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Translated by Chloé Sautter-Léger
Speculum [ˈspe-kyə-ləm] noun－From Latin speculum: « mirror ». An instrument for dilating a bodily cavity or passage to permit examination of its interior. (C16) Collins.
Cold. Intrusive. Unpleasant. Disruptive. Painful. Words used by women to describe the speculum are cutting and seem to describe not only the form of the object itself, but also the context in which it is generally used: the pelvic exam.
This series was created out of interest for medical anthropology and the history of sexuality and particularly, from the desire to contribute to women’s agency of their gynecological health. The three articles in this series aim to shed light on the origins and multiple uses of the speculum. In what sociohistorical context was this medical instrument created? Is the tool political? Is a subversive usage of the speculum possible?
In order to address these questions, we will first explore the advancement of the speculum and the role it played in the establishment of gynecology as a medical specialization in the 19th century. We will then discuss the use and appropriation of the tool by artists and women’s health movements since the 1960s.
On the Discovery of the Speculum
In A Woman’s Disease, Llana Löwry defines the speculum as:
“A medical tool used to examine body cavities. The most common is the vaginal speculum, employed to examine the vagina and the cervix, to take tissue and cell samples, and to apply medication. The vaginal speculum is usually a hollow cylinder with a rounded end that is divided into two hinged parts. It can be made from either steel (to be reused) or plastic (for a single use). The speculum is inserted into the vagina to dilate it and make it accessible to the examiner’s gaze.”
Although nowadays there are many meanings and uses of the speculum, its origins seem to be delineated within the scope of scientific literature. Historians have identified various similar tools used in the past 2000 years, such as the dioptre, and many European alternatives before the 19th century (Ricci, 1949), but the invention of the modern (duckbill) vaginal speculum is generally attributed to physician James Marion Sims in the United States, sometimes referred to as the “father of modern gynecology” (Kapsalis, 1997; Löwy, 2011).
The first recorded usage of the modern speculum, in the form of a folded tin spoon, is closely tied to the history of slavery in North America. The tool was used on Lucy, an enslaved black woman kept by Sims, who had a vesico-vaginal fistula—an internal tear, generally occurring because of labour complications, in which there is an abnormal connection (fistula) between the bladder and the vagina, often causing incontinence (Blaivas et al., 1995). Between 1845 and 1849, Sims operated on Lucy multiple times in order to perfect a surgical method that would serve to treat the vesico-vaginal fistula. Like other surgeries practiced on Sims’ slave women, these were carried out without anesthesia (Kapsalis, 1997; McGregor, 1998). It can be noted here that anesthesia was already used in the middle of the 19th century, but generally only for patients belonging to higher social classes (McGregor, 1998).
In his autobiography, Sims describes the first use of the speculum: “Introducing the bent handle of the spoon I saw everything, as no man had ever seen before. The fistula was as plain as the nose on a man’s face” (Sims, 1886, 234-235). The way he describes this event, saying “I saw everything, as no man had ever seen before” sounds similar to the description of discovering a “new” continent. This parallel, indeed, can be unequivocally confirmed in physician William Owen Baldwin’s funeral eulogy to Sims:
“[The speculum] has been to diseases of the womb what the printing press is to civilization, what the compass is to the mariner, what steam is to navigation, what the telescope is to astronomy, and grander than the telescope because it was the work of one man.”
The first recorded pelvic exam in North America using a speculum was conducted in a very particular place: the body of a racialized and impoverished woman. Although some doctors, such as Irwin H. Kaiser in an article for the American Journal of Obstetrics and Gynecology (1978), have pointed out that Sims’ practices should be interpreted in their historical context, Durrenda Ojanuga (1993) reminds that medical experimentation on slave women’s bodies was very rare in this period in the United States. This was, indeed, the beginning of the exploration of a new territory—female genitalia.
On the Proper Usage of the Speculum and the Birth of Gynecology
The newfound visibility of female genitalia is closely tied to the development of gynecology as a full-fledged medical specialization. French surgeon and gynecologist Joseph Claude Récamier (1774-1852), can be credited for popularizing the speculum in Europe. The instrument he developed was a thin tin cylinder capable of reflecting light (the Latin word “speculum” means “mirror”) during screenings and uterine wound treatments (Löwy, 2011).
Researcher Ilona Löwy (2011) mentions that, at the beginning of the 19th century, the main purpose of pelvic exams using a speculum was the detection of sexually transmitted infections on the bodies of sex workers. In Paris in 1810, women offering sexual services in exchange for money were required to regularly pass pelvic exams in order to detect wounds on the vulva, inside the vagina or on the cervix. Women presenting wounds were obliged to undergo treatment and could not obtain medical leave until the specialists judged they were healed, i.e. when all genital ulcers were gone (Löwy, 2011).
The origins of the speculum and the birth of gynecology as a field make clear the power balance involved in the evaluation and treatment of female genitalia.
Sims and Récamier’s choices of objects for gynaecological examination, in the 19th century, show which women’s bodies were favoured as places for medical experimentation: racialized women and sex workers.
Historically, the speculum—a novel medical instrument and gynecological tool of investigation, stands at a crossroads between sex, race, and social class.
Furthermore, beyond the obvious power relations at play with the exclusive roles of the penetrating and the penetrated, the use of the speculum marks a movement parallel to the development of gynecology—i.e. the appropriation of the speculum by medical practitioners and the devaluation of the expertise of midwives (Löwy, 2011; McGregor, 1998).
As a matter of fact, although the instrument offered more visibility to female genitalia, this new visibility was intended only for physicians, while midwives were not allowed to use the speculum.
This instrument, which is nowadays used to diagnose sexually transmitted infections, including gonorrhea and syphilis, was a tool associated with deviant sexual behaviours. Women deemed to have modesty were examined only very rarely. According to Ilana Löwy, who specializes in the history of the treatment of cervical cancer,
“The speculum became one of the main symbols of the power of male doctors over a woman’s body” (2011, p.23).
Linked to the exploration of women’s bodies and the acquisition of new gynecological knowledge, the speculum raises the following questions:
Who looks and who penetrates?
Is a subversive usage of the speculum possible?
Judging by the legacy of the women's health movement of the 1960s, where women were encouraged to take ownership of their sexual health through gynecological self-examinations, for instance; or if we consider performances by artist Annie Sprinkle—where the speculum and female genital organs are exposed to public view—rewriting the storyline of the speculum and of pelvic examination is indeed possible.
What if women reclaimed the speculum?
*The author would like to thank Jonah Campbell for his valuable advice.*
Read Part II of this article here.
Baldwin, W.O. (1884). Tribute to the Late James Marion Sims, M.D., LL.D. Montgomery: W.D. Brown & Company.
Blaivas, J. G., Heritz, D. M. and Romanzi, L. J. (1995). Early versus late repair of vesicovaginal fistulas: vaginal and abdominal approaches. The Journal of Urology, 153(4), 1110-1113.
Kaiser, I.H. (1978). Reappraisals of J. Marion Sims. American Journal of Obstetrics and Gynecology, 132(8), 878-882. DOI: 10.1016/0002-9378(78)90715-9.
Kapsalis, T. (1997). Public privates: performing gynecology from both ends of the speculum. Durham: Duke University Press.
Löwy, I. (2011). A Woman’s Disease: The History of Cervical Cancer. Oxford: Oxford University Press.
McGregor, Deborah Kuhn. (1998). From Midwives to Medicine: the Birth of American Gynecology. New Brunswick: Rutgers University Press.
Ojanuga, D. (1993). The Medical Ethics of the ‘Father of Gynaecology’. Journal of Medical Ethics, 19(1), 28-31. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1376165/.
Ricci, James V. (1949). The Development of Gynaecological Surgery and Instruments. Philadelphie: Norman Publishing.
Sims, J. M, (1884). The Story of My Life. New York: D. Appleton and Company.