Beyond the bedside, the speculum was an instrument of surveillance, deployed by police to detain prostitutes suspected of carrying venereal disease, according to Moscucci. Britain’s Contagious Diseases Acts of the 1860s introduced compulsory exams by speculum-wielding doctors. Similar laws targeted the separation of the “unclean” from the “clean” in France and Germany. This is how the speculum became a symbol of sexual deviancy, linked to syphilis and gonorrhea. Gynecology was a product of the social and political order—one that aimed to control women first. As Moscucci asks, why else would there be a medical science of women when no such equivalent exists for men?

In San Francisco, four women at the design firm Frog hope to revisit the speculum Sims created 170 years ago. Their design, known as Yona, grew out of a conversation between women designers about the flaws of the pelvic exam. From a product standpoint, the exam’s audio cues only ratchet up discomfort and anxiety. The patient, lying with feet in stirrups and unable to see what’s happening, hears the jarring sounds of jingling metal and the tightening of the screw. “You actually have open screws on this instrument,” Hailey Stewart, one of Frog’s industrial designers, told me. “You hear them as they’re opening you up.”

Stewart’s team also explored materials, settling on surgical-grade silicone for a quieter device that doesn’t feel as unnatural in the body as plastic or as cold as metal. It bears no resemblance to a medieval torture device. Fran Wang, a mechanical engineer working on the project, focuses on questions about the speculum’s received shape: “Why is it shaped so flat? Why is it so wide? Why is it angled? Why does the screw pinch when not covered by the provider’s finger?” After addressing exposed screws and pinching, the designers wanted to modify how the mechanism operates, with the goal of allowing providers to carry out the insertion and opening process with one hand, freeing the other to grab swabs. The result, they hope, will be a shorter exam. Stewart noted that even small adjustments to the apparatus magnify improvements in comfort during the exam. By pulling back the handle angle, they say Yona creates more space between the provider’s hand and the table, so that the patient no longer has to “scooch down” until they’re practically hanging off the edge.

Together with the designers Rachel Hobart and Sahana Kumar, Stewart and Wang hypothesized that the older generation of ob-gyns—providers with decades of experience using the hulking, gray instrument—would be less open to change than others who are just starting out. Yet, according to Stewart, interviews with clinicians confirmed the opposite. She says that providers recounted “ hacks” they adopt with the speculum “to put patients at ease” because they “know it’s not the right instrument” for the job. Gynecologists may be as eager for an alternative to the speculum as their patients.