It's difficult to find a modern woman who feels totally at home in the gynecologist's office, but we actually have a much better deal than any previous generation in history. Nobody's attempting to tell us that our womb is wandering, refusing to wash their hands while dealing with our childbirth, or failing to reveal the secrets of their forceps to us. Neither do they follow the example of 19th century American gynecologist J. Marion Sims, who pioneered modern gynecology by experimenting on female slaves without anesthesia. (The recent rediscovery of Sims' legacy inspired protests to have statues of Sims taken down.)
Life as a woman today may be far from a picnic, but for those of us who can afford good gynecological care (not exactly a given in today's America, unless you have access to Planned Parenthood), it can be comforting to think of how far we've come — and distressing to know the racist, sexist, and extremely scary history of gynecology.
The future of gynecology is decidedly space-age: 3-D printed ovaries are now a thing, for example. However, the female reproductive system continues to face serious challenges from the medical establishment. It's been uncovered in the past 12 months that one in 15 women fitted with a vaginal mesh device to help pelvic organ prolapse after childbirth will need to get it removed surgically, and that the mesh causes all kinds of serious complications. While we're certainly a long way from being made to ritually purify ourselves after childbirth, having reproductive organs as a woman remains, for many of us, a scary business indeed.
Ancient Egypt, India, & Mesopotamia
Our knowledge of treatments for gynecological issues in ancient Egypt largely comes from a series of medical papyri that demonstrate both a very tolerant female population and a generally hands-off attitude towards women’s reproductive issues. A lot of the recommended remedies don’t involve any actual medical work; uterine prolapse was treated by sitting a woman over a burning fire of particular ingredients, while a woman's fertility was measured by assessing their vomiting while they were sat on a floor spread with beer. The Egyptians also appeared to believe that the womb could be responsible for all sorts of non-gynecological issues. One woman's eye problem, for instance, was diagnosed as "discharge of womb in the eyes," and was solved by burning incense and fresh oil underneath the woman's vagina, and making her eat a donkey liver.
When it came to birth, it seems that some medical instruments were used, but only in the case of stillborn fetuses or dead mothers. Horrifically destructive implements like hooks used to remove stillborn children from their mothers have been recorded in ancient Sanskrit texts in places like Tibet, but they were likely only used as a last resort — because the mother would very likely die after their use.
Ancient Greece & Rome
Women's bodies, particularly their reproductive systems, were viewed as intensely important in ancient Greece, as necessary to the society's essential oikos, or family units. Reliefs and images show that, while men wrote gynecological texts in great numbers, women were often the ones doing the practical work of midwifery and examination, and the most highly-skilled ones were viewed as equal to male doctors. One of the gynecological innovations of the time was the idea of the “wandering womb”: the concept that many disorders in women, from the reproductive system to other illnesses, could be caused by the womb’s tendency to move around the body freely. Medical texts include recipes for “luring” it back to proper positions using sweet scents, hopefully used outside the body, not inside.
Childbirth across the ancient world was highly dangerous, but for ancient Greeks and other civilizations, it was also seen as "impure." Women who'd given birth, under ancient Greek and Roman religious lore, acquired an unclean “miasma” that meant they were unable to go to temples until they’d completed certain rituals and waited for a set period. Anybody who'd touched them while in labor was said to have unclean hands. We can also date the discovery of Caesarian sections to ancient Rome, but the myth that they came about because of the birth of Julius Caesar is likely untrue, for the simple reason that his mother survived. Caesarians may actually derive their name from a Caesar-era law that dictated that women who died while pregnant in Rome were not allowed to be buried unless the fetus was removed. The procedure likely came about, in other words, as a way of removing a likely stillborn child from a mother who had passed away during childbirth.
Medieval & Renaissance Europe
Medieval Europeans subscribed to many of the gynecological ideas of the ancient Greeks and Romans, including views about illnesses caused by build-up of menstrual blood, and the need for young virgins to have sex to avoid “green sickness," a collection of symptoms attributed to too much blood in the womb (Yes, really.) However, when it came to childbirth and the removal of stillborn children or afterbirths, physicians before the 14th century advocated baths and poultices on the belly rather than actually removing anything, possibly because surgery had such a high chance of death for the patient.
The invention of the printing press in 1440 meant that, for the first time, ideas about obstetrics and gynecology could be disseminated widely in pamphlets (as well as total nonsense, like the English woman who claimed in 1726 to have given birth to rabbits and was, for several months, thoroughly believed by her male doctors). People started buying hand-written medical textbooks to read at home around 1375, and the first obstetric textbook appeared in Europe in 1513. It spent its entire preface berating midwives for “ignorance”.
One of the most famous gynecological innovations of this period is mostly renowned for the fact that the family who invented it kept it secret for nearly a century, likely costing the lives of thousands of women. The Chamberlen clan, Huguenot refugees who became gynecologists in England in the 1600s, invented the obstetric forceps some time early in the century, but proceeded to keep it a professional secret until the 1690s. They attempted to sell it to the French government in 1670 with no result, and then finally gave the secret to a Dutch physician who was, fortunately for modern medicine, not as good at keeping secrets.
The 19th Century
The 1800s were a scary time for gynecology in Europe. For one, pelvic exams and STDs became synonymous with punishing "women of vice": in the 19th century, French women suspected of being prostitutes would be given gynecological examinations with speculums without their consent. British women had a worse time, if that was even possible: under the Contagious Diseases Act of 1860, any woman could be examined for venereal disease on the slightest suspicion of prostitution, and if convicted, forcibly confined to hospitals or asylums.
It also continued to be a time of severe danger for women in childbirth, despite advances that could have saved them. The real cause of puerperal fever, which was one of the greatest killers of pregnant women during that century, is the spread of germs and infection during birth, but gentleman doctors habitually handled childbirth without any kind of hygiene practice, and so caused countless deaths and epidemics. The tragedy was that Alexander Gordon had published a treatise on puerperal fever in 1795 pinpointing its exact cause, but nobody listened to him, or to Oliver Wendell Holmes, who wrote about it in 1843, or to Ignaz Semmelweiss, who reduced deaths in his hospital ward in the 1840s purely by making students wash their hands. It wasn't until 1879 that Louis Pasteur located the infectious cause of puerperal fever and was widely acclaimed for it.
One of the most controversial and upsetting chapters in 19th century gynecological history is currently causing an uproar in the United States: the actions of American doctor J. Marion Sims, known as the "father of modern gynecology." Sims invented the speculum as we know it, and pioneered a treatment for vesicovaginal fistula, a condition that occurred during childbirth, leaving a wound between the uterus and bladder. But to obtain that fistula solution, he experimented on his slaves — without anesthesia. Sims bought the women — named Anarcha, Lucy, and Betsey, per his diaries — in 1845, and though he wrote that he obtained their consent and that they were enthusiastic participants in the procedures, it's very hard to imagine a situation in which a Black female slave would feel able to say no to her white male owner performing experiments on her.
Sims didn't perform his operations with anesthesia as it wasn't widely available, and he believed that Black women had a higher pain tolerance than white women. In the wake of the push to remove Confederate statues, statues of Sims across the U.S. are now the target of protests, arguing that though he made medical advances, he did them at too great a humanitarian cost.
The 20th century brought more breakthroughs for gynecology than any other era, from contraception to artificial insemination, Pap smears to ultrasounds. But all that innovation was built on a foundation of medicine that was often disgusting, sexist, racist, and commonly very wrong.