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History of Modern Gynecology

Many people are unaware of how modern gynecology was started and how men (doctors and male-midwives) took over providing gynecological procedures and childbirth when medical school was invented. Before modern medicine, men were not allowed to be present at births or other procedures that dealt with the intimate parts of women.

Many midwives when medical schools were established bitterly opposed the involvement of men in childbirth. Some male practitioners also opposed the involvement of medical men like themselves in midwifery and even went as far as to say that male-midwives only undertook midwifery solely for perverse erotic satisfaction.

Midwives played a role in the development of obstetrics. For through most of the twentieth century, midwives have been thrust to the sidelines. Fortunately, midwifery is making a comeback and thousands of women enjoy the care of midwives and OBs. Either way, midwives are the ones who have assisted women during labor for thousands upon thousands of years. Without them, and their copious amount of knowledge, the first rung of obstetrics would never have been climbed. In fact, until the 20th century, the science of Obstetrics was still referred to as Midwifery in medical schools – and obstetrix is the Latin word for midwife!

Once the field of medicine and the arena of pregnancy and childbirth were usurped by modern medicine – all doctors, including obstetricians were men. The first female to graduate from medical school was Elizabeth Blackwell back in 1849, although it took more than a century and a half for female doctors to be considered “normal.”


Some Historical Facts About How Male Gynecologists Evolved:

1.) Dr. James Marion Sims from South Carolina is said to have invented modern gynecology in America. He is considered the “father of modern gynecology”. Dr. Sims is known for inventing gynecological techniques we still use today; most notably he invented a surgical technique to repair vesicovaginal fistula. Beginning in 1845 Dr. Sims developed a surgical technique to cure this taboo medical condition through experimentation on human subjects. What makes Dr. Sims’ experimental techniques so horrific is that he used enslaved black women as human subjects for his research and because these women were considered to be property, they could not consent to these appalling procedures. In fact, their owners were allowed to consent for them, owners with a strong financial interest in the success of these surgeries. Even worse, Dr. Sims performed these surgical procedures on black women without anesthesia because of his belief that black women were not capable of feeling pain; however, the very real pain of Betsey, Anarcha, and Lucy are detailed in Dr. Sims’ many journals. Not only did Dr. Sims violate these women without their consent, he also invited people to watch as he performed these experimental surgeries, further stealing the dignity of the women who were forced to partake in his research. Dr. Sims performed 35 surgeries on one single human subject, Anarcha, before completing a single “successful” surgery.

2.) In October 1889, Dr. Howard Atwood Kelly was appointed the first professor of gynecology and obstetrics, and is universally regarded as establishing gynecology as a surgical specialty.

3.) By the late 19th century the foundation of modern day obstetrics and midwifery began develop. Delivery of babies by doctors became popular and readily accepted, but midwives continued to play a role in childbirth.

4.) The American College of Obstetricians and Gynecologists (ACOG) founded in 1951 is a professional association of physicians specializing in obstetrics and gynecology in the United States. It is an organization with a membership of approximately 58,000 obstetrician-gynecologists and women's health care professionals. A majority of ob/gyns in 1951 were males.

Look at this important section about historical progression of pelvic exams in the article, Male physicians treating Female patients: Issues, Controversies and Gynecology below:

“The oldest medical text known to man is the "Kahun Gynecological Papyrus", written by the Egyptians around 1800 BCE. The papyrus provides a glance into early gynecological medicine and unveils the traditions of reproduction, conception and delivery in ancient Egypt. For the Egyptians, the main treatment modalities provided by the "swnw" (pronounced sounou, physician figure) were founded on pharmacopoeia from animals, plants and minerals; surgical intervention was never recommended (2). Magic spells were whispered, as it was believed that diseases were demonic in origin.

Due to compliance with religious doctrine, men were not allowed to be present at births or at other rituals that dealt with the intimate parts of a woman. Instead, it was the role of the midwife to take care of women and to assist them with their gynecological needs. Interestingly enough, the "Kahun Papyrus" provides some of the earliest evidence of midwifery in history.

Similarly, in the middle ages, it was often the norm for a woman's sexual organs to be examined by midwives, nurses or other females who previously had had similar problems to the patient's. By the early 1800's, with the advent of modern medical degrees and physical examinations, the pelvic exam began to be performed by male physicians, as women were not allowed to enroll in medical school. However, this examination was a variation of the modern version as it consisted of a "compromise" in which the physician kneeled before the woman but did not directly inspect her genitals, only palpated them.

The historic taboo associated with the examination of female genitalia has long inhibited the science of gynecology. This 1822 drawing by Jacques-Pierre Maygrier shows a "compromise" procedure, in which the physician is kneeling before the woman but cannot see her genitalia. Modern gynecology no longer uses such a position. The above picture is when they first introduced men to do gynecological procedures on women.


Source: Illustration by Emily Roberts, Verywell

The above picture is of how a pelvic exam is performed today. Speculum in 3 above is used for the Pap smear.

In addition, it was during this period that the use of a chaperone became a part of the clinical examination. The chaperone's role was to emotionally support and reassure the patient during a procedure that she found embarrassing or uncomfortable. The chaperone also acted as a witness in cases of malfeasance by the physician. Today, in many parts of the world where religious and cultural precepts often discourage female encounters with male physicians, chaperones still attend gynecological examinations.

The truth is chaperones are pretty useless. They are just there to protect the doctor. Check out the truth about chaperones by looking at this article, Do Chaperones Really Protect Patients?

By the 1970's, only 9% of enrolled medical students in the United States were women (3). The numbers have drastically increased since then: now 58% of medical students are women (4), yet there are still disparities in gender among the specialties. In Obstetrics and Gynecology, female residency enrolment rates have quadrupled from 1978 to the present, leaving men in the minority (women account for 71.8% of Obs/Gyn residents today). Between 1989 and 2002, the proportion of female Ob/Gyn residents rose from 44% to 74% while the proportion of female graduating medical students only increased from 33% to 44% (5).”

Modern medicine has worked to indoctrinate us that the gender of a gynecologist does not matter. Male gynecologists often charm women into accepting them due to their impressive surgical skills & training, compassion, and gentleness. Many male gynecologists who have sexually abused women were very professional, compassionate & gentle, and skilled.

Our culture sees doctors as experts on the body and the medical industry has worked to indoctrinate even the most modest women (those with very strict standards such as not wearing a 2 piece bathing suit and no sex until marriage) to accept that male gynecologists are okay over the past few centuries since modern medicine started. Because most gynecologists were males until recently, women of the past few generations conditioned their daughters to go to male gynecologists because that’s what their mothers did. This is a huge cultural blind spot. This also proves that doctors have so much power in our society.

Think about this scenario: A teenage daughter has a tampon stuck and she needs help to retrieve it. Her mom tried to retrieve it, but could not. The girl's father is better than her mother at retrieving things. Would it be appropriate for the girl's father to retrieve the tampon simply because he is more experienced than his wife? If the girl's mom cannot retrieve the tampon, they should look for another woman to retrieve it. The same should be true of doctor. You should look for a female doctor until you find the one that is skilled for your case.

The truth is most people in our society would accuse the father in the above scenario of incest if he helped to remove a tampon from his teenage daughter even if he had great intentions, but they would not look down on a male doctor removing the teenage girl’s tampon simply because he is a doctor. This is ridiculous because a male doctor is still a man.

If indeed the pelvic exam is a simple medical procedure, then a male doctor should not hesitate to perform an intimate exam on his own mother or his own daughter, or his grandmother, or any other female relative! Of course the mere thought of such an intimate exam on a close relative is alarming and disgusting to consider. Why? Because it raises the image of incest – sex among relatives, one of the most forbidding actions in human behavior. From this simple illustration we know positively that a pelvic exam is loaded with sexuality – it is not a mere medical procedure. In denying the sexuality of the pelvic exam for a century, the medical profession has been committing a fraud – a deliberate misrepresentation – on female patients. Sons do not look up their mother’s skirt and fathers do not look up their daughter’s skirt.

While it is great that modern gynecology has brought improvements such as C-Sections that have cut down on maternal deaths, surgeries for gynecologic cancers, etc., only women should have been allowed to be gynecologists in the beginning. Medical school made a big mistake by only allowing men to become gynecologists. Thankfully, there has been a big increase in female gynecologists in the 21st century. Sexual abuse and voyeurism by male doctors would have never happened if male doctors were prohibited from doing intimate procedures on women.

Many women dread having gynecological procedures (they see no sexual connotations to those procedures) so they assume that it is impossible for a male doctor to have any lustful thoughts especially because they do gynecological procedures all of the time. Also, many women are so focused on making sure they do not have cancer and this is why they submit to gynecological procedures. But the truth is men (no matter how good their intentions are) often have lustful thoughts when they see a woman’s private parts. Male doctors are no different from other men. Male doctors often have normal sex lives; many of them are married with children.

Women and men differ in their sexual responses. Rare is the man who can approach the idea of being asked to touch a naked female in her intimate parts in any context without a hint of sexuality entering his mind. Females are usually only eroticized by proper mood and situation, but the male sexual response is visual, tactile and immediate. This is exactly why women rarely think about how a gynecological procedure could be sexual for a male doctor.

Sadly, some female gynecologists are very insensitive to women’s modesty today because they see nothing wrong with referring a woman to another male doctor such as a gynecologic oncologist or fertility specialist. Many female gynecologists rotate with male gynecologists who could deliver their patients’ babies. Also, some female gynecologists use male medical personnel such as medical students, residents, nurses, etc. to assist them with gynecological procedures. Some female gynecologists have been desensitized in medical school that gender does not matter and that modesty is not important.

All women are encouraged to read this book, Women and Doctors by Dr. John Smith (Dell Publishing, 1992) that exposes the gynecology industry and how women are often mistreated by male gynecologists. Make sure you especially read the chapters, 3 – The Behavior of Doctors in General and 4 – The Miscasting of Males As Gynecologists. The book is outdated on some medical procedures such as pap smears and pelvic exams, but those two chapters are still relevant today in 2018. His chapter on unnecessary surgeries is still relevant because a lot of unnecessary hysterectomies are done today.

Dr. John Smith is a former male gynecologist who courageously shared that after 24 years of medical education and clinical gynecological experience that men should not be gynecologists. He shared that he had to do a lot of soul-searching as a male gynecologist. “Male gynecologists, like all men, go through the kind of ‘attitude setting’ that occurs in the proverbial locker rooms while they are growing into manhood.” Dr. Smith, whose practice was in Colorado Springs, says that “It is common and acceptable among practicing gynecologists to speak about their patients' bodies, sexual behavior, or medical problems indiscriminately, in terms that are demeaning and reflect a lack of kindness and respect.” (p. 32) Becoming more explicit, he charges them with eroticizing the medical scene: “It is a rare male who is able to see women day in and day out, examine their bodies, hear details of their sex lives, and not only never have a lascivious thought or abuse that access but always remain clinical…” (p.34) He confesses that “I have had a colleague invite me to do an exam on one of his patients under the false guise of a consultation because ‘she has a body you won’t believe’.” “I have seen a physician walk out of an exam room and tell a hallway full of doctors and nurses about the disease his married patient had contracted as a result of an affair. I have seen more than one gynecologist walk into an operating room where another doctor’s patient was already asleep for surgery, lift up the sheet, admire the patient’s breasts, and continue his conversation without pause.” (p.32-33) Dr. Smith concluded dramatically: After twenty-four years of medical education and clinical gynecological experience, it is my opinion that males should not be gynecologists. The role properly belongs to women.” (p.34).

Dr. John Smith also made some other important points in the book:

1.) At this point, many of you are saying “not my doctor, my doctor is honest, competent, and has only my welfare at heart. Please understand that a pleasant demeanor and impressive diplomas and certificates do not mean your doctor is incapable of the behavior I will describe in this book. (page 3) - This is true. Many of the male gynecologists who have abused women fool their patients by their professionalism, knowledge, and compassion.

2.) No other professional in America enjoys the degree of authority that physicians have managed to secure. Almost unquestioned in their judgments, they have been given the authority to exercise power in areas that extend beyond their medical area of competence. Physicians can also decide if you should be allowed to do certain kinds of work or if you can play a sport in school, and can exercise unquestioned power in myriad other aspects of your life. (page 23). - This is true. Many of doctors push patients into making decisions that they would not normally make in another setting.

3.) Too often, women rely on the gynecologist’s “reputation,” and if it appears to be good they assume the gynecologist, too is good. It is rare to hear information about how bad a doctor is, except from former patients, and they often do not have a large audience. It’s much more common today to hear, in a hospital’s advertisements for instance, that their staff physicians are all terrific, well-trained, caring, and attentive (page 117). – This is very true. In fact, many doctors are able to have their negative reviews from patients on web sites removed. One hospital in Ohio continued to show an ad about how wonderful one colorectal surgeon was even after he had anally raped a patient.

4.) What do you call it if a doctor subjects your daughter to a breast and pelvic exam when there is no medical indication for it and your daughter did not ask for it? Is it any less a sexual assault than her being fondled and disrobed by a date who thinks he “has the right’? (page 37) – This is very true.

5.) In recent years, we have recognized the seduction of a woman by her psychiatrist, is in fact, a criminal act. Similar abuse occurs in the gynecological setting, but it is called something else. Perhaps because women have not felt sufficiently empowered to threaten gynecologists’ positions, these doctors have not been subjected to the same level of scrutiny as other professionals (page 37). – This is very true. So many gynecologists can get away with abusing women. Many women are too embarrassed or scared to report their gynecologists. Many women want to report their doctors anonymously, but this is not possible so they just stay silent. Also, most medical boards won’t do much about gynecologists who have abused women.

6.) Hysterectomies are deliberately sold to women by doctors who use the operation as their major source of income. They are done by well-meaning but misguided physicians who believe women are better off without their uterus. Mostly they are done by male physicians who were trained in a milieu that did nothing to alter their ingrained male prejudices about women and that reinforced the attitude that it is all right to decide for a woman what she needs, instead of giving her knowledge and power to make the decision for herself (pages 47-48).

This is true. The United States has the highest rate of hysterectomy in world. Approximately 600,000 hysterectomies performed each year in the United States. It is estimated that 85% to 90% of all hysterectomies are unnecessary so it is important for women to get a second opinion preferably from a naturopathic or integrative medicine physician and do some research on alternative options before they proceed with a hysterectomy. Gynecologists, hospitals and pharmaceutical companies make more than $17 Billion dollars a year from hysterectomies.

Also, male gynecologists are more likely to do unnecessary hysterectomies on women. In fact, one ob/gyn practice in North Carolina that has 3 male gynecologists has a very high hysterectomy rate. They’ve done so many unnecessary hysterectomies on women mostly for benign conditions including one on a lady in her 70s for a prolapsed bladder that was unnecessary.

Some doctors use scare tactics to push women into having a hysterectomy such as telling her that she could develop cancer later due to endometriosis or another benign condition that she has. Also, many doctors tell post-menopausal women and women who do not plan on having any more children that hysterectomy is a good option for them without telling them the long term risks such as heart disease, high blood pressure, etc. they could develop as a result of the hysterectomy later in life.

Hysterectomy is only medically necessary for saving a woman’s life. Hysterectomy should only be done in the case of several life-threatening conditions:

• Invasive cancer of the uterus, cervix, vagina, fallopian tubes, and/or ovaries

• Unmanageable infection such as gangrene on uterus that could cause sepsis

• Unmanageable bleeding

• Serious complications during childbirth, such as a rupture of the uterus

We encourage all women to take time to read the article, Why Are Hysterectomies Often Unnecessary? Especially read the article, Hysterectomy may have long-term health risks by a female gynecologist at Mayo Clinic under Sources. It is very interesting that a male gynecologist in that article argued that women should not cancel hysterectomy due to possible long-term health risks.

We also encourage all women to take time to read the articles, Are Pap smears Necessary for Virgins?, Truth about Pap Smears, and Truth About Pelvic Exams.

ACOG has misguided guidelines about pap smears and pelvic exams because they have the same guidelines for all women and age groups. The truth is pelvic exams are basically useless for healthy women who are not pregnant with no symptoms. ACOG does not address that some women may be at a higher risk for cervical cancer while some women such as complete virgins who have never engaged in any kind of sexual activity basically have O% risk for cervical cancer. 99% of cervical cancer cases are caused by HPV, a Sexually Transmitted Disease. Pap smear is a screening test for cervical cancer only. Ovarian cancer is extremely rare and the most reliable way to diagnose ovarian cancer is through an ultrasound or blood test — not a pelvic exam.


** We are distributing stapled 12-page booklets to women about how they can protect themselves in medical settings and we are seeking volunteeers to help with distributing those booklets. We also need some financial support to pay for more booklets. You can see what the front cover of the booklet looks like by downloading this link. You can purchase booklets from this link. If you would like to volunteer to distribute booklets or support us financially, please



Sources:

Do Chaperones Really Protect Patients?

Male OB/Gyns in the News

Gentlemen Don’t Look Up Ladies’ Skirts

Women and Doctors By Dr. John Smith

The History of the Department of Gynecology and Obstetrics

Obstetrics

Gynaecology

6 Things You Didn’t Know About The History of Obstetrics

Let’s Honor the Mothers of Modern Gynecology

What Is a Pelvic Exam?


 
     
   
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