review essay

For Their Own Good:
Androcentrism, the Technology of Orgasm, & How the More Things Change, the More They Stay the Same

The second women's history month of the 21st century has arrived and almost gone, and great strides have been made, especially in the way science and technology have joined forces in the last century to produce vital tools for women's health. A majority of women would agree that the speculum, an instrument which allows a doctor to see a female patient's cervix, falls into the category of essential tools. But the vibrator? Most people are unfamiliar with the expressly medical context in which the vibrator was invented.

The Technology of Orgasm: "Hysteria," the Vibrator, and Women's Sexual Satisfaction, by Rachel F. Maines, has created quite a buzz in the history field by addressing this somewhat sordid history of a tool that many women today find indispensable. While the speculum isn't currently as controversial a topic as the vibrator, in Public Privates: Performing Gynecology from Both Ends of the Speculum, Terri Kapsalis argues that its inventor stepped considerably outside the bounds of the Hippocratic oath in developing this tool, which today is regarded as critical to gynecological health.

In a third, older book, For Her Own Good: 150 Years of the Experts' Advice to Women, Barbara Ehrenreich and Deirdre English argue that women have been regarded, from a medical and social viewpoint, as being ill and in need of treatment, and that their behaviors, ranging from sexual desire to activism, have been consistently interpreted and addressed within this disease model. Maines and Kapsalis also use this disease paradigm as a centerpiece in their books. What is striking about these numerous "diseases" and their "treatments," recorded in meticulous detail by all four authors and particularly by Maines, is how they seem at once completely outrageous yet sadly mundane.

An animal inside an animal

—Plato on hysteria

Hysteria was thought to be a consequence of lack of sexual intercourse. For centuries hysteria was believed by many to lead to inflammation of the uterus, which necessitated the expulsion of fluids to prevent it from wandering away from its anatomical home and possibly suffocating the woman who housed it. Physicians ranging from Hippocrates to Freud believed they had to coax the wandering womb back to its proper place or size with "massage treatments." A description of such a treatment reads like a cross between a medical report and soft-core pornography. The Greek physician Galen (AD 129-c. 216) noted that:

Following the warmth of the remedies and arising from the touch of the genital organs required by the treatment, there followed twitchings...From that time on she was free of all the evil she felt.

Similar accounts of these treatments and their results, most of which are hilarious and unbelievable, are in evidence throughout the centuries.

These descriptions leave one wondering how these treatments were deemed acceptable and how the results of such treatments were, for thousands of years, seen as "hysterical paroxysms" rather than the orgasms they clearly were. More glaring are the questions of the "disease" itself and how it became medically and culturally endemic.

Maines posits that an androcentric model of heterosexual intercourse (penetration to the point of male orgasm) is so deeply entrenched in our society that female sexuality has been constructed historically to fit this model. When women's behavior did not fit this mode—that is, when a vast majority of women did not (and do not to this day) achieve sexual satisfaction to the point of orgasm from penetration alone—this behavior was viewed within a disease paradigm. This framework made it possible to see the treatments, and the orgasms they produced, as medical rather than sexual, especially because no penetration was involved (early vibrator models were not shaped in the phallus model of modern vibrators). Husbands who were brought up, along with their wives, not to acknowledge the existence of women's sexual pleasure, were not pressured to change their actions. Doctors reaped significant benefits from treating healthy patients, and many of these doctors became extraordinarily wealthy.

No man (who is but never so little versed in such matters) is ignorant, what grievous symptomes, the rising, Bearing down and Perversion, and Convulsion of the Wombe do excite...

—William Harvey, 1653

Known records of hysteria and its massage treatments date back as far as 2000 BC in Egypt. Most physicians through the centuries prescribed marriage for a single woman or to be "strongly encountered by her husband" for a married woman. Though there is a strange consistency in the imagined scenario of the wandering or suffocating uterus, the noted symptoms of hysteria vary enormously. A 16th-century description of hysterics' behavior includes "a vehement and unbridled desire of Carnal Imbracement, which desire disthrones the Rational Facul[ty] so far, that the Patient utters wanton and lascivious Speeches." The millennia of evidence documenting hysteria is the basis of one of Maines's criticisms of her colleagues: She claims that Ehrenreich, English, and historian Peter Gay place hysteria in an inappropriately unique 19th-century context by ignoring (or not exploring) the evidence on hysteria from preceding centuries.

By the 19th century a sister disease, neurasthenia, similar to hysteria in its vague symptoms, became widely diagnosed and even surpassed hysteria in the role of what psychiatrist Charles Lasègue called the "wastepaper basket of medicine where one throws otherwise unemployed symptoms." Symptoms cited in For Her Own Good include weeping, irritability, depression, mental and physical weariness, morbid fears, forgetfulness, palpitations of the heart, headaches, writing cramps, mental confusion, fear of impending insanity, and constant worry.

It is not surprising, then, that by the late-19th century, three-quarters of women were "out of health" and represented the single largest market for therapeutic services, allowing doctors like Silas Weir Mitchell, the rest-cure physician who has been identified as the antihero of Charlotte Perkins Gilman's The Yellow Wallpaper, to earn $60,000 a year in the 1870s—the equivalent today of more than $300,000.

If there was anything I hated, it was investigating the organs of the female pelvis.

—James Marion Sims, 1884

By his own estimation, "the second wealthiest of all American physicians," James Marion Sims, "the father of gynecology," is credited as the inventor of the speculum and was awarded countless titles, honors, and fame. Sims's invention was developed under rather ethically dubious circumstances, at least by today's standards, according to Kapsalis in Public Privates. Sims was an Alabama slave owner who experimented on slave women (some purchased expressly for this purpose) in his own backyard "hospital" during 1845-49.

While doggedly pursuing a cure for vesico-vaginal fistula, "small tears that form between the vagina and urinary tract or bladder which cause urine [and bowel] to leak uncontrollably," thus limiting or damaging reproductive capacity, he operated unsuccessfully and without anesthesia on dozens of slave women. Sims then made a discovery of vaginal suction while attempting to "relocate" the uterus of a white woman who'd fallen from her horse (given the still prevailing belief that the uterus could become easily lost).

Realizing he could invent an instrument that could be held in place by this vaginal suction, he determined that if he could actually see the fistulas he'd been trying to mend in slave women, he could repair them with some success. He fashioned the first speculum out of two spoons and from there performed countless operations on slave women, again without anesthesia, but this time with some success. Kapsalis points repeatedly to the economic motivation for "fistula repair"—to restore slave women to their full reproductive capacity, ensuring their owners a greater abundance of future slaves.

[It seems] as if the Almighty, in creating the female sex, had taken the uterus and built up a woman around it.

—Professor M.L. Holbrook in an 1870 address to a medical society

Many women diagnosed with hysteria or neurasthenia were treated with methods other than the not entirely unappealing "massage." Because the prevailing medical attitude at the time saw the female reproductive organs as the source of virtually any illness from headaches to tuberculosis, these organs were subjected to "treatments," including leeches applied to the uterus and cauterization of the uterus with a white-hot iron instrument. Surgical removal of the ovaries—ovariotomy—was also common; in 1906 a leading gynecological surgeon estimated that 150,000 women had received ovariotomies. The rationale? According to historian G.J. Barker-Benfield in For Her Own Good: "Among the indications were troublesomeness, eating like a ploughman, masturbation, attempted suicide, erotic tendencies, persecution mania, simple 'cussedness,' and dysmennorhea (painful menstrual periods)."

By the end of the 19th century, all stages of a women's biological life cycle—menstruation, pregnancy, childbirth, and menopause, as well as mental health—were routinely treated within a disease framework. In For Her Own Good, Ehrenreich and English note that "[doctors] began to see the disease everywhere themselves until they were diagnosing every independent act by a woman, especially a women's rights action, as 'hysterical.'" The economic boon of treating and charging healthy patients, all four authors emphasize, eclipsed any criticism of methods that flew in the face of reason.

Vibration is life. It will chase away the years like magic. Every nerve, every fibre of your whole body will tingle with [the] force of your own awakened powers. All the keen relish, the pleasures of youth, will throb within you.

—Advertisement which appeared in the January 1913 issue of American Magazine

After a brief period of hydrotherapy (water-related or "douche") treatments for hysteria and neurasthenia, which proved too expensive and inconvenient for most physicians, Joseph Mortimer Granville invented the vibrator in the 1880s, initially for male skeletal muscle treatment. Granville was not alone in his championing of electrical and vibratory devices which were supposed to improve one's health. Over the next 40 years, the following devices gained legitimacy and popularity. The 1913 "Dr. Bell Electo Appliance" was an electric belt which "Dr. Bell" claimed would cure stomach, kidney, prostate, and bladder weakness as well as sexual debility.

There was the even less appealing 1918 "Prostate Gland Warmer and Recto Rotor," advertised as "the latest and most efficient invention for the quick relief of piles, constipation, and prostate trouble." Though inventor Granville was opposed to his vibrator's use on hysterical women, the appeal to doctors during this time period was too great, given the legions of patients needing treatment; the vibrator saved time and didn't demand manual skills or direct touch, which some doctors preferred to avoid. By 1900 a wide range of vibratory devices were available to doctors and later to women themselves, and by 1910 vibrator ads appeared innocuously in the Sears catalog alongside electric fans, mixers, and radiators—"aids that every woman appreciates." When vibrators began appearing in stag films of the '20s in obvious sexual contexts, they disappeared from doctors' offices and magazine advertisements.

The legacy of the vibrator's history is twofold. A gender-based double standard towards sexual pleasure continues to thrive in states like Alabama, Georgia, and Texas, where vibrators and "sex toys" were banned by the state legislatures, according to a March 29, 1999 New York Times article. The ACLU has filed complaints with these states, highlighting the double standard by emphasizing Alabama's permission to prescribe Viagra, given to cure impotence and often taken to enhance male sexual staying power. Sadly, a majority of women still seem to accept the notion that failure to achieve orgasm through traditional coitus alone is a defective flaw, even though it is estimated that their company includes two-thirds to three-quarters of women.

And what of the legacy of the speculum and the pelvic exam? In Public Privates Kapsalis points to an acceptance toward coercive reproductive control over women of color as one of the consequences. She presents a compelling comparison between Sims's work on fistula repair in slave women to ensure reproductive capacity and economic gain for owners and the (sometimes forced) testing and distribution of Norplant on Third-World women and women of color, in order to limit their reproduction.

Though Sims took ethically questionable liberties in developing his invention, the speculum nevertheless remains the most effective way of viewing the cervix and diagnosing cervical cancer; however, Kapsalis tends to blur her solid research with comparisons that aren't quite convincing. A theater performer and gynecological assistant, Kapsalis frequently theorizes about women's behavior during gynecological examinations. She is least persuasive when she veers into strained analogies like comparing the draped sheet over a patient's knees with a theater curtain, for instance, or discussing the parallels between a vagina and a stage.

The pelvic exam is, nonetheless, still mired in problems, with the patient expected to assume a passive role. Heidi Kruckenberg of Brandeis University cited "inadequate informed consent for surgical/invasive procedures" and "poor rapport (including unsympathetic response to patient)" as being among the top five communication issues between women and their gynecologists. Complaints were not limited to male gynecologists—apparently women, too, have failed to break out of the hardened mold of the female pathology model. Evidently, battery-powered satisfaction, "footies" on stirrups, and a month in spring devoted to women's history aren't quite enough to make the grade in the 21st century.

Reviewed by Rachel Koch
03.20.01