The gynecological examination and ‘duck’ revolution

Anxiety and fears sometimes arise in patients who undergo a pelvic exam. (Photo: iStock)

It took more than a century and a half for the concept of pelvic exam and speculum (or ‘duck’ as it is commonly known) to take a 180 degree turn, a tool designed in 1845 by James marion sims, American physician considered the father of modern gynecology.

His reputation as a genius of surgery is indisputable, as he was the first doctor in the world to perform a successful operation for the vesicovaginal fistula, a complication frequently associated with childbirth, which causes urinary incontinence.

However, Sims has been widely questioned because to achieve these medical feats he performed procedures and surgeries on African-American women without their full consent, since at that time it was not necessary for them to give it, since the political system of that country considered them slaves.

This background of objectification of women for the sake of the advancement of medicine, is what since the XXI century has been wanted to root out, and the results are tangible even in scientific articles that formally address the issue.

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The 10 things the gynecologist should consider

Such is the case of The Challenging Pelvic Examination, a study published in Springer’s Journal of General Internal Medicine, by Carol K. Bates, Nina Carroll and Jennifer Potter, researchers at the Beth Israel Deaconess Medical Center in Boston, Massachusetts.

The text reads as follows: “The pelvic exam can be a double challenge for both physicians and patients. We strive to provide not only an evidence-based evaluation of each component of the pelvic exam, but also recommendations to improve both the technical skill of clinicians and the acceptance and comfort of diverse patient populations. ”

In addition, it establishes a decalogue that places the dignity of women beyond medical efficiency during gynecological procedures, which implies a 180 degree turn from what Sims did in the 19th century.

The decalogue is primarily aimed at physicians treating patients with bad previous experiences in gynecological examinations and reads as follows:

1. Offer the patient the option of mental health counseling.
2. Recognize that pelvic exams can be difficult and anxiety provoking.
3. Respect the patient’s decision to prefer a gynecologist, as anxiety may be greater with a male examiner.
4. Offer only one consultation on the first visit, unless the patient chooses to undergo the exam on the same day.
5. Give the possibility of having a friend, relative, partner or doctor of the patient’s choice present in the examination room; She can also bring a comfort item, such as a stuffed animal, with her.
6. Offer the option of wearing a dress or skirt and removing only underwear for the exam.
7. Assure the patient that if she decides to continue, she can stop the exam at any time.
8. Offer the patient alternatives other than the dorsal lithotomy position.
9. Provide options for speculum insertion, including guided self-insertion.
10. With the signed consent of the patient and a companion present, an anxiolytic medication may be given prior to the exam.

The study ultimately concludes that with gentle persuasion, close collaboration with the patient, and a modicum of technical creativity, even the most challenging pelvic exam can finally be successful.

This is how it is currently sought that, under no circumstances, attending a gynecological clinic entails an ethical transgression. It is about making real the maxim of “the end does not justify the means” in a practice that allows detecting diseases such as cervical or ovarian cancer in time, especially in Mexico, a country that ranks third in the world in the occurrence of gynecological cancers, according to a report from the National Institute of Public Health (INSP).

A new gynecological ‘duck’

Under these principles Yona emerged, a speculum prototype developed by two American women: Rachel hobart, associate director of design, and Fran wang, a senior mechanical engineer, both employees of frog, a global innovation and design company.

This instrument is coated in surgical silicone so that it is not so cold and allows the doctor to manipulate it with one hand, and even its peach color is designed to stop looking like an intimidating mechanical device, in the style of the speculum invented by Sims .

Yona, speculum prototype.  (Photo: Courtesy)Yona, speculum prototype. (Photo: Courtesy)

Yona also aims to complement visits to the doctor through an app in which the patient can ask questions and learn more about the exam before performing it. It also includes a meditation guide that helps you undergo the exam in a better state of mind.

“We see that the revolution in the field of health is in creating a dance between functionality and emotion; balance health with centricity in people. Turning one’s eyes to patients and giving them their voice back is a revolutionary act in itself. The aim is to make pelvic exams a much more human experience, and this is just one example of the potential that design has to transform how we live health, “he says in an interview for Tec Review, Daniela martinez, director of business development at frog.

Since December 2019, this speculum prototype was presented in the United States and today its designers are looking for potential partners in Mexico with knowledge and experience in the development of medical devices and clinical tests that can help them bring their product to market starting in 2021. .