All in Her Head: The Truth and Lies Early Medicine Taught Us About Women’s Bodies and Why It Matters Today

by Elizabeth Comen

No other illness stokes our fears the way that cancer does, and the women I see in my practice every day are invariably frightened: of suffering, of dying, of living in remission for years only to have their cancer recur. But the emotion I encounter most in the examination room, more potent and insidious than fear, is shame.

Everyone has a master, after all, and the fault lies less with the individual men than with the system in which they lived and labored.

It haunts our footsteps as we navigate the medical maze of women’s health that was built by men whose ideas about women, while sometimes well-intentioned, were limited at best, paranoid, misogynist, and abusive at worst.

While medical and scientific advances progressed for the next several centuries (and both faith-based healing and burning women at the stake fell out of style), the field of medicine would continue to be haunted by the misogyny and superstition that fueled the witch hunts of the 1600s.

Today, the practice of cosmetic medicine is one that walks the line between empowering women to control their bodies and trapping them in a gilded cage of punishing beauty standards.

But for women, whose access to society was even more closely tied not just to looking normal but to being sexually desirable, cosmetic surgery promised to make the difference between a lonely, unhappy life on the fringes and a full, productive one as a wife and a mother.

And even now, in the golden age of labiaplasties, the place where a person is most likely to encounter one of these perfectly symmetrical, understated vulvas is on a porn star (an irony that appears to be lost on the participants in this particular culture war).

“The labia minora have a function,” she says—a fact that patients don’t always seem to recognize. If too much tissue is removed, the patient can experience chronic vaginal discharge, irritation, chafing, and debilitating pain.

It is possible to deplore the pressures that women feel to conform to a stereotyped standard of beauty, while at the same time defending their right to make their own decisions.

“Without doubt,” Le Bon concluded, “there exist some distinguished women, very superior to the average man, but they are as exceptional as the birth of any monstrosity, as, for example, of a gorilla with two heads; consequently, we may neglect them entirely.”

The only constant was a forgone conclusion: that women’s bones revealed them to be primitive and frail, underdeveloped and inferior, and above all, in need of watchful protection by male stewards.

That Comstock did not bother to ask any women about this before opining on the scourge of shoulder-deforming fashion is a remarkable early entry into the annals of mansplaining, but it also reflects the general bent of male doctors at the time, and nowhere is this more evident than in the panic around corsets and tight-lacing.

For this reason, it’s not surprising that the horrors of tight-lacing became a matter of mainstream concern; then, as now, the concerns of upper-class women received a disproportionate amount of attention, both medically and culturally.

increase it.” For those counting, that’s about one and a half complaints as to the impact of corseting on women’s health, and three complaints that it makes them hideous. But more importantly, this medical note contains zero testimony from women themselves, a fact that did not go unnoticed when it was reproduced in the Times of London.

The fact that Teschner could observe a fifteen-year-old girl performing a fifty-pound standing overhead press for ten reps and still call her “awkward” and “indolent” suggests that some doctors were predisposed to see their scoliosis patients as weak, lazy, and unmotivated, even in the face of compelling evidence to the contrary.

In addition to the idea that being immobilized was no big thing for women, patients suffering from frozen shoulder also appear to have been up against another form of prejudice that is by now familiar to any student of medical history: the notion that any problem mainly afflicting women must have a psychosomatic component.

The bicycle was a vehicle upon which a woman might exercise not just her body but her autonomy. It represented freedom, competition, and the possibility of a woman straying far from home under her own steam—and hence, also represented a host of burgeoning fears about the alarming effects of liberation on women’s role as wives, mothers, and guardians of the domestic realm.

“No woman should ride a bicycle without first consulting her medical man,” announced Harper’s Weekly in 1896.

Whispers trail her, even into the locker room; the other women, her competitors, talk about her as much as if not more than the officials do.

But when it came to the existence of elite female athletes, the scientific community was generally in agreement: nature did not intend for women to excel at competitive sports—and if a woman did excel, it was because she was, herself, a perversion.

At the center of the debate surrounding female athletes was an impossible, and preposterous, question: How athletic could a woman be before she didn’t count as a woman anymore?

And complicit in this humiliation of female athletes were doctors, who advised that a woman’s eligibility for competition be determined via roughly the same methods that farmers use for sexing livestock.

“There has been concern for a number of years that among the more successful female competitors many would be found who exhibited male characteristics, and who might be pseudohermaphrodites,” it reads, citing the need to confirm the sex of women athletes via genital examination.

But in too many cases, this conversation devolved into crude stereotyping rooted not in science but in sexism. And doctors, tasked not with diagnosing disease but rather enforcing the boundaries of femininity, too often erred on the side of stigmatizing strength.

But for women, this advice had acquired an aesthetic, and decidedly unscientific, gloss: the exercises recommended for women were meant to make the body not stronger, and not healthier, but smaller.

“The muscle-building type of exercise, such as weight lifting, does not suggest itself to any of us as suitable for girls, partly because a woman would not look attractive performing and partly because she would have to look unattractive to us if she had the muscles she’d need to perform well,” she wrote. “While this kind of exercise would not cripple a woman or decrease her ability to keep house well, it certainly would not add to her feminine image.”

Story books, romances, love tales, and religious novels constitute the chief part of the reading matter which American young ladies greedily devour. We have known young ladies still in their teens who had read whole libraries of the most exciting novels. The taste for novel-reading is like that for liquor or opium.

if the patient’s incontinence was a constitutional matter, simply part of the natural feminine condition, then surely it wasn’t anyone’s fault if they couldn’t cure it.

And that’s how the medical profession just sort of forgot that women need to pee, too.

This problem persists today in contemporary medical settings, in the form of discrimination against Black patients when it comes to rating and medicating pain; in Sims’s time, it is entirely possible that his willingness to perform experimental surgery on enslaved women—repeatedly, without anesthesia, and with nothing but opium to help them manage the pain as they convalesced—stemmed from the predominant wisdom of the time that they wouldn’t really feel it, not like a white woman would.

It was a conclusion in search of a hypothesis: doctors already “knew” that women were inferior creatures, and so any biological or anatomical differences between their bodies and men’s were assumed to be among the factors that made them that way.

In the United States, disseminating contraceptives—or even just information about how to use them—was banned by the government well into the 1960s.

What he promised was total freedom from pregnancy without any alteration to the body’s “natural” cycle; what he was actually doing, however, was flooding the bodies of his patients with powerful hormones that fundamentally altered their biological processes—and came with serious side effects.

“One of the essential qualities of the clinician is his interest in humanity, for the secret of the care of the patient is in caring for the patient.”