Why is gynecology still using a Civil War-era tool?

Taylor Townsell remembers her OBGYN reassuring her that her IUD insertion would feel like “just a pinch.” The pain came a split second later. The 32-year-old described it to Truthdig and 19th News in still-vivid detail: “Bright, electric, as if my body had become nothing but nerve endings.” She passed out.

Six years later, in 2023, as the time to get a new IUD inserted came closer and closer, Townsell grew increasingly terrified. For medical reasons, the IUD was the only contraceptive available to her — “though my doctor in Tennessee did suggest abstinence,” she noted. “I felt powerless,” she said.

Townsell wanted to understand what had happened to her back in 2017 and figure out whether the pain could be avoided this time around. On Instagram’s #IUDinsertion, she came across patient testimonies just like hers. Some even filmed themselves during the procedure: crying, vomiting, fainting, bleeding through paper gowns.

Townsell learned that the source of her pain was not her IUD itself but the instrument used to insert it: the tenaculum forceps. This was her first time hearing about the tenaculum, let alone seeing it. “I sort of understand why they don’t show it to us before using it in us,” she said: “It looks more like a medieval torture device than a gynecological tool.”

Shaped like a pair of metal scissors, the tenaculum’s sharp, pointed claws, curved inward, grab onto the cervix to stabilize it and grant easier access into the uterus. “That’s the pinch I’d been so casually warned about,” Townsell realized — though she described it more “like being stapled on the inside.”

A highly effective tool, the tenaculum is still routinely used without anesthesia on 120 million patients a year for IUD insertions, biopsies, hysteroscopies, and fertility treatments. It causes mild to severe pain in 90% of patients and has remained largely unchanged for over 135 years.

Though Townsell finally knew why she’d felt such pain, she couldn’t seem to find a way around it. Until one day, her online search led her to the website of a medical device company named Aspivix, which claimed to be “reimagining gynecology with ‘gentle’ in mind.”

Townsell read all about Carevix, a suction-based device to alleviate pain during cervical procedures. The tenaculum’s sharp metal claws were replaced with a plastic suction wand, which gently stabilizes the cervix without piercing it, dramatically reducing pain and bleeding during procedures.

“I knew this was what I’d been looking for,” Townsell said.

At your cervix

The story of Aspivix begins, improbably enough, with three men.

By the mid-2010s, David Finci, a Swiss OBGYN, had grown increasingly uncomfortable using the tenaculum on his patients during IUD insertions. Ikram Guerd, Aspivix’s general manager and CMO, said that Finci often felt “ashamed” of hurting his patients with a tool that had been adapted from a Civil War-era bullet extractor.

Several decades ago, researchers proved that the cervix is actually dense with nerve endings. Though the science has been corrected, the instrument itself hasn’t. The same goes for the cold, metal speculum; tested on enslaved Black women and still routinely described as the “can opener” by uncomfortable patients, it continues to be sold, taught, and used, often alongside Pozzi’s bullet extractor.

In 2015, Finci turned to his brother Julien — a medical device engineer — for help designing an alternative to the tenaculum. They were soon joined by Mathieu Horras, a colleague from the med-tech world. Together, the trio began experimenting.

Carevix’s origins are almost implausibly earnest. Inspired by the vacuum pump used in obstetrical procedures to pull the baby out during difficult deliveries, Finci knew what he wanted from the start: to use suction rather than claws to grab and hold the cervix without piercing it. “I had no idea what a cervix even looked like,” his brother Julien said with a laugh, “so my first prototype was completely upside down, and totally unusable on an actual cervix.” David eventually stepped in, using his kids’ Play-Doh to model a cervix for Julien to work with.

This origin story captures a broader contradiction within gynecology itself — a field historically shaped by men attempting to solve problems they did not physically experience and often did not fully understand. Many of the technologies and procedures governing reproductive care are still designed, financed, and approved within overwhelmingly male institutional structures. Aspivix’s founders seem aware of that imbalance, frequently citing Horras’s wife, a midwife, as a “constant source of inspiration” during the device’s early development.

When the three men finally figured out a design, they quit their jobs to launch Aspivix full-time and develop Carevix — a portmanteau of “care” and “cervix.”

Carevix was tested against the standard cervical tenaculum in a randomized controlled trial involving 100 women undergoing IUD insertion, who were asked to rate their pain levels throughout the process. These trials found that Carevix reduced pain during IUD insertion by up to 73% and bleeding by 78%, compared to the tenaculum.

Aspivix has since grown into a 14-person team that includes eight women.

‘Selling ballet shoes to a football team‘

Developing Carevix was one thing. Convincing financiers to confront an instrument many had never heard of, and a pain they had never experienced, was another entirely.

“Here we were,” Julien said, “three men trying to pitch rooms full of male investors a tool meant to alleviate cervical pain: it was like trying to sell ballet shoes to a football team.”

Over the past two decades, studies have repeatedly found that women are more likely to have their symptoms minimized, attributed to anxiety or emotion, and treated later and less aggressively — particularly when the pain is gynecological in origin.

To bridge the empathy gap in potential investors, Horras began carrying an old tenaculum in his bag. During pitch meetings, he’d pinch their fingers with it, asking them to imagine this same tool being used on their most sensitive bits. “They tend to all close their legs at once,” Guerd said with a laugh.

Growing more serious, Guerd added: “That’s when we would tell them that women have somehow been expected to normalize this exact sensation for centuries, without anesthesia.” Too often, investors would still leave the meeting with vague promises to ask their wives or girlfriends about the tenaculum, she said. “There’s still this reflex where anything involving the female anatomy immediately becomes niche,” Guerd said.

What Aspivix needed, they soon realized, was a story. The team began telling the story of a fictional young woman named Emma, a young student who accidentally fell pregnant because she was too afraid to have an IUD inserted. Investors, Julien explained, seemed more responsive to the broader social consequences of gynecological pain — unwanted pregnancy, contraception failure, lack of reproductive autonomy — than to the pain itself.

“Protected sex,” he said. “That caught their attention.”

In 2015, Bioceptive, a medical device company based in Louisiana, received Food and Drug Administration clearance for its own cervical suction retractor, which creates a portal through the cervix without needing a tenaculum. Like Aspivix, the company foregrounds its tool’s use in avoiding the undesirable “side effects” of pain and bleeding that “discouraged some women from necessary procedures.” As for pain itself, it, again, takes a back seat.

A no-brainer?

By 2024, Carevix had received FDA clearance and had been named one of Time magazine’s best inventions.

“You would think it would be a no-brainer,” Guerd said from California, where the company has spent the past two years trying to persuade U.S. hospitals and clinics to abandon the tenaculum. “You present the two instruments side by side and think: ‘Obviously doctors won’t choose the scary-looking scissors.’” But, as it turns out, she said, they often do.

The reason is, in part, inertia. The tenaculum is cheap, reusable, and embedded in medical training. Entire workflows are built around it. To replace it requires not only a new device but retraining, new purchasing approvals, reimbursement negotiations, and — perhaps hardest of all — convincing doctors to spend more time and money solving a pain many still underestimate.

Over the past two decades, a whole array of FemTech startups have run into similar roadblocks when attempting to redesign the speculum — the dreaded duck-shaped metal tool used to look into the vaginal opening. These new alternatives are made out of plastic, silicone, or polyurethane; some are inflatable, others come equipped with LED lights or come with fuzzy comfort socks. But few have actually made it into doctors’ offices. The barriers to entry still feel too high — especially when very few patients actually complain directly to their doctor about the speculum as it is.

Some doctors, Julien said, reacted defensively when presented with Carevix, insisting that the tenaculum worked perfectly well for them and that they would never hurt their patients.

“There’s a lot of ego involved,” Guerd added. Aspivix had initially hoped patients themselves would help accelerate adoption by requesting Carevix directly from providers. But that strategy occasionally backfired: “We had one patient who was extremely enthusiastic and brought the tool up to her doctor,” she recalled. The physician didn’t appreciate learning from their own patient that a new alternative existed and refused to use it.

“You often also have to convince doctors that there’s something in it for them,” Julien said. With this in mind, Aspivix began emphasizing that less bleeding meant less cleanup, that less fainting meant quicker turnover in examination rooms, and that happy patients tended to come back and recommend the practice to their friends.

Insurance, however, has only complicated matters. One of Aspivix’s biggest challenges, Guerd explained, is reimbursement. Insurers remain reluctant to cover “elective” pain relief during gynecological procedures, which leaves many patients with out-of-pocket costs.

To navigate that obstacle, Aspivix introduced what it calls a “Letter of Medical Necessity” on its website. Patients can download the document, ask their physician to sign it, and submit it to their insurer in hopes of securing reimbursement. “The idea,” Guerd explained, “was to create pressure on insurance companies by showing there is real patient demand for pain management options in gynecological care.”

Patient-centered and driven

Self-doubt remains one of gynecology’s quietest inheritances. Even the language clinicians use during procedures performs a kind of anticipatory minimization: Patients are told to expect “pressure,” “mild discomfort,” or “a small pinch.”

Growing distrust in the medical establishment left many patients fearful and anxious. Over time, thanks to social media, many realized that their pain was not mysterious or personal but rather systemic. POVs of painful IUD insertions were followed by multiple videos of Black women in labor writhing in pain in hospitals as they were ignored.

In the past few years, Aspivix has come to rely on this growing resistance to create momentum. One of the company’s earliest American adopters, Natalie Paul, a nurse practitioner and founder of Lavender Spectrum Health in Portland, Oregon, posted a Carevix demonstration on TikTok. The video quickly went viral, and patients began flooding in.

“Before adopting Carevix,” Paul said, “I had nearly stopped offering IUD insertions altogether. I hated doing it. I hated hurting people.” But when Carevix became available in the United States, Paul, whose practice focuses heavily on trauma-informed care, immediately ordered a dozen devices. Much of the response to the video, both online and in the clinic, Paul said, was less about technological fascination than relief at seeing a provider publicly acknowledge that gynecological pain mattered.

Aspivix began rolling out Carevix territory by territory, focusing on smaller regional networks before attempting national expansion. Guerd compared the strategy to “political campaigning”: train enough doctors in one area, generate enough patient demand, then gradually widen the circle. “The goal,” she explained, “is for a patient to be able to show up and ask about Carevix, “and the doctor already knows it, already trusts it, already knows how to use it.”

Carevix is now offered by some 50 providers across the United States.

The shift opened by patients has begun to ripple through medicine itself. In 2024, the Centers for Disease Control and Prevention updated its recommendations around pain management during IUD insertion, acknowledging that pain is often underestimated and poorly managed. The following year, the American College of Obstetricians and Gynecologists issued new guidance emphasizing patient-centered gynecological care.

One size fits all?

Of course, the device itself isn’t a panacea, and some parts of it could still use improvement, doctors say. But its limitations themselves expose a deeper problem: Efforts to make gynecology gentler are necessarily complicated by centuries of disregard for gynecological care. Though well-informed (and well-insured) patients can pick from an array of pain management options (ranging from ibuprofen or anti-anxiety medication to general anesthesia), none of these address the root cause of said pain.

Alissa Conklin, an assistant professor of obstetrics and gynecology at Indiana University, ran the first U.S. pilot study on Carevix. “I volunteered,” she said, “because no one’s invented anything new to hold onto the cervix since the 1890s. That sounded amazing. ”

After months of trials, she found that the device significantly reduces pain during IUD insertion, but that it has some practical limitations that the tenaculum didn’t. In some cases, she said, if the cervix is too small, if it has any cysts on it, if its shape has changed after pregnancy, Carevix’s current U-shaped suction cup just isn’t the right fit, or could actually end up causing bleeding. Conklin also pointed to the device’s current size and shape — “a long plastic wand with a fat handle” — which doesn’t fit into smaller speculums and can sometimes be difficult to handle when you’re used to the small tenaculum.

“It’s not a perfect replacement. But it also doesn’t poke holes in your patient’s cervix,” she concluded with a dry laugh. “So that’s nice.”

Something several practitioners also pointed out is that the device is currently single-use and significantly more expensive than a reusable metal tenaculum — depending on the size of a provider’s order, they could pay $50, $35, or $25 per device — creating financial strain for clinics with tighter budgets. Recent tariffs on imported goods have further complicated distribution in the United States. “The challenge,” Conklin explained, “is that the places serving the most vulnerable patients are often the least able to absorb additional costs.”

The team at Aspivix said that they are working on developing a reusable version of their device and attempting to adapt its suction cup to a more varied set of anatomies.

Even if massively adopted, Carevix would not solve every problem in gynecology. The process of measuring the uterus ahead of an IUD insertion can still hurt regardless of the tool used to hold the cervix. With or without Carevix, women still report severe cramping during and after insertions.

But now, Conklin pointed out, patients have options. “I think we as providers could do a much better job at providing patients with that autonomy,” she said. “Some patients, the younger ones, come here ready for that. They own the body, they own their experience, and they are 100% going to speak up for themselves. But I try to speak for the people who aren’t yet ready to speak for themselves — older women, Black women, patients whose pain has long been ignored — to let them know: You have that right, you have these options.”

Being heard

When Townsell found Aspivix’s website in her online search for an alternative to the tenaculum, she sent them a panicked email: “I basically wrote: ‘Please, please help me. I don’t know if I can do this again.’” Someone from the company replied almost immediately, and then followed up when she hadn’t answered. She was put in touch with physicians at Columbia University Medical Center, one of the first sites in the United States offering Carevix.

At the time, Townsell lived in Philadelphia. During her trip to New York, she braced herself for another traumatic ordeal. Accompanied by a supervising physician, a trainee, a patient advocate, and her boyfriend, she underwent the procedure using Carevix. “I kept waiting for the horrible part,” she said, “and then, suddenly, it was over.”

What stayed with her most, however, was not merely the absence of pain but the atmosphere surrounding the procedure itself. The doctors actually showed her the instrument to be used on her. They treated her fear as rational rather than exaggerated.

“It was the first time I felt like my pain had been anticipated instead of dismissed,” she said. “Women have been saying this hurts forever — it feels like we’re just now being heard.”

This article was co-published with Truthdig.

This story was produced by 19th News and reviewed and distributed by Stacker.