody and gruesome one. Sims used enslaved African American women to make his discoveries and conduct his surgical experiments. The treatments were sometimes incomplete and often led to death or severe maiming of the women’s genitalia. In 2011, the Journal of Urology published a study titled "The Portrayal of J. Marion Sims’ Controversial Surgical Legacy.” In this study, authors Dr. Sara Spettel and Dr. Mark Donald White summarise the contributions of Marion Sims aptly in a single beautifully worded line:

“[Marion] is a prime example of progress in the medical profession made at the expense of a vulnerable population.”

Anyways, the lack of ethics in medicine and the progress it has afforded mankind, is a topic for another day. Today we look at a more promising endeavour. For a hundred and fifty odd years, no one thought of coming up with a good replacement for the Sims speculum. Today however, from the most unlikely of places, a revolutionary change has taken place.

Before we talk about the solutions that people have come up with, let us understand the issues with the current tools available. The speculum of use today has major disadvantages for both the patients and the physicians. The patients have to deal with the discomfort of cold steel, pointy parts and pinch points which are exquisitely painful. For the physician, the angle of the handle makes it inconvenient to hold and limits mobility and the field of vision. All these factors make the whole experience something that neither the patients nor the doctors look forward to. In fact statistics show that more than half of American women in child bearing age groups avoid the gynaecologist's office because of the discomfort of the examination.

So now we know why this is an issue, what then, are the solutions that have been proposed?

Attempts to change this particular tool began in the early 2000s. In 2005, an inflatable speculum called FemSpec was introduced by a San Francisco based company. While it was an innovative instrument, it flopped on use because it lacked usability for the physician. A few years later, a company called Creek women’s Heath, based out of Oregon designed an entirely new toolkit for doctors. Their philosophy was that with speculums, the one size fits all ideology was moot. So they designed speculums of various sizes and angles in the hopes that a better fit would mean a better experience. However, the cost factor of this tool kit did not allow major expansion or wide spread use. Subsequently, one of the most promising designs came from Dr. Mercy Asideu who, at the time was a doctoral candidate in Biomedical Engineering at Duke University. She designed a tampon sized device with a two mega pixel camera at the end of it. While it provided excellent mobility and a video game like joystick for the physician, the field of vision was reduced and hence it didn’t catch on. Numerous other minor prototypes came out into the field and were showcased at health fairs but none caught on.

The instrument that has caught the eye of the physicians today is designed by a group of designers at Frog, a design firm based in San Francisco, California. On October 4th, 2017, the Frog design team, comprised entirely of women, held a press release, introducing their new product Yona. Now the revolution created by Yona is two fold. Firstly, the instrument that is being used has undergone some major redesigning. The speculum is now made up of autoclaveable silicone which allows it to be reused and takes away the cold hard feel of steel. The new material also ensures decreased damage to the sensitive tissues in the area. The angle of the speculum has been modified to allow greater range of movements for the physician and also makes it easy to position the patient on the exam table. They have also increased the number of opening bills, from two to three which increases the field of vision and comfort. But these design changes are not the only changes brought about by the Yona team.

The team aims to redesign the whole process of a pelvic exam. The team has reimagined every step of the process from the physician’s introduction, to the clean up after the exam. The team has aptly dubbed these opportunities for improvements as “moments of truth”. Known for their iconic design of the Apple Macintosh computers and the revolution that it created in the field of modern computing, frogHealth hopes to bring about a similar change in the field of health with this small contribution.

Of course, there is a possibility that Yona might never see the light of day or might not become sensational. But, that isn’t the point. Medicine is an ever growing field. Millions of people get check ups everyday and hundreds of thousands of health professionals give their time and efforts to this cause. The field, however, is far from perfection and from the hi hello of the physician, to the good bye of the patient, every step in the way can be reimagined and redesigned to provide better health, better care and a better experience for both doctors and patients. It is our duty as medical professionals to recognise these problems and to also understand that like the frog team from California, the solutions can come from anywhere. All we have to do, is be open to them.

To read more about Yona and its design, check out their website: http://yonacare.com/About