Going to a doctor, you generally expect a remedy to your problem. In fact, some times you might demand a cure even when there may not be one. (Now, be honest- How often have you visited a doctor’s office with a cold or a stomach virus and said, “But I don’t want it to run it’s course! Isn’t there something you can give me to make me better?!?”) Pain during sex can prompt visits, however uncomfortable they might be, to your general practitioner, urologist, or gynecologist. And, you expect results. After all, problems in bed can lead to other consequences- strain in the relationship, inability to conceive, linking sex with negativity rather than pleasure or enjoyment. Yet, barring an obvious physical problem, pain during sex, for women, is usually classified as vaginismus or dyspareunia- both mental disorders.
This view of female sexual dysfunction probably wouldn’t be as disturbing if this didn’t have sexist roots dating back over a century….
Generally speaking, sex in the United States has been viewed as a male need and for procreation since the late colonial era. With the rise of separate “spheres” for men and women, especially by the early to mid-1800s, the female orgasm fell to the wayside, and women were praised for their lack of sexual desire even within marriage. But, as more women demanded the right to vote and entered into the workforce- thanks to industrialization in the late 1800s, those separate “spheres” became noticeably more fluid. These developments threatened Victorian gender norms, and physicians sought to reassert male dominance in part by finding answers of some sort for female sexual dysfunction. After all, sexual dysfunction kept men from having sexual access to their wives (a major prereq for Victorian masculinity) and wives from performing what many considered a basic marital duty: sex.
Doctors had been using ether and chloroform to knock out their patients’ wives for their husbands to have sex with their unconscious spouses (I couldn’t even begin to count the number of problems there). To these doctors, sex was for male enjoyment and release. The woman’s pleasure was not a concern. Then, with the discovery of cocaine as the cure-all drug in the late 1800s, cocaine, in various forms, was administered into the vagina to numb the vaginal area (and likely clitoris too). Again, so much for female pleasure, at least as it related to sex itself.
At the turn of the twentieth century, doctors started using electrotherapy. Ah, you are probably thinking- vibrators. Sigh… No, not for female sexual dysfunction. For vaginismus and dyspareunia, long, thin metal rods that produced a high frequency current were inserted into the vagina or uterus. Although the patient might have enjoyed the treatment, the electrodes were positioned at the back of the vagina and not the front, which means they were missing the most erogenous zones, including the widely studied “G-spot.” Apparently there were other not-so-pleasant effects as a few doctors warned “a sudden break in the current will result in a disagreeable shock to the patient.” Just looking at the picture of the electrode (cringe), it’s easy to see this was not a precursor to a dildo or a variant of a vibrator. The idea was not to make the woman orgasm but rather tone the pelvic muscles to make sexual intercourse and thereby pregnancy possible.
Some doctors at this time started using dilators. A small glass or metal dilator was to be inserted in the vagina and left for a few days before removing it to insert a larger dilator. The method continued until the vaginal opening was considered large enough for sex. Sometimes, however, the dilators were as rudimentary (or barbaric if you will) as “a large glycerine plug” for twenty-four hours replaced with “a large-sized soft rubber stem,” which is “worn” for another two weeks. Whatever the exact make up of the dilator, early twentieth-century physicians believed sexual dysfunction could be treated with dilators to enlarge the vaginal opening and also, as some doctors clamored, to reassure the woman that her vagina could indeed withstand her husband’s penis. Yes, I’m thinking those nice glycerine plugs gave so much mental reassurance….
By the 1920s, doctors started going on the attack blaming women for sexual dysfunction. Even if a wife was trying to lead a virtuous life by regulating sex, this was considered a problem. One well-known doctor stated, “The average man…faces his wedding day with heart and soul overflowing with good intentions. Nobody can crush them except the woman he marries.” Marital discord, adultery, social chaos- that’s all the woman’s fault if she didn’t put out. These doctors also argued against feminist claims of female drudgery saying men where governed by biological clocks like women. As a woman had a menstrual cycle approximately every month, a man had the need to ejaculate “every four days.” And all the work the man did in producing and releasing his “perfected spermatozoa” was considered equal to the amount of energy a woman spent conceiving, carrying, delivering, and nursing a child. (I’ll pause here for laughter, screams of outrage, etc…………) The problem? It’s all in her head. The treatment for female sexual dysfunction then? Therapy. Let the man feel empowered and accept a submissive position. One doctor wrote:
“Not infrequently one came across a poor, sensitive husband overcome with shyness and confusion, and married to a big, physically robust wife of a domineering demeanor. Sex reversal, whatever its success might be in the poultry yard, was a failure as regards human life. Emancipated woman could not have it every way. If she desired to rule the household she must [be] prepared to rule an impotent husband. [Men should] take the ” cave-man ” attitude towards their wives, and a little alcohol would often assist in the assumption of such an attitude.”
This suggestion was praised as “excellent” by other doctors.
While medicine has advanced considerably in the last century, present treatments for female sexual dysfunction are not wildly different from those just described. Although cocaine is not used to numb the vaginal area, dilators and electrotherapy linger. Kegel exercises, of course, are the first recommendation. This technique teaches the female patient to strengthen her pubic muscles by contracting and relaxing them. But, some do not know which muscles to target (contracting instead anal or abdominal muscles), while other prefer a more passive treatment. As a result, the medical community still employs electrical stimulation. The modern devices look remarkably similar to those from the early 1900s.
Moreover, the DSM-IV, which is the most current Diagnostic and Statistical Manual of Mental Disorders, contains the diagnoses of dyspareunia and vaginismus. The fact that they are part of the DSM means these forms of sexual dysfunction are viewed as mental disorders and therefore treated in part by psychologists and psychiatrists. This classification system has roots in the 1800s, by connecting reproductive disorders, including pain during sex, with the female mind. And, this gendered method of treatment has important implications for women, for sexual pleasure, for views of women’s roles with sex. Women needing help with sexual dysfunction deserve more than often ineffective treatments or “It’s all in your head.”