A traditional cervical cancer screening requires a patient to lay on an exam table and place their feet into stirrups to hold their legs apart, while a provider inserts and expands a speculum into their vagina. This procedure, the status quo for cervical cancer screenings in the United States, can be distressing for many patients. As an at-home self-collected HPV test for cervical cancer, the Teal Wand^TM could offer an alternative to this traditional exam for those who cannot or prefer not to use the speculum. 

While an alternative to the speculum may be a preference for many, it is a necessity for some. Certain health conditions make using a speculum excruciating and at times impossible. These include genitourinary syndromes involving narrowing or tightening of the vaginal tissues, chronic vaginal pain, as well as lichen sclerosus, a chronic autoimmune vulvar skin disease. These conditions can intensify with the physiological changes menopause brings, and make using a speculum very difficult if not intolerable. 

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When the Speculum is Not an Option

We recently spoke to Jennifer and Kristin, both women in their mid-50s, about their health conditions and inability to screen with a speculum. Jennifer experiences pain from a stenotic hymenal band (or, hymenal stenosis and fibrosis), while Kristin was diagnosed with chronic lichen sclerosus. 

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Hymenal stenosis and fibrosis is a rare condition where a fibrous ‘band’ develops on the hymen, making one’s vagina more sensitive and narrow. There is little research on this condition, but medical case studies note that symptoms may include pain with using tampons, intercourse, and recurring urinary infections. In most cases, the condition can only be resolved surgically, with a hymenectomy. 

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Lichen sclerosus affects up to 3% of the population, although prevalence is likely higher, since its symptoms are frequently misdiagnosed. It can cause a patient’s vulvar skin to thin and narrows their vaginal opening, so patients often experience tearing, inability to have sexual intercourse, pain during urination, constipation, itching, and soreness. If left untreated it can cause scarring that may lead to complete loss of one’s vulvar architecture. There is up to a 5% risk that lichen sclerosus evolves into vulvar cancers. 

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Dr. Liz Swenson, an OBGYN and Teal’s Medical Director, tells us, “Unfortunately, these situations are not that uncommon. Despite the range of speculum sizes, it can still be too painful for some women to tolerate. Even if they make it through the speculum exam it can still have a negative impact, causing some to put off that next visit.”

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Unable to tolerate speculums, Jennifer and Kristin describe how an alternative to the current in-person speculum exam experience would make the difference between being able to participate in routine screening or falling behind and facing heightened risks.  

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Jennifer’s Story

Jennifer has been a midwife for almost 25 years and is passionate about her work. As a provider, she conducts cervical cancer screenings and has witnessed women struggle with the speculum time and time again. However, while Jennifer insists her patients should stay up to date on their screenings, she has not been able to do this for herself.

For Jennifer, traditional speculum exams are painful and have led her to delay her own screenings. Her last screening was almost 10 years ago, much longer than the current recommendations. “The advice I give to people as far as when they should have screenings, I am not following it - I'm terrible!” 

Jennifer has seen several providers about her hymenal stenosis and fibrosis. She first began feeling this pain during perimenopause, around her 40s. However, it has worsened in the past several years as her vaginal tissue changed during menopause and she stopped being as sexually active. The various interventions, like estrogen creams, dilators, and surgical procedures, have not been suitable for Jennifer.

“A speculum exam, honestly, it’s somewhat like torture,” she tells me, as she explains that during her last screening she “basically whimpered and cried the whole time.” She dreads (and has thus delayed) her cervical cancer screening because of her vaginal tissue sensitivity.

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“A regular speculum would be really, really uncomfortable, to a point where I don't even know if I would tolerate it.”

Using a self-collection device designed for all body types, with the convenience and comfort of being in one's own home is a critical option for someone like Jennifer.  She not only struggles with the exam, but also with finding time on her days off as a healthcare provider. The added comfort would mean that Jennifer can screen without pain. 

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Kristin’s Story

Kristin was diagnosed with lichen sclerosus in 2009, making it extremely painful to screen with a speculum. She has not been screened for cervical cancer since 2019. Although, she did attempt a screening in 2023, where she tells me, “(My provider) wasn't able to get the speculum in, even the smallest size. So, we had to stop. It was just not going in.” After Kristin exclaimed in pain, the provider stopped and sent Kristin home without offering any screening alternatives. 

Unfortunately, Kristin has often experienced dismissive and unsupportive healthcare. “There's just a lack of empathy [...]. I just feel like I'm just a number. [...] I do tell them about my disease, but I don't feel like there's a lot of information out there.” Her providers insist that her vagina will stretch with the speculum, despite the terrible pain.

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“You know how they're like, ‘Spread your knees apart’? I could never do that. I was just like ‘No, I can't. It hurts. That’s as far as it goes.’ It just feels like I'm ripping!”

Kristin’s vaginal pain and narrowing intensified throughout menopause. She describes the feeling of enduring a speculum as “being stretched,” and that interventions like dilators do not work for the same reason.

Kristin desperately wants to stay on top of her screenings but does not know how, given that she cannot use a speculum. “From here, I'm not sure what to do.”

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She adds, “Before I got diagnosed, I kept up to date with my screenings. […] This is the first time that I’ve let it lapse. [….] I tried. I know it’s still important to get tested. I want to get it done.”

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Paving the Way Forward Requires More Screening Options

For both Jennifer and Kristin, the speculum is out of the question. Here, devices like the Teal Wand* offer a critical solution for engaging in routine cervical cancer screenings. Jennifer tells me, “Honestly, if the Teal device was available now I would do it, and I probably would be good about how often I have to do it.” 

Kristin, in particular, looks forward to self-collecting at-home, where she can feel at-ease and in-control. At the clinic, Kristin says she is immediately “triggered, nervous, and upset.”

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“Even when the doctor just touches me with the speculum, I tense up from my past experiences. But if I could just do it at home and take my time, take a bath and get relaxed, I could just go at my own pace and not feel rushed.” 

While seeing providers in-person is important and needed at times, an in-person pelvic exam is not always called for during routine cervical cancer screenings. For some, like Jennifer and Kristin, self-collection is a necessity and can enable them to stay up to date on cervical cancer screenings. 

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For too long, women and people with cervixes have been made to accept that their healthcare is inevitably painful and a matter of endurance. However, providing alternatives can make all the difference between allowing people to readily participate in – versus indefinitely delaying – their life-saving cervical cancer screenings (when caught early, through screening, cervical cancer can be cured 92% of the time). 

A seasoned midwife, Jennifer highlights, “Especially for women, it can feel like so many things are done to us, so doing it yourself feels great.” She adds, “that feeling that I have just taken charge of my own health and did this on my own? That’s wonderful.” 

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Thank you, Jennifer and Kristin, for being so generous with your time and perspectives. Teal Health is honored to share your stories.

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*The Teal Wand is not yet FDA approved, but has been designated as a Breakthrough Device by the FDA, prioritizing its review

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