Photo by UniversalImagesGroup, via Getty. 

How Redesigning the Speculum Could Help Us Rethink the Rape Kit

In some cases, the speculum and rape kit can re-traumatize survivors by treating their bodies as crime scenes. Advocates say it's time to update them both.

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Mar 14 2019, 6:19pm

Photo by UniversalImagesGroup, via Getty. 

Erin Helfert Moësse was a Master’s student researching gender-based violence in Morocco when she was sexually assaulted by a housekeeper at an American diplomat’s New Year’s Eve party in 2008.

The next day, 26-year-old Helfert Moësse went to the police, bringing her clothing from that night in plastic bags and a written account of the assault. Then, without existing protocol for administering forensic exams to rely on, she personally found a general practitioner to perform a pelvic exam. But she had to tell him how to do it, she says.

“As best as I understood what a forensic exam was, I guided him through the process,” Helfert Moësse told Broadly. “I just had to dissociate from my body, take off my clothes, and have a male doctor do a pelvic exam on me, as well as other examinations on my body.”

“I had bite marks on my breasts, signs of having been penetrated very roughly; there were a lot of jagged lesions in my vagina that had been caused by fingernails; there were also lesions on the back of my throat, because the man had shoved his penis in my mouth very roughly,” she said. “I think I just went into autopilot and then tried not to think about it until I got home, then I definitely wept for quite some time.”

It would take five years and myriad bureaucratic and legal hurdles in both the US and Morocco for Helfert Moësse’s perpetrator to be brought to justice; he was eventually convicted and sentenced to six years in prison. Hers was the first case to use DNA evidence in a sexual assault trial in Morocco, according to RAINN, and ultimately, the rape kit did help her get justice. But the trauma of undergoing the forensic exam—like the pain of the assault itself—stays with her.

"What’s up with your rape cases?"

In the US, what is colloquially known as a “rape kit” hasn’t changed much since it was developed. Officially named for the Chicago police sergeant who helped create it, the “Vitullo Evidence Collection Kit” was unveiled in the late 1970s as a way to collect evidence from a person’s body using swabs, combs, slides, and fingernail clippings.

The kit itself and the protocols around it were rooted in the decade’s ideas about who was sexually assaulted and why; namely, that rape is a violent crime involving penetration by a stranger. Created in a time when marital rape was still legal in many states and LGBTQ people were still fighting to be heard, “the protocols of the rape kit gender[ed] sexual violence survivors as women, and the violence as taking place in public spaces rather than on dates or between partners,” sociologist Renee Shelby, the author of a 2018 paper on the history of the Vitullo kit, told Broadly.

Still, the kit was a revolutionary idea, and one that, while bearing the name of a man, was largely the work of grassroots feminists, according to Shelby’s research. Marty Goddard, a Chicago-based victim advocate, and Dr. Cynthia Porter Erie, an assistant professor at the University of Illinois at Chicago, were the driving force behind the rape kit, forming the Citizens Committee for Victim Assistance.

“This is the height of second-wave feminism, sisters are doing it for themselves, people are angry, the women’s movement is in full force, and in Chicago, there are these cases where women, survivors of sexual assault, are treated really poorly and it enrages these women,” Shelby explained.

So Goddard and Erie began cold-calling police departments, prosecutors, and crime labs to ask what the barriers to prosecuting rape cases were.

“They traveled around the state of Illinois, they would walk into police stations and say, ‘Hi, my name is Marty, what’s up with your rape cases?’” Shelby said. The women recall being told by police explained that the issue was in their inability to collect quality forensic evidence that could be preserved and analyzed.

Eventually, Goddard and Erie’s quest brought them to the Chicago Crime Lab and Sergeant Louis Vitullo, a high-profile officer in the department. Together, Goddard, Erie, and Vitullo— with funding from the Playboy Foundation—developed a standardized evidence collection protocol, trademarked it as the Vitullo kit, and used senior citizen volunteers to assemble the first 10,000 kits. Finally, they trained doctors and nurses how to use them.

The intention was “to standardize and protect evidence so that guilt can be established beyond a reasonable doubt —we want to avoid the loss, contamination, or alteration of evidence,” Vitullo told The New York Times in 1978.

"The rape kit as a source of power"

The Vitullo kit predated DNA analysis, but could use blood types to potentially identify perpetrators. And its creators believed that, in a time when (like today) many survivors of sexual assault were not believed, the kits would be a way to definitively prove the truth.

“They had this belief that science was foolproof and that you wouldn’t be able to have some sexist guy who doesn’t really understand the nuances of rape. Someone could say, ‘Actually, the science proves that this happened, you need to investigate my case,’’ Shelby explained. “They viewed the rape kit as a source of power that would give all survivors power, and in my opinion, I think they might have had too much faith in the science.”

With more recent research, we now know important stats that the creators couldn’t have taken into account: the fact that 33 percent of rapes are committed by a current or former partner or spouse, according RAINN, and eight out of ten rape victims know their accuser. The Vitullo kit, steeped in ideas that rapists are strangers who leave marks, saliva, blood, and semen on the body, can’t tell us about consent or about the circumstances that lead up to an assault.

“Most rapes don’t occur by some random stranger in an alleyway. Most rapes occur globally on an interpersonal level; someone that you know, someone in the family, it’s an intimate partner,” said Helfert Moësse, now an advocate for women and girls working on gender-based violence at Plan International. “So there aren’t going to be those kinds of trauma that, for example, I told the doctor to look for in my case. My case was almost exceptional in the fact that it was violent, and I don’t mean that in a good way.”

More than four decades after the Vitullo kit was unveiled, legal cases surrounding rape can still rely heavily on forensic evidence over survivor’s testimony, according to Jennifer Pierce-Weeks, a sexual assault nurse examiner (SANE) and the CEO of the International Association of Forensic Nurses.

“When the primary focus in these cases is on the evidence kit, one of the things we see happen is the relevance of what the patient is saying is diminished, because everyone is looking for some microscopic DNA example, and it feels as though that it is very dismissive of the clear statements being made by victims,” Pierce-Weeks explained.

"Your body clenches up"

Then there is the forensic exam itself, which many survivors find re-traumatizing when it is not done properly and with a trauma-informed approach. Sexual assault nurse examiners (SANEs) are specially trained to perform exams, but there is a dearth of them. So survivors’ experiences largely depend on where they live and who is working at the hospital when they walk in. The pelvic exam, which uses a speculum (a metal or plastic tool consisting of a handle and duckbill-shaped prongs that help open the vagina) and swabs to collect samples, can be particularly difficult, Helfert Moësse said.

“For a trauma survivor, often your body clenches up, and that includes the muscles of the vaginal wall, so it’s incredibly uncomfortable,” Helfert Moësse said. “It’s really, really quite an uncomfortable experience when you’re being told you have to loosen up or calm down, and you can’t calm down, you just have been through something extremely traumatic.”

The modern speculum hasn’t changed much since its invention in the 1840s by Dr. J. Marion Sims. Considered “the father of gynecology,” Sims conducted most of his experiments on unconsenting slave women, often without anesthesia. It’s this dark history—and the poorly designed, uncomfortable object itself—that Yona, a team of female industrial designers and engineers from Frog design, is trying to move away from.

“The speculum kind of started in this really dark place, and if you look at the original patent, it really hasn’t changed very much,” Fran Wang, a mechanical engineer on the Yona team, told Broadly. “While there has been a lot of modernization in different aspects of reproductive care, the speculum has always been one of those things that if you go to a clinic, you will see there are two common ones and they look very, very similar to the original patent.”

In order to redesign it, Yona researchers, including industrial designer Hailey Stewart, interviewed people with vaginas about their experiences around pelvic exams. That question “opened the floodgates,” Stewart told Broadly, and what the team found was that “it’s a very uncomfortable and very anxiety-inducing experience that we just tend not to talk about.”

Among the chief complaints were the cold metal or plastic material the speculum is made of, its wide, duckbill shape, the clicking sound it makes as it opens, and how it can sometimes pinch the labia. “It’s very utilitarian, so patients frequently complain of pain,” Wang said.

While the team didn’t specifically interview sexual assault survivors, many people offered up how trauma affected their experience of the exam.

“In our research, we had a lot of people reach out to us through email when our website went up, and there were several females and males who said they had experienced trauma, and part of negotiating the effects of that trauma is trying to deal with how this exam is done in such a way that it doesn’t cause further pain for them,” Wang said.

Yona’s rethinking of the speculum includes using sterilizable silicone, which is less cold and abrasive than metal or plastic, and having it open three ways instead of the current two, eliminating the unpleasant ratcheting noise and making it more gentle.

The Yona team is not in the testing or manufacturing phase yet, but they have offered up their research as an open source of information to spark a broader conversation about how the whole pelvic exam process can be improved.

“There are so many individuals who have very unique needs in this intimate, intimate exam process, so that comes down to looking at sexual assault survivors, people who are going in for the first time, LGBTQ people, people who have been diagnosed with HPV,” Stewart said. “If we can help create an exam that exudes comfort and reduces anxiety for them, it just trickles down to the rest of the individuals who have to experience an exam like this.”

Envisioning "a totally different way of doing rape kits"

Survivors and advocates say that when it comes to every facet of the rape kit—who performs it, where, and how—there is plenty that can be done to make the experience better. Of course, that includes making sure the kit is actually tested; hundreds of thousands of untested rape kits are currently sitting on the shelves of police departments and crime labs, according to End the Backlog.

“Having a female practitioner to do the exam seems very obvious, and that’s in the case of a male or female, but of course, it should be up to the choice of the survivor,” Helfert Moësse said.

Where and how the kit is performed could also change, Shelby said.

“What if you could do it at home? Or what if you could do it at your victim advocacy organization that is comfortable and you feel like you know them and the environment is not a dingy hospital that probably has very few sexual assault nurse examiners, if any?” Shelby said. “We could envision—if we have some smart minds in the room and all collaborate—a totally different way of doing rape kits.”

It’s also about shifting the narrative that it is at the very heart of the original Vitullo kit; that a sexual assault survivor’s body is a crime scene, and that forensic evidence should always be necessary to prove a victim’s testimony.

“It’s not just seeing the person as a body, it’s seeing the survivor as a holistic human being who had just as much of a psycho-emotional experience as they had a bodily experience. I think there needs to be much more psychosocial support,” Helfert Moësse said.

Pierce-Weeks agreed.

“One of the things that we do not like to hear is the reference to the patient that we take care of as their ‘body is a crime scene,’” she said. “Not only does this lead to an absolutely not trauma-informed approach, but it also contributes to this sort of myth that somehow nurses, who are healthcare professionals, are really an arm of law enforcement, which could not be further from the truth.

“My job as a nurse is to have sensitivity toward what is bringing that person forward for care, and to approach that person as the human being that they are, not to see them as a microscopic specimen,” she added.

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Ultimately, it’s about changing not just the objects—the speculum, the rape kit—but the process and prevailing attitudes around them, including in the courtroom, advocates say. It just won’t work to change one without the other.

“That product doesn’t live alone. So that experience that is around it is just as important as the product itself. Even if you improve that product but keep it in its current environment and don’t take a look at that holistically, it will fall flat,” Stewart said.