Clifton Boje, of Bonner Springs, demonstrates his anti-abortion views on March 5, 2025, outside the Senate chamber entrance at the Statehouse in Topeka. (Photo by Sherman Smith/Kansas Reflector)
It’s all about abortion.
It’s always been all about abortion.
The constitutional amendment calling for popular elections of Kansas Supreme Court justices has one central motivation: Allowing Republican officials to limit or ban abortion. And I will go out on a limb and predict that if the measure passes, elected justices will eventually sustain such limits or bans.
Yes, Kansans voted on abortion rights back in 2022. Yes, the subject has come up again, this time clothed in ever-more confusing language.
Kansas Reflector video
Both anti-abortion residents and abortion-right supporters should take a few minutes to understand how we got here, a mere four years after “Value Them Both” went down in flames. We all deserve straightforward truth about the amendment, not political spin. While I might not be the biggest fan of Republican Attorney General Kris Kobach, at least he didn’t run for the office claiming to be Ben Affleck.
And this amendment, while claiming to revere democracy, could well lead to a total abortion ban in a state that just rejected such restrictions.
Abortion rights have been contested in Kansas for decades, but the origins of this particular push to remake the Supreme Court originate with its 2019 decision in Hodes and Nauser. The justices ruled that “Section 1 of the Kansas Constitution Bill of Rights affords protection of the right of personal autonomy. … This right allows a woman to make her own decisions regarding her body, health, family formation, and family life — decisions that can include whether to continue a pregnancy.”
The Value Them Both amendment push of 2022 sought to overturn that finding and allow legislators to pass abortion limits. Advocates claimed the measure didn’t mean a ban on the procedure, but Kansas Reflector editor Sherman Smith revealed that officials told supporters that was exactly their intention.
The amendment failed by a nearly 20-point margin on Aug. 2, 2022, less than two months after the U.S. Supreme Court overturned Roe v. Wade and unleashed a wave of draconian restrictions across the country.
Less than two months later, then-attorney general candidate Kobach said what anti-abortion advocates had whispered. It was time to change tactics. If voters wouldn’t agree to ban abortion, it was time to enable the selection of state Supreme Court justices who would. That is, they needed to change the rules to win.
The Wichita Eagle’s Chance Swaim and Katie Bernard covered Kobach’s speech to the Wichita Pachyderm Club, where he proclaimed: “This issue is not over. The fight for life is going to continue.”
The Hodes decision created a huge problem for the movement, Kobach said: “There are two paths. One is to come in with a state constitutional amendment that corrects the decision. That’s what we just tried to do, and it didn’t work out. But there’s another path.”
He said the Legislature should pass another constitutional amendment, one exactly like the amendment appearing on ballots next month. That, he said, would allow advocates to “slowly and quietly” place anti-abortion justices on the court through popular elections.
In 2025, the Republican supermajorities in the Kansas House and Senate followed Kobach’s advice.
They followed their exact tactics from the last go-round, putting the judicial selection amendment on the low-turnout Aug. 4 primary ballot. Their hope, I believe, was and is to keep our state’s hefty number of unaffiliated voters from showing up. For reference, Kansas has more unaffiliated voters than registered Democrats.
Also in 2025, another high-ranking Republican made clear what he hoped to accomplish with the amendment. That would be Senate President Ty Masterson, who told the Marion County Patriots for Liberty in November that reversing the Hodes decision required electing judges.
“The solution in Kansas is that Supreme Court election,” he said. “But you can’t go out there and say it because they’ll say that if you elect your Supreme Court, you won’t have any right to abortion anymore.”
In other words, the Senate president and gubernatorial candidate said, you can’t tell the truth.
Neither Kobach nor Masterson have sought to deny or walk back their widely circulated statements, so I think we can take them as accurate representations of what top Kansas Republicans believe.
I’m not some wild-eyed alarmist out here (not to discourage the valuable work of other wild-eyed alarmists). The Kansas City Star’s Kacen Bayless reported last week about both the Kansas amendment and one in Missouri: “The two constitutional amendments could pave the way for Republicans to clamp down on abortion access for years to come. The votes illustrate a new playbook for abortion opponents after voters in both states recently protected the right to the procedure.”
If the amendment passes, any changes would all take time. The Legislature would have to create a framework for statewide judicial elections (the amendment itself offers few hard guidelines). The high court’s composition would shift gradually, as appointed justices departed and elected ones join.
Eventually, lawmakers could pass abortion restrictions with confidence that the court would find them constitutional. A ban would follow, soon as night follows day.
There’s more to it, of course. The amendment would affect many other issues and have broad implications for Kansas politics. As I wrote in May, it would fundamentally alter the state Supreme Court from a staid, merit-based body to one molded by out-of-control campaign spending and partisan rhetoric. School funding and LGBTQ+ rights could be shredded by a hostile new court.
But I keep coming back to abortion. Kansans wouldn’t be voting on the amendment next month otherwise.
Clay Wirestone is Kansas Reflector opinion editor. Through its opinion section, Kansas Reflector works to amplify the voices of people who are affected by public policies or excluded from public debate. Find information, including how to submit your own commentary, here.
ICE has already been operating like a paramilitary kidnapping squad. Officers roam through neighborhoods, stake out hardware store parking lots, and even occasionally enjoy some ethnic food just so they can raid the source of hospitality later.
It’s nasty, disturbing, and definitely doesn’t resemble any of the things that have made America great. Now, the rot has spread. It’s not enough for ICE to engage in daylight snatchings on the regular. Now, its internal oversight office has abandoned any pretense of keeping ICE in line. In fact, it has completely gone in the opposite direction, turning this wing of ICE into another set of secret police, as this report from Wired makes clear:
Voting was already underway when the ICE agents arrived at a polling site in Syracuse, New York, during the state’s primaries in June. The agents were there to see Paigelynne Gonyea, a poll worker who says they were concerned about an Instagram post she had supposedly made in January “doxing” an ICE agent. The only post she could find was one she had made crediting the Minnesota Star Tribune for identifying Jonathan Ross, the ICE agent who shot and killed Renee Good during the federal incursion in Minneapolis this winter, and calling for his indictment.
The agents at the poll site asked Gonyea to sign a warning notice that said it was unlawful to “threaten to assault, kidnap and/or murder” federal officials or their immediate family members in an effort to impede that federal official’s work. The form also requested that she remove her post “and/or discontinue” her behavior.
“My signature would have been an admission of guilt,” Gonyea says. “I refused to sign it.”
That’s just one person who’s been subjected to the OPR’s decision to stop investigating allegations against ICE officers to focus on allegations of external “threats” to ICE officers. There are more. Many more.
OPR was behind at least one of the flurry of administrative subpoenas sent to tech companies in recent months in an effort to unmask online critics.
[…]
In a court declaration filed in April, an ICE official said that between January 2025 and March 2026, OPR investigated 131 cases involving “incidents of doxing and threats directed towards ICE employees nationwide.”
That’s fucked up. This is definitely not what the Office of Professional Responsibility is supposed to be doing. According to the ICE OPR itself, its purview is limited to investigatingICE.
The ICE Office of Professional Responsibility (OPR) upholds the agency’s professional standards through a multi-disciplinary approach of security, inspections and investigations to promote organizational health, integrity, and accountability across the agency. OPR promotes organizational integrity by vigilantly managing ICE’s security programs, conducting independent reviews of ICE programs and operations, and impartially investigating allegations of employee and contractor misconduct.
To promote integrity, mitigate risk and uphold the agency’s professional standards, the OPR-led Integrity Coordination Center receives and assesses information it receives and refers any allegations of employee misconduct to appropriate offices for investigation, if necessary. This process ensures that allegations of criminal or administrative misconduct against ICE personnel are properly assessed and thoroughly investigated. OPR’s role permits the agency to focus on its larger mission of promoting homeland security and public safety.
Nothing in this says the OPR is investigating ICE critics. Nothing in this even minimally suggests the OPR’s directives can be expanded to cover external investigations of US citizens over social media posts, etc.
You have to scroll down the page a bit and expand a few things before you find ICE OPR’s justifications for being America’s ICE-focused Gestapo:
OPR protects the agency by detecting, preventing, mitigating and investigating internal and external threats against the agency, ICE senior leaders and ICE headquarters facilities by managing the ICE Insider Threat Program and counterintelligence functions involving ICE personnel.
This is new language, specific to Trump’s version of ICE. It wasn’t there last year. There’s nothing in this December 2018 OIG report on ICE OPR operations that says anything at all about “detecting, preventing, mitigating and investigating external threats.” There’s nothing in this 2008 OPR directive that says anything more than that the OPR is tasked with investigating allegations against ICE officers or personnel handling its detention facilities.
So, it’s reasonable to believe this language was added shortly after (March 2026) the OPR was rerouted to hunt down ICE critics, rather than focus on what must be thousands of complaints about ICE officers and/or detention facilities.
And despite these efforts apparently being well underway by April 2026, acting ICE director Todd Lyons made sure he didn’t bring up that part of OPR’s operations up when publicly testifying before Congress.
In written testimony for an April hearing with the House Appropriations Committee, which helps set the budget for DHS, Lyons touted OPR’s work inspecting detention facilities, vetting job applicants, and overseeing the agency’s 287(g) program, but didn’t mention the office’s work investigating online posters. ICE did not respond to questions about why Lyons didn’t discuss that work.
First off, the OPR should not be doing this, full stop. There are plenty of federal law enforcement resources available to be utilized in the rare case where an actual threat exists. Second, the OPR has never done this prior to being run by this administration. Third, this rerouting of OPR’s resources makes it clear the administration is more interested in punishing critics (First Amendment be damned) than engaging in any minimal oversight of ICE’s activities.
And this is bad news for the nation, obviously. If this OPR can be turned into literal speech police, the same can be expected from any other law enforcement agency with an in-house OPR. That’s tyranny. That’s fascism. That’s an entire administration treating Trump like a king and 325 million Americans subjects. It’s not only unacceptable, it’s antithetical to everything America once stood for. And all of this news arrives shortly Trump presided over the Republic’s wake on July 4th. We had a good run, but it’s probably time to stop pretending we don’t have a second King George that needs to be shown the door.
Wednesday, John Deere agreed to give farmers broader access to repair their tractors and farm equipment under an antitrust settlement agreement with the Federal Trade Commission, one of the biggest wins in the long right to repair battle. The settlement is the latest and by far the most important development in several recent lawsuits against John Deere, and is finally an agreement that isn’t full of half measures and doesn’t have massive, obvious loopholes.
The FTC settlement is far better than a recent, highly controversial settlement in a separate class action lawsuit against Deere brought by farmers in Illinois, and it’s worth breaking down the differences. Two years ago, I wrote an article called “The Walls Are Closing in on John Deere’s Tractor Repair Monopoly,” which followed that Illinois case, in which several farmers brought a complex, class action antitrust lawsuit against Deere. The judge in that case, Iain Johnson, wrote several scathing opinions about Deere’s anti-repair practices that indicated that he was seemingly inclined to hit Deere with stiff penalties.
But after years of litigation, the plaintiffs in that case decided to settle with Deere in April, earning a $99 million payout for farmers who paid for repairs over the last decade, and several right-to-repair protections that did not have much in the way of legal teeth.
This $99 million payout was roughly $79 million after legal fees and to be divided among more than 200,000 farmers; this means each farmer will receive roughly $395, or “less than the cost of a single authorized dealer service call for a typical 500-acre farm,” according to an analysis by Willie Cade, a longtime farm right to repair advocate.
“Bottom line is that farmers are getting $0.79 per acre for the eight years of Deere abuse,” Cade told me. “Bad settlement. The settlement is insufficient … the money is a small fraction of what the class could recover at trial, the claims process depends on labor-hour data only Deere holds, and the repair "fixes" are riddled with loopholes that leave Deere's monopoly intact.”
The Illinois settlement would prohibit farmers covered by it from filing any future repair-related litigation against Deere, and only required Deere to provide parts and repair guides to farmers under poorly defined “fair and reasonable” terms, a loophole that other manufacturers have used to claim that their parts and tools are constantly out of stock or cost astronomic prices.
“The ‘fair and reasonable terms’ standard is not price equality with dealers, nor is it a guaranteed price ceiling,” Cade wrote in his analysis. “Disputes about whether Deere’s pricing meets this standard are subject to Court oversight, but individual farmers may have limited practical ability to challenge pricing that does not obviously cross the line.”
The settlement in the Illinois case was so bad that one of the plaintiffs in the case, Wilson Farms, filed a 53 page formal objection to it two weeks ago, in part because it claims that there are many “unlitigated and uncompensated” cases in which farmers suffered under Deere’s monopoly. Under the settlement, farmers would no longer be able to sue Deere by “terminat[ing] Class members’ ability to collectively challenge Deere’s repair aftermarket monopolization for a generation.”
“Rather than provide any meaningful benefit to the Class, it appears that the proposed Settlement’s most important effect will be to give Deere its most powerful tool yet in its decades-long effort to block farmers from repairing their own equipment,” the objection says. “Extinguishment of farmers’ rights under the law.”
The good news is that the wildly disappointing and seemingly unnecessary selling out of farmers’ rights in the Illinois case that Deere appeared to be losing very badly is greatly mitigated by the FTC’s settlement from this week. The FTC case was brought by Lina Khan under the Biden administration; to its credit, the Trump administration decided to continue litigating.
The FTC settlement does not have monetary damages for farmers, but it has far better right to repair protections for John Deere customers moving forward. In the FTC deal, the “fair and reasonable terms” are better defined and are based on the price that John Deere dealers actually pay for repair parts and tools. Deere and its dealers are not allowed to “discriminate or retaliate” against farmers who repair their own equipment (manufacturers have been known to brick devices that consumers fix themselves). The FTC settlement also includes access to farmers for “future repair resources,” meaning repair tools, guides, software, and parts that Deere creates in the future.
Deere must also file “compliance reports” with the FTC, and the FTC will have oversight of the compliance. Crucially, the FTC settlement also does not affect farmers’ private grievances against Deere, meaning it is possible for farmers to sue Deere if the company’s repair practices have affected them.
The FTC settlement is one that has actual legal teeth and enforcement mechanisms that Deere should at least theoretically have to comply with. Earlier agreements and right to repair “wins” for farmers were often half measures (though it’s worth mentioning that Colorado passed a good agriculture right to repair law in 2023 after years of struggle from farmers and advocates). Deere and various farmers’ public interest groups had previously agreed to right to repair “memorandums of understanding” in which Deere promised to make repair parts and tools available to farmers. In practice, however, these tools and parts were often not available, were not as good as what dealers and authorized service providers had access to, or were unreasonably expensive. These memorandums of understanding also had few or no enforcement mechanisms.
Cade told 404 Media in an email that this settlement order “gives farmers real hope.”
Nathan Proctor, senior right to repair campaign director for consumer rights group U.S. PIRG, said in a statement that the FTC settlement “is much better than the deal secured in [the Illinois] class action lawsuit.”
“Deere has now agreed to make available all materials needed to conduct repairs, including some which it has previously withheld,” Proctor said. “I want to thank the FTC for its work on this case. Our goal from the start of our campaign was to ensure that farmers and independent mechanics get everything they need to fix equipment. We will continue to monitor the situation and advocate to ensure that goal is a reality.”
In other words, farmers finally have an actual, major win in the right to repair fight that goes far beyond earlier piecemeal and moral victories.
The Sense Pro is Schlage’s first Matter-over-Thread lock. It also supports hands-free unlocking via Apple Home Key, with Google and Samsung support coming soon through Aliro.
The Schlage Sense Pro is a beautiful smart lock. Sleek, discreet, and simple to use, it's Schlage's smartest lock to date. Thanks to ultra-wideband (UWB), it unlocks as I walk up to my front door; I don't need to enter a code or tap my phone or press my finger against it. I've tested several hands-free unlocking systems that rely on geofencing and other radio technologies, and UWB is faster and more reliable. It's the first one I actually trust.
Personal digital assistants like the iconic Palm Pilot were one of many devices we thought went extinct with the arrival of the smartphone. But similar to Canon resurrecting a nearly decade-old digital camera to appeal to point-and-shoot fans, Talisman Design is crowdfunding a clamshell PDA called the PocketMage that combines a tactile keyboard with both e-paper and OLED displays in a pocketable device.
There are two different preorder options for the PocketMage on Crowd Supply, plus you get your choice of parchment (gray) or royal purple accent colors. The $235 version comes fully assembled, while the cheaper $185 version requires you to b …
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 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 told Truthdig.
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 percent 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 told Truthdig.
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, told Truthdig 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 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, David 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 told Truthdig 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 percent and bleeding by 78 percent, compared to the tenaculum.
Aspivix has since grown into a 14-person team that includes eight women.
Carevix uses suction to stabilize the cervix during procedures such as IUD insertions, offering an alternative to the tenaculum, a sharp metal instrument that has long been used in gynecological care.
(Aspivix)
‘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 Finci told Truthdig, “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 told Truthdig.
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 Finci 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 their 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 told Truthdig 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 into 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 Finci told Truthdig, 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 Finci told Truthdig. With this in mind, Aspivix began emphasizing that less bleeding meant less cleanup, that less fainting meant quicker turnover in examination rooms, 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 in 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 nor 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 came to rely on this growing resistance in order 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 told Truthdig, “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 rippling into 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 told Truthdig, “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 told Truthdig that they are working on developing a reusable version of their device, and attempting to adapt its suction cup to a more various 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 percent 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 told Truthdig. “Women have been saying this hurts forever — it feels like we’re just now being heard.”
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