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

by Elizabeth Comen

The role of women was proscribed in medicine as in society, bolstered by the stereotype of the female nurturer: Doctors cured. Nurses cared.

One recent study revealed that women operated on by men have significantly worse outcomes, including death, than when operated on by women. (As for the men, their outcomes were the same whether a man or woman operated on them.)

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 while a medical education teaches doctors to recognize the diversity of “normal” shape and size when it comes to other body parts—including, notably, men’s penises—there is no analogous recognition of the normal diversity of women’s genitals, nor is that information available to anyone who might try to seek it out.

How athletic could a woman be before she didn’t count as a woman anymore?

In 1968, the International Olympic Committee instituted mandatory testing to verify the sex of female athletes—but

the most important thing a woman’s body can be is small.

women with a normal BMI but elevated levels of body fat—women like the latter patient in the hypothetical above—were at nearly double the risk of developing breast cancer.

the desire to be lean above all else is nothing more or less than the insidious legacy of the persistent notion that women should exercise not to be strong, but to be thin.

a constipated woman would develop brain poisoning from her own unexcreted feces.

the first American Heart Association conference for women wasn’t held until 1964—and even then, this conference was for women but about men. Titled “On Hearts and Husbands,” it instructed women in how to attend to (or manipulate) the men in their lives to live a heart-healthy lifestyle.

Today, fully one-third of women will develop heart disease at some point in their lives; for one woman in five, it will be the thing that kills her. That’s not just more than breast cancer; it’s more than all cancers, of every type, combined.

“A woman’s arrhythmic risk varies according to her menstrual cycle,” Khan explains. “When your estrogen peaks during ovulation, it’s not only body temperature that goes up; the heart rate goes up, too, by about two to four beats. Meanwhile, we’re at the lowest level of estrogen and progesterone right before the period starts, and that’s the time that women are more likely to have arrhythmias.”

a woman is still more likely to call an ambulance in response to her husband’s heart attack than she is to call one for her own.

It wasn’t until 2001, and the publication of a report from the Institute of Medicine titled Exploring the Biological Contributions to Human Health: Does Sex Matter?, that female mortality due to cardiovascular issues began to decline—and then it did so sharply.

the disease had made his wife into a “delicately, morbidly angelic” creature, recounting how she’d suffered a hemorrhagic coughing fit at dinner: “Suddenly she stopped, clutched her throat and a wave of crimson blood ran down her breast . . . It rendered her even more ethereal.”

“But no normal woman was ever satisfied without marriage and children.”

Every year, more women die from lung cancer than from breast, uterine, and ovarian cancers combined, and some of them surely don’t have to.

It’s also an enormous blind spot for medical professionals: for women with heavy and continuous exposure to cleaning products—which is to say, either working-class women who clean for a living or women in traditionally gendered arrangements that leave them responsible for the bulk of the household upkeep—the harm caused can be equivalent in its effect on the lungs to smoking a pack of cigarettes a day, every day, for twenty years. And

some estimates suggest that 10 percent of all women in the US will suffer a nonfatal strangulation incident in their lifetimes.

(John Kellogg became estranged from his brother, William, after an intense feud over the latter’s desire to make a flaked cereal that actually tasted good.) The original diet foods were flavorless—and intentionally so, as they were meant as an antidote to the spicy or otherwise stimulating flavors that these doctors believed were a cause of sexual corruption.

IBS was a function of personality type. The diarrhea these patients suffered from was a manifestation of their emotional brokenness: loose stools to counteract a rigid, terrible personality.

this was the consensus wisdom when it came to women’s GI issues: IBS is a bitch . . . and so are you.

As Dr. Lucak explains, women aren’t born with the longer, more circuitous colon that makes their colonoscopies so much riskier to perform. At the age of twenty, a woman’s digestive tract is anatomically indistinguishable from a man’s, more or less. But all those years of holding it in—or not taking enough time to let it out—takes its toll.

Consider the flow of hormones that regulates a woman’s menstrual cycle. It begins with the brain, the hypothalamus, which sends a message to the pituitary gland, which responds by releasing gonadotropic hormones that trigger ovulation, menstruation, and so on. But those same hormones also impact the GI tract—and make certain IBS symptoms worse. In other words, the root of a patient’s bloating, pain, and diarrhea may well be all in her head, in that it literally originates there. But is she imagining it? Responsible for it? Is it her fault that stress manifests in her body in the form of a disease that’s extremely difficult to treat?

But one of the most heartbreaking things I have seen in my medical practice—and a stark reminder of the dangerous mistrust that lingers in a system where women feel doubted, dismissed, and disenfranchised—is the patient with a curable cancer who chooses to put her faith in supplements instead.

Others believed that the women were only pretending they couldn’t pee, because they found it sexually exciting to be catheterized.

(Lest we take Skene too seriously, he also believed that he could tell the difference between a woman who masturbated and a woman who didn’t by smelling her; the odor of the masturbating ones, he said, “cannot be described, but when once experienced is easily remembered.”)

In the US, the campaign for equal access to public toilets is one of the earliest examples of women fighting back against the “pink tax” that imposes gendered costs on everything from tampons to razors; in 1969, Congresswoman March Fong Eu smashed a porcelain toilet with a sledgehammer in front of the California state capitol to protest.

Historically, the lack of a safe, free place to pee has often served to keep women close to home and out of the public sphere; in some countries, particularly India, it’s still a major concern. It’s

Millions of women suffer from interstitial cystitis, which remains so overlooked that it takes the average patient between four and seven years to receive a diagnosis.

the percentage of female practicing urologists saw a steady increase from 7.7 percent in 2014 to 10.3 percent in 2020.

If I were a judge, I would have such venomous, syphilitic whores broken on the wheel, and flayed, because one cannot estimate the harm such filthy whores do to young men who are so wretchedly ruined, and whose blood is contaminated before they have achieved full manhood. —Martin Luther, 1543

It was called the American Plan, and under its auspices, vast numbers of women were essentially kidnapped, imprisoned, and forcibly treated with dangerous drugs in the name of the common good.

In his book about the American Plan, author Scott W. Stern describes how medical authorities stalked, arrested, and imprisoned women who were engaged in activities that marked them as likely STD carriers

Women were told that putting the powder in their underwear would reduce odor, only for a link to emerge suggesting that talcum powder could cause ovarian cancer. This information came to light in 2006, when the World Health Organization issued a warning—and in 2007, Johnson & Johnson agreed that they would stop marketing talcum powder as a genital deodorant . . . to white women. (In 2023, Johnson & Johnson settled a $8.9 billion lawsuit regarding talc as a carcinogen.)

Women are 80 percent more likely to suffer from autoimmune disorders than men, for reasons that scientists have yet to understand.

how a system that treats women with skepticism sets them on a path first to doubt, then to disillusionment: “People end up just kind of bouncing around between doctors, having things missed. Regardless of what condition we’re talking about, there is suffering and damage that’s being done.”

PolitiFact was half right: there was no data as described. But this was not because the data didn’t exist; it was because researchers had simply never bothered to collect it.

And the female body, so many of whose workings remain medically mysterious even in an otherwise enlightened age, and so revered for its ability to grow, nurture, protect, and eventually give forth new life, also remains a vessel into which we can place all manner of things: blame, ignorance, incuriosity, fear.

If the uterus had migrated upward, the medical texts instructed, acrid substances should be placed near the woman’s nose, and pleasantly scented ones near her vagina, to lure it back into place.

Charcot claimed that a hysterical woman could be treated by applying pressure to parts of the body he called “hysterogenic zones,” which sounds scientific enough in theory but translated in practice to punching his patients in the ovaries.

Charles Darwin mused that women were best appreciated as “[an] object to be beloved and played with—better than a dog anyhow.”

The notion that hysteria was the result of too much intellectual stimulation existed in tandem with treatment protocols that aimed to make women as uneducated, docile, and idle as possible, including the “rest cure” developed by Silas Weir Mitchell.