The Financial Prioritization of Gender
December 03, 2025
For anyone who's had a pelvic exam, the speculum is a familiar and often dreaded tool. It's cold, invasive, and rigid — both physically and symbolically. Despite how routine gynecological exams are, the instruments used during them have not evolved with patients in mind. In fact, one of the most essential tools in reproductive care hasn’t changed in nearly two centuries. That’s not just bad design, it’s a reflection of whose comfort medicine has historically prioritized.
The original design of the modern speculum dates back to 1845. It was developed by James Marion Sims, a U.S. physician who, while admired by some as a pioneer, built his legacy on horrific violations. Sims conducted gynecological experiments on enslaved Black women without anesthesia or consent. The fact that the device he created is still in widespread use today, with few meaningful updates, should raise serious questions about how much patient experience truly matters in medicine.
Thankfully, some are beginning to challenge this legacy. Ariadna Izcara Gual, a recent graduate of TU Delft, and researcher Tamara Hoveling are working on a complete redesign of the speculum, one that centers the needs, comfort, and dignity of the patient, not just the convenience of the doctor. Their project isn’t just about engineering a better tool. It’s about confronting the way pain is normalized, and often ignored, in women’s health.
So why does the speculum hurt so many people? At its core, the device uses force to open the vaginal canal by pressing outward against sensitive internal muscles. It doesn’t adapt to individual anatomy, nor does it take into account how vulnerable the experience can be. It's a tool designed for access, not empathy. This isn’t a niche issue. People avoid reproductive care because of the fear or trauma associated with speculum exams. That’s not just uncomfortable, it’s dangerous. When pain is seen as the price of admission for basic healthcare, entire communities are left without care they need and deserve.
Redesigning the speculum is long overdue. But more than that, it symbolizes a broader challenge: the slow and often dismissive pace of innovation in women’s health. Too many medical tools that cause discomfort—or were developed without a full understanding of women’s experiences—have been preserved by tradition rather than improved through empathy and research. The speculum’s unchanged design isn’t a sign of its effectiveness, but of how medicine has historically overlooked those it’s meant to serve.
Change begins with design—but it must also include listening to patients, validating their pain, and creating care that respects rather than merely accommodates them. That’s the future reproductive healthcare should be working toward. Legal protections play a role too: the Equal Rights Amendment would provide a constitutional guarantee of sex equality, helping to challenge the systemic neglect of women’s health needs.
If we want a world where medical tools reflect progress, not outdated assumptions, we need the ERA—not just to improve the instruments, but to reshape the system that created them.
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