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The roots of American gynecology are based in racism and misogyny, two omnipresent oppressive forces that dominate the quality of care in the field today.

Graphic by author.

The brutal history of modern American gynecological studies is one that is often ignored in conversations concerning the barbaric nature of routine procedures, physician abuse, or the role race plays in maternal labor outcomes. It is within this history, however, that the answer to just about every question regarding the practice can be answered.

Dr. J Marion Sims is often credited as the “Father of Gynecology”, and many key inventions pertinent to the practice are the direct result of his research and developments. This is the man to blame for the dreaded speculum, a metal device — though we may be familiar with the plastic version — used to view the cervix by holding open the walls of the vaginal canal. Sims, born in Lancaster County, South Carolina in 1813, completed his medical education in just one short year and three months. This lack of adequate training resulted in a multitude of negative patient outcomes, beginning primarily with the death of his first two patients. In seeking a new start, Sims relocated to Alabama. Sims earned his name by carrying out his practice in the heart of the slave trade, Montgomery, Alabama.

During his time in Alabama, Sims was directly responsible for a number of barbaric, inhumane, and unethical medical experiments and procedures on Black women who were held as slaves. Many, if not all of the surgical experiments Sims conducted on Black women were completed without anesthesia, and to no surprise at all, after Sims had perfected those procedures, they were used on White women, who received anesthesia.

Sims’ primary victims were three slave women: Lucy, Anarcha, and Betsy. They were subject to incredibly painful surgeries, such as the vesico-vaginal fistula repair. A vesico-vaginal fistula is a hole through which urine would leak from a woman’s bladder into her vaginal cavity, causing infection, incontinence, and discomfort. This was most commonly seen in women who had given birth. It is important to note that the driving force to correct this aliment was racism, as plantation owners wanted to ensure the Black women they enslaved would still be in good health in order to continuously reproduce.

As mentioned prior, a number of these experiments were conducted without an anesthetic, and Sims himself even claimed that the pain must be great; yet he justified it, by claiming that only a woman could bear a pain this great. In that same breath, however, Sims also claimed that he found the use of anesthetic for fistula corrections unnecessary, stating that the procedure couldn’t possibly be painful enough to warrant the trouble. It is this exact contradiction in regards to women’s pain — but more specifically, Black women — that pervades gynecological practices today.

As a result of Dr. Sims’ assumptions about women’s pain, much of gynecology seems to ignore pain all together. To be a woman and in constant physical agony is expected. Pain associated with menstruation is dubbed the norm — it, in fact, is not. As such, pain is built into gynecology, patient suffering is a preexisting condition, which no one thinks is in need of treatment. Pain has become ignored in medicine.

This ignorance of pain is often coupled with fatphobic dismissal, in that wonton suggestions of weight loss are thrown around irrespective of patient history and other symptoms. Endometriosis and Polycystic Ovarian Syndrome (PCOS) are two prime examples of such cases. PCOS, which is often coupled with fluctuations in weight, is dismissed via suggestions of weight loss, and the prescription of a birth control regimen. Endometriosis is associated with debilitating menstrual pain, yet when this pain is reported, it is often brushed aside. PCOS and endometriosis are some of the leading causes of infertility, pelvic pain, and menstrual irregularity in American women, and despite this, have an average diagnosis period of three and ten years respectively.

At 19, I myself was diagnosed with PCOS. I was aware of the condition as a result of my keen interest in gynecology — I hope to become an Obstetrician Gynecologist someday. I documented my symptoms as they occurred, made specific note of the new irregularities in my period, and wrote down dates of when I experienced excruciating pelvic pain. When I finally had the insurance coverage to see a gynecologist, I mentioned my fears immediately. My goal with the appointment was to either confirm I had PCOS, or raise alarm to another potential condition. My suspicions were correct.

The point of this anecdote is not that I was correct in self-diagnosis. The point is that I was prepared with a mountain of evidence, preemptively argumentative, and afraid, for a doctor’s appointment. I was afraid to ask my physician what might be wrong with me because I was afraid I would not be believed, afraid my pain would be ignored, afraid my health would suffer as a result.

Fear, too, is built into gynecology.

This fear is not specific to being ignored or dismissed. It is applicable to pre-procedure anxiety. Gynecology is one of the few fields of medicine in which routine procedures are popularized for their particular painfulness.

In recent years, there has been an increase in conversations surrounding pain management for routine gynecological procedures. Most specifically, many patients have justifiably complained about the lack of pain management during IUD (Intrauterine Devices) insertion. As of 2019 in the United States, roughly 10.4% of birth control users rely on the IUD for coverage, which translates to millions and millions of people. Some have reported passing out during the insertion, experiencing pain to the point of tears, and crying out. IUD patients have taken to social media platforms such as TikTok and Twitter to share their personal stories.

This mismanagement of pain reaches far beyond gynecology and greatly impacts how patients receive care across medical specialties. In an alarming 2016 study, out of 222 White medical students and residents, half maintained beliefs that Black people felt pain differently, and that darker skin correlated with higher pain tolerance. This ideology cannot at all be separated from Sims’ experimental studies. Matter of fact, gynecology is not the only medical specialty with roots in slavery and racism. As a result, the false belief in the difference in pain threshold in Black patients ranges across all specialties, resulting in a general lack of concern for their pain.

There is much work to be done in finding justice for patients, improving treatment plans, and emphasizing patient advocacy in gynecology. In addressing the ills of the past, we may pave the way for a brighter future in medicine as a whole.

This concludes the introductory article of my Women’s Health series. Next Wednesday, I will cover reproductive/bodily autonomy and the history of birth control in the United States. As we grapple with current changes to privacy and bodily autonomy laws, it is critical to understand the history of these battles, and that they do not begin with us. Allow us to look into the past and learn lessons from those before us. Education is elevation.

Women’s Health: A Condensed History of American Gynecology and Pain was originally published in NYU Local on Medium, where people are continuing the conversation by highlighting and responding to this story.

This content was originally published here.