It’s Cervical Cancer Awareness Month: Let’s Talk About Speculums
Cervical cancer is one of the most preventable forms of cancer, yet thousands of people are diagnosed with late-stage disease every year. Screening is essential for early detection, but many individuals avoid it, often due to discomfort with the screening process and the tools involved. As January marks Cervical Cancer Awareness Month, it’s a fitting time to explore the history of one of the central tools in gynecological care—the speculum—its limitations, and the promising innovations that seek to make screening more patient-centered.
The speculum, the device used during pelvic exams to visualize the cervix, has changed little since its invention nearly 200 years ago. Unfortunately, this is a recurring theme in women’s health—just look at the tampon. Developed in 1931, it remained virtually unchanged for decades.
James Marion Sims, often referred to as the “father of modern gynecology,” created the first prototype of the speculum in 1845 while treating vesicovaginal fistulas—tears between the bladder or rectum and the vagina caused by prolonged childbirth. Sims’ methods, however, were horrifying. He conducted experiments on enslaved women without anesthesia, operating under the racist assumption that Black women had a higher tolerance for pain. His initial prototype was a bent gravy spoon used to separate vaginal walls, which evolved into a double-bladed instrument. (They look like torture devices because they essentially were.)
In 1870, Thomas Graves refined this design into the duck-billed speculum we recognize today. But we’ve seen little innovation in this area since then.
The Problem with the Modern Speculum
Today’s speculum, whether made of (cold) metal or disposable plastic, is often uncomfortable and intimidating. Many patients describe the device as invasive, painful, and anxiety-inducing. For some, knowing its unethical origins adds another layer of discomfort.
This unease contributes to a significant public health challenge: avoidance of cervical cancer screenings. Pap smears and HPV tests are critical tools for early detection, yet the discomfort associated with speculum exams discourages many from seeking care. This delay can lead to missed opportunities for early intervention, increasing the risk of severe outcomes.
In addition to the speculum itself, many patients report feeling rushed or dismissed during gynecological exams, further compounding the negative experience. These systemic issues highlight the need for more empathetic, patient-centered care in addition to improvements in medical tools.
Innovations in Cervical Cancer Screening
Despite the speculum’s long history of stagnation, recent innovations offer hope for a more comfortable and accessible future.
Nella Speculum
The Nella Speculum, made of smooth, temperature-neutral medical-grade polymer, is designed to reduce discomfort during exams. Its narrower shape offers a less invasive experience compared to traditional metal or plastic speculums. The company also provides a “comfort kit” that includes items like cozy socks and stress balls to help ease patient anxiety during exams.
Teal Wand
The Teal Wand is an at-home cervical cancer screening device currently under FDA review. It eliminates the need for in-office Pap smears, speculums, and stirrups by allowing users to self-collect samples and mail them to a lab for analysis. Early trials have shown that the device works with highly sensitive HPV screening tests, making it a significant step toward improving accessibility and patient autonomy.
Callascope
Another notable innovation is the Callascope, a tool developed with comfort in mind. Unlike the traditional speculum, it allows for cervical visualization in a less invasive manner. Studies have shown high success rates in both clinical and self-insertion contexts, with participants reporting significantly greater comfort compared to speculum-based exams.
Beyond Tools: The Need for Systemic Change
While advancements in tools like the Nella, Teal Wand, and Callascope are exciting, they cannot address the full scope of barriers to cervical cancer screening on their own. Broader cultural and systemic changes in gynecological care are necessary.
Healthcare providers play a pivotal role in improving the patient experience. Simple changes, such as warming the speculum, explaining each step of the exam, and encouraging open communication, can make a significant difference. Building trust and showing empathy can transform a routine screening into a more positive experience.
Cultural stigma surrounding cervical cancer, reproductive health, and the terms used to describe them (like “vagina” or “HPV”) also hinders progress. Public health campaigns must focus on normalizing these conversations to encourage more people to prioritize their health.
Cost and access remain additional barriers. While innovative tools like the Teal Wand and Callascope are promising, their adoption depends on insurance coverage and affordability. Efforts to make these technologies widely available will be critical for reducing disparities in cervical cancer screening.
Why Screening Matters
Cervical cancer develops slowly, and early-stage disease is often asymptomatic, which is why routine screening is so crucial. Symptoms of advanced cervical cancer may include abnormal vaginal bleeding, pelvic pain, or unusual discharge. However, by the time these symptoms appear, the cancer may already be in a more advanced stage.
Screening allows healthcare providers to detect precancerous changes and high-risk HPV infections before they develop into cancer. Regular Pap smears and HPV tests have drastically reduced cervical cancer rates in countries with accessible healthcare systems. Yet gaps in screening persist, particularly among marginalized communities.
As we observe Cervical Cancer Awareness Month, it’s essential to reflect on the barriers that continue to prevent people from accessing life-saving care. The speculum’s history and shortcomings highlight deeper issues in women’s health—a long-standing pattern of neglect, insufficient research, and a systemic failure to prioritize women’s comfort and well-being.
The future of cervical cancer screening lies in patient-centered care: redesigning tools, normalizing conversations, and breaking down systemic barriers to access. With innovations like the Nella, Teal Wand, and Callascope, coupled with a commitment to empathy and equity, we can make cervical cancer screening more comfortable, accessible, and effective for everyone.
Cervical cancer is preventable. Together, we can save lives by advocating for better tools, better care, and better access.
