Throughout history, women have been overdiagnosed with mainly psychiatric ailments and syndromes that have already been ruled out, from hysteria to nymphomania. This distorted portrait, which had its golden age in the 19th century, has been questioned in recent decades by the research community.
"Born weak and sensitive, the woman, faithful companion of man, deserves the most lively interest and presents a vast field for the meditations of philosophers and doctors." This is how the Treatise on the Diseases of Women begins, a text from 1844 that aims to be an update of everything known by medicine about women to date.
The "fair sex" or the "angel in the house" were names used by some scientists of the 19th century, who underpinned the notion of the "weaker sex" in the collective imagination to refer to women.
“The physical modifications that constitute the beauties of women are in inverse proportion to those that constitute those of men. The features of her face have fine and pleasant proportions, her feet are smaller and her hands are delicate, her arms, thighs and legs are thicker, the muscles of all her limbs are sweetly demarcated with undulating lines”, writes the doctor Baltasar de Viguera in Female physiology and pathology (1827).
For De Viguera, who recounted the sensitivity and delicacy in forms, senses and character of women, their qualities had to do with "the organs of the womb."
“This prodigious sphere of the perpetuity of the species is the one that determines the attributes of the fair sex, the one that presides over all its functions, the one that develops the modifications of its instinct, in short, the one that commands and imperiously influences its passions, tastes , appetites, ideas, properties and inclinations”.
Blaming the uterus
This conception of the female reproductive system endorsed inequalities, among others, the one that prevented women from accessing higher education:
"The theory of energy conservation served to make some oppose women's education, since the effort they would have to dedicate to their instruction would take away from them an energy necessary for the correct functioning of their menstrual and reproductive functions; that would prevent them from their primary purpose: to be mothers”, say S. García Dauder and Eulalia Pérez Sedeño in The "Scientific Lies" about Women.
The uterus has been blamed since ancient Egypt: then, it was said that the organ moved inside the woman's body causing all kinds of conditions. Later, more or less elaborate theories have followed that relate the uterus to diseases or unruly behavior of women. The word hysteria, disease of the uterus (hystera, in Greek), accompanied these diagnoses and had a new golden age in the 19th century.
'Angel in the house'
García Dauder and Pérez Sedeño affirm that all the “ailments resulting from gender inequalities” fell into the mixed bag of hysteria. Its vast symptomatology included fainting, insomnia, fluid retention, abdominal heaviness, muscle spasms, irritability, headaches, loss of appetite or a tendency to cause problems. "The hysterical woman was one step away from the romantic ideal woman: a being who had to be fragile, dependent, passive, without sexual desire, publicly invalid, domestic and idle", they relate.
Although today hysteria has disappeared from diagnostic manuals, “the prejudice that women are weak, sensitive, that they put up with less, that they complain about small things, remains. What was for long called "a hysterical woman," María Teresa Ruiz Cantero, professor of Preventive Medicine and Public Health at the University of Alicante, tells SINC.
And it's not a trivial concern. This prejudice, says Ruiz Cantero, is at the base of an important diagnostic error: that women are overdiagnosed with syndromes. “It is common that, when it is not very well known what is happening, the label "functional problem" is used. They stay in primary care wandering around and end up being prescribed painkillers, while the men are referred to a specialist, who provides curative treatment. This is very serious," she says.
The hysterical woman was one step away from the romantic ideal woman.
An example, for the expert, is found in the early days of Covid-19: “In the beginning, the disease was mainly related to a condition of the respiratory system, which affects men more. It was later seen that it is also associated with intestinal problems, more common in women. In this way, women came out underdiagnosed, which has to do with mortality”.
Female hysteria and such diseases were "healed" through the stimulation of the pelvic area, as shown in this illustration of a French pelvic douche in the 1860s.
“She touches herself every night”, says, sobbing, the mother of a teenage girl to the doctor who is the main character of the television series The Alienist, “the priests say that she needs cold baths and leeches, that the devil is in her mind”, to which the doctor replies that there is nothing wrong with her mind, “but that she is becoming a woman”, in a perspective that many of her colleagues in real life did not seem to share.
“There is no healthy enjoyment that is not reproductive. The guilty and harmful desires are those of the infertile, the wet nurses, the prostitutes, the readers, the consumptive and the hysterical”, wrote the gynecologist Ángel Pulido in 1876. Masturbation was considered a "fatal habit", and female desire was associated with the lower classes, "the primitives from warm environments and the nervous and physical patients", so a term was found to pathologize the female libido: nymphomania.
As the sexologist Laura Morán explains to SINC, it is very difficult to determine how much desire or how much sexual arousal is too much: “They tried to modernize nymphomania by calling it hypersexuality, but it was not possible to quantify these variables and that is why it does not appear in the latest Diagnostic Manual of mental disorders. As long as you can perform basic survival functions like eating, sleeping, working, and socializing, if you want to spend the rest of your time having sex, then good for you."
This belief was so ingrained in society that, according to the historian Cristina Domenech in Ladies who built themselves a long time ago, some teachers from an Edinburgh school for girls, presumably a couple, won a trial thanks to the fact that the jury could not believe that a woman knew sexual enjoyment.
As the century progressed, the idea spread that normal and healthy women, house mothers, should be fertile women, owners of moderate sexuality. And here comes the next ad hoc creation: frigidity. "It is a disease? No, what happened is that the processes of female arousal were not understood. Not even women themselves knew them, they couldn't explain to their sexual partners what they liked and what they didn't. This has to do with an unsatisfactory sexual education”, says Morán.
What is female sexual dysfunction (FSD)?
The current female sexual dysfunction (FSD) is a disease that, in the opinion of García Dauder and Pérez Sedeño, was created to create a market niche for a new drug. Changes in women's sexual desire, they say, are not a disease but a normal process, "even a healthy response to factors such as stress."
But, although moderate desire was well seen, masturbation was still not seen with good eyes, and its presence in adolescents was especially worrying. Another disease that had already disappeared appeared in them: chlorosis, which generated paleness, respiratory difficulty, drowsiness or suppression of menses.
“Often, medical diagnoses linked the disease to menstruation and masturbation. For many authors, the disease disappeared when the adolescent matured and normalized her sexual life through marriage”, pediatricians Miguel Zafra Anta and Víctor Manuel García Nieto affirm in this article.
A sign of the times was the creation of the first department stores, which brought out of the house women with money, who until then ordered clothes from home. The streets, suddenly, were not only male territory, says the researcher Nacho Moreno in Ladronas victorianas. For them, he says, it was no longer enough to stay at home.
The reputation of upper-class women did not allow them the scandal of going to jail if they committed a crime, so doctors specialized in female disorders determined that their impulse to steal was nothing more than delusions related to menstruation.
For disorders caused by the pace of modern civilization, the remedy was “rest cures”. A neurologist who pioneered these cures was Silas Weir Mitchell. His remedies were criticized by the writer Charlotte Perkins Gilman in The Yellow Wallpaper (1890), an account that describes being confined to a room without permission to work or receive visitors: "Live as homely a life as you can, do not have more than two hours of intellectual activity a day and never again touch a pen, a brush or a pencil”, was his prescription.
If the cause of all evil was the uterus, some considered that the solution was also to remove it.
Other doctors indicated the manipulation of the female genitalia until reaching hysterical paroxysm, orgasm, something that only they or midwives could do, since female masturbation was indecent. Treatments such as hypnosis, isolation or diet were also practiced. And others as delirious as leeches applied to the vulva, the anus and the neck of the womb; cauterization of the cervix with silver nitrate; injections of various fluids into the vagina, hydrotherapy in the form of douches, vaginal water-jets, and cold or warm baths, as well as electrotherapy, as explained in Women in gender discourses.
If the cause of all evil was the uterus, some considered that the solution was also to remove it: hysterectomies, oophorectomies (removal of the ovaries), even ablation of the clitoris were recommended. María Fernández Chereguini, gynecologist and member of the Spanish Society of Gynecology and Obstetrics (SEGO) explains, in a conversation with SINC, that even today this intervention is avoided: “Except for a malignant pathology, bleeding, fibroids or for genital prolapse. Conditions that can’t be controlled with medical treatment. And if it is done, it is normally by laparoscopy. This way of non-invasive removal was impossible at the time”.
In addition to reproductive function, the uterus is responsible for supporting the pelvic floor, but its removal should not cause side effects. However, "removing the ovaries can cause early menopause, with the problems that this entails: cardiovascular risk and bone problems, among others."
The female gaze
Inequalities in medicine continue to exist and "affect the quality of life of patients, and their life project," says Ruiz Cantero. A gender sensitive perspective is necessary because biases, she says, “are contagious and we end up believing them to be real, both men and women. Women end up reproducing the prejudices that are held about women by denying their own ways out”.
“Today there are more women scientists, and they are changing the very way of doing science. Questions are being asked that have never been asked before,” says journalist Angela Saini in her book Inferior. “Things that were taken for granted are questioned, and old ideas give way to new ones. The distorted – often negative – portrayal of women in the past has been challenged in recent decades by researchers, who say it was wrong.”
She concludes: “In a world where many women continue to experience sexism, inequality and violence, [data] can transform the way we see each other. If we have serious studies and reliable figures, the weak can become strong and the strong, weak”.