Sexism Kills: Medical Misogyny and Ignorance of Female Bodies

In the 5th century BCE, followers of Hippocrates—the founder of Western medicine—published “The Hippocratic Corpus.”  The exact writers of this ancient text are lost to history, but their views of the human body prevailed for centuries in the West.  One of the works included in the corpus is called “On the Diseases of Women,” which introduced the “wandering uterus” theory.  2,500 years ago, doctors believed that almost any illness that a woman contracted was caused by her uterus literally floating around her body, putting pressure on other organs and poisoning her blood.

During the Enlightenment, the “wandering uterus” theory fell out of favor, only to be replaced by the “sexual fluid build-up” theory.  Male doctors began diagnosing female patients with “hysteria,” then believed to be an actual, bodily female disease.  Hysterical women allegedly exhibited symptoms which could include nervousness, emotional outbursts, and sexual arousal.  Today, however, all of these “symptoms” of hysteria are considered normal aspects of female sexuality.

How did doctors “cure” hysteria?  The solution was to purge sexual fluids from a woman’s body. If they were married, doctors would tell their husbands to have frequent sexual intercourse with them; if they were too young, midwives (or doctors themselves) would use their fingers to force a hysterical girl to orgasm.

Victorian doctors rejected hysteria as a physical condition, instead characterizing it as a psychological disorder.  In the 1880s, Sigmund Freud believed that hysteria was a result of a young woman’s sexual trauma in realizing that she is not a man, and therefore (in Freud’s view), not “whole.”  His recommended treatment was for a hysterical woman to get married and have sex as quickly as possible.  And if women could not get married, then they should be brought to orgasm by a doctor as treatment (usually through the use of a vibrator).

The heart of this matter is that the medical community has been misinterpreting and mistreating female patients for thousands of years.  Even as medical science made leaps and bounds during both the Greco-Roman period and the Enlightenment, the understanding of the female body continued to be limited to her “finicky” sexual organs.  Rather than try to learn about female sexuality, male doctors propagated beliefs that women were incomplete, imperfect versions of men, who, because of this imperfection, suffered greatly from their sexuality.

But orgasm was not the only solution to treat feminine illnesses: if it was, historical women may have been a lot happier than they were.  Ancient Greek women who experienced sexual arousal were often forced to eat mule excrement, while women who had miscarriages would be covered in cow excrement to prevent another.  In the 1840s, J. Marion Sims – a man who is still viewed today as the “father of gynecology” – surgically experimented on dozens of African female slaves, without anesthesia and sometimes when they were pregnant.  Additionally, Victorian doctors like Isaac Baker-Brown often performed non-consensual clitoridectomies on women, which involved removing the clitoris to prevent masturbation and make “intractable women” into “happy wives.”  This barbaric practice continued in the West up until the mid-20th century: in 1944, a Michigan girl—only 12 years old—went to her doctor to be treated for hysteria.  In the exam room, “an attendant clamped an ether-soaked rag over her mouth from behind.  When she woke up, her clitoris was gone.  ‘They tried to keep me from masturbating,’ she said.

Hysterical women who were not “cured” by stimulation were often sent to asylums, where they were sterilized during the eugenics era of North American medicine.  Some states had compulsory sterilization laws for women who were “mentally defective.”  Physical sterilization morphed into mental sterilization in the 1950s, when American housewives who were suffering from depression, anxiety, and insomnia (which Betty Friedan later called “the problem that has no name”) were given sedatives by doctors in order to keep them calm and complacent.  The societal malaise that women of the 1950s were afflicted with, combined with the intense tranquilizers that doctors prescribed, bred intense depression in many women.  Some said that they felt empty and incomplete; others said that they felt as if they didn’t exist.

The women’s liberation movement of the 1960s and 1970s began to bring these problems to the fore of American consciousness, but they did not end there.  During the height of the “war on drugs” in the 1970s and 1980s, doctors were less likely to assess female patients for substance abuse, and when women were arrested for nonviolent drug offenses, the rehabilitative programs that they were entered into were catered to and designed for men.

Medical misogyny has existed throughout all of human history, and it has harmed and killed millions, if not billions, of women.  Does it still exist today?  Of course, the answer is yes.

For one, women’s pain is treated less seriously than men’s, even in the ER.  When women report experiencing pain to doctors, their pain is often dismissed as “‘emotional’ or ‘psychogenic’ and, therefore, ‘not real.’”  Women’s physical experiences are taken less seriously, despite the fact that women are more likely to experience pain.  Women are also “treated less aggressively in their initial encounters with the healthcare system until they ‘prove that they are as sick as male patients.’”  Because of this denial of female pain, women are often forced to wait longer than men for medical treatment. For acute abdominal pain, a man will wait an average of 49 minutes before receiving treatment; a woman will wait 65 minutes for the same treatment.

There have been countless personal examples of this.  One woman, Rachel Fassler, who had the life-threatening condition of ovarian torsion (when the fallopian tubes are twisted by an ovarian cyst) was forced to wait 14 hours before receiving treatment, because male doctors assumed that her pain was caused by a kidney stone.  It was only after a female nurse looked at her CT scans—after all of the presiding doctors had gone home—that the ovarian cyst was detected.  In this case, a woman’s specifically female pain (i.e. ovarian torsion) was dismissed and misdiagnosed through a male-centric model of similar pain (i.e. kidney stones); this dismissal caused hours upon hours of unnecessary anguish and could have led to her death.

In 2012, Marley Hoggatt began experiencing excruciating migraines every month.  When she went to her doctor, they prescribed an antidepressant; when she went to a neurologist, they asked her about her love life and recommended seeing a psychiatrist for her “boy problems.”  After two years of taking ibuprofen every day, she was finally able to receive an MRI from a female doctor, who discovered a herniated disc and a pinched nerve.

Another woman, Starr Mirza, went into cardiac arrest after having her fainting spells and chest pain be dismissed by doctors for years.  According to Mirza, she would go to doctors and describe her symptoms, only for them to roll their eyes and tell her parents to take her to a psychiatrist.  When Mirza had a heart attack in 2003 and was diagnosed with QT syndrome, she started laughing in joy, “because, for 10 years, I knew something was wrong, and finally I was validated.

And in 2005, a woman named Lori Kupetz began experiencing chest pain, and was referred to numerous cardiologists, who assured her that there was nothing wrong with her heart.  In fact, they prescribed her antidepressants and urged her to go to a psychiatrist.  Instead, Kupetz went to a women’s health center, where they did more tests and found three blocked arteries.  Kupetz later said: “I was a walking time bomb…had I listened to the doctors who told me to go on antidepressants, I would not be here today.”

Mirza and Kupetz are not alone in their misdiagnosed heart conditions: women on average are 7 times more likely than men to be sent home from the ER in the midst of a heart attack.  Similarly, women are twice as likely to die from a heart attack as men, because female symptoms of cardiac arrests are very different from men’s.  The most well-known symptoms of a heart attack are chest pain and left arm numbness, but these almost exclusively apply to men: women who undergo cardiac arrest are more likely to experience shortness of breath, heartburn, and lightheadedness.

It is also not uncommon for women to be denied effective drug treatments.  Although 70% of chronic pain patients are women, men are more likely to receive actual painkillers, while women are more often prescribed sedatives or antidepressants.  And women are aware of this fact: of 2,400 surveyed female chronic pain patients, 90% of them reported feeling discriminated against because of their gender by their doctors.

The story is even worse for women who experience menstrual, reproductive, and sexual pain.  When Jeannine Hall Gailey got her first period, she bled so heavily that she had to be hospitalized.  Despite this, doctors assured her that this was “normal,” and she proceeded to deal with heavy blood loss and vomiting every month for 15 years until she was diagnosed with a bleeding disorder.  Karen Goldstein contracted repeated yeast infections every month, and when she asked her gynecologist for treatment, he refused and said that it would go away on its own, and that yeast infections “aren’t that bad.”

In 2018, Abby Norman published a memoir entitled, “Ask Me About My Uterus: A Quest to Make Doctors Believe in Women’s Pain.”  In the book, she discusses her own personal struggle with endometriosis: a chronic and painful illness in which a woman’s uterine cells grow outside of the uterus.  For years, Norman went undiagnosed, even though approximately 1 in 10 women between the ages of 15 and 49 contract endometriosis.  Doctors refused to treat her until her boyfriend accompanied her to the doctor and testified to her pain during sex; of this, Norman writes, “Becoming a disappointment to a man seemed to do the trick.”

This is par for the course for people with endometriosis: on average, it takes between 10 to 12 years after symptoms appear for somebody to be correctly diagnosed with the disease.  And endometriosis diagnoses have their own problems as well: black women who suffer from endometriosis are more likely to be misdiagnosed with an STD, thus propagating the racist stereotype that black women are more promiscuous.  And transgender men—who are also at risk for endometriosis—are often not even provided with information about the condition, thus making trans access to healthcare even worse for sufferers of reproductive diseases.

Childbirth and maternal mortality rates are also a highly visible sign of medical misogyny in our modern society.  Despite incredible advances in science and technology, an estimated 289,000 women die around the world from pregnancy and/or childbirth every year: that’s almost 800 women a day.  In the United States, 700 women die each year from pregnancy and/or childbirth, despite the fact that 60% of those deaths are preventable.  Maternal mortality is also heavily tied to race: black women are three times more likely to die from pregnancy and/or childbirth than white women are.  This has recently gotten some attention, due to both Beyoncé and Serena Williams speaking out about how they almost lost their lives because they were “giving birth while black in America.”

Sometimes, pain and harm aren’t just incidental or unintended consequences of medical sexism: sometimes, doctors are active perpetrators of harm.  For example, a “husband stitch” is an extra, unnecessary stitch that some doctors have reportedly given to new mothers when repairing her episiotomy or vaginal tearing.  Allegedly, this extra stitch tightens the woman’s vagina for “increased pleasure of a male sexual partner.”  In addition to being completely antithetical to the Hippocratic Oath and basic human decency, doctors who give husband stitches cause their victims to have excruciating pain during sex from then on, until they receive another surgery to correct the stitch.

In 2005, after Sarah Harkins gave birth to her first child, she can remember her doctor saying to her husband, “Yeah, let’s go ahead and add in another stitch so we can make sure this is nice and tight.”  Harkins didn’t learn about this until later, as she was extremely exhausted after a long and arduous birth.  But looking back on it, she describes it as a violation and an injustice, “to wound me in my privates, at a time when I was most vulnerable.”

In 2013, Angela Sanford scheduled a pap smear with her new midwife, who examined her vagina and told her that she had been stitched too tightly by the presiding doctor when she had given birth.  This extra stitch had caused Sanford 5 years of pain during sex: “My midwife said, ‘They think that some men find it more pleasurable,’ [but] my husband has been worried about me and fearful of hurting me.  He would never have asked for this.”

In 2015, while Tamara Williams was resting from an exhausting birth, the birth center midwife winked at her boyfriend and told him that “she’d throw in an extra stitch for him.”

It’s impossible to know how many women today have been victims of this outdated, medically incorrect, and violently misogynistic practice.  But as is so often the case, women’s reproductive health is mistreated whether they become mothers or not.  There is also significant discrimination against women—especially young women—who seek out medical treatment which would make them unable to conceive.  More than 15% of American women voluntarily seek out sterilization, but it is often incredibly difficult to convince a doctor to perform female sterilization.

Until the 1970s, many doctors and hospitals followed the formal “120 rule,” which held that “a woman was ineligible for sterilization unless her age, multiplied by her number of children, totaled at least 120.  That meant a 30-year-old woman had to have four children before she could be sterilized.”  These arbitrary and misogynistic rules continue today, albeit more informally.  Many doctors refuse to provide female sterilization (the most common method being through tubal ligation [i.e. getting your tubes tied]) if the patient is younger, has few or no children, and is not in “full agreement” with her husband (if she is married at all).  And yet, any man over the age of 18 can get a vasectomy with little to no questions asked, and they can get the procedure done for a cost roughly 6 times cheaper than the cost of tubal ligation.

Many women online have described the flat-out sexism that they have been faced with when trying to seek sterilization.  Twitter user @afroSHIRL tweeted in 2017: “Dr wouldnt tie my tubes cuz I wasnt married and maybe someday my husband might want kids.  Medically, my body belongs to a man I havent met.”  Tumblr user “a-singular-canadian” wrote of her experience with the “three child rule,” which discourages doctors from providing hysterectomies unless a woman has already given birth to at least three children.

Single women who seek sterilization are often met with questions from doctors like, “What if you meet the right man and he wants to have children?”  One woman reported her doctor asking, “What if you met a billionaire who wanted to have kids with you?”  Alejandra Mattoni wrote that it took her over a decade to find a doctor who would take her seriously in her desire for tubal ligation: most doctors she consulted told her to “go home and discuss [her] fertility with [her] husband or partner, even though [she] had neither at the time.”  Yet despite doctors’ concerns about women regretting their decision, 80% of women who are sterilized do not regret their decision years later.

Since time immemorial, women have been mistreated, abused, and misunderstood by the medical community.  I have had my fair share of sexist medical treatment: the most egregious case happened in 2013.  I woke up in the middle of the night unable to breathe, and having the worst pain I’d ever felt in my upper abdomen.  I immediately called my parents in, and they called 911.  When the paramedics arrived, they took one look at me, listened to my heart, and concluded that it was an anxiety attack and that there was no need for me to go to the hospital.  At this point, even though I was barely able to speak, I urged them to take me to the hospital.  When I was loaded into the ambulance, the paramedic with me was filling out forms and not interacting with me.  I begged him to give me an oxygen mask, and he sighed before conceding: “If it will make you feel better.”  And it did, marginally.  He also offered to give me a sedative to “calm me down,” but I said no—I wanted to be awake when I actually spoke to a doctor.  We arrived at the hospital and I was brought into the non-urgent section of the ER: even though I was struggling to breathe, a nurse didn’t come to see me for 10-15 minutes.  But when she did see me, and I told her about the unbearable, level 10 pain that I was experiencing in my abdomen, she immediately got an oxygen pump to measure how much air I was able to breathe in: it turns out that my lung capacity was extremely diminished.

The doctor at the ER diagnosed me with temporary, acute atelectasis, which is a partial collapse of a specific area of the lung.  It was probably caused by a pinched nerve and extended periods of shallow breathing while I slept.  Luckily, atelectasis is a completely reversible condition, and I was given an oxygen pump to re-inflate my left lung: I was completely cured within 2 weeks.

Were the paramedics being sexist when they dismissed my condition as an anxiety attack?  Maybe not.  Maybe they were simply going off of their best judgement with regards to my symptoms.  Or maybe they saw a panicked, 16 year old girl in the middle of the night, and assumed that I must be overreacting, that there must be a problem with my mental health rather than my physical health.

These kind of things happen all of the time, and it is becoming increasingly clear that one of the best ways to solve this is to have more female healthcare providers.  Although women in the medical field are susceptible to internalized sexism as well, they are more likely to take a female patient’s claim for what it is: in my case, a lung emergency.  The good thing is that of doctors under the age of 35, more than 60% are female, compared to older age brackets which are more than 70% male.

But that is not the only solution that we can enact.  Of 159 medical schools surveyed in the U.S. and Canada, only 13 said that they had formally integrated sexual differences into their curriculum for their students.  Dr. Marjorie Jenkins set out to fix that by creating a medical school curriculum for sexual differences in patients, which has now been adopted by at least ten universities.  The National Institute of Health has also made great strides in trying to change the academic side of medicine, by incentivizing medical researchers to include an equal number of female human subjects, as well as female test animals and cells, in their studies.  This will force researchers to collect data on pharmaceutical and chemical reactions in both men and women.

Medical misogyny is something that is rarely discussed, and yet is almost universally experienced by women all over the world.  If you are a woman, consider if your doctor has ever dismissed your concerns about pain you’ve been having; consider if you have ever had to urge them to conduct some sort of test to figure out if something is wrong; consider if they have assumed that you were sexually active or not sexually active based on your appearance; consider if they dismissed a sexual, menstrual, or ovarian problem as “normal,” or if they have (intentionally or unintentionally) devalued your pain.  All of these issues are symptomatic of the larger problem of sexism that plagues the medical community, as it plagues our entire society.  And this will not abate until women—both patients and doctors—begin to take a stand and fight for equal medical care as men.

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