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Speculum Speculation

I love medical history. It’s fascinating to see the entire process of where something comes from, especially when it comes to the female body. Who thought “let’s just shove that into the vagina” or “how about into the uterus”? But the speculum gets its own special spot in my heart.

Each year, you have to make an appointment for “that exam”.  But, have you ever thought about the history behind “that exam”? There’s some controversy as to when the speculum made its debut.  Versions of a speculum were found in the ruins of Pompeii.  I’m not sure what they were looking for back then, but one can speculate the goal of the speculum was to open the walls of the vagina to look inside of a woman.  Those speculums looked like our current day wine bottle openers with two blades on the sides and a corkscrew in the middle.

Eventually, through the years, we developed more crazy versions with cranks and handles and tubes.  Imagine the clicking and clanking of a metal instrument so that the a stranger can peer into your vagina?  Worse yet, doctors thought it was not a good idea to look at female body parts, and therefore did these exams blindly.  Exams were done with a doctor’s hands underneath the dress of a woman without looking at where they were going.  The medical profession of the time postulated that women with morals may turn into sex addicts if they were to undergo such an exam.  The doctors worried that women would mistake the pelvic exam with sexual pleasure, and then want a pelvic exam all the time.  Really?

The speculum was not always used as an instrument to help women with issues down there.  In Europe, prostitutes were forced into getting these exams in order to rule out venereal diseases.  If they refused the exam, they could be put in jail.  The speculum was used as a threat against these women.

Marie Anne Boivin

Eventually, the speculum developed into the bivalve instrument we use today.  Many versions have come and gone, but the basic structure remains the same.  You guessed right, a woman developed this version.  A midwife name Marie Anne Boivin.  She never really got the credit she deserved because of the era in which all of this was evolving. She invented a way to measure the female pelvis, the speculum, and ways to dilate the vagina in order to examine the cervix.  She is one of the first to use a fetoscope to listen to the fetal heart. It must have been quite difficult to steer change in a time where female organs and female sexuality were taboo topics.

The man who eventually made the speculum famous was Dr. James Marion Sims.  Dr. Sims opened up a women’s hospital in Alabama.  Many of his patients were local slaves.  Over and over, he saw women who complained of leaking urine and stool through the vagina.  He soon realized the cause was prolonged labor and vaginal injury during delivery.  The trauma to the vagina led to a hole directly into the bladder or bowels.  In order to fix the problem, he needed to peer into the vagina.  A brilliant idea came to him:  use a bent spoon to retract the vaginal tissue.  This version called the Sims retractor is still used today.  In fact, when we perform hysterectomies we use this instrument all the time.  We say “hand me a Sims.”

Dr. Sims could now look into the vagina and perform surgeries on these fistulas and fix them.  Amazing.  But, it’s not all glory for Dr. Sims.  In fact, he is a controversial figure in medicine.  He made some great strides in the care of women, but some of his practices were dubious and unethical.  He operated on slaves, in fact buying them in order to perform his experiments.  He didn’t use anesthesia when operating even though anesthesia was available.  He used these women as experimental subjects without their consent.

Even with this horrific background, Dr. Sims is labeled the “Father of Gynecology”.  Hopefully through the years, his inventions have helped more women than the number of women who suffered through his experiments.

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