“Anatomy is one of the key sites for the production and maintenance of sex and gender as embodied dualities, as these excerpts imply. It offers an institutionalized discourse rife with vivid representations which claim the body for medicine and then insist on simplification and universalization.”

[Lisa Jean Moore and Adele E. Clarke, “Clitoral Conventions and Transgressions: Graphic Representations in Anatomy Texts, c1900-1991”, Feminist Studies, Vol. 21, No. 2. (Summer, 1995), pp. 255-301.]

Inspired by ladoctorita’s “sins and virtues in medical education, part 2: pornification”, I’ve been contemplating genital anatomy as it was taught in twentieth-century medical school.

My medical school used Grant’s Method of Anatomy. A relative of mine went to the same school in the mid-twentieth century, so I have a 1989 edition and a 1958 edition to compare.

1958

The 1958 edition describes the male perineum first. For nine pages. This section isn’t labelled “The male perineum”, however – it’s just “The perineum”. The natural, default body is the masculine body. There are segments on the anal triangle, the urogenital triangle, two pages on the penis, the superficial perineal muscles, the deep perineal pouch, the nerves and vessels, and how to expose the prostate.

“The Female Perineum” follows. (Yes, intersex bodies are invisible.) The female genitalia are described not as anatomical structures in their own right, but as simplified, mutilated male genitalia. Homologous parts in the female are rudimentary, simplified, diminutive. You can’t just describe something like this – so I’ll regale you with the author’s words, and some of the accompanying illustrations:

“If you have familiarized yourself with the details of the male perineum, you will not have difficulty in appreciating the structure of the female perineum. The anal triangles are the same in the two sexes; the urogenital triangles differ.

Perhaps the simplest way to begin is to plunge a knife into the male urethra, entering it on the under surface just behind the glans penis, and carryign an incision right back to the prostatic utricle and, in so doing, dividing everything encountered including the urethra, scrotum, Bulbo-spongiosus, bulb of the penis, and u.g.diaphragm. This you may do actually or in imagination. By this procedure you convert the male perineum into a female one – or you restore it to the female condition, for in fetal life the male passed through the simpler female state.

The different structures are common to both sexes, but their propoertions, of course, differ. This: The female penis, called the clitoris, is diminutive and is not traversed by the urethra. It comprises two corpora cavernosa clitoridis and a glans clitoridis which caps the conjoint corpora cavernosa.

The incision suggested above would bring about the following changes and produce homologous female parts:

a. The edges of the incised urethra – the right and left labia minora. Each labium minus is a thin cutaneous fold, devoid of fat and lying along side the orifice of the vagina. The posterior end is free. The anterior end divides into two lesser folds which unite with their fellows across the median plane, the upper folds forming a hood, the prepuce of the clitoris, over the glans, the lower joining to form a band, the frenulum of the clitoris, which is attached to the under surface of the glans.

b. The scrotum is split into – right and left labia majora. Each labium majus is a broad, rounded, cutaneous ride lying lateral to the labium minus and covering a long finger-like process of fat. This process extends backwards from a medium skin-covered mound of fat, the mons pubis situated in front of the pubis and continuous with the fascia of Camper.

[description of nerves, vessels deleted]

Sebaceous glands open on to both surfaces of the labia minus and major; hair covers the mons and the lateral surface of the labium majus.”

There is a further one page of description of the deeper structures of the female perineum, in which the comparisons to the “default” male perineum are continued. And with a gratuitous sow reference for good measure:

The ejaculatory ducts, which in the male open on to the lips of the prostatic utricle, generally disappear in the female, but, as the ducts of Gartner, they may persist as blind tubes on the anterior wall of the vagina, and become cystic; rarely they open on to the skin surface, as in the sow.

As ladoctorita says in her comment:

[…] i’m more used to addressing the “female as sick version of male” and “female as less evolved version of male” concepts. it completely serves its purpose, however: what better was to induce revulsion at the sight/ thought of female genitalia than by imagining cut-up, disfigured male genitalia?

I’m not going to go into the “Pelvis” chapters here, so I’ll just post a little taste in the form of an image:

1989

The newer 1989 edition of Grant’s Method, which prides itself as taking a “clinical problem-solving approach” has, seven and a half (slightly larger format) pages on the male perineum, including a newly-added description of erection and ejaculation. Thankfully, the description of female genitalia as mutilated male genitalia has been expunged, though homology remains a theme. The entire description of the female perineum has been condensed to barely over a page, and the sow reference has been deleted. The “male perineum” section opens with a clinical scenario involving a healthy 48-year-old man presenting for a routine insurance examination including prostate examination.

The “female perineum” section opens with a clinical scenario involving a woman in normal labour undergoing “routine” episiotomy, an unnecessary and damaging operative procedure foisted on enormous numbers of perfectly healthy birthing women. The birth scenario includes a saccharine but rather menacingly facile description of the “ever-magic event of parturition” and the mother’s post-episiotomy pain relief being “facilitated by her elation”.

My point (and I do have one!): Women’s bodies are not considered normal or healthy under the medical gaze. The theory is that female bodies are othered, pathologised, written as weak and defective, and read as being in need of rescue, control, and mutilation. The praxis varies dramatically: I argue that it includes everything from Freudian ideas on the aberrant nature of female sexuality, to birth narratives and obstetric practices, to female genital cutting and mutilation in its protean forms from infibulation and clitoridectomy to infant intersex surgery and labiaplasty.

Categories: gender & feminism, health, medicine, Science

Tags: birth