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The Secret History of the Speculum

 

 The ubiquitous gyno tool is probably your least-favorite thing that goes in your vagina—so how did it get there? It’s a scary story

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By Johanna Gohmann

Illustration by Maritsa Patrinos

During a recent visit to my gynecologist (the too-perfectly named Dr. Fuchs), I realized I had been subconsciously crossing and uncrossing my legs as I waited for my name to be called. Although I am an adult woman who has had more pelvic exams than I can count, and have even pushed an actual human being out of my vagina, I still dread a visit with what I’ve always thought of as “the can opener of the cervix” – the speculum.

Probably just reading the word “speculum” made you do an involuntary Kegel. For most of us, our encounters with them can range from mildly uncomfortable to downright painful. And even with the gentlest of gynos, there’s a very unique vulnerability that comes with lying on your back while a stranger positions an alien-looking device into one of the most sensitive parts of your body. But as horribly awkward as they may be, we know we have to welcome them in, since they give our docs a prime view of our secret gardens in all their glory. 

The speculum has been around for centuries, and I’m sure it will come as a surprise to no one that something vagina-related has a dark history of misogyny, political power struggles, and abuse. But precisely how dark that history is will shock you. Regardless of how you look at speculums now, you’ll never look at them the same way again.

Versions of the speculum date all the way back to 97 A.D.  Gynecological artifacts were unearthed in the ruins of Pompeii, though the ancient Roman model looks a bit more suited to uncorking a bottle of merlot than to holding back vaginal walls. By the 19th century, a more modern version of the speculum, created by French gynecologist Joseph Récamier, became popular. This one kind of looked like a cross between a Barbarella space gun and a tiny butter churn. Specula continued to evolve and change after that, with handles added and tubes lengthened and shortened. In 1821, an Italian surgeon named Giuseppe Cannella fashioned a combination speculum and knife that was used to amputate the cervix in cases of cancer or uterine prolapse. 

Even though docs had these tools on hand, there was a great deal of turmoil when it came to actually using them. The 1800s were a time when most doctors were men, and men were not supposed to be looking at a woman’s body. Many medical exams were conducted blindly, with a doctor essentially rooting around under a woman’s dress while looking away, or perhaps even worse, staring straight into her eyes. There was also concern that women might turn into raving sex maniacs if they allowed their bits to be explored. Dr. Charles Meigs, a professor of medicine in Philadelphia in the early 1800s, once said he was “...proud to say that in this country generally, certainly in many parts of it, there are women who prefer to suffer the extremity of danger and pain rather than wave those scruples of delicacy which prevent their maladies from being explored. I say it is fully an evidence of the dominion of a fine morality in our society.” 

Of course, these concerns were only for “proper ladies,” and didn’t extend to the wayward women of the streets; after all, only prostitutes got pelvic exams. In 19th-century Paris, sex workers who had been arrested were forced to undergo examinations by doctors, and the speculum was essentially used as a threat or a torture device. If these women refused to be examined, they could be imprisoned. Either way, they were punished, and their fates were grim.

Marie Anne Boivin

Luckily, a French midwife named Marie Anne Boivin brought a much-needed woman’s touch to women’s health. In 1825, she invented what would eventually become the modern bivalve speculum—the kind that can be screwed into place and left there, freeing up a doctor’s hands. Boivin was one of the most important obstetricians of her time, despite having been denied entrance into medical school because of her gender. Her examination skills were such that she was described by a contemporary surgeon as having “an eye at the tip of each finger.” Boivin’s outstanding work earned her acclaim and awards, and even led more universities to open their doors to hopeful female gynos. Unfortunately, her contributions were overshadowed by the mess of misogyny that followed as the speculum evolved.

Enter J. Marion Sims, an Alabama doctor whose 1845 invention rocked the gynecological world. It’s surprising that Sims had anything to do with the field at all, considering he was, by his teachers’ accounts, a poor student who claimed that lectures on women’s diseases made him “shudder inside.” In Sims’ autobiography, he wrote, “If there was anything I hated, it was investigating the organs of the female pelvis.” 

Nonetheless, Sims was determined to learn how to fix vaginal fistulas, an incredibly painful condition caused by a long childbirth or other injury, wherein a hole forms between a woman’s rectum or bladder and her vagina. In order to repair fistulas, Sims needed a wide-open view of the vagina. In a moment of inspiration, he grabbed a gravy spoon, bent the handle, and used it to prop the vaginal walls open. Thus, the Sims speculum—the one that most closely resembles the duck-billed device we use today—was born. 

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J. Marion Sims

Sims' Speculum

Sims’ invention and his subsequent ability to heal fistulas were major leaps forward for medicine. However, these advances came at a horrific price, as his research methods can only be described as monstrous. Sims would buy or borrow injured slave women (whose masters were happy to help, since they wanted fertile slaves), bring them to his backyard hospital, and use them as test subjects for his surgeries. He invited other doctors to watch him work—as well as anyone who wanted to pay for standing room. He operated on these women for hours without anesthetics, even after anesthesia became readily available (Sims wasn’t known to use it on his white patients, either, but believed, like many at the time, that African-Americans had a higher tolerance for pain). Little is known about the women who endured Sims’ experiments, but it’s believed that Sims operated on a woman named Anarcha up to 30 times. Another woman nearly died after a sponge Sims left inside of her caused an infection. Ultimately, though, Sims was able to heal these women, and claimed that some of them were so eager to be cured that they had assisted him with their surgeries.

Once Sims’ work was proven to be effective on slaves, it was deemed safe enough for white women. His ability to repair fistulas catapulted both the doctor and his speculum to fame, and he would go on to become the consulting surgeon for the French Empress Eugenie, head of the American Medical Association, and founder of the very first hospital exclusively for women. Sims is now remembered as “The Father of Gynecology,” and a statue of him stands in Central Park. While there is no argument that he made tremendous contributions to medicine and women’s healthcare, there is also no doubt that his methods for doing so were beyond abhorrent. In addition to the wretched and racist things he did to unconsenting slave women, Sims was also a proponent of clitoridectomies—that is, the surgical removal of the clitoris as a means to curb “hysteria” and “improper” sexual behavior.

But while men like Sims were taking on women’s surgery, childbirth was still largely the domain of the midwife. Midwives treated vaginal problems through natural means, and until the 1800s, birth was not considered an occurrence that required medical intervention. The medical establishment was very keen to change this perception. After the Sims speculum boomed in popularity, doctors were able to promote the fact that they now had special tools designed specifically for women. Well-to-do women began to ditch their midwives and flock to doctors, believing they were more capable; by the end of the 1800s, doctors were considered the foremost experts on women’s bodies. 

Illustration of specula excavated in Pompeii

As medicine advanced over time, vaginal exams became accepted and commonplace, and fears of women tearing their doctors’ clothes off in fits of unbridled passion eventually subsided. There was now a modern tool that allowed a relatively safe view into women’s bodies. Great, right? Except that the male-dominated medical establishment had no intention of letting women take a look for themselves. The belief that women simply had no business down there persisted for decades. It wasn’t until the second wave of feminism in the 1960s that women began to boldly fight back against the medical establishment. Barbara Ehrenreich, author of Witches, Midwives, and Nurses, says,“I began to realize how much women had experienced humiliation or even injury in the medical system. I had a bad time with the doctor during my first pregnancy, and that’s when I really became a feminist…I became really furious dealing with sexism, and the fact that I could not escape these bloody issues.” The speculum was, of course, a part of this painful experience, but could the feminist movement change that?

In 1960s America, free clinics for women began to sprout up across the states. But these clinics, for the most part, still used male doctors, and women were still shamed and treated with condescension. In Ruth Rosen’s The World Split Open: How the Modern Women’s Movement Changed America, she asks, “Would women doctors have thoughtlessly shoved a cold metallic speculum into another woman? Would feminist doctors have blithely told patients that the dilation of the cervix wouldn’t hurt? The woeful ignorance of the female biological experience sparked a campaign to train more women doctors, to re-educate male physicians, and to create a women-oriented health movement.”

In 1969, a group of brave broads banded together and formed what would become the Boston Women’s Health Book Collective, which would go on to publish Our Bodies, Ourselves. The book was groundbreaking, offering the means for women to truly gain control and ownership over their bodies by learning how they worked. Another truly great moment in speculum history came in 1971, when feminist lawyer and author Carol Downer walked into a Los Angeles bookstore, dropped her drawers, and inserted a speculum. She then invited the ladies in attendance to come and take a gander. Activists like Downer were known as “self-help gynecologists,” and their aim was to give a firsthand lesson in female anatomy. These demos soon caught on, and thousands of women began to attend similar workshops. Then, in 1972, Downer was arrested for the truly heinous crime of showing another woman how to use a speculum. Clearly a menace to society, Downer was hauled to jail and charged with practicing medicine without a license (she had also recommended using yogurt for a yeast infection).

Downer was acquitted, and her arrest only helped to spread the message that women must fight to gain control over their own bodies and health. Ladies began to ask doctors to let them help insert the speculum during exams, and to hold up a mirror so they could see their own bits. Of course, docs didn’t much care for this, and women were often met with hostility. To thwart this, ladies began to bring buddies along to take notes during their exams, making it clear to the docs that they expected to be treated with respect.

Speculum in use, from a 1655 medical text

Over time, women have gained more control of the speculum and the way it’s used on their bodies. These days, there’s a plethora of lady docs to choose from, and female OB/GYN residents outnumber men. If you were to ask to insert your own speculum, or inquire if you could take a look at your own goods, your doctor would likely not fall over in a dead faint from the shock. (One of my friends recently had her doc not only show her how to insert the speculum, but actually give her a couple of disposable specula to take home, should she wish to do any further investigating.)

And yes, even the speculum has changed…a bit. Now there are the aforementioned disposable ones made of plastic, and some come with little lights attached, to help illuminate our splendor. But the design of the speculum itself hasn’t changed much from the Sims version. I can hear you saying to yourself: Hey, didn’t a solar-powered jet just take off from Abu Dhabi to fly around the globe? And we, in 2015, really can’t come up with a better way to prop open a vulva? Well, it’s not that people haven’t tried. There have been various attempts to come up with a new speculum. The most recent one was called the FemSpec, and it was an inflatable ring that pushed a woman’s vaginal walls outward, sort of like blowing up a party balloon inside your cervix. And even though the feel was supposed to be much more natural, the FemSpec never really caught on.

Still, empathetic experts and vaginal activists alike seek to expand the dialogue surrounding gynecological care and make strides past Sims’ tainted legacy. Who knows? Maybe in the future, there will be some sort of speculum app for phones, where a hologram of your cervix shoots out and floats in front of the doctor’s face, and we can do away with the dreaded device altogether. In the meantime, though, let’s make sure our lady bits get the care and respect they deserve.   

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