“Throughout the nineteenth century,
normal menstruation was frequently pathologized
into surgical oblivion, while abnormal menstruation
was often dismissed as common or
garden-variety women’s troubles” (Cleghorn 195).

Menstruation isn’t inherently disabling. As we continue to destigmatize menstruation and gynecologic health, we have to acknowledge what it really is: just the normal monthly expulsion of blood and lining from the uterus. However, pretending that periods aren’t a problem for everyone is as damaging as if we left the stigma intact. Dysmenorrhea, or excessive menstrual pain, is by definition debilitating. Even today it’s one of the leading causes for missing school and work and can contribute to a poor quality of life (De Sanctis et al.). And pain isn’t the only complication that can accompany periods.

But let’s step back a century and a half. Because if periods are still a problem now, in an age of relatively advanced medicine, what about during the time that scientists were just starting to accept germ theory? During the time the Comstock Act made the circulation of literature on contraception and abortion through the U.S. Postal Service illegal? When women couldn't even vote, in part because they were considered too mentally unstable? The nineteenth century was a bleak time for women and gynecology.

The quote heading this section carries significant implications for the medical and social models of disability around the turn of the twentieth century. Namely, women not actually disabled by their menstrual health were pathologized into disability by their physicians—and women who truly needed help suffered all the more.

The nineteenth century saw the professionalization of many trades, among them medicine, and among medicine obstetrics and gynecology. As women’s “trades” lay in the home, female-led midwifery was eclipsed by the professional practice of male physicians. During the mid-1800s, James Marion Sims was a physician for slaves in Montgomery, Alabama. At first, he held no specialty in women’s health or diseases, being “repulsed by their ‘soft parts’” (Cleghorn 77). This changed during his treatment of an enslaved young woman named Anarcha.

Anarcha was no longer able to perform the tasks she was demanded to after developing a vesicovaginal fistula postpartum. According to author-historian Elinor Cleghorn, a vesicovaginal fistula “damages the bladder and causes urine to leak through the vagina. … It was often caused by obstructed childbirth and was common in enslaved women whose poor diets and grueling work regimens deformed their pelvic bones. But it could also be caused by inept medical interventions and, chillingly, rape” (77). In his attempt to restore Anarcha to a level of health adequate to resume her duties, Sims encountered two other enslaved women, Betsey and Lucy, who also had fistulas.

In exchange for “‘not [charging] a cent for keeping them,’” Sims bargained with the girls’ owners to perform experiments on them (Cleghorn 77). These experiments were done without anesthesia, as Sims falsely believed that Black women felt less pain than white women, and caused immense trauma. In Sims’ own words, “‘Death would have been preferable. But patients of this kind never die; they must live and suffer’” (Cleghorn 78).

In 1876 Sims was elected the president of the American Medical Association, and today he is credited with being “the father of modern gynecology” (Holland). In other words, our modern understanding of gynecology is founded on the pain and torture of Black women.

In any conversation on the history of gynecologic and women’s health, it is ethically imperative to recognize this martyrdom.

Nineteenth century physicians attributed most of nineteenth century women’s physiological health problems to psychological and neurological disorders, namely hysteria and neurasthenia. 

Hysteria was defined as “a nervous disorder in which the nervous system is deranged without the existence of any organic disease” and exclusive to women (Herman 29). Because women only had domestic duties to preoccupy them, they were prone to overactive imaginations that manufactured physiological symptoms and mimicked disease; sympathy from their female friends only encouraged their condition (Herman 30). Prevailing wisdom dictated that one of the best treatments for this condition was simply “neglect” (Herman 33); if hysteric women weren’t given the attention they sought their maladies were sure to disappear. 

Alternately, hysteria could be triggered by sexual desire. The size and sensitivity of the clitoral glans were pathologized, and women who masturbated were wont to experience symptoms such as headaches, menstrual problems, memory loss, sentimental thoughts, attention-seeking behaviors, and epileptic attacks (Cleghorn 88). Treatments included applying leeches to the clitoris, clitoridectomy or the surgical removal of the clitoral glans, and institutionalization (Cleghorn 89-91). 

Another popular treatment for hysteria was the rest cure developed by Silas Weir Mitchell, which prescribed staying “in bed for two months, [being] fed rich foods including raw beef soup and four pints of milk a day, [being] massaged regularly, [receiving] electrotherapy, and [being] forbidden any activity whatsoever apart from teeth cleaning” (Cleghorn 117). For some women, the rest cure or variations on it were effective. Typically these women were either so impoverished they were allowed to stay in the hospital or wealthy enough to travel abroad; women in the classes between had neither option (Cleghorn 102). But the rest cure was also infantilizing and oppressive. Author Charlotte Perkins Gilman’s negative experience with it inspired her to write “The Yellow Wallpaper,” which remains today an important text for women’s medical autonomy (Cleghorn 120). 

Neurasthenia indicated legitimate physiological discomfort or illness that was exacerbated by an oversensitive nervous system (Herman 12). While not gender-specific, women were more prone to it because of the naturally higher sensitivity of their nervous systems compared to men’s (Herman 2); society’s “pampering” of women was alleged to increase this sensitivity and contribute to greater weakness in tolerating physiological symptoms (Herman 15). According to many physicians, women’s neurasthenia could resolve itself just by being told there nothing to worry about (Herman 12-13).

Neurasthenia’s list of symptoms was expansive, including depression, anxiety, suicidal ideation, noise and light sensitivity, excessive sweating, numbness and tingling in the limbs, tremors, muscle cramps, an inability to sit still, nausea and vomiting, frequent urination, and even excessive flatulence (Herman 15-18). Today we might be able to identify numerous diseases and disorders from among these symptoms, such as mood disorders, migraines, multiple sclerosis, and other autoimmune diseases. As we will learn, however, this is always not the case.

“A treatise on all the causes of chronic ovarian
pain would include almost all the diseases
to which women are subject” (Herman 67).

For most of the nineteenth century and through the early turn of the century, menstrual pain was somehow considered normal and pathological at the same time (Herman 42). Part of this is explained by the medical community’s belief that women’s nervous systems were more sensitive than men’s and that women’s dispositions made it difficult to ignore pain and discomfort. And in 1865, German physiologist Eduard Friedrich Wilhelm Plfüger taught that menstruation had a neurological origin (Cleghorn 103).

In his 1899 treatise Diseases of Women: A Clinical Guide to Their Diagnosis and Treatment, George Ernest Herman asserted repeatedly that the nature of most women’s ovarian or menstrual pain was neurasthenic and would be treated as such:

“There seems to be a disproportion between the local
suffering and the patient’s power of resistance.
In some cases it is from an increased disposition
to complain, there being no other reason than the
patient’s statements to think that she suffers more than
most women. I have known a suggestion of removal of the
ovaries cause nothing more to be heard of the pain.
But other patients have been energetic, unselfish
women, and there was no reason to question their
statements that they did suffer much” (549).

For the unselfish women, treatment for mild pain included hot vaginal douches, a change in scenery (Herman 77-78), and even “fruitless attempts at intercourse by an impotent husband” (Herman 81). In cases of more serious pain, treatments ranged from insultingly passive to dangerously invasive: “regular and abundant sleep; frequent and suitable meals; … sunshine, fresh air, and moderate exercise” (Herman 531); doses of arsenic and mercury (Herman 531); dilatation, or the widening of the uterine canal to make more room for the passage of membrane and ease of contractions; the curette and caustic, or the scraping or removal of endometrial tissue with a chemical such as nitric acid (Herman 531-532); and, only in the most extreme cases, “the stoppage of menstruation by spaying” (Herman 532). Interestingly, Herman instructed against prescribing opiates because of their addictive nature, saying that “removal of the ovaries would be preferable” (Herman 532).

Many physicians also advised that higher education contributed to menstrual pain. The British psychiatrist Henry Maudsley wrote in 1874 that “excessive education strain” resulted in “baneful effects on female health,” as “[w]hat Nature spends in one direction, she must economize in another direction” (Cleghorn 111). This failed to account for women who spent their energy on heavy labor instead of studying and did not experience menstrual pain at abnormal rates (Cleghorn 112). Ultimately, it was highly educated women who began to shift the medical community’s perception of menstruation.

Through 1876, Mary Putnam Jacobi performed an extensive study on 268 menstruating women of “varying classes, backgrounds, occupations, and education levels” and observed that the week before most women’s periods was actually “‘a period of increased vigor and … increased nervo-muscular strength,’ where the ‘nerve-force’ needed to support normal, painless periods was established” (Cleghorn 115). Women who rested too much before their periods, the popular advice of physicians at the time, were actually more likely to have painful menstrual cramps than women who remained active (Cleghorn 115).

Clelia Duel Mosher, who herself experienced chronic ill health after a childhood bout of tuberculosis, was determined to debunk sexist pseudoscience after negative experiences with doctors throughout her own life (Cleghorn 191). By 1896 she had observed more than 3,350 menstrual cycles in more than 400 women and determined that menstruation was as normal a bodily function as breathing (Cleghorn 192). She also disproved the prevailing medical myth that women were incapable of breathing through their abdomen or diaphragm (Cleghorn 193). Mosher speculated that many of women’s medical problems were caused by fashions of the time, including voluminous skirts up to 12 feet in diameter and corsets, which respectively contributed to menstrual pain and the breathing myth (Cleghorn 193). Her thorough study led her to develop Moshering, a combination of abdominal and breathing exercises, that effectively reduced menstrual pain (Cleghorn 193).

But if the male-dominated gynecological field of medicine wasn’t poorly postulating about periods, it was massively misunderstanding menopause, the natural permanent stopping of menstruation. In the nineteenth century, this meant the end of a woman’s purpose: pregnancy and childbirth. In Herman’s words, changes to the uterus and vagina during menopause “are not important to women who have been married at the most suitable age; but to women who have been married late, to husbands younger than themselves, they may be” (583). Women in more “civilized” cultures were said to experience climacteric, the onset of menopause, later than others—which effectively translated to white women having a longer period of usefulness than women of color (Herman 580).

Just as how ovarian pain could be sourced to any menstruating women’s health concern, menopause could be sourced to any non-menstruating women’s health concern (Cleghorn 179). Again it was both normal and pathological at the same time: Women’s metabolic “instability” made them “more vulnerable to endocrine diseases” and “biochemical disturbances,” which included menopause (Cleghorn 179).

Women at the onset of menopause were also more likely to be considered insane. Apparently the stress of childbirth made women “especially liable to insanity,” and so it followed that the end of a woman’s fertility would carry the same risk (Herman 583). This tendency toward insanity would aggravate women’s weak and oversensitive nervous systems, which spurred the headaches and depression often associated with menopause (Herman 584).

Of course, because men never menstruated or went through menopause, they were stable and wise enough to decide these things for unstable, emotional women (or so they believed).

“‘It is important to understand that mystification
is the primary process here … It is mystification that makes
us postpone going to the doctor for ‘that little pain’ since
he’s such a ‘busy man.’ It is mystification that prevents us
from demanding a precise explanation of what is
the matter and how exactly he is going to treat it. It is mystification
that causes us to become passive objects who submit
to his control and supposed expertise’” (Women and Their Bodies,
qtd. in Cleghorn 279).

The medical establishment may no longer label women as hysterical, but harmful gender bias still exists. While women seeking medical treatment would be well-advised to educate themselves and self-advocate, the responsibility should not rest with them to find relief.

Gynecologic disorder and disease remain quite mysterious in medicine. There is no agreed-upon reason for why only some, but not all, women experience painful periods or menopause symptoms (Dusenbery 216). Then, those women who do experience menstrual pain are told that their experience is “normal,” that everyone gets cramps sometimes (Dusenbery 221). But when other physiological processes hurt, that’s abnormal—so what’s the difference (Dusenbery 222)?

Most severe menstrual pain is suspected to be a symptom of endometriosis, a disease in which tissue similar to the endometrium that lines the uterus is found elsewhere in the body, usually the abdomen (Dusenbery 216); other symptoms include general pain, inflammation, nodules, cysts, scar tissue, and sometimes “large masses called adhesions that can even glue the organs of the pelvis together” (Dusenbery 216). A third of sufferers will be infertile, and more than half experience pain during sex (Dusenbery 216-217). Endometriosis affects 6.3 million people in the U.S., and medicine does not know the cause (Dusenbery 216).

Vulvodynia is “chronic pain of the vulva that lasts more than three months and does not have a clear, identifiable cause” (Dusenbery 231). Frequently the pain is localized or provoked by touch (Dusenbery 231). While 7% of American women have experienced it, only 60% sought treatment, and 60% of those who did had to see three or more doctors and sometimes still didn’t receive a diagnosis (Dusenbery 238). This condition is often embarrassing or emotionally difficult to cope with due to its sexual nature, even though biologically it may be no different than other types of chronic pain (Dusenbery 238).

22,000 Americans are diagnosed with ovarian cancer each year, and annually 14,000 die of it (Dusenbery 305). If caught in the early stages, before it spreads outside the ovary, 92% of patients will survive 5+ years, but only 15% of cases are detected in this stage because there is no standard screening method for it, like a pap smear or a mammogram (Dusenbery 305). Only a third of those diagnosed will survive for 10 years or more (Dusenbery 305). Symptoms of other serious cancers are often mistaken for menopause, which also leads to untimely death (Dusenbery 248).

Over the past century and a half, symptoms of hysteria have been re-identified as unique diseases and disorders. These include many chronic illnesses such as thyroid conditions, lupus, rheumatoid arthritis, and other autoimmune diseases (Cleghorn 292). They also include so-called “fashionable” illnesses like fibromyalgia, chronic fatigue syndrome, and chronic Lyme disease (Dusenbery 253). The common factor between all these is that they are “women’s diseases” that still struggle to be taken seriously.

Many women see a battery of doctors and remain undiagnosed. They are said to have contested diseases or functional diseases, which are diseases the affected women consider physiological but medicine says are psychological (Dusenbery 252). This issue is also highly racialized and class-oriented, with educated white women considered to be hypochondriacs while less-educated women of color are malingerers “looking for a disability check” (Dusenbery 313). A hypochondriac is someone whose severe anxiety convinces them they have a disease, while a malingerer is someone feigning illness for attention or financial gain (Dusenbery 100-102); while neither label is complimentary, linking less-educated women of color to malingering implies a moral deficiency that doesn’t exist. Doctors don’t like to treat patients they suspect of falling under these labels, calling them heartsink patients who are a waste of time to treat because nothing will make them better (Dusenbery 100-101).

While receiving a diagnosis can be “devastating,” it can also be “a relief” (Cleghorn 314). After years of having their symptoms disregarded as hormonal, psychological, or even signs of pregnancy, a diagnosis means no more shame, no more guilt, and no more self-doubt (Cleghorn 314). After having their bodies so pathologized by medicine that they start to believe the discomforts and inefficiencies of their own bodies are normal, a diagnosis means women are finally able to trust themselves again (Cleghorn 320).

Women deserve better. We can do better.

Charlotte Perkins Gilman’s 1892 short story "The Yellow Wallpaper” is an important work for women’s rights to body and medical autonomy. Read it here. How was it relevant to its time? Why is it still relevant now? And is there something to be said for madness and liberation?

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De Sanctis, Vincenzo, et al. “Dysmenorrhea in adolescents and young adults: a review in different country.” Acta BioMed, vol. 87, no. 3, 16 Jan. 2016, www.pubmed.ncbi.nlm.nih.gov/28112688/. Accessed 15 Nov. 2021.

Dusenbery, Maya. Doing Harm: The Truth About How Bad Medicine and Lazy Science Leave Women Dismissed, Misdiagnosed, and Sick. HarperOne, 2018.

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Herman, George Ernest. “Fig. 13—Situation of Superficial Tenderness accompanying Ovarian Pain. (After Head.)” Diseases of Women: A Clinical Guide to Their Diagnosis and Treatment. New York, William Wood and Company, 1899, p. 70, www.archive.org/details/diseasesofwomenc00herm.

--- Diseases of Women: A Clinical Guide to Their Diagnosis and Treatment. New York, William Wood and Company, 1899, www.archive.org/details/diseasesofwomenc00herm.

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“Mosher, Clelia Duel." Encyclopedia of World Biography, edited by James Craddock, 2nd ed., vol. 32, Gale, 2012, pp. 263-265. Gale eBooks, www.link.gale.com/apps/doc/CX4017300130/GVRL?u=morenetumsl&sid=summon&xid=c5915ca4. Accessed 15 Nov. 2021.

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