Gynaecological instruments have not changed much since ancient times
Why not? A gynaecologist still has to look inside the vagina, one researcher observes.
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“It's astonishing how similar old instruments are to the modern versions still used on women around the world,” Tone Enden, a researcher and doctor at Oslo University Hospital, wrote in the Journal of the Norwegian Medical Association (link in Norwegian).
Her article refers to the gynaecological instruments displayed at the National Museum of Archaeology in the Italian city of Naples. These were used by the Romans around the year 0.
The point is that a number of them have not changed very much since then.
This particularly applies to the vaginal speculum, Enden notes.
Gynaecologists need to see into the vagina
Even though the instrument from ancient times shares similar mechanisms to what we have today, it has been modernised from time to time throughout history.
The last time the speculum was changed was in the 1850s. This is the same model gynaecologists use today.
“Some basic instruments have remained unchanged over many years,” says Kathariina Laine, a gynaecology researcher at the University of Oslo.
“Perhaps it's because a gynaecological examination is still conducted in the same way as before. A gynaecologist has to see inside the vagina."
Therefore, she doesn’t think that the vaginal speculum can be modernised significantly. She points out that there are measures that can make using the speculum more comfortable, such as keeping it warm or replacing it with plastic variants.
The cough trick
Enden says another instrument that has not changed is the tenaculum.
These are forceps with two pointed hooks that are used to grasp the cervix when inserting an IUD.
Many of us who have sat in the gynaecologist’s chair know what she is talking about. The tenaculum is introduced after the speculum has been inserted into the vagina to open it up.
Then the doctor asks you to cough.
At that moment, she clamps the tenaculum to grasp your cervix.
This is called the cough trick.
No less painful with anaesthesia
“Attaching the tenaculum to the cervix is a bit painful, but a lot depends on the technique,” Risa Lonnée-Hoffmann, a gynaecologist and researcher at the Norwegian University of Science and Technology, (NTNU) said to sciencenorway.no.
“An alternative is to apply a local anaesthetic first, but this hurts just as much,” she says.
Whether the cough trick actually makes it less painful to get a hold of the cervix is doubtful. A study from 2020 shows that the pain was the same regardless of whether the gynaecologist asked the women to cough or not.
Are tenaculum available for men?
Tone Enden writes in the Journal of the Norwegian Medical Association that she has wondered if there has been any other time in history when anyone has come up with an instrument to examine a healthy organ in an awake patient that looks as brutal as the tenaculum.
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“If it were a man being examined, an improved version would likely have been developed long ago – that is, if the tenaculum had been used at all,” she writes.
Even though it has not changed much over many hundreds of years, the threshold for using the tenaculum has changed, according to Lonnée-Hoffmann.
“The vast majority of gynaecologists only use it when absolutely necessary. And with good technique, most women tolerate this well,” she says.
Can be replaced with a suction cup
There are indeed alternatives to the tenaculum.
In a study from last year, researchers compared the tenaculum to a newly developed instrument that attaches to the cervix with a small suction cup.
Compared to women who had an IUD inserted using a tenaculum, there was less bleeding and less pain with the new prototype.
Whether the new instrument will be adopted by Norwegian gynaecologists remains uncertain.
This will only happen if the findings can be replicated and there is commercial interest in the product, according to Enden.
A new speculum made in Norway
There are also people in Norway trying to make gynaecological instruments more gentle and modern.
A gynaecologist and midwife at Nordland Hospital Trust have developed new instruments to make the experience of going to the gynaecologist more pleasant.
They developed a new type of vaginal speculum that has thin, elastic sidewalls and is made of plastic instead of metal. It is also completely silent.
For their innovations, they received Northern Norway Regional Health Authority's innovation award in 2022.
Dilating and scraping the uterus
Other gynaecological instruments have also remained unchanged for hundreds of years, Lonnée–Hoffmann says.
Two examples are Hegar dilators and the curette.
Hegar dilators are used to dilate the cervix.
“You can administer medicinal treatment to soften the cervix beforehand, so it doesn't hurt as much,” Lonnée-Hoffmann says.
She mentions alternatives to the instrument, such as a thin rod that slowly expands on its own.
“But this is impractical,” she says.
The curette is used to scrape the uterus.
“It's used much less now that new techniques have been introduced that use vacuum or endoscopic methods instead,”she says.
Supporting gynaecologists
In her article, Enden asks what we can expect in the near future regarding better design and innovative functionality in instruments and medical equipment for gynaecological exams or procedures.
Laine believes gynaecologists have been both innovative and proactive.
“Focusing on two instruments and concluding that these indicate a lack of development or willingness to develop among gynaecologists is quite a narrow view,” she says, in reference to the speculum and the tenaculum.
“Women's health and gynaecology are so much more than these two instruments.”
She believes there has been significant progress in the field.
“When it comes to surgical treatments and instruments, gynaecologists have always been at the forefront of adopting more patient-friendly methods,” Laine says.
“Gynaecologists are very concerned about women's health and what is best for women. There are no other professions that advocate more strongly for what is best for women than gynaecologists."
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Translated by Nancy Bazilchuk
Read the Norwegian version of this article on forskning.no
