A Spoonful of Sexism Helps the Medicine Go Down
“You know, I have four women a week in my office just like you, crying about how their vaginas hurt. If you’d all just get about your lives, the pain would go away”
This was Jane’s first dose of “medical misogyny”, it would take another six doctors and over a year to finally find her a diagnosis. It was vulvodynia: chronic pain of the vulva. It would be wonderful to read this and know that it was an anomaly, a single moment in isolation, however, this is not the case. Sexism, as we all know, is insidious. It pervades all walks of life from career prospects to lifestyle choices and unfortunately to the medical treatment that we receive. This discrimination is particularly evident in the focus that has been placed upon penetrative sex and reproduction in the treatment of endometriosis and female sexual dysfunction.
Endometriosis is a condition characterised by the abnormal growth of uterine (endometriotic) tissue outside the uterus. It leads to painful menstruation and, at times, infertility. Endometriosis affects approximately 1.5% of women worldwide. Female Sexual Dysfunction (FSD) is an umbrella term relating to “disorders of desire, disorders of arousal (and orgasm) and pain disorders”, affecting approximately 43% of women. These disorders are a useful point of reference for discussing discrimination in women’s health due to the impact that they have on women’s abilities to fulfil their societal role: partaking in heteronormative, penetrative sex and procreating.
The scientific community have long emphasised the correlation between infertility and endometriosis, citing that around 50% of infertile women also suffer from endometriosis, however the mechanics of this correlation are still not well understood. Despite this endometriosis treatment was based upon the “explicit goal…to predict women’s chances of getting pregnant.” The American Fertility Society measured the severity of endometriosis on the positioning of cysts in relation to the ovaries and fallopian tubes; sites considered the most ‘high risk’ areas affecting fertility. Sites where a woman was less likely to experience infertility, but more likely to experience pain, did not feature in this understanding. Despite patient bodies asking for greater research into pain as well as infertility, minimal revision has been made and pain is still not featured in the revised American Fertility Society codification. This classification is a paradigm of the secondary position female patients held, and continue to hold, in women’s health, focused entirely on reproduction as opposed to women’s experiences. For many women suffering with endometriosis, infertility is a great concern, but solely focusing on this aspect has left many women who can reproduce, but still suffer immense pain, abandoned by the medical industry.
The focus on infertility within endometriosis is painfully evident in the dubbing of the nickname the “career woman’s disease” which was utilised throughout much of the 20th century and continues to be used in the 21st Century. This definition argued that endometriosis was most common in women in their thirties and forties who had not had children and who had high-stress jobs. Thus, women who transcended their social obligations through seeking employment and not reproducing were held responsible for their endometriosis. Mary Ballweg’s research has highlighted how this operated in medical treatment. In one instance a patient recalled her doctor’s advice that “if I got married and had a child, my symptoms would go away”. The patient was being called upon to uphold her social role in order to cure herself of endometriosis. Conversely, another patient revealed that her endometriosis was found when she was 13, but doctors refused to diagnose her because she did not fit the category of “career woman”. Instead, they questioned her about how often she engaged in sexual intercourse. She remarked that at the age of 13 she did not know what intercourse was. This experience highlights that when women did not fit the profile for endometriosis, their conduct was called into question. Thus, what is apparent is that, historically treatment for endometriosis has been focused predominantly on women’s reproduction, and not those suffering with endometriosis and the notion of the “career woman’s disease” is one of the most ardent manifestations of this.
Sexism within FSD was most prevalent through the overt emphasis placed on heterosexual penetrative sex. Under this lense, “real sex equals coitus: penetration of the vagina by penis”. This was problematic when considered in the sphere of sexual dysfunction, but also more widely failing to include anything other than heteronormative sex as ‘real sex’. Successful heterosexual sex in this setting, was not one of mutual enjoyment, but one in which the woman was able to endure penile penetration ‘painlessly’. This approach was blatantly obvious in surgical methods used to treat vaginismus that enlarged the vagina for penile penetration. This was called perineotomy. Dr. Helen Kaplan, remarked on an encounter with a vaginismus patient who had undergone this surgery. They informed Kaplan that prior to the surgery, they could achieve orgasm with clitoral stimulation, but not have penetrative sex, after the surgery they could have penetrative sex, but could not reach orgasm. Clearly the ability to have penetrative sex was heavily prioritised over any notion of female sexual enjoyment. This was evident more recently with Peter Pacik’s 2005-2009 study on the use of intravaginal Botox treatment. The study boasted that of the twenty patients treated sixteen “now experience the joys of having pain-free sex”. The notion of women enjoying sex did not appear in the study and the only failure was in regard to a patient who could not progress beyond the smallest dilator. The fact that even within the 21st century female sexual pleasure is not even considered in the treatment of FSD speaks to a dangerous way that the needs and desires of women have been side-lined by the medical industry.
This is but a fragment of the overall discrimination that women have endured at the hands of medicine, while the majority of this research is focused in the past, the painful truth is that so much of this prejudice is prevalent today.
This article is part of a themed week of articles sharing summaries of undergraduate dissertations related to feminism or women’s history and literature. We hope you enjoy!