Top 5 Design Improvements of Specula in the 21st Century
The modern speculum was invented in the 1840s by an American physician named James Marion Sims, and it was, shall we say, never designed with patient comfort in mind. And not all that much has changed. The biggest difference is that Sims made his speculum from pewter. Newer specula are plastic or stainless steel. (Some versions of the speculum are much older, with one found in Pompeii that looks like a torture device). It’s safe to say that no woman enjoys a pelvic exam. Further, the speculum is the most dreaded part as it is associated with unpleasant physical sensations.
However, as we move into the 21st century, there are some improvements that are making the speculum easier for women to deal with. Some previous issues had to do with the way the tool is used. Now, some women benefit from being allowed to insert the device themselves. Other improvements include increased speed and accuracy for better ergonomics. Here are some of the most significant advances.
Seeing what’s going on in the vagina can be hard. The longer the speculum has to stay in the vagina, the more discomfort the woman experiences. An integrated light allows the physician a better view without any trailing wires (which can be a trip hazard) and can help them finish the exam faster. Combined with plastic specula, this can give a much better view of the vaginal wall, making certain examinations easier. They also reduce how much the vagina has to dilate for the physician to obtain the cervical swab.
Integrated lighting has become much easier to include with the invention of small, bright LED lights. These lights don’t add to the bulk of the speculum, especially important for women who need smaller sizes. The light bulb and battery can be removed from disposable specula and recycled. Modern designs have been tweaked to make battery removal much easier so as to reduce waste.
Killing the Click
The horrible clicking sound of the speculum being ratcheted apart can bother some patients as much as the physical discomfort. Some companies are now producing click-free designs that also open the speculum more smoothly, reducing patient discomfort significantly. They do take a little bit of practice from clinicians used to traditional speculum. Although reusable metal specula have less of a click, they have other problems, such as being extremely cold.
The clicking sound can also interfere with coping mechanisms, such as meditation, that anxious patients may engage in to try and make the exam more tolerable. It serves as an unpleasant reminder of what is happening to those who want to ignore it.
Improved Handle Angle
This is actually a big thing. Modern designs have altered the angle of the speculum’s handle. This makes it easier for the clinician to insert the speculum smoothly in one motion, and eliminates the need for the patient to scooch along with the table until their backside hangs off it. This makes many women feel more vulnerable. It also reduces physical contact between their hand and the patient. Improved ergonomics in the handle’s angle can make a surprising difference. 105 degrees seems to be ideal. In the past, a 90-degree angle did not work well for either the examiner or the patient. Pelvic exams are uncomfortable and embarrassing by their very nature, and older specula tended to make that worse.
Designers are also working on improving the overall ergonomics of the handle so it is more comfortable for physicians and easier to use. For gynecologists who may do a lot of pelvic exams, good ergonomics are important to avoid repetitive strain injury and fatigue. Fatigue, in turn, can cause a sloppy insertion technique that can result in patient discomfort.
Modern speculums have been designed to lock in place so that the physician has both of their hands to perform the exam. Other designs are single-hand use. Thus, keeping the other hand free. This also helps perform exams faster than with older designs, reducing patient discomfort. It makes it easier to take swabs for HPV testing. Although, HPV testing alone can now be performed without a speculum at all. Many companies are looking into further ergonomic improvements to make performing exams easier and quicker, but the locking mechanism is a significant advancement that makes things a lot easier for the gynecologist doing the exam.
Anything that makes things easier for the gynecologist is also going to be helpful for patients, and locking also often goes hand-in-hand with the click free designs already mentioned.
Pewter is a thing of the past, but metal specula are starting to go out of use, and many women are thankful. Stainless steel specula are cold and like most multiple-use devices can be hard to clean. Heating a metal specula prior to use does help, but it is not always enough to avoid the associated chilly sensation. Some patients also find that the metal specula’s appearance is offputting.
Plastic single-use specula eliminate cross-contamination and the plastic used is clear, giving the clinician a good view of the vaginal wall. Some designs also use metal covered with silicone, which is much easier to run through an autoclave. In the future, there may be better materials to make disposable specula out of biodegradables. (For those concerned about the environmental impact, it is often lower than that of running the autoclave).
Incremental design improvements will continue to make pelvic exams easier for doctors and more comfortable for patients. If you are looking for a specula for your practice that incorporates many of these improvements, you should look at the HER-SPEC Single-Use Click-Free Vaginal Speculum. To find out more about how our disposable specula can help your practice, contact obp today.