The Virgins’ Malady: How Marriage Became a Medical Treatment

---

“Arise, fair sun, and kill the envious moon, / Who is already sick and pale with grief /… / Be not her maid, since she is envious; / Her vestal livery is but sick and green / And none but fools do wear it; cast it off.” To modern readers, Romeo’s words in the balcony scene of Romeo and Juliet (Act II, Scene II) might just sound like the poetic ramblings of a love-struck teenager. But for Shakespeare’s sixteenth-century audience, they carried a deeper meaning. Romeo is comparing Juliet to Diana, goddess of the moon and chastity, whose devotion to virginity has left her “sick and green” with envy. Romeo urges Juliet to “cast off” her virginity by marrying him, warning that prolonged chastity would make her sick and framing consummation as a medical necessity.^[1] The belief that Juliet would become ill if she did not marry reflects a medical habit of defining women’s health through their expected sexual and reproductive roles. Even today, women’s illnesses are often treated as urgent only when they interfere with their ability to fulfill those demands.

In his Epistolarum Medicinalium, physician Johannes Lange (1485-1565) catalogued the symptoms of a condition he believed was caused by prolonged chastity in young women. He described them as having a “pale, as if bloodless” appearance, aversion to food, difficulty breathing, and lack of menstruation. From the sixteenth century through the nineteenth, physicians commonly diagnosed this as green sickness, or, as Lange called it, morbus virgineus, “the disease of virgins.” In a letter to an acquaintance seeking medical advice for his young daughter, who was “desired in marriage by many suitors,” but unable to wed due to her illness, Lange described his recommended cure:

I order virgins suffering from this disease to live with men as soon as possible, and have intercourse. If they conceive, they recover. In fact, if they are not attacked by this disease during puberty, then it seizes them a little later, unless they have married a man. And of the married, it is certainly the barren who suffer this more.^[2]

Lange’s prescription did not emerge in isolation, but drew from a tradition of medical theory stretching back centuries. The ancient Greek Hippocratic text On Virgins states that “virgins who do not take a husband at the appropriate time for marriage” experience an accumulation of blood in the body, which eventually travels up to their heart and causes hysteria.^[3] Later, the thirteenth-century text De secretis mulierum would attribute symptoms like difficulty breathing, dizziness, and weakness in sexually inactive women to retained menses and corrupt humors^[4]. The text called the condition “suffocation of the womb,” and prescribed sex as the cure, believing intercourse would release the accumulated substances.^[5] Both Lange and these earlier texts define the female body in terms of its capacity for marriage and childbirth, with their solutions conveniently allowing women to return to those expected roles. In this way, medicine has a long history of relying on patriarchal assumptions in its treatments for women.

Shakespeare’s allusion to green sickness – believed to afflict women who failed to fulfill their sexual or reproductive duty – shows that these ideas were not confined to medical texts. The cure for green sickness became embedded in popular culture during the late sixteenth century, circulating openly in literature and on stage alongside its discussion in contemporary medical writing. The late seventeenth-century ballad, A Remedy for the Green Sickness, describes a young woman who “look’t as green as grass,” insisting that only a man can ease her of her pain. When a “gallant lively Lad” rushes in to help, she warns him to be quiet so her father will not hear as he jumps into bed to cure her. The ballad reveals the double bind green sickness had created. Women’s bodies were often pathologized for being overtly sexual, while sexual expression itself was tightly policed until marriage made it socially permissible. In the ballad, the woman’s suffering is framed as a medical problem, yet the cure must be given secretly because it occurs outside the bounds of marriage.

The name “green sickness” also reveals the underlying assumptions embedded in the diagnosis. Despite the name, physicians rarely observed actual green skin; instead, “green” likely referred more to a state of emotional and bodily imbalance in women. The Oxford English Dictionary traces “green” to associations with “tender age,” youthfulness, and inexperience.^[6] The Greeks, citing humoral medicine, linked “green” to sickness, envy, and other “unpleasant emotions,” believing that an overproduction of bile produced a greenish complexion.^[7] The name likely drew from both meanings, with the social and physiological assumptions about women reinforcing each other. Together, these associations contributed to beliefs that female development was a process of shaping young women into socially acceptable, reproductive members of society.

If the marriage cure were truly about women’s health rather than social control, we might expect it to be universally prescribed. Instead, physicians, aware of alternative therapies, still prioritized marriage and sexual activity as the primary remedies. Early gynecological authorities, most famously Rodrigo de Castro in his De universa mulierum medicina (1603), treated cloistered women as a distinct category with their own treatments. Though nuns were not simply “unmarried” but occupied a religious state with its own sexual ethics, physicians nevertheless believed nuns could suffer the same bodily imbalances as virgins destined for marriage. In the absence of marriage as a cure, Castro instead recommended bloodletting, enemas, and strong laxatives to nuns as substitutes for the sexual activity that marriage would provide. The availability of these alternative treatments makes clear that the marriage cure was not only about healing women but also about reinforcing social expectations that women’s bodies should serve their reproductive and domestic roles when possible.

By the eighteenth century, the condition would also be referred to as chlorosis, though its core assumptions remained unchanged. As late as 1771, the Encyclopaedia Britannica still recommended marriage, but now as a last resort, noting that if iron-based treatments failed, “matrimony [is] a certain cure.” Though medical science was evolving, cultural assumptions about gender endured. The uncertain nature of chlorosis left room for moral, sexual, class, and dietary explanations to coexist alongside one another. Through the nineteenth century, physicians used chlorosis as a catch-all label for a range of issues in young women, from nervous disorders to poor diet and iron deficiency.^[8] Victorian doctors would regard chlorosis as “a cultural construction embedded in the context of Victorian medicine and family life.”^[9] The disease came to be expected in adolescent girls of the leisure class as the consequence of an “idle but well-nourished lifestyle.”^[10] As historian Joan Brumberg notes, “British doctors promoted a ‘medicalized condemnation’ of the luxurious habits associated with the leisure of girls in the privileged classes.”^[11] Physicians criticized respectable daughters for becoming ill, even though the restrictions of their class and gender left them with little choice but to live in ways that continued to make them sick.

Advances in nutrition and hematology through the 1900s finally detached chlorosis from women’s conduct. Iron supplements replaced marriage as a treatment, as researchers recognized that some young women simply suffered from iron-deficiency anemia caused by restricted diets imposed on them.^[12] By the 1930s, understanding of nutrition and anemia had led to the disappearance of chlorosis from medical textbooks. But the underlying diagnostic logic of treating women only when they are impeded from marriage or fertility persists in modern medicine. Lange’s acquaintance, after all, sought his medical advice only when his daughter’s illness prevented her from marrying.

Today, this logic resurfaces most clearly in how medicine continues to define women’s bodies primarily through their reproductive potential rather than as patients deserving of individual care. Women with endometriosis – a chronic pain condition affecting roughly one in ten women – wait an average of nearly ten years for a diagnosis, often seeing four or five doctors before receiving treatment. During that time, doctors routinely dismiss their pain as normal period symptoms or attribute it to stress and anxiety. But Yale-affiliated clinical researchers recently found that, for many women, diagnosis and medical attention for endometriosis only become urgent once they begin to struggle with infertility. As Dora Koller, PhD, puts it: “Many times, women only get taken seriously when they are unable to get pregnant.”^[13]

Contemporary concerns about medication safety during pregnancy or the focus on potential reproductive outcomes also frequently overshadow women’s overall health. Medical research has historically excluded women from clinical trials due to concerns over reproductive effects. The U.S. Food and Drug Administration’s decision to include women of “childbearing potential” rarely in early drug trials left physicians with limited data on how treatments affect female patients and perpetuated a cycle of inadequate care. This exclusion from research has led to over-cautious regulations that discourage pregnant women from using necessary prescription drugs, prioritizing potential fetal risks over the health of the mother, even when avoiding treatment harms both. More recently, documented cases following the overturning of Roe v. Wade and subsequent state abortion bans revealed that miscarrying women were left to bleed or develop infections while doctors delayed care to ensure their pregnancies were non-viable. In some cases, that delay proved fatal for the mother.

Whether it’s treating Victorian girls only once their symptoms prevented marriage or denying modern women treatment to protect hypothetical pregnancies, medicine has a long history of prioritizing women’s reproductive capacity over their individual health. This enduring pattern reveals how women’s health is often prioritized within social structures that see their bodies mainly through the lens of marriage, childbearing, and social usefulness. Until medicine fully separates female health from female social obligation, the same logic that produced chlorosis will remain unchanged in modern medical care.

Notes

1. J.M. Pressley, “Romeo and Juliet: ‘But, soft! What light through yonder window breaks…” Shakespeare Resource Center, 1997-2025, accessed February 9, 2026, https://www.bardweb.net/content/readings/romeo/lines.html ↑
2. Johannes Lange, De morbo virgineo, in Medicinalium Epistolarum Miscellanea (Basel: J. Oporinus, 1554), quoted in Helen King, The Disease of Virgins: Green Sickness, Chlorosis and the Problems of Puberty (London: Routledge, 2004), 38-40. ↑
3. Hippocrates, On Virgins, VIII.466-70 Littré, in Mary. R. Lefkowitz and Maureen B. Fant, eds., Women’s Life in Green and Rome: A Source Book in Translation (Baltimore: Johns Hopkins University Press, 2016), 349. ↑
4. Humoral theory, the dominant medical framework from ancient Greece through the early modern period, posited that the body contained four fluids – blood, phlegm, yellow bile, and black bile – whose balance determined one’s health. It was believed that disease resulted from an excess, deficiency, or corruption of one or more of these humors. ↑
5. Helen Rodnite Lemay, Women’s Secrets: A Translation of Pseudo-Albertus Magnus’ “De Secretis Mulierum” with Commentaries (Albany: State University of New York Press, 1992), 55, 131-34. ↑
6. Kenneth F. Kiple, ed. The Cambridge World History of Human Disease. (Cambridge: Cambridge University Press, 1993), 640. ↑
7. Shuqiong Wu and Dilin Liu, “Exploring Metaphorical Conceptualizations of ENVY in English and Chinese: A Multifactorial Corpus Analysis,” Language and Cognition 17 (2025): e1, https://doi.org/10.1017/langcog.2023.56. ↑
8. Irvine Loudon, “The diseases called chlorosis,” Psychological Medicine 14, no. 1 (1984): 27-36, https://doi.org/10.1017/S0033291700003056. ↑
9. Joan Jacobs Brumberg, “Chlorotic girls, 1870-1920: a historical perspective on female adolescence,” Child Development 53, no. 6 (1982): 1468–7, https://doi.org/10.2307/1130073. ↑
10. Ursula Potter, “Navigating The Dangers of Female Puberty In Renaissance Drama,” SEL: Studies In English Literature 53, no. 2 (2013): 421-439, https://doi.org/10.1353/sel.2013.0013. ↑
11. Brumberg, “Chlorotic girls,” 2003. ↑
12. Sumera Aziz Ali, Savera Aziz, Nayab Khowaja, and Fazal Ur Raheman, “Role of Iron Therapy and Hematology in Re-Conceptualizing Chlorosis to Hypochromic Anemia: A Historical Perspective,” International Journal on Infectious Disease and Epidemiology 5, no. 1 (2024): 1-7, DOI: 10.51626/ijide.2024.05.00054. ↑
13. Isabella Blackman, “Endometriosis: Changing the Trajectory of a Painful Systemic Disease,” Yale Medicine Magazine, March 20, 2024, Yale School of Medicine, https://medicine.yale.edu/news/yale-medicine-magazine/article/endometriosis/ ↑

---

Featured image caption: An oil painting of a virgin and a unicorn, representing chastity (c. 1450-1550). (Courtesy Wellcome)