An endocervical instrument with the patient in mind.
Flora began as an exploration into medical products that are used for women’s health. Specifically pelvic exams were researched , as they have historically been up for debate among medical professionals, designers, and women themselves. In 2019, discussions regarding women’s sexual and reproductive health are improving with a rising wave of feminism and awareness. However, there are an increasing number of medical procedures that are necessary to detect diseases like cervical cancer in women, that are being avoided or taught against. The social issues surrounding women’s health transcends to slower redevelopment in product and service innovation within the medical field.
Professor Jeff Kapec
Brooklyn, New York
50 million pap smears are performed each year in the US to detect cervical cancer and its precursors.
Yet the wands below are the current instruments being used to collect endocervical specimen during this procedure
(instruments courtesy of Pratt Student Health).
After researching the history of women’s health products, and connecting it to the modern innovation of them (or lack there of), three main points were used as a catalyst to the redevelopment of the endocervical instrument:
Women’s Health as a Taboo
The historical and cross-cultural taboo about women’s health has led to an awkwardness that is mis-associated with the field at large, thus creating a sense of inappropriateness to those who try to tackle its issues.
This hinders interest in approaching design challenges for women’s products.
Clinical efficacy is often a driver for doctor-centered design. And while medical professionals are the end user of a medical product, the main stake holder is the patient. A patient’s comfort during a procedure and their understanding of the medical product being used on them are equally as important as the doctor’s usability of the tool.
However, most medical tools are designed for cost efficiency and ergonomics for the doctor, without considering empathy or the emotional needs of the patient.
Non-cohesive Product Line
Standardized medical products often don’t follow a streamlined aesthetic for well branded instruments (as seen in the photo above). Their form language is also not obviously indicative of their function.
In an era where good product identity equates to higher consumer trust, creating a cohesive line is a severely missed opportunity that most medical products face.
I reached out to nurse practitioners who provide women’s health care to gain their insights on the overarching topic of women’s health historically, how their practice has changed the way they approach performing procedures based on different patients. This provided us the opportunity for the nurse practitioners to participate in the design process.
Adult Health & Women’s Health Nurse Practitioner
Pratt Student Health
Samantha has been working in medicine in a variety of modern practices. Her former work at Planned Parenthood gives her perspective on women’s health and its accessibility a fresh edge. She has a range of experience practicing professionally, in the form of an women’s health nurse practitioner, as well as academically, in the form of medical training for women’s health procedures.
Family Health Nurse Practitioner
Pratt Student Health
Debbie has been a practicing medical professional for over 25 years. She is well experienced, and has observed shifts in medical products and instruments throughout her work. After her medical education she noted that as products change over time, there’s not always an enforced learning of the new tools, and medical professionals have to adapt to the changed instruments on their own.
Mapping the Medical System
Roughly mapping out the components of western medical systems surrounding women’s health resulted in a greater understanding of how the products and services interact with the main users of medical devices and instruments, but also the main stakeholders. It was imperative in identifying what connections were successful, and where there were opportunities for improvement or redirection.
THE USER —
A medical professional is any medically trained individual who conducts medical examinations to diagnose or advise patients. Most commonly, an obstetrician and/or gynecologist would be conducting pelvic exams.
THE STAKEHOLDER —
Any person that biologically has a vagina, cervix, and uterus, regardless of self-definition, is a valued stakeholder for vaginal and cervical health exams. The typical age for general pelvic exams are between the ages of 18-40 years old.
emotional efficacy *
a successful medical procedure caused by a product adequately conveying emotion or empathy to a patient
* The meaning of this term has been used singularly towards the focus of women’s behavior about health procedures, and does not necessarily comply with alternative definitions of emotional efficacy seen elsewhere on the internet.
Product Perception vs Experience Accuracy
Most women’s products follow a similar trend in colors, textures & materials, shapes, and finishes: soft to the touch, nude tones, rounded edges and surfaces. All of these are strategic to entice women to use the products, but to also ease the use of it. Similarly, medical instruments that are interfacing a conscious patient should have a look and feel that is informative of its function, yet elegant and non-threatening in its visual appeal. However, current instruments fail to attain a product language that aligns with the trends of successful everyday women’s products, while also mitigating the inherent anxiety around not knowing what it does or why it looks so sterile.
A survey was taken of 32 uterus-havers* to research whether or not women who have experienced cervical pelvic exams know what the instruments do, and how they correlate the physical look of the product to an ancillary pain assessment.
* The term “uterus-haver” is used instead of “woman” because people who identify as something other than a woman, but still have a uterus, cervix, and vagina, have responded to this survey and are a vital part of the data set.
Respondents were shown images of the business end (head) of five endocervical instruments: broom, spatula, swab, cytobrush, and forceps. They were asked what their opinion of painfulness of product was based on an image alone with no descriptive words of the instrument.
Respondents were shown images of the business end (head) of five endocervical instruments: broom, spatula, swab, cytobrush, and forceps. They were asked to answer what the purpose of each instrument was based on the way the instrument looked alone with no descriptive text. These answers posed to be inconsistent with some respondents data when asked to assess pain, as well as when asked if they had experienced the instrument in a former pelvic exam. This insight sheds light on the lack of knowledge provided by the instrument itself as a product.
an endocervical instrument that incurs a higher specimen yield while maintaining form and ergonomics
Alternative tip designs were formulated as a round or cylindrical shape compared to scraping with a flat paddle shape to cultivate cells. A rounded form mimics the annular anatomy from which you extract the cells, and also mimics the form of other successful women’s products.
The current handles for specimen collecting instruments are not cohesive, and do not incorporate the subtle dexterity needed within the palm and the fingers. Round and undulating forms were physically and digitally prototyped to test grip performance and improvement in accuracy when being used by various hand sizes.
The final form was a simple 3d printed two-peak curve made from UV PLA plastic. The material was rigid enough to maintain strength, but offered a bit of flex as it has a long and skinny shaft for when the OBGYN is turning the handle to swab the inside of the cervix.
a new endocervical instrument > flora
Delicate Like a Flower
The redesigned endocervical head has been formed to follow the successful trends of other women’s products. Its rounded features take shape of a budding flower, not only to mimic the anatomical values of other products that are inserted into the vagina, but also to comment on the gentle nature of pelvic exams.
The wand staff has been redesigned to maintain a relationship with the head by mirroring a lengthened undulating curve. It satisfies clinical needs by improving the ergonomics of the hand placement, allowing for all angles of the hand to be comfortable while collecting specimen.