The latest Women and Equalities Committee (WEC) report on female reproductive health was published in December. It describes how women’s accounts of debilitating symptoms are subject to clinical dismissal and disbelief, resulting in thousands needlessly suffering for years (even decades) after first seeking professional support.
However, medical misogyny is nothing new. Activists, patients, researchers and clinicians have been trying to expose and challenge this phenomenon for decades. To make real progress, we need to expose the societal myths that inform unconscious bias within medicine and integrate female reproductive health into school and general medical education.
The WEC report
The WEC report provides a comprehensive overview of the nature and impact of medical misogyny, well illustrated by some shocking examples of clinical negligence. It also manages to keep its focus on female-prevalent symptoms and health conditions, which makes a nice change from the typical drift into pronatalist discussions of (in)fertility – as if our health only matters when it impacts others. However, the report fails to fully identify and challenge the gender and racial myths underpinning the dismissal of certain symptoms and patients, and how these are so embedded within society and medicine that merely pointing out the problem (again) is never enough. Tangible interventions which challenge common beliefs and practices are required, so actually naming and shaming these societal/ biological myths might be a good start.
Why we don’t believe women
For hundreds of years, Western patriarchal societies (those in which men hold power over women) have relied on a particular social construct – that of the ‘Man of Reason’ and its implied (although also often also explicitly stated) ‘binary’ opposite, the ‘irrational female’. Even though this concept is not supported by any empirical data, it serves as a useful political tool to discount and dismiss the voices, opinions, rights, opportunities and status of women, especially those who dare oppose these gendered inequalities. The supposed ‘irrationality’ and ‘pathological emotionality’ of women have been used explicitly in arguments against girls’ education, women’s suffrage, access to certain professions and commercial/political leadership.
This gender myth has been actively perpetuated (albeit often unintentionally) by the natural sciences and medicine for several centuries. In the 17th century, around the same time that the ‘Man of Reason’ became an influential popular philosophical construct, the medical use of the word ‘hysteria’ changed from a generic term describing a range of (physical) gynaecological complaints to a diagnosis of pathological emotional (later psychological) distress. The medically endorsed myth of the ‘hysteric’ was born: the pathologically emotional and, thus, irrational woman, who is prone to inventing, exaggerating, imagining and even manifesting all sorts of female-prevalent symptoms (especially pain) and experiences (especially sexual abuse) due to her reproductive biology.
Of course, it just so happened that at exactly the same time, an increasing number of women in industrialising nations were lobbying for the right to comprehensive education, to vote, for better pay and employment opportunities, and to inherit familial assets – all things which directly challenged men’s supposedly ‘natural’ superior status within society.
From hysterical to hormonal
While doctors today are highly unlikely to consciously believe in the myth of the hysterical female, my research shows how its influence persists as a contemporary gender myth: the ‘hormonal’ female. Certainly, a woman’s supposedly ‘hormonal’ nature (i.e. more emotionally changeable (and capricious) than a man’s, which is dictated by her reproductive body) remains a core sexist trope.
Crucially, the ‘hormonal female’ is also another catch-all medical explanation for a wide range of female prevalent symptoms – despite a distinct lack of empirical evidence. Additionally, other physiological processes associated with cyclic/perinatal/perimenopausal hormonal changes (i.e. the activities these hormones coordinate), which could more readily explain female-prevalent symptoms (e.g. inflammation and iron deficiency), are almost entirely omitted from current medical education. There is no scientific explanation for these omissions, which is highly suggestive of the (unconscious/unintended) influence of societal gender myths.
In my forthcoming Menstrual Myth Busting: The Case of the Hormonal Female, I argue that the omission of comprehensive female reproductive physiology from school and medical education needlessly perpetuates the myth of the hysterical/hormonal female. In turn, this myth directly contributes to the problem of medical misogyny: namely the dismissal of female patients without adequate medical care and poor-quality research into female-prevalent symptoms and conditions.
Why we especially don’t believe racialised women
Less well known is the myth of the ‘hysterical and hormonal Other’ (racialised/enslaved/colonised/homosexual/poor/non-Christian person). When the sex hormones were first identified and isolated from each other in the 1920s, they were immediately taken up by colonial and Fascist eugenic discourses to argue against the human rights of enslaved or colonial populations, the working classes, homosexuals and, of course, women. The hormonal narrative simply built upon pre-existing beliefs about the ‘natural’ biological superiority of educated, wealthy, White, heterosexual, Christian men (responsible for the perpetration of violence upon these groups).
In addition, to the compounding effect of two or more intersecting ‘hormonal’ myths on racialised female patient experiences, are additional racist medical myths. One persistent inaccurate belief (dating back to US slavery) is that Black people have (literally and figuratively) ‘thicker skin’– making them able to handle physical and emotional pain without the need for medical support. Another one is that Black people are biologically ‘prone’ to certain conditions, and so their experiences of pain/distress can be minimised and normalised (i.e. inadequately treated). Plus, there is a racist belief that Black and other racialised patients may be more likely to feign or exaggerate pain to access pharmaceutical medications (especially in the US). Again, there is no empirical evidence behind any of these myths.
So what?
Unfortunately, modern medicine appears reluctant to acknowledge its historical role in ‘justifying’ political gender and racial inequalities and so medics are still not routinely taught about their profession’s shady past, or the myths behind their unconscious biases. As a sociologist, I would argue that this is probably because we all continue to live and operate within White supremist patriarchal societies, which rely on unscientific beliefs regarding the supposed ‘natural’ inferiority of oppressed populations. In very real terms, if medics are not taught about these incredibly pervasive gender and race myths, and medicine’s role in their origin and reproduction, they will continue to (unintentionally) discriminate against their patients for centuries to come.
Sally King is a postdoctoral fellow in menstrual physiology at King’s College London who specialises in integrating biological and sociological research and data concerning menstrual health. She is the Founder of Menstrual Matters, the world’s first evidence-based information hub on this topic (www.menstrual-matters.com).
Menstrual Myth Busting by Sally King is available on the Bristol University Press website. Order here for £19.99.
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