Reclaiming the Speculum Part 1: Demanding Decent Gynaecological Care

Does a visit to your gynaecologist ever feel like torture? You’re lying naked and vulnerable under a flimsy hospital gown, legs held open on stirrups, a stranger forces a cold metal object into your vagina while talking about the weather, gossiping with a nurse, or making disapproving noises from between your legs before they proceed to roughly scrape cells from your cervix. You are prodded and poked without explanations, quizzed about your sexual history by an inquisitor with an ever present raised eyebrow, and advised how to ‘be more responsible’ in the future.

speculum-3Modern gynaecology and torture, are not, in fact, strangers. The most ubiquitously used instrument in gynaecology today, the speculum, is the product of torturous experiments and medical procedures carried out on enslaved women by Dr. James Marion Sims. Sims, who is widely credited as the father of modern gynaecology, was a slave owner and a self taught gynaecologist from Montgomery Alabama. In 1845 he opened a women’s hospital where other slave owners could bring enslaved women suffering from gynaecological problems –  particularly fistulas due to long and painful childbirth – to be ‘fixed-up.’ This probably had less to do with a concern for their welfare than with the desire to maintain the reproductive abilities of the women so that their masters could get their money’s worth from their ‘investments’.

As his practice grew and his methods became more famous Dr. Sims bought enslaved women specifically for use in his experiments. He performed multiple operations and experiments on these women in unsanitary conditions, without anaesthetic (even though it was available at the time) and often with an audience of numerous men. It is reported that he carried out up to different 30 procedures on one woman alone. The women, who of course did not and could not consent to be participants in these experiments, suffered unimaginable pain and often endured wounds that festered for months following the experiments. This is, perhaps, one of the most brutal and dehumanising chapters in the history of the North American slave trade. Black women’s bodies, considered inferior to the bodies of white women and thus more able to bear pain, were physically, sexually and medically exploited until they could litterally give no more. The gynaecological ‘benefits’ and ‘discoveries’ would be enjoyed primarily by white women, a reproductive injustice that is still relevant to this day.

Throughout history many other attempts at designing speculum-like instruments were made but the Sims speculum, the (in)famous duck billed model, is the one that has survived the test of time. More recent attempts have been made to find a more ‘friendly’ alternative but none of them have managed to achieve the same level of visibility and access to the vagina and cervix. So despite the barbaric origins of the Sims speculum it seems it is the one we are stuck with, for the moment.

Leave Your Dignity at the Door and Spread Your Legs 

Sims’ barbaric practices cannot be compared with a visit to the modern gynaecolgist’s clinic. Yet, interventions such as Sims formed part of a larger historic moment in which  women’s healthcare was appropriated by the modern, male, medical establishment. Midwives and other women healers who had traditionally cared for all aspects of women’s health and attended their pregnancies were gradually sidelined and eventually prohibited from practicing. It marks the shift from a woman centred model of care towards the greater medicalisation and dehumanisation many of us have experienced in modern medicine.

The visit two the gynaecologist in the 21st centuries is often both loathed and feared: a necessary evil in our routine healthcare. According to recent research, many people simply avoid this experience altogether, putting their health and their lives at risk. The numbers of young people who seek gynaecological care in the UK are falling. Many feel too embarrassed to have a stranger peer between their legs, even if it is a trained medical professional.

In Ireland it is not even common to have your own gynaecologist. Most people will go to their GP, where the nurse carries out a PAP smear. The Irish state provides free cervical screening to all women over 25 every three years through the Cervial Check scheme. If you want to be tested more frequently you will have to pay. Aside from that there are a few Well Woman Clinics, the Irish Family Planning Association and a few public GUM/STI clinics. Gynaecologist’s are generally only sought if there is a problem detected and then people needing treatment can face a waiting list of anywhere from 6 months to a year for an appointment.

For my first ever smear test at 23 I sought out a ‘woman friendly’ doctor in Cork city, in an effort to find a happy medium between my GP (not anonymous enough) and the STI clinic (too anonymous and normally do not perform PAP smears). As I squirmed on the bed the Doctor assured me that it was perfectly normal for the speculum to ‘pinch a little’. That supposed little ‘pinch’ was actually the pain of her repeatedly shoving a cold speculum against my cervix in the vain attempt to force it further in. I was bleeding, sore and delicate for days afterwards, also supposedly normal. It almost put me off smear tests for life.

I never went back to that doctor but I consider myself responsible in my own sexual health so even though it is something I used to dread, I have never fail to go for my yearly check up. I did not fare much better, however, in the STI clinic at my university nor at the public  hospitals in Galway and Cork. I have judge on my choice of menstrual hygiene products. I been asked ‘how often do I wash down there?’ – yes really, in those words, without using correct anatomical terms of vagina or vulva. I have been judged as a ‘high risk’ patient simply because some of my partners have been from Latin America (where I just happen to have lived for about 6 years) and not because of any relevant sexual practices. I have suffered knowing glances exchanged between nurses without being told whether there is actually something wrong with me or not. I have been lectured and reprimanded for not being ‘responsible’. I have endured the raised eyebrows, the tut-tuting and the sudden intakes of breath, without responding because that’s just par for the course right?

These experiences are mild compared to what you might have to go through if you are a survivor of sexual violence, gender non-conforming, or define yourself as ‘other’ than heterosexual. I once heard of the case of a refugee woman, a survivor of sexual violence, who was told by a nurse at an STI clinic that she should ‘get over’ her inability to enjoy sex because her husband ‘has needs too.’

Attitudes like these from health care professionals reinforce the guilt and shame that still surrounds our sexuality and sexual health. Many of us think of this kind of treatment is normal or par for the course. We just have to grin and bear the pain, the discomfort, the implicit or explicit judgement, the discrimination and even violence in judgement as we leave our bodies at the mercy of ‘experts’ who know our bodies better than we do and who are empowered to make decisions over us and our care. Furthermore, judgemental attitudes from medical staff only reinforce the misconception that gynaecological cancers are associated with promiscuity and irresponsible sexual practices, contributing to falling rates of younger women attending screenings. In the worst case scenario women simply opt out of gynaecological check ups to avoid pain and embarrasment.

It wasn’t until I came to Guatemala that I found a gynaecologist who treated me with respect, who didn’t judge me, make comments that insinuated my genitals were somehow, inexplicably, abnormal, who carried out a full pelvic exam and ultrasound, who spent time with me to talk about screenings and results, who dicussed birth control options with me, who didn’t dismiss any concerns I might have had and who respected the (informed) decisions I made about my own health and my own body.

We may have little or no choice about where we go or who we see for our gynaecological check ups. This does not, however, mean that we are powerless or that we have to put up with discriminatory or judgemental attitudes. We can visit our gynaecologist or STI clinic armed and prepared with knowledge about what we can expect from the exam and comfortable with our own bodies so that we are better able to defend our bodies and our choices. For instance: we can ask to insert the dreaded speculum ourselves if we would feel more comfortable (this is often recommended for survivors of sexual violence). If we are feeling too intimidated to face all this alone than we can also take a trusted friend or partner with us for moral support, there is no reason why this should be a solitary experience unless we want it to be.

There are many online resources about that can help us navigate our visits to the gynaecologist’s office or the STI clinic. One of my favourites at the moment is from cartoonist Erika Moen who contributes to the Oh Joy Sex Toy website, she has a special comic dedicated to the pelvic exam. Also check out Planned Parenthood, Women to Women and Scarleteen for more info.

My closing thought on the speculum is that until something better comes along it can become one of our best tools for self care. Rather than celebrating the legacy of Dr. Sims though, think it is more appropriate to be aware of its origins and honour the women whose whose dignity, health and bodies were sacrificed unwillingly for the sake of so called ‘modern medicine.’

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