Improving Cervical Insufficiency Diagnostics: Designing a Device to Measure Uterine Cervical Stiffness; Conceptualizing and Communicating Women’s Pain

Boland, Emily, School of Engineering and Applied Science, University of Virginia
Guilford, William, EN-Biomed Engr Dept, University of Virginia
Ferguson, Sean, EN-Engineering and Society, University of Virginia

Medical knowledge is largely based on men’s bodies and was “discovered” by male-identifying researchers. Men are treated as the norm in the medical system, and women the aberration. In fact, for thousands of years, nearly all women’s illnesses were attributed to the uterus. The term hysteria, removed from clinics for less than 50 years ago, directly translates to wandering uterus. Over time, as public opinion shifted responsibility from the uterus to the brain, hysteria took on new meaning, but wasn’t even applied to men until Freud. Hence, while men’s symptoms and pain have historically been believed and investigated, women’s have been ignored. As a result, much of women’s health, including pregnancy and pain, is still largely misunderstood. This portfolio explores ways in which healthcare can maximize positive outcomes for women through two sub questions.

The first sub question addresses the surprising number of clinical unknowns surrounding pregnancy. Cervical insufficiency, wherein the uterine cervix cannot mechanically withstand forces exerted by a growing fetus in utero, occurs in 1/100 pregnancies, resulting in miscarriage or spontaneous preterm birth. Interventions exist to extend pregnancies, but current diagnostic methods often struggle to identify patients who may benefit. Although studies suggest cervical stiffness may be a better predictor of cervical insufficiency than current methods, there is no clinically approved way to quantify it. In our technical project, my team and I have designed two low-cost devices to accurately and reliably measure cervical stiffness, which aim to inform interventions to improve gestational outcomes.

The second sub question explores conceptualization and communication of women’s pain. Medical literature is rich with examples illustrating unequal treatment of men’s and women’s pain, but these inequalities persist. In my sociotechnical project, I analyze 12 women’s varied narratives surrounding pain management. Three key repeating themes reemerged: the power of a name, the impossibly thin line, and unknowing thyself. Even given the seeming universality of these experiences, no common words exist to capture them. Using hermeneutical injustice as a guiding framework, I contend that increased verbalization of these common hermeneutics serves to reclaim and recontextualize the very experiences that have been stigmatized for millennia and indicates a potential culture shift towards increased justice.

This portfolio is the culmination of many efforts over many years. Reproductive biomechanics have long been a passion of mine, although this technical project first gave me a chance to explore it. It would never have been born without Dr. Will Guilford’s insights and Dr. Donald Dudley’s guidance. Madeleine Hoang and Dr. Christopher Ennen were integral in raising that project from an idea to an actual device. I’ve spent countless hours holding discussions on gender equality through my work with Culture of Respect Educators and truly enjoyed the opportunity to connect that work to medicine. I had the good fortune of having two incredibly astute STS professors this year, Dr. Peter Norton and Dr. Sean Ferguson, both of whom largely guided that process and ultimately explain the narrowing of scope between my prospectus to my finished sociotechnical project.

BS (Bachelor of Science)
women's pain, narrative analysis, hermeneutical injustice, feminist, birth, cervical insufficiency, preterm birth, reproductive biomechanics, cervical stiffness, cervix

School of Engineering and Applied Science
Bachelor of Science in Biomedical Engineering
Technical Advisors: Will Guilford, Donald Dudley, Christopher Ennen
STS Advisor: Sean Ferguson
Technical Team Member: Madeleine Hoang

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