July 5, 2021

A doctor first came up with the idea of pushing a T-shaped contraption into a woman’s vagina over a century ago. Many would argue that the painful procedure to insert an IUD hasn’t advanced much in the intervening years. “I had to lean over the side of the ‘chair’ to throw up”; “I begged them to stop”; “worse than childbirth”; “My male consultant told me beforehand not to worry it’s just like a period pain”. After Lucy Cohen started a petition to insist women were given pain relief before the procedure, and Caitlin Moran wrote about her own painful experience, a tremendous chorus of women found their voices.

Naga Munchetty, admitted: “I screamed so loud my husband tried to find out what room I was in to make it stop… and fainted twice.” And yet the experts insist: “having a coil fitted should not hurt.” It’s hard to not to imagine how men would respond to a similar procedure. As Moran pointed out, compellingly, “If men had paper clips shoved up their willies, they’d be given morphine”.

This all shouldn’t really come as a surprise, though, when you consider the long history of women’s health in a man’s world. Despite her ability to give life, a woman’s body and aliments have long been constrained, objectified and often simply dismissed. As Elinor Cleghorn points out in her fascinating book Unwell Women: A Journey Through Medicine and Myth in a Man-Made World, “If you are a woman, you will encounter the kinds of gender biases that have been ingrained in medical culture and practice for centuries.” This includes misdiagnosis of serious illness, disbelief, dismissal and undiagnosed physical agony. Cleghorn herself experienced this after painfully suffering from Lupus for seven years before it was correctly diagnosed. She was dismissed by her physician as “hormonal”, among other things.

It was ever thus. Since records began — well, back in ancient Egypt, c1550BC — women’s health has been linked to the functioning of her uterus, and the equilibrium of her mind. One of the most common and disturbing historical theories concerning the womb and female illness is the phenomenon of the “wandering womb”: the belief that a woman’s womb literally moved around the body, suffocating her essential organs and destabilising her body and her mind, leading to hysteria (from the Greek “hysterikos,” meaning “of the womb”).

Symptoms attributed to ‘hysteria’ are noted in the Ebers Papyrus — one of the oldest and most important medical papyri of ancient Egypt. It describes seizures and panic attacks in women; the author determined that the uterus had shifted: dislodged from its natural place in the body causing a physical and emotional reaction from its host. In order to tempt it back into position, pleasant aromas were released at the opening of a woman’s vagina to coax the uterus back down the body. It is depressing to note Gwyneth Paltrow still advises women to do similar on her website Goop, asserting that they should “steam their vagina” for optimal vaginal wellness.

But vagina-steaming seems relatively innocuous when you consider some of the other cures for the “wandering womb”.

Back in Cos, a girl was found wandering the streets incoherent and distressed, sick with fever and hallucinating. Her panicked father whisked her to the nearest physician, desperate to cure her melancholy and pain. He was reassured that her illness was quite common: the girl had reached puberty and begun to menstruate. According to the physician, she was drowning in her own blood. As it flowed untempered throughout her body, it seeped into her senses, poisoning her body and her mind. His prescription? Marriage. Intercourse was the cure, for pregnancy would appease her wandering womb: a fulfilled womb was a content, compliant womb.

Ancient Greece is considered to have laid the foundations of modern medicine. But its advances didn’t always extend to a proper understanding of women’s biology. Aristotle, for example, stipulated that the female body was simply the inverse of the male: a woman’s genitalia was a man’s turned outside in, inferior and weaker than the male’s. The myth of Pandora offers futher insight into prevailing attitudes: created from clay by the Gods, the “first woman” in Greek Mythology — akin to Christianity’s Eve —  was given a pithos (a jar) and told not to open it. Tempted by the secrets inside the jar, Pandora opened the lid and released evil into the world. In a society obsessed by fecundity, Pandora was alluring and pure, but deceptive, for inside her shell, her box, her female organs were evil — and had to be controlled.

Society believed a woman’s sole purpose was to bear children. If her body, or her womb, were not occupied, therefore, it was deemed to be “deceptive”.

The fear of the ‘Pandora’ woman was perpetuated throughout Ancient Greek society, leaking further into mythology. The virgins of Argo, for example, refused to honour the phallus and fled to the mountains. Their behaviour was considered “madness” and in order to “cure” them, the Argonaut Melampus concocted a potion from hellebore (a poisonous buttercup) and urged the women to have sex with the young men of Argo. Once their virginities were lost, their madness subsided. Melampus concluded that these women suffered from poisoned humours caused by the inactive womb: the cure for their suffering was sex.

This notion of madness as an internal “poison” that slowly punishes the female reproductive organs for their barrenness was perpetuated by the father of medicine, Hippocrates. He did — correctly — reason that women’s bodies were to be treated differently, for their organs were clearly different to men: women’s bodies were considered “wetter” due to menstrual blood. But he also raised concern around “womb suffocation”: when the womb is not weighed down by a foetus, it smothers other organs in the body as it moves around. Emotional distress, in women, originated from the womb. He grouped physical ailments into one hegemonic term, “hysterikos” — and so became the father of hysteria, as well as of modern medicine.

One of the most common illnesses that Cleghorn describes as “an object lesson in male-dominated medicine’s historic failures” is the incurable, excruciatingly painful disease endometriosis. Affecting a vast one in ten women, endometriosis (endo) is the incurable growth of endometrial tissue onto other organs within the body. The tissue sticks together and causes heavy bleeding, back and pelvic pain, nausea, infertility and mental health issues. It takes on average eight years to diagnose and just one cell can regenerate anywhere in the body: in some people it spreads as far as the brain.

The author Hilary Mantel has spoken candidly about her personal experience of endometriosis in her memoir Giving Up the Ghost, as she ponders on the spirits of unborn children: a family that might have been, had she not become infertile. As a student at Sheffield, she was stuffed with anti-depressants that blurred her vision until she could not read and lulled her into inertia. “Minor tranquillisers” resulted in her imagining inflicting harm on others: arson and murder. “When I saw a carving knife I looked at it with a new interest.” When she was given Fentazine, she developed akathisia — a side effect of anti-psychotic medication; “the patient paces, she is unable to stay still. She wears a look of agitation and terror. She wrings her hands; she says she is in hell.” She describes pleading for help from her doctor: “you whisper that you are dying, you are damned, you are already being dipped into hell and you can feel the flames on your face.”

Though endometriosis was identified in the 1920s, it was not until the 1970s that black women were finally diagnosed with it, despite frequently suffering more severe bouts than their white counterparts. Racist bias was piled on top of gender bias and black women until this point were mostly misdiagnosed with pelvic inflammatory disease, a sexually transmitted bacterial infection, implying promiscuity. Cleghorn points out that the typical case study endometriosis patient is a “white, middle class, over-educated, socially and economically privileged young woman who resisted the biological imperative of having children.”. This was an image perpetuated by medics in the Forties blaming women for their “inactive womb”. Women are still, in the 21st century told that pregnancy is a cure for endometriosis, albeit a temporary one.

The suggestion that the womb should be occupied in order to stop endometriosis is a thumping echo of the myth of the “wandering womb” that tormented women in early history. As Cleghorn points out, the man-made medical world was not listening to women in the fourth century BC and it is still not listening to women. “No unwell woman should be reduced to a file of notes, a set of clinical observations, a case study lurking in an archive.”

But it does feel like something is shifting. Partly it’s the advent of social media, where women can openly share their biological fears and complaints, it’s also the fact that the shame women have harboured about their bodies, and their reproductive capability, is receding.

Woman is still her biology, as Cleghorn puts it, but as she gains confidence to challenge those long held medical ideas about pain and symptoms and the inadequacy of her body, she will no longer have to be at the mercy of it.