The Gyno Instrument We All Dread Is Finally Getting an Extreme Makeover | Vogue

Margot Robbie’s Barbie character aside, trips to the gynecologist aren’t met with much enthusiasm for those who have a vagina. One reason for that aversion has to do with the usage of one specific instrument: the speculum. Used to pry open the vaginal walls so doctors can peer inside and get a clear view of the vagina and cervix, the duck-billed, stainless steel (and sometimes plastic) device looks like an ancient implement of torture. And many women would attest that that’s what it feels like too.

The design of the speculum has, in fact, remained unchanged for over 150 years. It was conceived of by J. Marion Sims, a villainous doctor referred to for much of history as the “father of gynecology,” who brutalized enslaved women practicing vaginal surgical techniques on them without anesthesia or consent. So problematic is his legacy that a monument to him was removed from New York’s Central Park in 2018. Yet the instrument that he invented remains, despite its shortcomings, a gynecological standard. One that more than 60 million women are at the receiving end of every year during a pelvic exam. It’s a fact that Fahti Khosrowshahi was so troubled by that she was inspired to course correct, and thus was born Nella, a company behind a next-gen version of the speculum.

“If you look at a metal speculum from today and compare it to one from 100 years ago, something I’ve seen firsthand at museums in British Columbia and England, they look shockingly similar,” says Khosrowshahi. “It’s a device that works, it gets the job done, and clinicians are used to it, but it’s not something most women look forward to.” For Khosrowshahi, a history of infertility made pelvic exams that much more anxiety-inducing. And the same is often true for women with a history of sexual trauma and those in the menopause transition, who because of a lack of estrogen, says Mary Rosser, MD, an ob-gyn at Columbia University in New York, make them physically painful. “What I teach residents and medical students is that women experience these exams with their clothes off so they’re already in a vulnerable position,” says Rosser. Pelvic exams can be so intimidating for some patients, she explains, that they end up skipping their appointment entirely, a decision which can jeopardize their health. “These centuries-old devices being used on women make something that by nature is already very uncomfortable, unnecessarily excruciating,” adds Khosrowshahi.

When Khosrowshahi was in the throes of a long fertility journey that would, after many years and many IVF rounds and many doctor visits, result in the birth of her two daughters, she wondered, why isn’t there a better speculum? “I would go to my doctor’s office and feel like I was taking a step back in time,” she says. After conducting a blinded market research survey of thousands of women wherein 90% reported their dislike of the speculum, she quit her job and started Nella, finding a consumer product design and engineering firm and partnering with two ob-gyns and a nurse midwife to bring the idea to life. “It was critical to me that patients, and their comfort, would be at the forefront of the design,” says Khosrowshahi. The new speculum had to be narrow; it couldn’t be too cold or too warm; it couldn’t feel sticky; it had to be comfortable for the patient; it had to be functional and ergonomic for the doctor wielding it and work as well in male or female-sized hands; and, crucially, it had to be silent (the sound of the traditional speculum, adds Rosser, can be particularly triggering). A Goldilocks search that saw the team cycling through 150 rounds of prototyping, each one continually being updated based on feedback from doctors and patients.

The final Nella speculum was preferred by 99% of the patients it was used on. According to Rosser in her practice where she has been testing them, the speculum has been a game-changer. “One patient who is always extremely and vocally nervous about pelvic exams did not say a word,” she says, adding that she was just as impressed by the efficacy of the speculum from the clinician perspective. “An innovation like this one especially during an invasive procedure is so important.” Which begs the question, how did it take this long? The attention, or lack of it, paid to women’s pain in medical settings has continually come under scrutiny, as they see their complaints ignored. Last year’s podcast “The Retrievals” shared the stories of dozens of women who reported that the excruciating pain they experienced during egg retrievals was made light of; it would turn out they were receiving saline instead of anesthesia.

A number of studies back up this sidelining and silencing of women’s pain in the medical setting: In 2022 the Journal of the American Heart Association found that women who went to the ER with chest pain from a possible heart attack waited significantly longer than men to be examined. Khosrowshahi found that when she started meeting with clinicians about Nella that some questioned why they would need to consider a new speculum when they never heard any objections from their patients. “Some said, well, my patients never complain so why do I need to change,” says Khosrowshahi, adding that while there are many practitioners who are incredibly in tune with their patient’s needs, others rarely question whether a woman is having an uncomfortable exam. And many women don’t complain because they don’t think they can and also, because, when they do, those complaints are sometimes downplayed. While she can’t fix it all, Khosrowshahi’s goal is to get Nella into as many clinics and doctor’s offices as possible to address at least one of the pain points women face when they go to the doctor. And the brand also sells them directly to consumers on their website so women can BYO speculum to their next appointment. Now, is a pelvic exam ever going to be a totally pleasant experience? Unlikely. But that doesn’t mean it has to be a deeply unpleasant one.