NIMMI RAMANUJAM, DUKE UNIVERSITY
The work that I direct at Duke University’s Center for Global Women’s Health Technologies is based on the principle of human-centered design and, most importantly, values women-led research to address issues of women’s health disparities.
The story of the Pocket Colposcope shows how women in biophotonics can harness their creativity to transform women’s health through their unique perspective on issues they can personally connect with. The device, which is the result of five years of research, is a health care innovation that reimagines the way a gynecological exam is performed. It replaces a traditional speculum and a low-power microscope called the colposcope to reduce the discomfort, embarrassment and pain that the traditional gynecological exams cause.
James Marion Sims, “the father of gynecology,” developed the precursor to the modern speculum using a bent pewter spoon. He tested it on African-American slave women whom he purchased for his experiments. Anesthesia was not available at the time, but he chose to go ahead with the experiments on a vulnerable population that did not have the right to refuse his experimentation. His speculum, notably, was designed with no input from the subjects despite the immense pain the experiments caused them. More than 200 years after its invention, there have been few changes in the speculum’s original design. In fact, modern gynecology has evolved around it.
The speculum has been a major barrier in cervical cancer screening. In one study, more than 300 women in Moshi, Tanzania, revealed significant concerns about embarrassment and pain because of screening with the speculum. In another study, more than 90 percent of 133 Australian women indicated discomfort, embarrassment and vulnerability from having another person insert a device to examine their cervix. Even in the U.S., compliance rates to cervical cancer screening vary, and embarrassment and fear of pain during examination have been reported as potential barriers to screening.
Photonics has been key in reimagining the speculum and could potentially revolutionize modern gynecology. Currently, colposcopy is used as the confirmatory test for the presence of cervical cancer and its precursors. This involves the visualization of the cervix with a colposcope after the application of vinegar. A traditional colposcope is built around the speculum and by design is external to the cervix. It requires high-end optics, high-resolution cameras, a computer monitor or television screen, and a tall and weighted stand to stabilize the device while the provider visualizes the cervix.
The Pocket Colposcope is a tampon-like device developed by a female-led engineering team at Duke. Rather than visualizing the cervix from outside the speculum as other colposcopes do, our device can be used inside a speculum and, more importantly, without a speculum at all. Unlike traditional colposcopes, including recent low-cost redesigns, the Pocket Colposcope does not have a viewing system. Instead it has a consumer-grade light source and camera at the tip that, when inserted, can provide a live video stream or image of the cervix on a phone or tablet.
The ability to insert the colposcope through the vaginal canal enables a close-up view of the cervix (three centimeters rather than 30 centimeters away from the cervix), eliminating the need for high-end optics and high-resolution cameras, which make traditional colposcopes expensive. The speculum-free version is even amenable to self-examination. This involves a woman introducing a tampon-like inserter that houses our device. The image available on a smartphone helps her navigate the device to her cervix and to make quick adjustments if she feels discomfort, something that would be much more challenging for a provider to do.
According to the World Health Organization, 85 percent of cervical cancer deaths occur in low- and middle-income countries. But the disease is preventable and has well-developed solutions based on imaging strategies. Leveraging a low-cost and patient-friendly diagnostic such as the Pocket Colposcope could help close the gap between health outcomes in the developing and developed world. Moreover, the idea of having women do self-examinations could address two barriers: the shortage of health care providers in the most resource-poor environments and the ability for women to be agents of their own health. This technology also can be an educational tool and bolster advocacy campaigns for cervical cancer prevention. Our team, for example, is working on an art campaign to allow women to personally and visually become aware of their own reproductive anatomy.
Our device, which is in the final stage of commercial translation, resulted from photonic advancements, a human-centered approach to design and a team led by a woman for women. The team includes many female researchers who know from personal experience about fundamental barriers to health care and have the technical expertise to pursue alternatives. The project that reimagined traditional colposcopy demonstrates the need of a women’s perspective to address health issues related to women through technological advancements. However, women comprise only 11 percent of the workforce in the engineering field, and data has shown that women make up only 16 percent of the total membership of a major photonics organization, SPIE.
Biophotonics research can impact other women’s health fields such as breast and ovarian cancer screening and diagnosis; minimally invasive and conservative treatments of cervical, breast and other female cancers; and the reduction of maternal mortality. Because technological advances in women’s health benefit from a woman’s perspective, there is a compelling need to increase the pipeline of women in biophotonics who will play a central role in developing the technologies that will improve outcomes and save lives.
Meet the author
Nimmi Ramanujam is the Robert W. Carr Jr. Professor of Biomedical Engineering and director of the Center for Global Women’s Health Technologies at Duke University. She leads a multidisciplinary translational research program focused on the development of novel optical technologies for noninvasive or minimally invasive assessment of breast and cervical cancer; email:[email protected].