Advocan
Improving the pelvic exam
Timeline
2020-2021
Founder
Skills
Fusion 360, Adobe Dimension, User Research, Customer Persona, Prototyping, Product Development
Goal
Create a better pelvic exam experience
Awards
Joan F. and John M. Thalheimer ‘55 EUREKA! Ventures Competition Winner, People’s Choice Award
About this Project
This project was part of my M.Eng. in Technical Entrepreneurship graduate studies at Lehigh University. The goal of this program was to identify an industry of interest, define an opportunity for innovation, and build a business and/or product.
I’ve always been fascinated by instances in which groups are not considered in the design process (intentionally or not), the consequences, and how to design more thoughtfully. My inspirations in this project include the efforts to redesign the breast pump (Elvie, Willow, Moxxly, etc.) and Invisible Women: Exposing Data Bias in a World Designed for Men by Caroline Criado-Perez.
When looking into the healthcare space and conducting preliminary interviews and research, there was one experience that continued to surface: the pap smear.
The Problem
The pelvic exam and pap smear are routine examinations in gynecology. Despite being integral to healthcare, these exams are notoriously uncomfortable and even painful. Patients are in a vulnerable position, legs up in stirrups, and chilly and exposed in thin gowns. Providers use medical equipment that is cumbersome and hasn’t been significantly redesigned since its invention in 1845. It is time for improvement.
“Beforehand I wasn’t worried, but now that I know how a pap smear feels, I have anxiety about my next exam.”
“I don’t understand why it’s like this. It shouldn’t be uncomfortable to get the same exam every year.”
“I didn’t have any issues with my first pap smear, but I did a lot of research beforehand and there were other nurses in the room walking me through each step.”
“As an entrepreneur, I experienced success focusing on a product that was both needed and hated.”
Initial Concepts
First, I focused on the pap smear experience. During a pap smear, a physician uses a swab to collect cervical cells and screens for cervical cancer. Often, this is done in conjunction with a test for Human Papillomavirus (HPV), a sexually transmitted infection that can cause cervical cancer.
Since much of the patient discomfort seems to come from the experience of visiting their gynecologist, I wondered if we could eliminate the visit entirely. My first solution bypasses the process: an at-home test kit for HPV.
This idea was received well by the patients I spoke to. However, I learned that many at-home HPV test services already exist. Additionally, this test is separate from a pap smear, which requires an experienced care provider.
Lateral Benchmarking
How might we make getting a pap smear similar to inserting a tampon? Can we create a device similar to a tampon to collect cervical cells?
This concept was promising. However, the pap smear is only a small part of the patient experience. It is often done every three years, while a pelvic exam is annual. I pivoted my focus to the pelvic exam and speculum. The speculum is a duckbill-shaped device inserted into the vagina during an exam in order to visualize the cervix.
What makes this speculum different?
I conducted provider interviews and shadowed doctors at Tower Center for Women’s Health to observe and gain insights into the pelvic exam experience. A doctor gave me these speculums to look at and take apart.
There are two main categories of speculums: reusable metal, and disposable plastic. There are benefits and tradeoffs with each.
Below are my key insights from interviews and observations, and how they translated into features.
“Plastic is warmer than metal. Changing or coating the metal would eliminate patient discomfort.”
The speculum is made of a sturdy, reusable plastic.
“It’s really difficult to visualize using the external lights we have. I do like the clear speculums to see better, but that clear part would only be necessary for the last inch or so.”
This design includes a clear end & internal light.
“You lock the speculum into position using knobs and screws. It’s cumbersome and difficult to use. Sometimes the patient’s hair gets caught in the knob.”
With this metal speculum, a physician presses the lever shown above to open it. Then, they spin the knob along the screw until it locks the speculum into that angle. This device is also only designed for right-handed physicians.
In my design, there are lock and release buttons to replace the screw/knob mechanism. Additionally, the button is centered so either a right or left-handed physician can use it with ease.
One doctor I spoke with told me that some patients may get pinched by the speculum depending on their anatomy.
Her solution was to place a condom over the speculum. This is a known practice utilized by other doctors.
I would support this method by providing clear disposable slips designed to fit over the speculum. Alternatively, designing protective side folds into the speculum is worth pursuing.
That’s it for now!
If I were to continue this project, my first step would be to visit hospitals and women's centers to conduct more in-person research. I was limited as this project took place in 2020-2021 at the height of the pandemic. My most valuable experience was shadowing Dr. John Dougherty at the Women’s Health Center in Reading PA towards the end of this project.
I would also prototype and validate the mechanics of opening and locking the speculum in place with the goal of avoiding loud plastic ratcheting. Finally, I would test the usability with doctors.
This project is wrapped up, but I enjoyed this challenge and would love to do similar work in the future. Thank you for joining me on this journey!