Heterosexuality in Medicine

I walk into the examination room, dreading what is about to happen. My heart’s racing. First, they take my warm comfortable clothes and make me put on a plain, crinkly, paper gown. The doctor walks in and washes her hands, making them ice cold to the touch. I get goosebumps. I lay down on a cot, place my feet up, and brace for what is about to happen. Here comes the loud, metal speculum. It’s so uncomfortable, but I know I am not alone. As women, we all shudder at the thought of a pelvic examination, but recognize its importance in preventative health. Yet, many of us don’t know the history behind this examination and significant role it has in shaping our present day ideas of heterosexuality. The medical field has and continues to reinforce the ideas of female heterosexuality.

The terms “heterosexual” and “homosexual” were created by US doctors in the late 1800s. At the time, they had an entirely different meaning than they do today. In 1892, Dr. James G. Kiernan was the first doctor to use the term heterosexual, defining it by a mental condition “psychical hermaphroditism” with symptoms that include “inclination to both sexes.” He also defined “Pure Homosexuals” as persons whose general mental state is that of the opposite sex, meaning the individual acted too much like the opposite sex they were assigned. That same year, Dr. Richard Krafft-Ebbing’s “Psychopathia Sexualis” was introduced to the United States.1

His definitions — that heterosexual people have an erotic feeling for the opposite sex, while homosexual people have an erotic feeling for the same sex — are the definitions we use today. These terms gradually became accepted in the medical field, and the idea of heterosexuality became the basis for the modern standards of masculinity and femininity. Physicians normalized heterosexuality because of the idea that our inherent purpose was procreation, and if anyone thought otherwise they were labeled mentally ill.

Richard von Krafft-Ebing’s Psychopathia Sexualis (Haack/Wikimedia Commons)

It is evident in Carolyn Herbst Lewis’s “Waking Sleeping Beauty,” that the ideology physicians had about heterosexuality and its significance became incredibly heightened after the Cold War. It was believed that a stable marriage produced a secure nation, safe from the threat of communism, and that proper female heterosexuality was key to a successful marriage. Physicians linked the rising divorce rate to sexual maladjustment in marriage. Physicians had the ideology at the time that sexual distress in marriage was caused by ignorance and fear of sex, more so on the women’s side. This is why the pelvic examination focused on the women, as its purpose was to erase any fears the bride to be may have about penetration while consummating their marriage.2

Physician Nadia Kavinoky stated that having a small amount of pain or bleeding on the wedding night often leads to an unhappy marriage and divorce. So, it was believed that fulfilling healthy heterosexual gender and sexual roles, made evident by a satisfying sexual relationship, was crucial to establishing and maintaining a secure marriage. Physicians believed the way of ensuring this was by establishing healthy female heterosexuality through state-mandated premarital consultations. In 1935, Connecticut was the first state that passed a law mandating premarital physical examinations for both men and women. Seventeen additional states passed similar laws within 4 years. By 1964, 37 states had passed laws regarding premarital medical examinations.3

During these premarital pelvic examinations, physicians stressed the importance of vaginal orgasm. It became the basis for determining if a couple’s sex-life was fulfilling or maladjusted. The ability for a woman to have a vaginal orgasm verified her gender and sexual role performance; a passive and feminine wife must be subordinate to her active, masculine husband. It was believed that if a woman was sexually aggressive, it would raise men’s mental anxieties of castration, which threatened male heterosexual performance and their psychosexual adjustment. Doctors defined the “right kind” of sex was when a woman was performing her sexual and gender roles properly. Yet despite the idea that this was normal, knowing how to perform healthy heterosexual behavior was not meant to be innate. Physicians expected women to be pure, and lacking in both sexual knowledge and experience prior to the pelvic examination.4

A creepy bearded white guy stands on a short ladder to be at hip height to a table on which a woman is laid out with her legs spread. He had his hands on her hips, and a nurse holds her arms at a 45 degree angle from the patient's head.
A gynecologist and nurse demonstrate the proper examination of a patient in 1905. (Pincus/Flickr)

Physicians wanted to ensure a sexually fulfilling marriage, so the center of attention was removing any fear of penetration the bride might have so the bride would be ready for the wedding night. They advocated that women perform certain exercises in order to be properly prepared. A physical examination, including premarital dilation, was the answer to this. Physicians would insert a lubricated instrument into the woman’s vagina. According to Dr. Kavinosky, “The virgin [could] realize that there is a normal opening in the hymen that leads into a deep vaginal canal.”5

Doctors studied the women’s reactions during this examination. They were afraid a woman would resist penetration if she was anxious, which could potentially cause her to fail at her role of heterosexuality in marriage. To solve this, many women would go home with dilators, in hopes it would make them more comfortable with penetration.6 Yet, this was only made possible if the groom approved it. It was assumed that a woman’s body did not belong to just herself, but also her future husband and her family. It was stated that premarital dilation not only subsides the bride’s fear, but also any fears the groom may have about injuring his bride. The idea was that physicians were setting up their patients for a healthy sexual marriage, ending in a fairytale life. But that fairytale was only ideal for those who were straight.

Up until recently, the only accepted marriage was straight marriage. During the era of the premarital pelvic examinations, sexual behavior was an indicator of mental health — therefore, physicians classified homosexuality, with its “deviant” sexual behavior, as a psychiatric disorder. More than one million men had been rejected from the military due to neurological and mental disorders, along with those who were dismissed for being homosexual.7 This indicated the mental and sexual health of men was adversely affecting the United States.

At the time, homosexuality was seen as a problem and a threat to national security. This ideology contributed to why physicians stressed the importance of heterosexuality, focusing on the home and family as the main way to combat homosexuality.8 Because of the focus on heterosexuality and stigma that LGBT people were mentally ill, many people did not get the adequate health care they needed.9 Yet, it is evident that as the population’s views change and become more accepting, the medical field is required to reevaluate their practices and conform to society’s needs. This is what has created modern medicine.

Modern medicine has evolved to fit the population’s needs and has changed the way physicians treat their patients. In the first half of the twentieth century, patient’s preferences were overridden if they went against what the physician believed was appropriate care. The physician-patient relationship has evolved to include the patient’s opinion, with doctors and patients collaborating together on what is the best course of treatment. These changes came from citizens advocating for certain rights in the examination room.10 For example, the feminist movement argued that the line between personal and political had been crossed during the era of premarital pelvic examinations.11

Sexuality was used as a weapon, both nationally and politically. This influenced society’s views on what sexuality was supposed to be. Physicians’ focus has shifted from heterosexual health to the inclusive health of all patients.12 Yet it is undeniable that the ideology doctors had about sexuality in the past has greatly impacted today’s views on male and female sexual/gender roles. The only way we can continue to decrease the inequality and stigmas of sexuality is to keep an open mind, discuss issues, and continue to evolve in our thinking about what sexuality is supposed to be.

Notes

  1. Jonathan Ned Katz, The Invention of Heterosexuality (Chicago: University of Chicago Press), 1995. Return to text.
  2. Carolyn Herbst Lewis, “Waking Sleeping Beauty: The Premarital Pelvic Exam and Heterosexuality during the Cold War,” Journal of Women’s History 17, no. 4 (2005): 86-110. Return to text.
  3. Lewis, “Waking Sleeping Beauty,” 86-110. Return to text.
  4. Lewis, “Waking Sleeping Beauty,” 86-110. Return to text.
  5. During this time, it was expected that a woman was a virgin until marriage and unknowing of the anatomy of her sexual parts. As a part of the Pelvic Examination, physicians would show women that their vagina had an opening and was deep enough for penetration. Return to text.
  6. Lewis, “Waking Sleeping Beauty,” 86-110. Return to text.
  7. Lewis, “Waking Sleeping Beauty,” 86-110. Return to text.
  8. Lewis, “Waking Sleeping Beauty,” 86-110. Return to text.
  9. Madeline B. Deutsch, “Guidelines for the Primary and Gender-Affirming Care of Transgender and Gender Nonbinary People,” University of California, San Francisco. June 17, 2017, accessed December 5, 2017. Return to text.
  10. Ludwig, MaryJo and Wylie Burke, “Physician-Patient Relationship: Ethical Topic in Medicine,” University of Washington School of Medicine, October 28, 2014, accessed December 5, 2017. Return to text.
  11. Lewis, “Waking Sleeping Beauty,” 86-110. Return to text.
  12. Deutsch, “Guidelines.” Return to text.

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