Molly Callahan has up to 16 speculums inserted into her vagina on her busiest days while working full-time as a gynecological teaching assistant, helping medical students practice cervical cancer screenings and breast examinations before treating actual patients, The Guardian reported.
Pap smears have reduced cervical cancer-related deaths by 86%, according to data cited by The Guardian, yet many women avoid the screening due to confusion over guidelines, lack of symptoms, and speculum discomfort or embarrassment.
A large study of US cancer statistics found that from 2005 to 2023, 32% of women aged 21 to 29 and 15% of women aged 30 to 65 had never received a pap smear, a disparity driven largely by historical medical frameworks that prioritized diagnostic possibilities over patient comfort.
How Patients Can Minimize Discomfort During Examinations
- Speculum Selection: Speculums are available in multiple sizes, including pediatric, small, medium, and large. Patients can request smaller sizes or alternative methods like a blind swab to minimize physical discomfort.
- Procedural Communication: A proper pelvic examination functions as a collaboration where providers explain each step, monitor for physical tension or wincing, and use techniques like touching the inner thigh first to establish consent.
- Longitudinal Tracking: Tracking personal anatomical changes and historical experiences with providers helps patients advocate for comfortable, evidence-based care during subsequent appointments.
Training Medical Students on Gynecological Teaching Assistants
Gynecological teaching assistants emerged in the 1970s to improve the ethics and educational quality of pelvic examinations, which were historically performed on anesthetized patients. Today, more than 90% of medical schools in the US and Canada utilize teaching assistants like Callahan, who teaches at 30 universities and hospitals in the tri-state area, as reported by The Guardian.
Callahan observed that despite earning nearly $100 per hour with a flexible schedule, approximately 40 teaching assistants operate in the tri-state area alongside more than 15,000 medical students. Trainees spend two months learning anatomy, breast and pelvic examination tactics, cervical swabbing, and abnormality detection before passing a final test.
“If [your] reaction to my job is that it sounds like torture, I hope you feel scammed” Speaking to The Guardian, the 30-year-old Callahan also serves as president of an international association for GTAs and MUTAs (male urogenital teaching associates).
During a teaching session observed by The Guardian in Teaneck, New Jersey, Callahan instructed two labor and delivery nursing students from Fairleigh Dickinson University on performing tactile breast examinations on the outer tissue and underarms where malignancies are most prevalent. She guided the students through pelvic examination protocols, including checking the labia for redness, inspecting the clitoral hood for adhesions, and examining vestibular glands for cysts.
Historical Context of Cervical Examination Comfort
“So much of that conversation [on pap smears] was about the medical possibilities, not about the impact on the female patient,” Dr Kirsten Gardner, director of medical humanities at the University of Texas San Antonio, told The Guardian. Early 20th-century cervical cancer screening methods concentrated heavily on early detection metrics rather than patient sentiment.
Gardner pointed to research by biologist and sexologist Alfred Kinsey in the 1950s, where cotton probes stroked the cervix of study participants; only 5% of 878 participants felt the sensation, while a larger object elicited responses from 84%. Only the former finding entered the final draft, reinforcing the clinical consensus that the cervix lacked sensitivity.
| Metric / Study Group | Data Point | Context & Source |
|---|---|---|
| Cervical Cancer Mortality | 86% reduction | Impact of screening programs |
| Never Screened (Ages 21–29) | 32% | US cancer statistics, 2005–2023 |
| Never Screened (Ages 30–65) | 15% | US cancer statistics, 2005–2023 |
| Kinsey Report Cervical Sensation | 5% vs 84% | Cotton probe vs larger object response rates |
Dr Corey Babb, medical director of the Haven Center in Tulsa, Oklahoma, told The Guardian that larger speculums are frequently selected by default because they push away more tissue for visualization. Babb said that patients can mitigate discomfort by requesting warmed, well-lubricated speculums, alternative insertion methods, or nitrous oxide when available.
Medical providers operate under the assumption that everyone hates the process, considers it awful and bizarre, yet Callahan mentioned to The Guardian that this experience does not have to remain that way.
Contraindications & When to Consult a Doctor
Patients experiencing persistent pelvic pain, dyspareunia (pain during sexual intercourse), unusual bleeding, or sudden changes in breast tissue firmness should consult a qualified healthcare provider immediately. Individuals with severe trauma histories, vaginismus, or acute pelvic infections must discuss specialized accommodation options—such as patient-inserted speculums, pediatric-sized instruments, or sedation options—with their obstetrician-gynecologist prior to undergoing routine cervical screenings.
