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Content warning: This article may contain subject matter that some readers may find upsetting, including discussions of non-consensual or coerced medical procedures related to women’s health, and medical abuse.

In a previous blog post on the topic of female nurses’ participation in the Contagious Diseases Acts (CD Acts) compulsory speculum examinations, our anonymous author explicitly described the figure of the surgeon, including his “instruments of steel or glass.” In an article intended as a critique of the gender-dynamics at play in the CD Acts “inspection offices,” this brief departure from centering the persons involved to the objects used in the examination room is worth noting. Certainly, there was a purpose in highlighting the instruments in their description of the “horrifying” examination process. Somehow the surgeon’s instruments made him and the process of the examination all the more menacing and offensive.

The notorious advocate for repeal of the CD Acts, Reverend Robert Eli Hooppell, was known for his vivid descriptions of the speculum examinations at repeal meetings in the North of England, even going so far as to display the instrument itself to shocked crowds of working-class men and women. This practice was considered particularly distasteful by the repeal leader Josephine Butler, who described it as “needlessly and grossly indecent,” repelling “many good men” from their cause.

Despite Butler’s objections to the “indecent” display of the instrument itself, the repealers certainly did not shy away from describing the “outrages” and abuses of the CD Acts examinations. They frequently highlighted the corrupting influence of such examinations on both the patient and the physician and offered highly expressive accounts of the pain and suffering experienced by women during the procedure and in the aftermath of the exam.

A particularly powerful example of this can be found in what is perhaps the most evocative piece of writing produced for the repeal movement: The Forcible Introspection of Women for the Army and Navy by the Oligarchy (1870) by the homeopathic physician and passionate advocate for repeal, John Garth Wilkinson. Wilkinson’s work features many alarming and graphic descriptions of women’s experiences in the examination room and the speculum appears prominently within these accounts. The CD Acts, Wilkinson argued, had “let women into the secret” of the speculum examination, and soon, they would be “the end and doom of the general use of the speculum in this nation.” [1]

It is clear that Wilkinson, like Hooppell, believed there was added significance in experiencing the physical, tangible medical object of these pelvic examinations.  In one passage addressing the Home Secretary and noted supporter of the Contagious Diseases Acts, Henry Bruce, Wilkinson begs the politician to have a speculum brought before him, to have him handle “the unfeeling glass and steel telescopes” of the “Parliament surgeons.” He continues:

I beg you for yourself to turn the screw and work the spring which expands them when they are fully hilted in the woman’s genitals; in the bodies among others of little delicate girls of fourteen or fifteen; and I beg you to ask yourself not as a statesman, not as a second-hand expert, but as a man, as the son of a mother’s womb—perhaps as the husband of a wife and a father of girls (if you are such) […] [2]

Within the above passages we can see how Wilkinson emphasizes the materiality of the speculum, describing them as being made from “unfeeling glass and steel,” highlighting the contrast between the soft, vulnerable internal tissues of the body and the hard, industrial materials of this medical instrument.

In addition to the materials of the speculum’s composition, a primary concern in Wilkinson’s writing is the size of the instruments used by these physicians. Wilkinson reported that despite the various shapes and sizes of subjected women’s physical frames and the existence of “large and small specula” (the latter of which he suggested were completely ineffectual given the limited area of flesh they exposed), “all the women are treated alike.” [3] Likewise, in a letter from Josephine Butler included in the appendix to Wilkinson’s manuscript, Butler states that the subjected women she encounters “chiefly complain of […] the great size of the instruments. The same sized ones seem to be used for small, delicate girls of 15, and slight women, as for large women who have had children.” [4]

When taken together, Hooppell’s visual display of the instrument’s workings and Wilkinson’s written descriptions of its materials and form speak to the broader power and influence of medical objects. Today, we recognize that our relationship to medicine and to its providers (physicians, surgeons, nurses, technicians, etc.) is mediated by objects. We can think of objects that are designed to create a physical barrier between physicians and patients such as personal protective equipment (PPE), or objects that remove the need for physical touch altogether (for example, the pulse oximeter which removes the need to monitor the patient’s pulse manually).

This all changed with the re-discovery of the speculum in the early nineteenth century. The speculum removed the need for physical contact, yet it horrified Victorian sensibilities by bringing the physician into visual proximity with a woman’s genitalia. Moreover, the material construction of the instrument added to the potential for pain during examinations.

Even today, numerous studies have suggested that a fear of potential pain and discomfort during pelvic examinations is a “barrier to patient compliance” for gynaecological procedures such as cervical screenings. Yet, there are few guidelines for physicians to follow when it comes to selecting the “right” speculum. There are suggestions for selecting the size of speculum based on a patient’s age and sexual/reproductive history, but it is up to physician preference (and/or what supplies are available in a given clinical setting) whether they use a metal or plastic instrument. No studies have yet been undertaken to determine if the choice of materials could affect the pain level of a patient during examination. In fact, studies are still being undertaken to determine if the use of lubrication, or the method of placement of the speculum can “reduce patient discomfort.” Recent medical literature has even questioned the necessity and effectiveness of conducting routine pelvic examinations in asymptomatic, non-pregnant patients altogether.

In a 2014 article for The Atlantic, writer Rose Eveleth explored whether a “better” design for the speculum was even achievable. While numerous alterations and complete redesigns have been pitched over the years, doctors and instrument makers continuously return to the classic duck-billed construction. Ultimately, as Eveleth wrote, while “our technological bias may tell us that old things should be thrown out and redesigned completely […] in the case of the speculum, however, the old thing seems to work just fine.” Perhaps, as Eveleth and the physicians and scholars she consulted suggest, women’s discomfort with the pelvic exam may be less an issue of “a badly designed device,” than “a badly designed patient experience,” and empowering patients may offer the only solution to alleviating our general discomfort with the pelvic exam. [5]