Trips to the gynaecologist are sometimes among the worst experiences. The problem with gynaecology dates back to the discipline’s creation and the fact that its application has remained largely unchanged. But four San Francisco-based designers are hoping to challenge this problematic practice by redesigning not only the tools but also the experience.
It began when Hailey Stewart and Sahana Kumar, two of Frog Design’s industrial and interaction designers, traded their own stories of disappointment and discomfort. In between projects at the time, the two enlisted the help of two more women and then embarked on a journey that they hope will put the comfort of patients at the centre of gynecological practice.
Called Yona, their project tackled the speculum first. It was designed in 1845 by James Marion Sims, a 32-year-old surgeon in Montgomery, Alabama. For his efforts he is known as the father of gynaecology but, as it goes with most revered white men throughout history, his accomplishments were achieved on the backs of slaves.
Twelve enslaved women, whose names Sims for the most part did not record, were subjected to numerous surgeries (some as many as 30) without anaesthesia as Sims perfected his technique to repair fistula, the first of its kind. It was also then that he developed the first duck-billed speculum to better see inside the cervix.
He later founded the first hospital for gynaecological surgery in New York that served the country’s white, affluent clientele. He is still immortalised in the city’s Central Park where a controversial statue of his likeness stands today. The speculum he created, while it has been refined, has remained largely the same.
Up against an unchanged, deeply violent artifact of medical invention, Stewart and Kumar took the approach of deconstruction, looking at each component individually to see how it could be improved, from the sound of clunky metal, to the feeling of the cold steel.
According to Wired, what many physicians have found is that the two-pronged duck bill shape is not the optimal tool when trying to see inside the cervix. The main problem is that the tissue walls fall in, obstructing the view anyway.
At the same time, the sounds the device's screws make heightens anxiety and dread. That there are exposed screws at all are a problem in such a sensitive area.
Noting these problems, Stewart, Kumar and their team chose to cover the device in autoclavable silicone. The material is not cold to the touch, is completely silent, is easily sterilised and easier to insert.
The team reworked the device’s shape, choosing to go with a three-pronged approach which gave physicians a triangle view of the cervix. This, they said, was the most popular approach among physicians because it allowed for the same view with less of the discomfort for the patient.
They also added a button that unlocks the speculum with one hand, eliminating the need for screws and freeing up the physician's other hand.
While still in a developmental phase, the project has a lot of hurdles to overcome. A number of specula redesigns have tried and failed to change the way women experience gynecology. According to the Atlantic, the reason why no device has been able to succeed yet is because doctors are skeptical of new designs.
“I have a feeling that if there was a design that clinicians thought was an improvement, and particularly that their patients would be happier with, that they would be willing to try it out,” Terri Kapsalis, a professor at the School of the Art Institute of Chicago, was quoted as saying.
Kapsalis pointed to a poorly designed patient experience as the possible reason that women dread the pelvic exam rather than a poorly designed device. “This clanky thing comes out of a drawer and is put in their vagina before they even know what’s going on,” she explained.
The Yona team looked at gynaecology holistically, pairing their device with ideas on how to change the experience entirely. They devised a list of guidelines for physicians on how to make their patients feel more at ease such as explaining the components of the exam and creating a more accessible environment.
"It's never going to be perfect," Kumar told Wired. "So how do we at least prepare people emotionally for how it's going to be, and make them feel like they got some value out of it at the end?"
Part of Yona’s mission will have to incorporate not only a redesign of the tools, but a redesign of the way physicians practice their craft if their project is to succeed where others have failed.