If you were to ask any woman about health exams, you’d probably get answers ranging from reluctant groans to nightmare memories. This essential health checkup often involves wearing a flimsy paper hospital gown, assuming an uncomfortable position in stirrups, while a rather intimidating-looking tool is used for examination.
It is no surprise that women commonly report fear, embarrassment, and anxiety during these exams. While pelvic exams play a crucial role in screening for cervical abnormalities, sexually transmitted diseases, and various health issues, the distressing nature of the experience has led many to approach it with apprehension.
Some individuals find the experience so traumatic that they choose to forgo their annual appointments altogether. The American College of Physicians (ACP) acknowledges that unless a woman is experiencing specific pelvic issues, skipping yearly exams is acceptable. In 2014, the ACP even determined that routine exams for healthy women can cause unnecessary distress, including anxiety and discomfort, without reducing mortality rates.
But must caring for women’s bodies always be such an uncomfortable and anxiety-inducing experience? Not necessarily. Enter Yona, a women’s healthcare project developed by a team of designers and engineers at Frog.
Their approach is centered around human well-being, aiming to enhance a crucial instrument that has seen minimal innovation over the past 170 years: the speculum. However, their vision extends beyond improving the speculum alone. They take a holistic view, addressing every examination aspect, from the waiting room experience and interactions with the OB-GYN to the interpretation of exam results.
By giving greater attention to women’s physical, emotional, and experiential needs, they envision transforming pelvic exams into empowering events that patients no longer dread or avoid.
A Modern Speculum for Enhanced Comfort
The speculums used today closely resemble the original design created by American physician James Marion Sims back in the 1840s. These medical instruments typically feature two cold stainless steel lips that open like a duckbill, allowing doctors to separate the vaginal walls for cervix inspection.
Dr. Cindy Duke, a board-certified OB-GYN and medical director at the Nevada Fertility Institute, emphasizes that most people fear the speculum. Its intimidating appearance, combined with a bright light shining between a woman’s legs, can make the experience feel like being in a spotlight, contributing to heightened anxiety.
Interestingly, this anxiety can extend the exam duration for both the doctor and the patient. The cold room temperature and the patient’s tense muscles can make it challenging to navigate the tissue, ultimately slowing down the examination.
Yona’s team decided it was time to reimagine the speculum, and their innovations reflect their commitment to improving both patient and physician experiences.
They introduced a third lip to the speculum, offering doctors a clearer view of the cervix while enhancing the patient’s comfort during dilation.
Silicone, a warmer and smoother material, now covers the stainless steel, ensuring a more comfortable insertion process. Additionally, any visible screws that were present in previous models are now concealed.
The designers even devised a way to incorporate light into the handle, eliminating the intimidating “spotlight” sensation.
Considering the physician’s perspective, the team relaxed the handle’s angle for greater comfort, enabling one-handed operation while maintaining a familiar design for gynecologists trained on traditional speculums.
Mechanical engineer Fran Wang emphasized the importance of maintaining a patient-centric focus while ensuring ease of use for doctors and cost-effectiveness for medical practices.
While the Yona speculum is still in development and undergoing a lengthy U.S. Food & Drug Administration (FDA) review process, it will only be readily available for a few years.
In the meantime, healthcare providers have options beyond traditional stainless steel speculums that may intimidate patients. Welch Allyn, a manufacturer of medical diagnostic devices, offers disposable plastic vaginal speculums in four sizes, each equipped with built-in LED lights.
According to Jamie Wood, manager of the women’s health category at Welch Allyn, approximately 55 percent of providers have transitioned to the plastic version. This assures patients of receiving a clean, brand-new speculum for their examination, fresh out of the packaging, and never previously used on another patient.
Engaging All Senses for a Comfortable Exam
During a pelvic exam, a woman finds herself in a vulnerable position, lying nearly unclothed on a medical examination table, with legs apart and feet secured in stirrups. In such a situation, she becomes acutely aware of every sound, sensation, and touch, making it crucial to consider all her senses to enhance the overall experience.
Sensitivity to each of these sensory aspects can help transform the pelvic exam into a more positive encounter.
Patients often tense up when they hear the clicking noises produced as the speculum is inserted, as noted by Dr. Cindy Duke. The Yona design addresses this by eliminating these disconcerting sounds.
Doctors can also play a pivotal role in mitigating patient anxiety by verbally guiding them through the speculum insertion process. By informing patients about the sounds they will hear and reassuring them that nothing is being harmed or broken, healthcare providers can lighten the mood and alleviate apprehensions, according to Duke.
Temperature is another concern, particularly as patients are partially undressed. To address this, the Yona team developed a comfort kit, which includes items like socks, a weighted blanket, and a stress ball. These additions cater to the patient’s comfort and help create a more soothing environment.
The use of stirrups, while enhancing access to the vagina for providers, has drawbacks such as limiting patient movement, reducing comfort, and potentially heightening anxiety. While some healthcare providers, like certified nurse-midwife Stephanie Tillman, have opted to forgo stirrups, Dr. Duke emphasizes that stirrups can actually make the pelvic exam less painful. Thus, she does not advocate their elimination.
The Yona project has introduced innovative solutions to address many of women’s concerns during OB-GYN exams. However, healthcare providers can improve pelvic exams immediately, often without incurring any additional costs. The key is for doctors to recognize that patients are human beings with emotions and to acknowledge the intimate nature of these examinations, ensuring they approach each exam with sensitivity and compassion.
Promoting Relaxation and Learning for Patients
It’s common for patients to experience pre-exam anxiety while waiting for their gynecology appointment. According to Rachel Hobart, visual designer at Yona, this anxiety can be just as high as the moment when the speculum is inserted.
Yona’s app offers a valuable solution to address this issue by providing guided meditation for patients to self-soothe, whether they are in the waiting room or in the examination chair. This feature aims to help patients relax before the examination.
In addition to meditation, healthcare providers can inject humor into the experience, where appropriate, to create a more relaxed atmosphere. Yona has incorporated a whimsically designed sheet for the examination table that humorously states, “Your butt goes here,” helping patients situate themselves correctly and making the exam room feel more personalized and considerate. This also eliminates the need for awkward positioning requests during the appointment.
While most women understand the importance of their annual exam for their health, they may need to fully comprehend the details of what happens during the examination. The Yona app addresses this by providing a platform for patients to ask questions they might feel embarrassed about, connect confidently with their doctors, and receive their results in simple, understandable language.
Some doctors, like Dr. Duke, have already implemented strategies to educate patients and establish trust without relying on digital technology. For example, Dr. Duke consults with patients, employs organ models to illustrate their anatomy, and demonstrates the examination process before patients undress.
The Yona project can potentially revolutionize the future of women’s reproductive health. However, healthcare providers do not need to wait for technological innovations to enhance the pelvic exam experience. By dedicating additional time to patients, using comfortable speculums, and considering the overall patient experience, doctors can create a more comfortable and reassuring pelvic exam experience for women.