wandering wombs and female troubles

Wandering wombs and hysteria: the tortuous history of women and pain

Women face an uphill battle to have painful symptoms taken seriously by doctors. Gabrielle Jackson found out the hard way.

It wasn't in a doctors office or a hospital that Jackson learnt for the first time that her long list of painful symptoms were all typical of endometriosis.

She was sitting in a university lecture.

"I cried and I cried and I cried. For most of my life I'd doubted myself, feeling second-rate, weak and flaky," she writes.

What happened next is detailed in her book Pain and Prejudice, where she describes being diagnosed with two chronic inflammatory diseases, endometriosis and adenomyosis, in her early 20s.

Jackson's experience is not unusual. In fact chronic pain is common: it's estimated that nearly one in five Australians lives with it in some form.

But Jackson says women in particular struggle to receive a diagnosis.

It's a problem that's been around for a very long time.

Pain as punishment

For much of history, pain has been seen as an intrinsic part of womanhood.

According to the Abrahamic religions, the first woman ever was dealt pain in childbirth as punishment for disobeying God, when she and Adam dared to take a bite out of an apple plucked from the tree of knowledge.

Social and behavioural scientist Kate Young says institutions like religion, government and education have always played a big part in how we understand women's bodies.

"Women's sexuality has been constructed as volatile and in need of control," she says.

Physicians in Ancient Greece were among the first to describe and systematically categorise various diseases and medical conditions.

Chief among them was Hippocrates, inventor of the "Hippocratic Oath" to do no harm to patients, and widely considered the father of medicine.

He popularised the idea of the "wandering womb", a belief that the medical afflictions suffered by women were the fault of her uterus dislodging itself from her pelvic region and wandering freely around her body.

Hippocrates named one of these afflictions after the Greek word for uterus, hystera.

"The idea was that if they weren't having children, which is what they were 'biologically destined' to do, that must be why they were getting sick,'' Young says.

"The uterus wasn't being used for what it was meant to be so it was wandering around their body."

A hysterical woman was seen as difficult, irrational and dysfunctional, and certainly not fit for public life.

Over time, as scientific understanding of human anatomy developed, the wandering womb theory fell out of favour.

Hysteria, however, persisted in medical textbooks well into the 20th century.

During the 18th century industrial revolution, it was re-framed as a disease of the nervous system.

The transition from agriculture to industry brought with it a pace of life that was seen as incompatible with the inherent frailty of femininity.

Women in pain were victims of a rapidly changing civilisation.

Asylums in the society

In the 19th century, much of a sick woman's fate was determined by her wealth (or more often, the wealth of her husband).

"For wealthy women, the frailty became fashionable, an idle wife was proof of her husband's success,'' writes Jackson.

Poor women were more likely to be locked away in asylums for the insane.

The problem at this time was often framed as either an excess or deficiency in female sexual desire, and as such, treatments often appeared at odds with one another.

Some physicians sought to induce orgasms in their patients, others opted to remove the clitoris altogether.

Other treatments included hypnosis, and traditional blood-letting with leeches.

A persisting pain gap

These days, women's pain is better understood.

Many of those "mad" and "hysterical" women of history were likely suffering from conditions we now know as endometriosis, epilepsy, anorexia and chronic fatigue syndrome.

Hysteria has been demoted from a legitimate medical condition to an admonishment, usually levelled at a woman seen to be behaving in an overly emotional manner.

But the pain gap between men and women lingers.

"Women wait longer for pain medication than men, are more likely to have their physical symptoms ascribed to mental health issues [and] suffer from illnesses ignored or denied by the medical profession," writes Jackson.

Ms Young says there is still a strong cultural belief in western society that pain is normal for women.

Her research into endometriosis revealed that medical professionals often prioritise a woman's fertility over easing her pain symptoms.

"We know that the treatment goals of clinicians and women often conflict," she says.

"Women often privilege symptomatic relief, and want to be able to go about their everyday lives.

"Clinicians instead privilege fertility.

"One of the reasons for that is probably to do with their training, and might go back to the fact that we haven't incorporated women's perspectives and knowledge about their bodies into science and medicine.

Mice, men and difficult women

GP and ambassador for Chronic Pain Australia, Caroline West, agrees that a dearth of good research into women and their bodies had compounded the problem.

"It's in part the fault of the medical profession in not realising that there are clear gender differences in terms of how the body functions,'' she says.

"When it comes to chronic pain research there's definitely been a strong gender bias.

"The irony is that the majority living with chronic pain are women yet 80 per cent of the research is done on men or male mice.

"It's ridiculous to think that you could just study men and expect to have the answers about women's pain."

Jackson points out in her book that PubMed has nearly five times as many clinical trials on male sexual pleasure as it has on female sexual pain.

Young says while it's not the job of women to close the gaps in pain research, improvements in women's healthcare are often the result of them demanding better.

"The women who didn't take no for an answer, who came back and said to a doctor and said "this isn't good enough", they're often framed as the difficult women," she says.

"I love difficult women. I think they are challenging a long history of male-centred medicine.

"Every time they go back to their doctor and say 'I want more from you', I think they are challenging that... and that's so powerful."

• X (formerly Twitter)

Related Stories

'my gp thinks it's all in my head': why some doctors don't take women's pain seriously.

• Endometriosis
• Women's Health

To revisit this article, visit My Profile, then View saved stories .

• Backchannel
• Newsletters
• WIRED Insider
• WIRED Consulting

Fantastically Wrong: The Theory of the Wandering Wombs That Drove Women to Madness

I don’t have a womb, but I know women who do. All the time, they say to me, “Sorry that I’m out of sorts, my womb just started moving around my torso yesterday!” I tell them that they should probably see a doctor--or at least a sorcerer--immediately.

Fantastically WrongIt's OK to be wrong, even fantastically so. Because when it comes to understanding our world, mistakes mean progress. From folklore to pure science, these are history’s most bizarre theories.Sounds crazy, but in Ancient Greece, this conversation would have actually come up frequently, only it would have been in Greek instead of English. You see, for the Greeks, there was no ailment more dangerous for a woman than her womb spontaneously wandering around her abdominal cavity. It was an ailment that none other than the great philosopher Plato, as well as Hippocrates, the father of modern medicine , described at length.

Greek physicians were positively obsessed with the womb. For them, it was the key to explaining why women were so different from men, both physically and mentally. For Hippocrates and his followers, these differences could be explained by a “wandering womb.” The physician Aretaeus of Cappadocia went so far as to consider the womb “ an animal within an animal ,” an organ that “moved of itself hither and thither in the flanks.”

The womb could head upward and downward, and left and right to collide with the liver or spleen--movements, argued Aretaeus, that manifest as various maladies in women. If it moved up, for instance, the womb caused sluggishness, lack of strength, and vertigo, “and the woman is pained in the veins on each side of the head.” Should the womb descend, there would be a “strong sense of choking, loss of speech and sensibility” and, most dramatically, “a very sudden incredible death.”

Boone Ashworth

Lauren Goode

Emily Mullin

Luckily, the womb had a weakness. “It delights also in fragrant smells,” Aretaeus added, “and advances towards them; and it has an aversion to foetid smells, and flees from them.” And yeah, you guessed it: To cure a wandering womb, physicians could lure it back into position with pleasant scents applied to the vagina, or drive it away from the upper body and back down where it belongs by having the afflicted sniff foul scents.

There was a Greek dissenter, though, by the name of Soranus. This physician, writes Helen King in her essay " Once Upon a Text: Hysteria From Hippocrates ," argued that the womb was not mobile, and that the success of scent therapies was not due to an animalistic organ reacting violently to odors, but to such aromas causing relaxation or constriction of muscles.

How men could get all of the symptoms of a wandering womb--the headaches and vertigo and, of course, very sudden incredible death--without owning an actual womb, is quite problematic for the theory. But for the Greeks, the womb was clearly the seat of a woman’s wily ways, and very much a weakness (Aristotle held that a woman was a “deformed” or “mutilated” male). The womb was a rather more intimate version of the Achilles’ heel, if you will.

And how’s this for a shocker: The looming threat of a wandering womb was used to assert power over women, argues King. One prescription, for example, was for women to be pregnant as often as possible to keep the ostensibly bored womb occupied, and therefore in its rightful place. Physicians would also prescribe consistent sex.

The Romans, thankfully, distanced themselves from the notion of a truly wandering womb, with the physician Galen noting that while it may seem to be moving, it’s actually the tension of the membranes that hold it in place that pull it up slightly. The problem, he claimed, was the “suffocation” of the womb by a buildup of menstrual blood or, even worse, the female version of “seed” that mixed with male sperm. Retained seed would proceed to rot and produce vapors that corrupt the other organs.

After the fall of the Roman Empire, a Byzantine physician by the name of Paul of Aegina proposed an imaginative cure: Make the lady sneeze and, no joke, shout at her. And when the original Greek writings on womb movement, the Gynaikeia , eventually trickled into the Islamic world, physicians there adopted both Aretaeus’ concept of a wandering organ and also rolled in Galen’s idea of suffocation, greatly expanding on the causes of, and cures for, malignant womb vapors.

All of this knowledge, and I use that term loosely, arrived in Italy in the 12th century, and for the next several hundred years, much emphasis was put on scent therapy and sneezing (hey, sneezing may stop your heart, but it does wonders for the womb--OK, sneezing doesn’t actually stop your heart, and it does nothing for the womb). And by the 1500s, argues King, “the hysteria tradition was complete.” While wombs were no longer thought to wander, they were very much to blame for the ostensible irrationality of women. Over the course of several thousand years, the womb had become less and less of a way to explain physical ailments, and more and more of a way to explain psychological dysfunction.

In the 1700s, the theorized cause of hysteria began to shift from the womb to the brain. But this didn’t stop the emergence of the widespread female hysteria commotion in the 19th century , in which countless cures for haywire wombs were peddled on the population, including hypnosis and vibrating devices (not a joke) and blasting a woman’s abdomen with jets of water (sadly, also not a joke). And consider those women of Victorian literature, who were so overcome with emotion--and not at all the suffocating corsets--that they collapsed after announcing they had “a touch of the vapors.” Yes, those same vapors. And how to awaken these women? Smelling salts. Yes, those same foul odors of Hippocratic medicine .

Then along comes Sigmund Freud, who says, Whoa, let’s everyone just settle down . Men get so-called hysteria as well. Freud, in fact, attested to experiencing as much himself, and his study of male hysteria indeed eventually informed his famous Oedipus complex . Most importantly, Freud made it abundantly clear that psychological disorders come from the brain, not from a malfunctioning womb.

Today, what the ancient Greeks or Romans or Arabs would consider to be hysteria is in fact a wide range of psychological disorders, from schizophrenia to panic attacks. (The theory lingers in the word “hysteria” itself: It’s derived from the Greek for “womb.”) And the womb, that organ that so befuddled the physicians of yesteryear, is now much more widely appreciated as that thing that, you know, gave birth to all of us. Unless you're Zeus, and you give birth out of your head . Such are the mysteries of male childbirth, I suppose.

References:

King, H., et al. (1993) Hysteria Beyond Freud . "Once Upon a Text: Hysteria From Hippocrates." University of California Press

Tasca, C., et al. (2012) Women and Hysteria in the History of Mental Health. Clinical Practice and Epidemiology in Mental Health. 2012; 8: 110–119 .

Maggie Chen

Carmen Valeria Escobar

Rachel Lance

Beware the Wandering Wombs of Hysterical Women

• Read Later  

From ancient Greek physician Hippocrates to the infamous doctor Isaac Baker Brown of the 19th century, the pains and ailments of women were thought to be because of a ‘wandering womb’, better known as ‘hysteria’.

Hysteria, of the Greek translation 'hysterika,' which meant 'that which proceeds from the uterus’ was the generalized term given to women who suffered discomfort of every manner, ranging from mental illness to sexual deviancy, the lack of sexual desire, and even migraines.

Throughout history, medical practitioners have been in a constant struggle with their own codes of morality and treatment. This resulted in the creation of several techniques and machines, which inevitably resulted in the clinical and uncomfortable act of pelvic massage, and even masturbation. Still, the treatments never provided a cure and no matter what physicians did, the problems of a dissatisfied and uncomfortable woman remained.

In certain times in history, hysteria became known as the precursor to a complete demonic possession, resulting in priests having to perform exorcisms and root out potential witches in the area. The belief of hysteria as a symptom continued into European medicine and was extended to encompass several more symptoms with every passing century.

It was only in the early 20th century that hysteria became phased out due to its over-generalized use and diagnosis. Even though hysteria is no longer relevant in the modern era, a disorder of a ‘ wandering womb ’ still exists in the form of endometriosis.

Though the diagnosis and symptoms are not the same, endometriosis is when the lining and cells of a uterus begin to expand and grow in regions where it shouldn’t. Endometriosis, by modern clinical definition, is literally a wandering womb.

How could hysteria have lasted for so long? To answer this, one will need to study its history in detail.

Women under hysteria as depicted in 1880. (Damiens.rf / Public Domain )

The Early History of Wandering Wombs

Its most notable appearances were in the writings of Hippocrates in his Hippocratic Corpus . In his earliest writings, hysteria was a disease of the womb , treatable with massage and exercise.

It was generally believed that the uterus could move within and throughout the body, depending on the health of the woman. According to Hippocratic physicians of the time, the womb itself was like an animal, and it moved to find cold and moist places within the body due to a lack of male seed irrigation.

The result of the womb’s vagabond nature was to create emotional and physical torment until the womb itself had found comfort. This resulted in women having fainting spells, menstrual pain, and a loss of verbal coherence. One treatment prescribed by Hippocratic physicians was to place sweet smells by the vaginal regions and foul salts by the nose in order to lure the uterus back to the woman’s lower groin.

However, by the 1st century AD, the philosophers Celsus and Saronus felt that the remedy for hysteria needed further additions to its treatment. Along with genital massage with sweet oil, exercise and relaxation were now added to the remedies of hysteria.

Diagnosing Hysteria

The definitions of hysteria remained similar in its multifaceted explanations for hundreds of years. Most symptoms included congestion of bodily fluids, nervousness, insomnia, sensations of heaviness in abdomen, muscle spasms, shortness of breath, loss of appetite for food or sex, being demanding, causing trouble, and deficiency of sexual gratification.

By the European Middle Ages, according to contemporary scholar Rachel Maines, the name of 'hysteria' was changed to the ‘suffocation of the uterus’. The diagnosis remained the same and so did the attitudes.

In later documents nearing the 11 th century AD, marriage and masturbation to orgasm became the untold cure for the symptom even though most medieval doctors were hesitant to prescribe this method in fear of being asked to perform it on their female patients. Most though would prefer for women to have their husbands or midwives perform the treatment.

Water massages as a treatment for hysteria 1860. (Laurascudder / Public Domain )

During the 12 th century in Europe, most medical physicians relied on the Greek Classics from Plato and Hippocrates in order to diagnose most ailments. Additional diagnosis of hysteria would now include "the retaining of blood or of corrupt and venomous uterine humors that should be purged in the same way that men are purged of seed that comes from their testicles next to the penis”, as stated by the physician Trotula. However, in the years to come, the fear of the devil would become instrumental in the extreme treatments for hysteria when the previous methods did not work.

Hysteria and Possession

The 13th century Europe was no different in their definitions of hysteria, only now recommending that widows and nuns partake in the treatment of hysteria to balance the fluids and emotional stability of such individuals. The preferred treatments, however, was still married intercourse , as well as vaginal massaging techniques. However, if these methods did not work, the alternative and most extreme explanations would be of the supernatural torment of demons.

It was a widely held belief that if hysteria was not treatable by methods of the older ways, then the symptoms were the beginnings of a demonic possession caused by a hexing witch. The most desirable victims for the alleged demons were young women suffering from depression, single women, women who were viewed as difficult, and elderly women.

• 4,000-Year-Old Assyrian Tablet Makes First Known Infertility Diagnosis and Recommends Slave Surrogate
• Seven-Pound Calcified Uterus Unearthed in British Cemetery
• Archaeologists unearth 18th Century Sex Toy in Ancient Latrine in Poland

Demonic possession as a result of hysteria, 1858. (Fæ / Public Domain )

The notion of demon possession came from the misunderstanding of mental illnesses which existed during the time. Because of this, most physicians assumed that the traits for demon-possessed women, or demoniacs, were consistent: convulsions, increased intelligence accompanied by clairvoyance and spontaneous tremors, amnesia, and extreme emotional unbalance. Once this was diagnosed, the popular assumption was that there was another witch that had caused the possession of the suffering patient and would need to be found in order to reverse it.

By medieval canon law , any women suffering from either hysteria or demonic possessions were considered blameless of their actions. Thus, rather than stand trial, hysterical female criminals, or in the extreme cases, the ' possessed ' were to be sent to priests in order to have exorcisms performed . Alas, if the exorcism did not work to calm the women, it would mean they were unsavable and the priests feared being taken by the demon possessions themselves.

It wasn’t until the late 17th century when the belief of these unusual ‘possessions’ was phased out, and the possibility of seeing these troubles as mental illnesses became more present in the medical world.

Hysteria and Mental Health

In the 17th century, hysteria emerged as one of the most common female diseases that could be treated by medical practitioners. However, what was changing was attitudes about mental health . During this time, the medical thoughts on hysteria were being studied as a psychological brain disorder, rather than a wandering womb.

The French physician, Philippe Pinel , one of the first physicians to develop more humane psychological study of patients, believed that the disease hysteria, and to some extent nymphomania, were mental instabilities caused by sexual frustrations. Though the diagnosis began to change, the cures remained the same. Pinel also believed in the form of vaginal massage in order to bring balance to the brain.

Hysteria was believed to be caused by nymphomania and other mental instabilities. (robertwaghorn / Public Domain )

During the 18th century, the symptoms of hysteria would be broadened to also include hypochondriac men. However, for the most part, it was still considered a woman’s disease since most practitioners felt that it was now, not only connected with a woman's mental state but also deeply connected to female sexual organs simultaneously.

Female Hysteria in the 19th Century

During the 19 th century, for women, the western world was plagued with a plethora of fears not only consisting of catching hysteria but also with the concerns of uncurable sexual diseases such as syphilis . With such fears that were prevalent in 19 th century society, so were the extreme treatment methods for such conditions. During the 19 th century, the desires for pleasure and the self would be seen as terrible.

Though in previous years, hysteria was considered uniquely feminine and directly connected to their sexual organs, the practitioners of the time now felt that hysteria was a more negative extreme state rendering “…women difficult, narcissistic, impressionable, suggestible, egocentric, and labile; not to mention idle, self-indulgent and deceitful, craving for sympathy, who had an unnatural desire for privacy and independence…” (Donkin, 1892)

Physicians carried a fear that they were promoting the notion of sexual debauchery by having their work compared to masturbation. Due to this, during the 19th century, there was an extreme treatment, though not very popular with most physicians of the time, to perform clitoridectomy (the circumcision of the clitoris ) in order to prevent female masturbation, and therefore isolating the problems most women had with the alleged symptom of hysteria.

Gynecology or 1822, to treat hysteria doctors often performed the procedure of a clitoridectomy. (Morgoth666 / Public Domain )

Such 19 th century gynecologists such as Isaac Baker Brown (1812-1873), who was also president of the Medical Society of London, believed that the clitoris was utterly responsible for hysteria, epilepsy , and manic depression. In his opinion, if one were to surgically remove what he considered the ‘unnatural irritation’ called the clitoris, the issues which all women faced would be gone.

During this time, there was a widespread belief which most doctors of the time had that the mental and emotional disorders were directly connected to the female reproductive organs , and by simply removing them, it would make a woman compliant and trustworthy. However, by 1867, this fell out of practice.

In the second half of the 19th century, however, newer and more technical methods for treating hysteria would separate the sexual aspect of the disease and keep the physicians free from the lewd act of vaginal massage. This would come in the form of medical vibrators, and as scholar Rachel Maines would explore in her studies, there was a market that could be indefinitely exploited.

As a scholar, Rachel Maines theorized that medical practitioners from the early 19th century until the early 20th century practiced the techniques of medical masturbation upon female patients until they reached a sexual climax , in the most clinical and most non-romantic way.

• Bodies Left Behind - A Cruel History of Persecution, Shamanic Ecstasies & the True Witches Sabbath
• The Urine Wheel and Uroscopy: What Your Wee Could Tell a Medieval Doctor
• Ancient Egyptian Mummy Head Shows Woman Had Skin Condition Due to Beauty Practice

A 1918 ad with several models of mechanical vibrators, developed to treat hysteria. (PawelMM / Public Domain )

More often than not, most husbands and family members of the patient would be in the same room as a medical doctor would vaginally massage her to orgasm. This has been documented to take hours at a time and be very uncomfortable to watch.

As mentioned prior, due to the sexually perverse nature of the act, medical doctors desperately tried to recommend the technique to the patient’s husband or midwife to perform, rather than directly performing the treatment themselves. With the problems of symptoms continually returning to patients, another technique was promoted by way of mechanical automation.

Main's notion was that this tool was not only a better alternative to medical practitioners performing vaginal massage but also was a very marketable tool in terms of medical revenue: “Hysterical women represented a large and lucrative market for physicians. These patients never recovered nor died of their condition but continued to require treatment.” (Rachel Maines, 1999)

Though, even with Maine’s hypothesis, many other scholars believe this to be a skewed interpretation of the facts. Other scholars have chosen to keep the history of the vibrator and the history of hysteria as two separate and competing theories which exist in academia today.

Hysteria Redefined for the Modern Age

By the early 20th century, the number of women suffering from hysteria drastically declined due to its overgeneralized diagnosis. In the 21st century, hysteria was no longer recognized as an illness at all.

Within several hundred years, the definitions of wandering womb and hysteria seemed to stay somewhat consistent. Through time, more symptoms were added to the disease to explain further mental disorders which could not be accounted for.

However, the theme and treatment seemed to remain the same until the turn of the century. Only then was the disease hysteria phased out for further scientific and more specific definitions for ailments. Although it can be argued that advances in medical technology and thinking were the reasons for the social maturing, it may be potentially due to women attaining more rights than they had before.

Top image: Hysteria was a term used to diagnosis wandering womb a female medical condition branded by ancient Greeks. Source: rodjulian / Adobe Stock

By B.B. Wagner

Griffith. 2014. The Mysterious Case of the Wandering Womb . The University of Melbourne. [Online] Available at: https://blogs.unimelb.edu.au/sciencecommunication/2014/10/17/the-mysterious-case-of-the-wandering-womb/

Maek, H. 2009. Of Wandering Wombs and Wrongs of Women: Evolving Conceptions of Hysteria in the Age of Reason . University of Regina. [Online] Available at: https://ejournals.library.ualberta.ca/index.php/ESC/article/download/20152/15580

Maines, R. 1999. The Technology of Orgasm: “Hysteria,” the Vibrator, and Women’s Sexual Satisfaction . The Johns Hopkins University Press.

Mayo Clinic Staff. Date Unknown. Endometriosis . Mayo Clinic. [Online] Available at: https://www.mayoclinic.org/diseases-conditions/endometriosis/symptoms-causes/syc-20354656

Rudnick, L. and Heru, A. 2017. The ‘secret’ source of ‘female hysteria’: the role that syphilis played in the construction of female sexuality and psychoanalysis in the late nineteenth and early twentieth centuries . Sage journals. [Online] Available at: https://journals.sagepub.com/doi/full/10.1177/0957154X17691472

Spanos, N. and Gottlieb, J. 1979. Demonic possession, mesmerism, and hysteria: A social psychological perspective on their historical interrelations . Journal of Abnormal Psychology. [Online] Available at: https://psycnet.apa.org/doiLanding?doi=10.1037%2F0021-843X.88.5.527

Tasca, C., Rapetti, M., Carta, M., and Fadda, B. 2012. Women And Hysteria In The History of Mental Health . Clinical Practice and Epidemiology in Mental Health. [Online] Available at: https://www.researchgate.net/publication/232746123_Women_And_Hysteria_In_The_History_Of_Mental_Health

Ussher, J. 2013. Diagnosing difficult women and pathologizing femininity: Gender bias in psychiatric nosology . University of Western Sydney, Australia. Feminism and Psychology. [Online] Available at: https://journals.sagepub.com/doi/abs/10.1177/0959353512467968

B.B. Wagner is currently working on a master’s degree in Anthropology with a focus in Pre-contact America. Wagner is a storyteller, a sword fighter, and a fan of humanity’s past. He is also knowledgeable about topics on Ice Age America... Read More

Related Articles on Ancient-Origins

• ESC: English Studies in Canada

Of Wandering Wombs and Wrongs of Women: Evolving Conceptions of Hysteria in the Age of Reason

• Heather Meek
• Association of Canadian College and University Teachers of English
• Volume 35, Issue 2-3, June/September 2009
• pp. 105-128
• 10.1353/esc.2009.a404822
• View Citation

Additional Information

Project MUSE Mission

Project MUSE promotes the creation and dissemination of essential humanities and social science resources through collaboration with libraries, publishers, and scholars worldwide. Forged from a partnership between a university press and a library, Project MUSE is a trusted part of the academic and scholarly community it serves.

2715 North Charles Street Baltimore, Maryland, USA 21218

+1 (410) 516-6989 [email protected]

©2024 Project MUSE. Produced by Johns Hopkins University Press in collaboration with The Sheridan Libraries.

Now and Always, The Trusted Content Your Research Requires

Built on the Johns Hopkins University Campus

This website uses cookies to ensure you get the best experience on our website. Without cookies your experience may not be seamless.

The Womb Wanders Not: Enhancing Endometriosis Education in a Culture of Menstrual Misinformation

• Open Access
• First Online: 25 July 2020

Cite this chapter

You have full access to this open access chapter

• Heather C. Guidone 7  

34k Accesses

11 Citations

23 Altmetric

Embedded in the centuries-old assertion that the womb was a nomadic entity wandering about the body causing hysteria and distress, persistent menstrual misinformation and misconceptions remain prevalent wherein pain disorders like endometriosis are concerned. Affecting an estimated 176 million individuals worldwide, endometriosis is a major cause of non-menstrual pain, dyspareunia, painful menses and reduced quality of life among individuals of all races and socioeconomic backgrounds. Wide-ranging symptoms may be dismissed as routine by both patients and practitioners alike due to lack of disease literacy, and lengthy diagnostic delays can exacerbate the negative impact of endometriosis on the physical, psychological, emotional and social well-being of those affected. This chapter identifies some of these challenges and explores how obstacles to best practice can be reduced in part through adoption of early educational campaigns which incorporate endometriosis as a major component of menstrual health education.

The vernacular of endometriosis is rooted in classic scholarship and the topic of menstruation itself is often cited as an example of biological reductionism: the medicalization of women and standardization of bodies (Rodríguez and Gallardo 2017 ). Hence, the author acknowledges that the terms “women” and “women’s health” are enforcers of hetero-cisnormativity, gender binarism and gender essentialism. For the purposes of this chapter, incorporation of such terms is intended only as a theoretical framework, inclusive of all bodies who struggle with endometriosis and have suffered from the bias, negligence, misdiagnosis and medical misogyny which so often characterize the disease; such use is not intended to trivialize, equate or otherwise limit the scope of the condition to only lived experiences of those essentialized categories of “females.” Furthermore, although often associated with the disease, “menstruation” is not synonymous with “endometriosis.”

Much of what is communicated about endometriosis, particularly in the scientific literature and media, reflects a stagnant belief system that perpetually confounds the diagnostic and treatment processes. Whilst medical knowledge, clinical experience and therapies are ever-evolving, the condition remains fundamentally mired in outdated assumptions that invariably lead to poor health outcomes. If we are to achieve real progress, we must strive towards an ideology which is truly reflective of modern concepts in order to elevate the condition to the priority public health platform it well deserves. To that end, though not intended as exhaustive or all-encompassing, the author has endeavored to incorporate the most current, authoritative facts about endometriosis herein—some of which run contrary to public doctrine.

You have full access to this open access chapter,  Download chapter PDF

Similar content being viewed by others

Individual Actions

Endometriosis: patient–doctor communication and psychological counselling

Using Medical Illustration to Improve Understanding of Endometriosis

The endometriosis enigma.

Described as “a riddle wrapped in a mystery inside an enigma” (Ballweg 1995 , 275; Wilson 1987 , 1), endometriosis is defined by the presence of endometrial- like tissue found in the extra-uterine environment (Johnson and Hummelshoj for the World Endometriosis Society Montpellier Consortium 2013 ). The disease elicits a sustained inflammatory response accompanied by angiogenesis, adhesions, fibrosis, scarring, and neuronal infiltration (Giudice 2010 ). The gold standard for confirmation of diagnosis is laparoscopy (D’Hooghe et al. 2019 ).

Characterized by marked distortion of pelvic anatomy (Kennedy et al. 2005 ), development of endometriomas and high association with comorbidities (Parazzini et al. 2017 ), endometriosis can result in significantly reduced quality of life. Although considered ‘benign,’ the disease may also be associated with higher risks of certain malignancies and shared characteristics with the neoplastic process (Matalliotakis et al. 2018 ; He et al. 2018 ).

Endometriosis is estimated to affect nearly 176 million individuals globally (Adamson, Kennedy, and Hummelshoj 2010 ), and ranks high among the most frequent causes of chronic pelvic pain (van Aken et al. 2017 ). A leading contributor to infertility, gynecologic hospitalization, and hysterectomy (Yeung et al. 2011 ; McLeod and Retzloff 2010 ; Ozkan et al. 2008 ), systemic influences of the disease can significantly impair physical, mental, emotional, and social health (Marinho et al. 2018 ). Definitive cause remains elusive, as does universal cure or prevention, and much of the discourse surrounding etiology and treatments remains ardently debated. Endometriosis imposes a staggering healthcare burden on society, with associated costs soaring into the billions (Soliman, Coyne, et al. 2017 ).

The complexities of this multidimensional condition remain poorly elucidated in current scientific works and little progress has been made toward deciphering endometriosis. Although research seems omnipresent, much of it is redundant in nature and the few qualitative studies conducted on the realities of living with the disease lack rigor (Moradi et al. 2014 ).

Though classically viewed as a ‘disease of menstruation,’ a uterus and routine menses are not de rigueur to diagnosis. The condition has been documented in post-hysterectomy/postmenopausal individuals (Ozyurek, Yoldemir, and Kalkan 2018 ; Soliman, Du, et al. 2017 ), rare cis males (Makiyan 2017 , et al.), gender diverse people (Cook and Hopton 2017 ; Yergens 2016 ) and the human fetus (Schuster and Mackeen 2015 ; Signorile et al. 2010 , 2012 ). Nevertheless, many continue to link the condition to simply ‘painful periods’ despite its profound impact far and apart from menses.

Comprehensive review of treatments for endometriosis, and the ensuing debates encompassing each, is outside the scope of this writing. However, timely diagnosis and multidisciplinary, integrative treatment are necessary to effectively manage the condition—yet universal access to quality care remains limited in many settings, due in large part to dismissal of symptomology. In brief:

Laparoscopic excision is one of the most effective therapeutic options (Donnellan, Fulcher, and Rindos 2018 ; Franck et al. 2018 ; Pundir et al. 2017 ), affording biopsy-proven diagnosis and subsequent removal of lesions at the time of the surgical encounter. However, accuracy of diagnosis and treatment depends on ability of the surgeon to adequately identify the tissue in all affected areas.

Secondary to surgery are medical therapies. No drugs for endometriosis are curative; all have potential side effects (Rafique and Decherney 2017 ) and similar clinical efficacy in temporary reduction of pain. Menstrual suppression—which does not treat endometriosis, only symptoms—further supports the perception that menstruation is ‘unhealthy’ and requires pharmaceutical intervention.

Despite over 100,000 hysterectomies being performed annually as of this writing for a primary diagnosis of endometriosis and approximately 12% of individuals with the disease eventually undergoing hysterectomy as ‘treatment,’ there is an approximate 15% probability of persistent pain after hysterectomy, which may be due to incomplete disease removal, and a 3–5% risk of worsening pain or new symptom development (Rizk et al. 2014 ). Nor is menopause protective, with an estimated 2–4% of the endometriosis population being postmenopausal (Suchońska et al. 2018 ). In fact, postmenopausal endometriosis has demonstrated a predisposition to malignant change, greater tendency for extrapelvic spread, and development into constrictive and/or obstructive lesions (Tan and Almaria 2018 ).

Derived from the misogynist, antediluvian belief that painful menstruation was ‘ordained by nature as punishment for failing to conceive’ (Strange 2000 , 616), pregnancy has long been suggested as a treatment or even cure for endometriosis. Nonetheless, pregnancy is not a ‘treatment’ option in any current clinical guidelines (Young, Fisher, and Kirkman 2016 ), nor does it prevent or defer progression of endometriosis (Setúbal et al. 2014 ). Moreover, the disease is linked to infertility, miscarriage, and potential complications in obstetrical outcomes (Shmueli et al. 2017 ) and ectopic pregnancy (Jacob, Kalder, and Kostev 2017 ).

Finally, adjuncts like pain management and pelvic physical therapy are also often recommended post-surgically to address secondary pain generators common with endometriosis that is, pelvic floor dysfunction. Other alternative and complementary measures may also be considered.

Defying Dogma: ‘Killer Cramps’ Are Not Normal

Classic presentations of endometriosis include but are not limited to abdominopelvic pain, infertility, dyschezia, dyspareunia, dysuria, physiologic dysfunction, and significantly reduced quality of life. Extrapelvic disease, while less common (Chamié et al. 2018 ), may manifest in a variety of ways for example, catamenial pneumothorax. Among the most widely recognized of endometriosis symptoms is incapacitating menstrual cramping (‘dysmenorrhea’).

Indeed, menstrual pain without pelvic abnormality (“primary dysmenorrhea”) is among the most common of gynecological disorders. Though accurate prevalence of dysmenorrhea is difficult to establish, it is estimated to impact up to 93% of adolescents (De Sanctis et al. 2015 ) and between 45 and 95% of all people with periods. When interviewed by Writer Olivia Goldhill ( 2016 ) for her heralded Quartz article on the lack of research into dysmenorrhea, Professor John Guillebaud went on record stating “period cramping can be almost as bad as having a heart attack.” Though some have questioned the notion that any degree of menstrual pain is “normal” (Dusenbery 2018 , 221), primary dysmenorrhea generally maintains a good prognosis.

Conversely, severe pain failing to respond to intervention (“secondary dysmenorrhea”) is typically associated with conditions like endometriosis and warrants timely intervention (Bernardi et al. 2017 ). Moreover, a link between dysmenorrhea and the future development of chronic pelvic pain has been suggested (Hardi, Evans, and Craigie 2014 ), though symptoms are routinely misdiagnosed or otherwise dismissed (Bullo 2018 ). As a result, those suffering may be disparaged as ‘menstrual moaners’ or portrayed as simply unable to ‘cope with normal pain’ (Ballard, Lowton, and Wright 2006 )—yet nearly 70% of adolescents with intractable dysmenorrhea or pelvic pain that fails to respond to initial therapy will later be diagnosed with endometriosis (Highfield et al. 2006 ).

Delays in the diagnosis of causative gynepathologies persist at the individual and medical level. To that end, healthcare professionals must engage patients in conversations which remain sensitive to cultural context, perceptions, and attitudes, yet draw out possible menstrual issues early so individuals are treated in timely and effective ways that harmonize with their specific needs.

Embodied Experience

A widespread lack of public education about pelvic pain and menstrual-related disorders persists. As a result, endometriosis remains under-diagnosed, inadequately treated and frequently marginalized. Inappropriate diagnostic tests, poor history taking, provision of temporary analgesics or hormonal suppression to merely treat symptoms—but not the disease itself–creates confusion in diagnosis, postponement in diagnostic confirmation and mismanagement (Riazi et al. 2014 ). Only a minority of studies adds to the contextual information required to understand what it means to actually struggle with endometriosis.

Misinformation about the disease remains ubiquitous, saturating the healthcare and public sectors. Affected individuals may delay seeking care for their symptoms, believing them to be a part of ‘normal’ menstruation, and healthcare workers may in turn dismiss their pain as “imaginary” (Bloski and Pierson 2008 ). To that end, healthcare encounters have been expressed as double-edged, both destructive and constructive; affecting not only the perception of the individual’s physical condition, but her self-esteem, body, and sexuality (Grundström et al. 2018 ) as well. As a result, those with the condition must often become ‘expert’ or ‘lead’ patients; that is, those who are proactive with respect to their health and possess knowledge of their disease and symptoms in order to effectively direct and manage their own care.

Individuals with the endometriosis from all backgrounds have long described journeys characterized by ignorance, disbelief, and lack of knowledge on the part of their doctors and the public. Encountering attitudes that they ‘exaggerated or imagined their symptoms or [have] low pain thresholds’ and further insinuation that “psychological factors or former abuse enhanced the symptoms” (Grundström et al. 2018 , 8) may compound feelings of vulnerability and anxiety. Many “feel angry and frustrated when they [have] experiences with doctors who misdiagnosed, did not diagnose, delayed diagnosis of endometriosis, or just generally did not listen to their concerns, symptoms, and experiences” (Moradi et al. 2014 ). Not surprisingly, some people with endometriosis may resort to maladaptive coping strategies as a result (Zarbo et al. 2018 ).

Clark ( 2012 , 83) has described the impact endometriosis may have on a woman’s sense of identity: “self-doubt plagued many . . . where they questioned their perception of the severity of the symptoms and ultimately their own sanity; mainly due to not being believed by medical practitioners and other lay people.” Yet as Culley et al. demonstrated ( 2013 ), the distress so commonly experienced by those with endometriosis is in fact related in large part to dissatisfaction with care for the disease. The authors correctly suggest the negative social and psychological impacts of the condition could be improved by a number of strategies; not least of which include practitioner education efforts and raising awareness via education through schools and support groups.

Pandora’s Jar: The Impact of the Wandering Womb and Hysteria on Endometriosis

From Greek hysterikos (‘of the womb’), assumptions on the ‘wandering’ uterus have long influenced attitudes about women’s health. Since the genesis of gynecology arose from the mythical first woman, Pandora, the womb was believed to have ‘no natural home.’ Identification of Pandora’s jar ( pithos ) as a uterus has been widely represented in Hippocratic gynecology and Western art; its subsequent opening brought forth ‘a range of evils including disease’ (King 1998 , 2, 47–48, 58).

Anxiety, sense of suffocation, tremors, convulsions, or paralysis and more have been attributed to the ‘migratory uterus’ (Tasca et al. 2012 ). Hippocrates remains largely credited for grouping such issues under the single designation of “ hysteria ,” though King ( 1998 ) challenges such ascription (227, 237). Nonetheless, early physicians suggested that ‘hysteria’ could be counted among the ‘… symptoms of menstruation.’ Some advised that women who frequently displayed nervous or hysterical symptoms in relation to menses ‘ought to be incarcerated for their own safety and the good of society’ (Strange 2000 , 616); a tenuous correlation might even be drawn to today’s menstrual huts.

Nezhat, Nezhat, and Nezhat ( 2012 ) further suggest there is irrefutable evidence that “hysteria, the now discredited mystery disorder presumed for centuries to be psychological in origin, was most likely endometriosis in the majority of cases …” and as Jones ( 2015 ) proposes, discourse about the disease is “at least related to if not influenced by the social forces that shaped a diagnosis of hysteria” (1084).

Though ‘hysteria’ has been largely abandoned in modern nomenclature, the legacy of its impact persists. Today, symptoms of endometriosis may dismissed not as hysteria but ‘somatization’ (Pope et al. 2015 ). Women’s pain is routinely under-treated, labeled inappropriately as having a sexually transmitted infection, told their symptoms are ‘in their head’ (Whelan 2007 ) or too often, simply not heard (Moradi et al. 2014 ).

Endometriosis also remains tethered to psychological profiling, with those suffering routinely described as high risk for anxiety, depressive symptoms, and other psychiatric disorders. In fact, however, it has been demonstrated that the presence of pain—versus endometriosis per se—is associated with such psychological and emotional distress (Vitale et al. 2017 ). Whelan ( 2007 ) further asserts what those with the endometriosis well know: “[c]ertainly, medical experts’ ways of representing endometriosis often undermine the credibility of patient accounts . . . patients have often been represented in the medical literature as nervous, irrational women who exaggerate their symptoms” (958). Indeed, endometriosis is very much a corporeal condition with no regard for race, religious, sexual, socioeconomic, or mental health status.

Sampson and the Itinerant Uterine Tissue

Reminiscent of the migrating womb, much of the dogma guiding endometriosis treatment and research today is rooted in the archaic supposition that the disease is caused by normal endometrium that has ‘roamed’ to distant sites. Just as the uterus does not wander, however, nor do fragments of entirely normal uterine tissue simply meander idly hither and yon resulting in endometriosis.

The premise of the condition arising from wholly normal albeit peripatetic endometrium sustains a century-old concept based on the works of Dr. John Sampson ( 1927 ). Essentially, he considered endometriosis lesions to be comprised of ordinary endometrial cells; in fact, while somewhat resembling native endometrium, they are not identical (Ahn et al. 2016 )—an important distinction. An abundance of differential invasive, adhesive, and proliferative behaviors have been demonstrated in the eutopic and ectopic counterparts of endometrial stromal cells in patients with the disease (Delbandi et al. 2013 ), and the tissue is functionally dissimilar (Zanatta et al. 2010 ).

Contrary to Sampson’s Theory, there is also evidence of endometriosis in cis males (Rei, Williams, and Feloney 2018 , et al.), the human fetus (Signorile et al. 2009 , 2010 , 2012 ), females who have never menstruated (Suginami 1991 ; Houston 1984 ), and premenarcheal girls (Gogac et al. 2012 ; Marsh and Laufer 2005 ). The premise of ‘retrograde periods’ also fails to account for extrapelvic endometriosis in most cases. Moreover, though reflux menses is very common among people with periods, not all develop endometriosis; the incidence of disease is small compared to the occurrence of backflow experienced by most menstruators (Ahn et al. 2015 ). Similarly, as Redwine ( 1988 ) confirmed decades ago, endometriosis lacks the characteristics of an autotransplant (Khazali 2018 ).

Undeniably, pathogenesis remains rife with contention. Differing theories on varied mechanisms abound; stem cells, genetic polymorphisms, dysfunctional immune response, and an aberrant peritoneal environment have all been suggested in the establishment of endometriosis (Sourial, Tempest, and Hapangama 2014 ). The evidence also favors embryologic origins, with additional cellular and molecular mechanisms involved (Signorile et al. 2009 , 2010 , 2012 ; Redwine 1988 ). Nevertheless, no unifying theory to date accounts for all of described manifestations of endometriosis (Burney and Giudice 2012 ).

Unremitting Misinformation, Menstrual Taboos, and Diagnostic Delay

Much of society’s derogatory view of menstruating individuals, including within the political sphere (‘ blood coming out of her wherever   … ’), remains virtually unchanged, and the very normal physiological process of menstruation remains linked to unfavorable attitudes in all cultures (Chrisler et al. 2015 ). Periods are still considered taboo in many parts of the world, with persistent knowledge gaps resulting in part from poor puberty guidance (Chandra-Mouli and Patel 2017 ). Research on menstrual cycle-related risk factors is lacking (Harlow and Ephross 1995 ), and the media continues to reinforce misconceptions around social captivity, restrictions, professional inefficiency, physical, and mental discomfort (Yagnik 2012 ) related to menses. Menstrual bleeding continues to be portrayed as “messy, inconvenient, and [an] unnecessary phenomenon to be controlled or possibly eliminated” (McMillan and Jenkins 2016 , 1). Yet, with a nod to Bobel and Kissling ( 2011 ): “menstruation matters:” menstrual history is a key component in a comprehensive women’s health assessment and an increasingly important variable in disease research (McCartney 2016 ).

For many, persistent taboos and perpetuation of ‘period shaming’ come at a high price: menstrual pain specifically, such as that often accompanying endometriosis, is routinely dismissed. Hence, the path to diagnosis is largely dependant upon the individual’s own “knowledge and experience of painful menstruation and other symptoms and whether they know other people who have been diagnosed” (Clark 2012 , 85).

Delayed diagnosis serves as a high source of stress responsible for an important psychological impact on individuals with endometriosis. Average diagnostic delays worldwide hover around 7.5 years (Bullo 2019 ) or even longer, with continued resistance to timely intervention and referrals. Indeed, several clinicians consider themselves inadequately trained to understand and provide psychosocial care for patients with the disease (Zarbo et al. 2018 ). Conversely, earlier diagnosis and efficient intervention decreases productivity loss, quality of life impairment, and healthcare consumption, consequently reducing total costs to patients and society alike (Klein et al. 2014 ).

Studies reveal a relationship between ambivalent sexism and more negative attitudes toward menstruation, which may also lead to reticence to report menstrual cycle-related symptoms (Marván, Vázquez-Toboada, and Chrisler 2014 ). Others may deliberately conceal concerns for fear of stigmatization, further leading to diagnostic delay (Riazi et al. 2014 ). Still others may seek to reduce stigma associated with menstruation through ‘menstrual etiquette’ (Seear 2009 ), perpetuating social rules and normative expectations of menstruating persons and fearing that disclosure would result in embarrassment or perception that they are ‘weak’ (Culley et al. 2013 ). The literature further suggests some patients may simply fail to seek timely medical help due to their own inability to identify symptoms as ‘abnormal’—a failing of our menstrual education system.

To navigate the experiences of menstruation, endometriosis, and other episodes related to pain or vaginal bleeding, individuals “require factual and supportive information that enables them to differentiate between healthy and abnormal bleeding, to understand and take care of their bodies or those of dependents who may require assisted care, and to seek health advice appropriately” (Sommer et al. 2017 , 2). Yet, menstrual teachings remain hampered by deficient cycles of misinformation. Education and perception are primarily communicated by mothers, sisters, or friends who themselves may lack accurate understanding (Cooper and Barthalow 2007 ), with resulting poor body literacy regarding reproductive anatomy, female hormones and their functions, effect of hormones on the menstrual cycle, ovulation, and conception (Ayoola, Zandee, and Adams 2016 ).

Likewise, menstrual health education programs in school and community settings remain deficient, particularly in low income settings, with many girls viewing school education about menstruation as “ inaccurate, negative, and late ” (Herbert et al. 2017 , 14).

Conquering the Prevailing Ethos of Menstrual Shaming to Effect Positive Change

The perpetuation of menstrual shaming (for example, ‘The Curse’) has led to a prevailing ethos of generational taboos and lack of body literacy. There are consequences for such persistent bias, poor information systems, and practices; the resulting lack of education leads to delayed diagnosis and quality treatment of endometriosis and other gynepathologies with subsequent impact on fertility, loss of libido and pleasurable sex, chronic pain, diminished quality of life, loss of sense of self, body-negative thoughts, and more.

While disease knowledge has evolved, the deeply entrenched cultural norms surrounding both endometriosis and menstruation must continue to be challenged. Existing gaps must be bridged in order to eliminate the enduring barriers that persist. How and when girls learn about menses and its associated changes can impact response to the menstrual event and is critical to their knowledge, autonomy, and empowerment. Hence, it is necessary to overcome persistent myths, increase authoritative awareness of endometriosis, and articulate effective strategies to develop more robust literacy on the condition than presently exists.

Cooper and Barthalow ( 2007 ) previously established the need for menstrual education in schools, with the topic being offered even before menarche in order to better prepare girls for the experience and continuing throughout their educational career so that students can build upon their basic knowledge of the many themes involved with menstrual health. A three-pronged approach has been suggested (Subasinghe et al. 2016 ) to better inform individuals about dysmenorrhea specifically: having the school nurse provide educational leaflets to increase familiarity with the condition; encouraging health professionals to be more proactive in asking patients about the topic so that young menstruators with dysmenorrhea may be more likely to disclose their pain and symptoms; and finally, joint promotion by health professionals and schools of reliable, authoritative websites, and resources for additional guidance.

Oni and Tshitangano ( 2015 ) previously proposed that school health teams may also consider screening students for menstrual disorders in order to help diagnose underlying pathological causes and attend such issues accordingly. Similar findings on the need for adolescent education on the effective management of dysmenorrhea suggest that extending the educational program to parents and school leaders is beneficial as well (Wong 2011 ).

Evidence demonstrates that consistent delivery of a menstrual health education program in schools specifically increases awareness of endometriosis (Bush et al. 2017 ). Two successful examples of such programs are already underway:

The Endo What? Documentary team School Nurse Initiative ( https://www.endowhat.com/school-nurse-initiative ), founded by Shannon Cohn, is a collaborative effort to provide endometriosis education and awareness among school nurses and their students and

The New Zealand model and the first of its kind in the world, developed over two decades ago by Deborah Bush, MNZM, QSM, Dip Tchg. LSB, Chief Executive of Endometriosis New Zealand ( http://www.nzendo.org.nz/how-we-help/all-about-me ). Both efforts have served to educate countless individuals.

Building on the examples above, clinicians and the public alike will benefit from better understanding of endometriosis, thereby improving patient experiences and leading to improved outcomes. We must incorporate correct disease information along with ethical, social, cultural, economic, and diversity perspectives in emerging menstrual education curriculum.

In order to ensure appropriate intervention and reduce costly, unproven protocols, like-minded collaborators from practitioner, allied and mental health and others need to engage in associated efforts. There must be an emphasis placed on optimal pathways, evaluation of modern concepts, and cross-collaborative strategies. It is imperative that all individuals know when, where and how to obtain help when symptoms of menstrual-related disorders first arise, and it is vital that the public, including but not limited to, legislators, hospital administrators, gynecologists, and subspecialists become involved in these efforts.

Moreover, in that mothers often traditionally teach their daughters, we must rectify misperceptions and offer instruction on menstrual practices and disorders like endometriosis by providing compulsory education at school, in clinics, and kinship settings in order to encourage story-telling narratives and break the legacy of silence, misinformation, and fear. We must better elucidate the parameters of normal versus abnormal bleeding, pain, and related symptomology in order to recognize disorder and pain signaling throughout the cycle.

To address difficulties faced by low resource and medically underserved communities, use of participatory/community-based efforts, integrated messaging during clinic visits, and use of Information Technology (IT) and digital health tools where applicable can improve access to healthcare services and information in ways that enhance patient knowledge and self-management, thereby positively impacting health outcomes.

Through stakeholder partnerships, we can foster new menstrual educational programs to produce high-quality educational materials and afford better outcomes for all. A strong public health agenda for menstrual/endometriosis education must include a collaborative interface among public health, community and non-healthcare sectors.

Endometriosis has the propensity to take away so many of an affected individual’s choices: when and whether to engage in sex, when or if to pursue fertility, whether or not to undergo invasive procedures or to choose oft-ineffective menstrual suppressives that alter her cycle and more. We must strive toward early recognition and diagnosis, better understanding of pathophysiology and pain mechanisms, increased translational research and dissemination of authoritative facts on a widespread basis, starting with menstrual education among youth.

The current deficiency in quality menstrual education leads to confusion, inaccurate beliefs about and negative views on menstruation and related conditions. Though steps forward have been made, many individuals lack understanding of what constitutes menstrual dysfunction and when, where and how to seek care. It is imperative that patients and health professionals alike become better educated on the clinical characteristics of endometriosis, not least general practitioners and school nurses, who play crucial roles in early diagnosis. This is achievable through menstrual education programs that incorporate the disease as a leading cause of pain. Outlining optimal care pathways, encouraging timely recognition, improving research priorities, accepting modern concepts and emphasizing appropriate, cross-collaborative strategies to optimize outcomes can transform endometriosis care and reduce the role of ‘menstrual silence’ in its diagnosis and treatment.

Embarking on robust educational programs which begin in the primary setting and are shared across varied resources will enhance literacy on painful menstruation and gynepathologies, thereby affording access to better, earlier care and improving the lives of the millions suffering. By revitalizing menstrual communication and key conversations, we can put an end to the secrecy, silence, shame, and pain.

Adamson, D., S. Kennedy, and L. Hummelshoj. 2010. “Creating Solutions in Endometriosis: Global Collaboration Through the World Endometriosis Research Foundation.” Journal of Endometriosis and Pelvic Pain Disorders 2 (1): 3–6.

Google Scholar  

Ahn, S. H., K. Khalaj, S. L. Young, B. A. Lessey, M. Koti, and C. Tayade. 2016. “Immune-Inflammation Gene Signatures in Endometriosis Patients.” Fertility and Sterility 106, no. 6 (November): 1420–1431.e7.de.

Ahn, S. H., S. P. Monsanto, C. Miller, S. S. Singh, R. Thomas, and C. Tayade. 2015. “Pathophysiology and Immune Dysfunction in Endometriosis.” BioMed Research International 2015: 1–12. Article ID 795976. https://doi.org/10.1155/2015/795976 .

Article   Google Scholar  

van Aken, M. A. W, J. M. Oosterman, C. M. van Rijn, M. A. Ferdek, G. S. F. Ruigt, B. W. M. M. Peeters, D. D. M. Braat, and A. W. Nap. 2017. “Pain Cognition Versus Pain Intensity in Patients with Endometriosis: Toward Personalized Treatment.” Fertility and Sterility 108, no. 4 (October): 679–86.

Ayoola, A. B., G. L. Zandee, and Y. J. Adams. 2016. “Women’s Knowledge of Ovulation, the Menstrual Cycle, and Its Associated Reproductive Changes.” Birth 43 (3): 255–62.

Ballard, K., K. Lowton, and J. Wright. 2006. “What’s the Delay? A Qualitative Study of Women’s Experiences of Reaching a Diagnosis of Endometriosis.” Fertility and Sterility 86, no. 5 (November): 1296–301.

Ballweg, M. L. 1995. “The Puzzle of Endometriosis.” In Endometriosis , edited by C. R. Nezhat, G. S. Berger, F. R. Nezhat, V. C. Buttram, and C. H. Nezhat. New York, NY: Springer.

Bernardi, M., L. Lazzeri, F. Perelli, F. M. Reis, and F. Petraglia. 2017. “Dysmenorrhea and Related Disorders.” F1000Rsesearch 7 (6): 1645.

Bloski, T, and R. Pierson. 2008. “Endometriosis and Chronic Pelvic Pain: Unraveling the Mystery Behind This Complex Condition.” Nursing for Women’s Health 12 (5): 382–95.

Bobel, C., and E. Arveda Kissling. 2011. “Menstruation Matters: Introduction to Representations of the Menstrual Cycle.” Women’s Studies 40 (2): 121–26.

Bullo, S. 2018. “Exploring Disempowerment in Women’s Accounts of Endometriosis Experiences.” Discourse & Communication 12 (6): 569–86.

———. 2019. “‘I Feel Like I’m Being Stabbed by a Thousand Tiny Men’: The Challenges of Communicating Endometriosis Pain.” Health (London). February 19: 1363459318817943. https://doi.org/10.1177/1363459318817943 .

Burney, R. O., and L. C. Giudice. 2012. “Pathogenesis and Pathophysiology of Endometriosis.” Fertility and Sterility 98 (3): 511–19.

Bush, D., E. Brick, M. C. East, and N. Johnson. 2017. “Endometriosis Education in Schools: A New Zealand Model Examining the Impact of an Education Program in Schools on Early Recognition of Symptoms Suggesting Endometriosis.” The Australian and New Zealand Journal of Obstetrics and Gynaecology 57, no. 4 (August): 452–57.

Chamié, L. P., D. M. F. R. Ribeiro, D. A. Tiferes, A. C. Macedo Neto, and P. C. Serafini. 2018. “Atypical Sites of Deeply Infiltrative Endometriosis: Clinical Characteristics and Imaging Findings.” Radiographics 38, no. 1(January–February): 309–28.

Chandra-Mouli, V, and S. V. Patel. 2017. “Mapping the Knowledge and Understanding of Menarche, Menstrual Hygiene and Menstrual Health among Adolescent Girls in Low-and Middle-Income Countries.” Reproductive Health 14: 30.

Chrisler, J. C., M. L. Marván, J. A. Gorman, and M. Rossini 2015. “Body Appreciation and Attitudes toward Menstruation.” Body Image 12 (January): 78–81.

Clark, M. 2012. “Experiences of Women with Endometriosis: An Interpretative Phenomenological Analysis.” Doctoral Thesis, Queen Margaret University, Edinburgh. Accessed January 2, 2018. http://etheses.qmu.ac.uk/1812 .

Cook, A., and E. Hopton. 2017. “Endometriosis Presenting in a Transgender Male.” Journal of Minimally Invasive Gynecology 24 (7): S126.

Cooper, S. C., and P. Barthalow Koch. 2007. “’Nobody Told Me Nothin’: Communication About Menstruation among Low-Income African-American Women.” Women & Health 46 (1): 57–78.

Culley, L., C. Law, N. Hudson, E. Denny, H. Mitchell, M. Baumgarten, and N. Raine-Fenning. 2013. “The Social and Psychological Impact of Endometriosis on Women’s Lives: A Critical Narrative Review.” Human Reproduction Update 19, no. 6 (November–December): 625–39.

Delbandi, A. A., M. Mahmoudi, A. Shervin, E. Akbari, M. Jeddi-Tehrani, M. Sankian, S. Kazemnejad, and A. H. Zarnani. 2013. “Eutopic and Ectopic Stromal Cells from Patients with Endometriosis Exhibit Differential Invasive, Adhesive, and Proliferative Behavior.” Fertility and Sterility 100, no. 3 (September): 761–69.

D’Hooghe, T. M., A. Fassbender, F. O. Dorien, and A. Vanhie. 2019. “Endometriosis Biomarkers: Will Co-Development in Academia-Industry Partnerships Result in New and Robust Noninvasive Diagnostic Tests?” Biology of Reproduction. February 1. https://doi.org/10.1093/biolre/ioz016 .

Donnellan, N. M., I. R. Fulcher, and N. B. Rindos. 2018. “Self-Reported Pain and Quality of Life Following Laparoscopic Excision of Endometriosis as Measured Using the Endometriosis Health Profile-30: A 5 Year Follow-Up Study.” Journal of Minimally Invasive Gynecology 25 (7): S54.do.

Dusenbery, M. 2018. Doing Harm: The Truth About How Bad Medicine and Lazy Science Leave Women Dismissed, Misdiagnosed, and Sick . New York: HarperOne, pp. 221.

Franck, C., M. H., Poulsen, G. Karampas, A. Giraldi, and M. Rudnicki. 2018. “Questionnaire-Based Evaluation of Sexual Life After Laparoscopic Surgery for Endometriosis: A Systematic Review of Prospective Studies.” Acta Obstetricia et Gynecologica Scandinavica 97: 1091–104

Giudice, L. C. 2010. “Clinical Practice: Endometriosis.” The New England Journal of Medicine 362 (25): 2389–98.

Gogacz, M., M. Sarzyński, R. Napierała, J. Sierocińska-Sawa, and A. Semczuk. 2012. “Ovarian Endometrioma in an 11-Year-Old Girl Before Menarche: A Case Study with Literature Review.” Journal of Pediatric and Adolescent Gynecology 25, no. 1 (February): e5–e7. https://doi.org/10.1016/j.jpag.2011.09.009 .

Goldhill, O. 2016. “Period Pain Can Be ‘Almost as Bad as a Heart Attack.’ Why Aren’t We Researching How to Treat It ?” Quartz Media . Accessed October 15, 2017. https://qz.com/611774/period-pain-can-be-as-bad-as-a-heart-attack-so-why-arent-we-researching-how-to-treat-it .

Grundström, H., S. Alehagen, P. Kjølhede, and C. Berterö. 2018. “The Double-Edged Experience of Healthcare Encounters among Women with Endometriosis: A Qualitative Study.” Journal of Clinical Nursing 27, nos. 1–2 (January): 205–11.

Hardi, G., S. Evans, and M. Craigie. 2014. “A Possible Link between Dysmenorrhoea and the Development of Chronic Pelvic Pain.” Australian and New Zealand Journal of Obstetrics and Gynaecology 54, no. 6 (December): 593–96.

Harlow, S. D., and S. A. Ephross. 1995.”Epidemiology of Menstruation and Its Relevance to Women’s Health.” Epidemiologic Reviews 17 (2): 265–86.

He, J., W. Chang, C. Feng, M. Cui, and T. Xu. 2018. “Endometriosis Malignant Transformation: Epigenetics as a Probable Mechanism in Ovarian Tumorigenesis.” International Journal of Genomics 27 (March): 1465348.

Herbert, A. C., A. M. Ramirez, G. Lee, S. J. North, M. S. Askari, R. L. West, and M. Sommer. 2017. “Puberty Experiences of Low-Income Girls in the United States: A Systematic Review of Qualitative Literature from 2000 to 2014.” Journal of Adolescent Health 60, no. 4 (April): 363–79.

Highfield, E. S., M. R. Laufer, R. N. Schnyer, C. E. Kerr, P. Thomas, P. M. Wayne. 2006. “Adolescent Endometriosis-Related Pelvic Pain Treated with Acupuncture: Two Case Reports.” Journal of Alternative and Complementary Medicine 12, no. 3 (April): 317–22.

Houston, D. 1984. “Evidence for the Risk of Pelvic Endometriosis by Age, Race and Socioeconomic Status.” Epidemiologic Reviews 6 (1): 167–91.

Jacob, L., M. Kalder, and K. Kostev. 2017. “Risk Factors for Ectopic Pregnancy in Germany: A Retrospective Study of 100,197 Patients.” German Medical Science 19, no. 15 (December): Doc. 19.

Johnson, N.P., and L. Hummelshoj for the World Endometriosis Society Montpellier Consortium. 2013. “Consensus on Current Management of Endometriosis.” Human Reproduction 28 (6): 1552–68.

Jones, C. 2015. “Wandering Wombs and ‘Female Troubles’: The Hysterical Origins, Symptoms, and Treatments of Endometriosis.” Women’s Studies 44 (8): 1083–113.

Kennedy, S., A. Bergqvist, and C. Chapron et al. 2005. “ESHRE Guideline for the Diagnosis and Treatment of Endometriosis.” Human Reproduction 20 (10): 2698–704.

Khazali, S. 2018. “The BSGE Meets…David Redwine.” BSGE Newsletter/The Scope . Issue 10, Autumn, p. 25.

King, H. 1998. ‘Hippocrates Woman’: Reading the Female Body in Ancient Greece . London: Routledge, pp. 2, 47–48, 58, 227, 237.

Klein, S., T. D’Hooghe, C. Meuleman, C. Dirksen, G. Dunselman, and S. Simoens. 2014. “What Is the Societal Burden of Endometriosis-Associated Symptoms? A Prospective Belgian Study.” Reproductive BioMedicine Online 28, no. 1 (January): 116–24.

Makiyan, Z. 2017. “Endometriosis Origin from Primordial Germ Cells.” Organogenesis 3; 13, no. 3 (July): 95–102.

Marinho, M. C. P., T. F. Magalhaes, L. F. C. Fernandes, K. L. Augusto, A. V. M. Brilhante, and L. R. P. S. Bezerra. 2018. “Quality of Life in Women with Endometriosis: An Integrative Review.” Journal of Women’s Health 27, no. 3 (March): 399–408.

Marsh, E. E., and M. R. Laufer. 2005. “Endometriosis in Premenarcheal Girls Who Do Not Have an Associated Obstructive Anomaly.” Fertility and Sterility 83, no. 3 ( March): 758–60.

Marván, M. L., R. Vázquez-Toboada, and J. C. Chrisler. 2014. “Ambivalent Sexism, Attitudes towards Menstruation and Menstrual Cycle-Related Symptoms.” International Journal of Psychology 49, no. 4 (August): 280–87.

Matalliotakis, M., C. Matalliotaki, G. N. Goulielmos, E. Patelarou, M. Tzardi, D. A. Spandidos, A. Arici, and I. Matalliotakis. 2018. “Association between Ovarian Cancer and Advanced Endometriosis.” Oncology Letters 15 (5): 7689–92.

McCartney, P. 2016. “Nursing Practice with Menstrual and Fertility Mobile Apps.” The American Journal of Maternal/Child Nursing 41 (1): 61.

McLeod, B. S., and M. G. Retzloff. 2010. “Epidemiology of Endometriosis: An Assessment of Risk Factors.” Clinical Obstetrics and Gynecology 53, no. 2 (June): 389–96.

McMillan, C., and A. Jenkins. 2016. “’A Magical Little Pill That Will Relieve You of Your Womanly Issues’: What Young Women Say About Menstrual Suppression.” International Journal of Qualitative Studies on Health and Well-Being 23, no. 11 (November): 32932.

Moradi, M., M. Parker, A. Sneddon, V. Lopez, and D. Ellwood. 2014. “Impact of Endometriosis on Women’s Lives: A Qualitative Study.” BMC Women’s Health 14: 123.

Nezhat, C., F. Nezhat, and C. Nezhat. 2012. “Endometriosis: Ancient Disease, Ancient Treatments.” Fertility and Sterility 98 (6): S1.

Oni, T. H., and T. G. Tshitangano. 2015. “Prevalence of Menstrual Disorders and Its Academic Impact amongst Tshivenda Speaking Teenagers in Rural South Africa.” Journal of Human Ecology 51 (12): 214–19.

Ozkan, S., W. Murk, and A. Arici. 2008. “Endometriosis & Infertility: Epidemiology and Evidence-based Treatments.” Annals of the New York Academy of Sciences 1127: 92–100. Assessment of Human Reproductive Function.

Ozyurek, E. S., T. Yoldemir, and U. Kalkan. 2018. “Surgical Challenges in the Treatment of Perimenopausal and Postmenopausal Endometriosis.” Climacteric 21, no. 4 (August): 385–90.

Parazzini, F., G. Esposito, L. Tozzi, S. Noli, and S. Bianchi. 2017. “Epidemiology of Endometriosis and Its Comorbidities.” European Journal of Obstetrics & Gynecology and Reproductive Biology 209 (February): 3–7.

Pope, C., V. Sharma, S. Sharma, and D. Mazmanian. 2015. “A Systematic Review of the Association between Psychiatric Disturbances and Endometriosis.” Journal of Obstetrics & Gynaecology Canada 37 (11): 1006–15.

Pundir, J., K. Omanwa, E. Kovoor, V. Pundir, G. Lancaster, and P. Barton-Smith. 2017. “Laparoscopic Excision Versus Ablation for Endometriosis-Associated Pain: An Updated Systematic Review and Meta-Analysis.” Journal of Minimally Invasive Gynecology 24 (5) (July–August): 747–56.

Rafique, S, and A. H. Decherney. 2017. “Medical Management of Endometriosis.” Clinical Obstetrics and Gynecology 60, no. 3 (September): 485–96.

Redwine, D. B. Mulleriosis. 1988. “The Single Best Fit Model of the Origin of Endometriosis.” Reproductive Medicine 33 (11): 915–20.

Rei, C., T. Williams, and M. Feloney. 2018. “Endometriosis in a Man as a Rare Source of Abdominal Pain: A Case Report and Review of the Literature.” C ase Reports in Obstetrics and Gynecology 2008 (January 31): 2083121.

Riazi, H., N. Tehranian, S. Ziaei, E. Mohammadi, E. Hajizadeh, and A. Montazeri. 2014. “Patients’ and Physicians’ Descriptions of Occurrence and Diagnosis of Endometriosis: A Qualitative Study from Iran.” BMC Women’s Health 14: 103.

Rizk, B., A. S. Fischer, H. A. Lotfy, R. Turki, H. A. Zahed, R. Malik, C. P. Holliday, A. Glass, H. Fishel, M. Y. Soliman, and D. Herrera. 2014. “Recurrence of Endometriosis After Hysterectomy.” Facts, Views and Vision in Obstetrics and Gynaecology 6 (4): 219–27.

Rodríguez, M. B., and E. B. Gallardo. 2017. “Contributions to a Feminist Anthropology of Health: The Study of the Menstrual Cycle.” Salud Colect 13, no. 2 (April–June): 253–65.

Sampson, J. A. 1927. “Metastatic or Embolic Endometriosis, Due to the Menstrual Dissemination of Endometrial Tissue into the Venous Circulation.” The American Journal of Pathology 3 (2): 93–110.43.a

De Sanctis, V., A. Soliman, S. Bernasconi, L. Bianchin, G. Bona, M. Bozzola, F. Buzi, C. De Sanctis, F. Tonini G, Rigon, and E. Perissinotto. 2015. “Primary Dysmenorrhea in Adolescents: Prevalence, Impact and Recent Knowledge.” Pediatric Endocrinology Reviews 13, no. 2 (December): 512–20.

Schuster, M., and D. A. Mackeen. 2015. “Fetal Endometriosis: A Case Report.” Fertility and Sterility 103, no. 1 (January): 160–62.

Seear, K. 2009. “The Etiquette of Endometriosis: Stigmatisation, Menstrual Concealment and the Diagnostic Delay.” Social Science & Medicine 69, no. 8 (October): 1220–27.

Setúbal, A., Z. Sidiropoulou, M. Torgal, E. Casal, C. Lourenço, and P. Koninckx. 2014. “Bowel Complications of Deep Endometriosis During Pregnancy or In Vitro Fertilization.” Fertility and Sterility 101, no. 2 (February): 442–46.

Shmueli, L., L. Salman, L. Hiersch, E. Ashwal, E. Hadar, A. Wiznitzer, Y. Yogev, and A. Aviram. 2017. “Obstetrical and Neonatal Outcomes of Pregnancies Complicated by Endometriosis.” Journal of Maternal-Fetal and Neonatal Medicine 29 (October): 1–6.

Signorile, P. G., F. Baldi, R. Bussani, et al. 2010. “New Evidence of the Presence of Endometriosis in the Human Fetus.” Reproductive BioMedicine Online 21 (1): 142–47.

Signorile, P. G., F. Baldi, R. Bussani, M. D’Armiento, M. De Falco, and A. Baldi 2009. “Ectopic Endometrium in Human Foetuses is a Common Event and Sustains the Theory of Müllerianosis In the Pathogenesis of Endometriosis, a Disease That Predisposes to Cancer.” Journal of Experimental and Clinical Cancer Research 28 (1), article 49.

Signorile, P. G., F. Baldi, R. Bussani, R. Viceconte, P. Bulzomi, M. D’Armiento, A. D’Avino, and A. Baldi. 2012. “Embryologic Origin of Endometriosis: Analysis of 101 Human Female Fetuses.” Journal of Cellular Physiology 227 (4): 1653–56.

Soliman, A. M., E. X. Du, H. Yang, E. Q. Wu, and J. C. Haley. 2017. “Retreatment Rates among Endometriosis Patients Undergoing Hysterectomy or Laparoscopy.” Journal of Women’s Health 26, no. 6 (June): 644–54.

Soliman, A. M., K. S. Coyne, K. S. Gries, J. Castelli-Haley, M. Snabes, and E. Surrey. 2017. “The Effect of Endometriosis Symptoms on Absenteeism and Presenteeism in the Workplace and at Home.” Journal of Managed Care & Specialty Pharmacy 7: 745–54.

Sommer, M., P. A. Phillips-Howard, T. Mahon, S. Zients, M. Jones, and B. A. Caruso. 2017. “Beyond Menstrual Hygiene: Addressing Vaginal Bleeding Throughout the Life Course in Low and Middle-Income Countries.” BMJ Global Health 2: e000405.

Sourial, S., N. Tempest, and D. K. Hapangama. 2014. “Theories on the Pathogenesis of Endometriosis.” International Journal of Reproductive Medicine 2014: 179515.

Strange, J. M. 2000. “Menstrual Fictions: Languages of Medicine and Menstruation, c. 1850–1930.” Women’s History Review 9 (3): 607–28.

Subasinghe, A. K., L. Happo, Y. L. Jayasinghe, S. M. Garland, A. Gorelik, and J. D. Wark. 2016. “Prevalence and Severity of Dysmenorrhoea, and Management Options Reported by Young Australian Women.” Australian Family Physician 45, no. 11 (November): 829–34.

Suchońska, B., M. Gajewska, A. Zyguła, and M. Wielgoś. 2018. “Endometriosis Resembling Endometrial Cancer in a Postmenopausal Patient.” Climacteric 21, no. 1 (February): 88–91.

Suginami, H. 1991. “A Reappraisal of the Coelomic Metaplasia Theory by Reviewing Endometriosis Occurring in Unusual Sites and Instances.” American Journal of Obstetrics and Gynecolog 165, no. 1 (July): 214–18.

Tan, D. A., and M. J. G. Almaria. 2018. “Postmenopausal Endometriosis: Drawing a Clearer Clinical Picture.” Climacteric 21, no. 3 (June): 249–55.

Tasca, C., M. Rapetti, M.G. Carta, and B. Fadda. 2012. “Women and Hysteria in the History of Mental Health.” Clinical Practice & Epidemiology in Mental Health 8: 110–19.

Vitale, S. G., V. L. La Rosa, A. M. Rapisarda, and A. S. Laganà. 2017. Comment on: “Impact of Endometriosis on Quality of Life and Mental Health: Pelvic Pain Makes the Difference.” Journal of Psychosomatic Obstetrics & Gynecology 38, no. 1 (March): 81–82.

Whelan, E. 2007. “‘No One Agrees Except for Those of Us Who Have It’: Endometriosis Patients as an Epistemological Community.” Sociology of Health and Illness 29, no. 7 (November): 957–82.

Wilson, E. A. 1987. Endometriosis . New York, NY: Alan R. Liss.

Wong, L. P. 2011. “Attitudes towards Dysmenorrhoea, Impact and Treatment Seeking among Adolescent Girls: A Rural School-Based Survey.” Australian Journal of Rural Health 19, no. 4 (August): 218–23.

Yagnik, A. S. 2012. “Construction of Negative Images of Menstruation in Indian TV Commercials.” Health Care for Women International 33 (8): 756–71.

Yergens, A. R. T. 2016. “Endometriosis and Gender Nonconformity.” Huffington Post, June 9. Accessed September 1, 2018. https://www.huffingtonpost.com/ashley-rt-yergens/pumpkin-spice-lattes-endo_b_10265178.html .

Yeung, P. Jr., K. Sinervo, W. Winer, and R. B. Jr. Albee. 2011. “Complete Laparoscopic Excision of Endometriosis in Teenagers: Is Postoperative Hormonal Suppression Necessary?” Fertility and Sterility 95, no. 6 (May): 1909–12, 1912.e1.

Young, K., J. Fisher, and M. Kirkman. 2016. “Endometriosis and Fertility: Women’s Accounts of Healthcare.” Human Reproduction 31, no. 3 (March): 554–62.

Zanatta, A., A. M. Rocha, F. Carvalho, R. Pereira, H. S. Taylor, E. Motta, E. Baracat, and P. Serafini. 2010. “The Role of the Hoxa10/HOXA10 Gene in the Etiology of Endometriosis and Its Related Infertility: A Review.” Journal of Assisted Reproduction and Genetics 27 (12): 701–10.

Zarbo, C., A. Brugnera, L. Frigerio, C. Malandrino, M. Rabboni, E. Bondi, and A. Compare. 2018. “Behavioral, Cognitive, and Emotional Coping Strategies of Women with Endometriosis: A Critical Narrative Review.” Archives of Women’s Mental Health 21, no. 1 (February): 1–13.

Download references

Author information

Authors and affiliations.

Warwick, NY, USA

Heather C. Guidone

You can also search for this author in PubMed   Google Scholar

Editor information

Editors and affiliations.

Department of Women’s, Gender, and Sexuality Studies, University of Massachusetts Boston, Boston, MA, USA

Chris Bobel

Institute for the Study of Human Rights, Columbia University, New York, NY, USA

Inga T. Winkler

Women and Gender Studies & Social and Cultural Analysis, Arizona State University, Glendale, AZ, USA

Breanne Fahs

Center for Genetics and Society, Berkeley, CA, USA

Katie Ann Hasson

Women’s & Gender Studies, Eastern Washington University, Cheney, WA, USA

Elizabeth Arveda Kissling

Department of Psychology, Colorado College, Colorado Springs, CO, USA

Tomi-Ann Roberts

Rights and permissions

Open Access This chapter is licensed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license and indicate if changes were made.

The images or other third party material in this chapter are included in the chapter's Creative Commons license, unless indicated otherwise in a credit line to the material. If material is not included in the chapter's Creative Commons license and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder.

Reprints and permissions

Copyright information

© 2020 The Author(s)

About this chapter

Guidone, H.C. (2020). The Womb Wanders Not: Enhancing Endometriosis Education in a Culture of Menstrual Misinformation. In: Bobel, C., Winkler, I.T., Fahs, B., Hasson, K.A., Kissling, E.A., Roberts, TA. (eds) The Palgrave Handbook of Critical Menstruation Studies. Palgrave Macmillan, Singapore. https://doi.org/10.1007/978-981-15-0614-7_22

Download citation

DOI : https://doi.org/10.1007/978-981-15-0614-7_22

Published : 25 July 2020

Publisher Name : Palgrave Macmillan, Singapore

Print ISBN : 978-981-15-0613-0

Online ISBN : 978-981-15-0614-7

eBook Packages : Literature, Cultural and Media Studies Literature, Cultural and Media Studies (R0)

Share this chapter

Anyone you share the following link with will be able to read this content:

Sorry, a shareable link is not currently available for this article.

Provided by the Springer Nature SharedIt content-sharing initiative

• Publish with us

Policies and ethics

• Find a journal
• Track your research

• United Kingdom
• When Wombs Wandered How Hysterias...

When Wombs Wandered: How Hysteria’s History Still Affects Women’s Health

History Editor

Once a common medical diagnosis for women, ‘hysteria’ has since been discarded as a sexist myth – but the legacy of the ‘disease’ still has an impact on how women are treated in medical and social settings today.

Suffocation, emotional outbursts, sexual voraciousness and frigidity were only some of the symptoms attributed to ‘hysteria’. Considered a “ garbage-bag diagnosis ” for disruptive women, hysteria has shaped Western perceptions of women’s capability and trustworthiness in both social and medical settings.

Ancient Greek and Roman doctors thought a thirsty uterus made women ill

In Ancient Greece and Rome, women’s health issues were sometimes directly attributed to the womb, or hystera in Greek. Ancient doctors believed that women experienced a myriad physical symptoms due to the uterus’s movement around the body in search of moisture, which has led to early instances of hysteria to be referred to as ‘wandering womb syndrome’.

“The symptoms womb movement produced depended on where it went,” says Professor Helen King, who focusses her research on classical studies and the history of women’s medicine. “The idea of a wandering womb was linked to the social control of women to the norm of marriage and childbearing. But wandering wombs could be caused by exhaustion or not enough to eat, they could affect pregnant women too – marriage and pregnancy weren’t guaranteed cures.”

While ancient medical documents show the womb ( hystera ) as a cause of some physical ailments, King cautions that it is important not to conflate Ancient Greek and Roman diagnoses with psychological hysteria diagnoses in the 19th century: “I’m not sure I’d even go so far as to call it wandering womb syndrome! To assume it corresponds to what a 19th-century doctor meant by hysteria is to take it too far.”

Hysteria was classified as a psychological disorder in the 19th century

Over the centuries, the thought persisted that physical ailments were caused by misplaced wombs. The commonly prescribed cure was often marriage (and marital sex by extension) or pregnancy, as they were thought to affix the uterus into its rightful place. However, by the 19th century, the understanding of hysteria began to shift from a physical ailment to a psychological one that manifested in physical and emotional symptoms.

At a time when technological advancements were influencing social change and urbanisation, a moral panic began to develop, and its focus centred on the protection of women . Rather than attribute the rise of hysteria diagnoses to the breadth of causes and symptoms, the disorder was linked to women’s inability to make sense of a modernising world.

Women who challenged this? Hysterical.

It was not unheard of for fathers, husbands or brothers to send the women in their lives to asylums for hysteria treatment . However, after treatment, many patients were often worse for wear. Protestations to hospitalisation was proof of insanity and led to longer internment. Some may have actually presented symptoms of true illness, but there were also a large number of women admitted simply because they didn’t fit the feminine ideal: quiet, pliant and pious.

Did Victorian doctors really use vibrators to cure hysteria?

While new technologies were seen as corruptive to the female psyche, they did end up playing a part in the treatment of hysteria. However, unlike the 2011 film Hysteria suggests, orgasm was not the intended outcome.

“Victorian doctors were doing some very odd things to women and their genitals, but masturbating them to orgasm with a vibrator was not one of them. For a start, Victorian doctors believed too many orgasms caused hysteria. Masturbation was viewed as seriously injurious to health and potentially fatal,” says Dr Kate Lister, who runs the website Whores of Yore , which explores the history of sex and sexuality.

The myth that the vibrator was a “godsend” for doctors who were tired of manually stimulating their patients originates from Rachel Maines’s wildly popular book The Technology of Orgasm (1998), but recent scholarship has proven the theory to be faulty.

Electric vibrators were historically used to treat muscle pain or paralysis that developed from hysterical episodes and the machines were sometimes used internally to reposition the uterus, but doctors never intentionally prescribed masturbation as a cure.

Lister says that the use of vibrators for sexual pleasure is more likely a result of what she calls the “ kink minute ”, or “the insanely short length of time between the introduction of new technology and its adaptation for sexual purposes”.

While the vibrator myth might be a flirty icebreaker, it is ultimately harmful to how women’s health is understood today. According to King: “Maines and her users play into a male fantasy of passive women waiting for men to give them pleasure and assume historical continuity in women’s sexual expectations and practices.”

Hysteria has shaped the way we conceive of women’s health and general credibility

Reconfiguring how we think of women’s agency over their bodies and minds is especially relevant in the age of #MeToo. As the majority of people affected by sexual abuse identify as women, the trauma of sexual harassment and assault is often discounted.

More concerning, depression and anxiety associated with sexual trauma – both symptoms attributed to hysteria – are sometimes cited as proof that accounts of sexual assault are unreliable.

“Women aren’t diagnosed as hysterical any more, but they are frequently called hysterical when they show strong emotions,” Lister explains. “Since the Ancient Greeks, Western medicine has taught that women are at the mercy of their emotions, are weaker and more unstable than men – because of their biology. We still see echoes of this today. The link between women, wombs and madness is entrenched and dangerous. ”

Further, women are sometimes told that their physical pain is a psychological manifestation – a sort of medical gaslighting that can result in dire consequences . When a woman’s perception of her own health is associated with the notion that a woman’s body is outside of her control, it places her under an inordinate amount of pressure to prove the credibility of her experiences.

It may seem wild, but even the idea that a uterus could suddenly become detached persisted well into the mid-20th century – uterine detachment was cited as a reason to exclude women from the Olympic cross-country skiing competition. Women’s emotional constitution continues to be questioned as female politicians like Hillary Clinton have been called unfit for office due to a biological predisposition towards menstruation. When it comes to physical and mental health, it is worth reflecting on the historical narratives that have influenced medical understanding of women’s ability to make sense of their own bodies and minds.

Wednesday 10 October is World Mental Health Day . To highlight this, Culture Trip is looking at how different societies are shining a light on this important issue in innovative and alternative ways.

The content of this article is provided for general information only and is not an attempt to practise medicine or give specific medical advice, including, without limitation, advice concerning the topic of mental health. The information contained in this article is for the sole purpose of being informative and is not to be considered complete, and does not cover all issues related to mental health. Moreover, this information should not replace consultation with your doctor or other qualified mental health providers and/or specialists. If you believe you or another individual is suffering a mental health crisis or other medical emergency, please seek medical attention immediately.

If you are experiencing mental health issues, in the UK, Samaritans can be contacted on 116 123 or email [email protected]. You can contact the mental health charity Mind by calling 0300 123 3393 or visiting mind.org.uk. Please note there are no affiliations of any kind between the aforementioned organisations and Culture Trip .

Since you are here, we would like to share our vision for the future of travel - and the direction Culture Trip is moving in.

Culture Trip launched in 2011 with a simple yet passionate mission: to inspire people to go beyond their boundaries and experience what makes a place, its people and its culture special and meaningful — and this is still in our DNA today. We are proud that, for more than a decade, millions like you have trusted our award-winning recommendations by people who deeply understand what makes certain places and communities so special.

Increasingly we believe the world needs more meaningful, real-life connections between curious travellers keen to explore the world in a more responsible way. That is why we have intensively curated a collection of premium small-group trips as an invitation to meet and connect with new, like-minded people for once-in-a-lifetime experiences in three categories: Culture Trips, Rail Trips and Private Trips. Our Trips are suitable for both solo travelers, couples and friends who want to explore the world together.

Culture Trips are deeply immersive 5 to 16 days itineraries, that combine authentic local experiences, exciting activities and 4-5* accommodation to look forward to at the end of each day. Our Rail Trips are our most planet-friendly itineraries that invite you to take the scenic route, relax whilst getting under the skin of a destination. Our Private Trips are fully tailored itineraries, curated by our Travel Experts specifically for you, your friends or your family.

We know that many of you worry about the environmental impact of travel and are looking for ways of expanding horizons in ways that do minimal harm - and may even bring benefits. We are committed to go as far as possible in curating our trips with care for the planet. That is why all of our trips are flightless in destination, fully carbon offset - and we have ambitious plans to be net zero in the very near future.

Food & Drink

The best international afternoon teas in london.

Bars & Cafes

The best bars in london for stylish nights out.

Places to Stay

The coolest hotels in london.

A West End Performer’s Guide to London With Sam Harrison

See & Do

The 41 best things to do in london.

Pillow Talk: Between the Sheets of the Beaumont, Mayfair

Five London Hotels to Familiarise Yourself With

Guides & Tips

Must-visit attractions in london.

A High-Rollers Guide to a London Staycation

How the Metaverse can help you plan your next trip

Top European Cities for a Plant-Based Foodie Fix

Culture trip spring sale, save up to $1,100 on our unique small-group trips limited spots..

• Post ID: 1000459461
• Sponsored? No
• View Payload

Advertisement

Supported by

Why ‘Unwell Women’ Have Gone Misdiagnosed for Centuries

• Share full article

• Apple Books
• Barnes and Noble
• Books-A-Million

When you purchase an independently reviewed book through our site, we earn an affiliate commission.

By Janice P. Nimura

• June 8, 2021

UNWELL WOMEN Misdiagnosis and Myth in a Man-Made World By Elinor Cleghorn

In order to recognize illness, you have to know what health looks like — what’s normal, and what’s not. Until recently, medical research generally calibrated “normal” on a trim white male. Such a patient, arriving in an emergency room clutching his chest as they do in the movies — and in the textbooks — would be immediately evaluated for a heart attack. But heart disease in women, inconveniently, doesn’t always come with chest pain. A woman reporting dizziness, nausea and heart-pounding breathlessness in that same E.R. might be sent home with instructions to relax, her distress dismissed as emotional rather than cardiac.

Heart disease has clear markers and proven diagnostic tools. When a woman’s symptoms are less legible or quantifiable — fatigue, vertigo, chronic pain — the tendency to be dismissive grows. In “Unwell Women,” the British scholar Elinor Cleghorn makes the insidious impact of gender bias on women’s health starkly and appallingly explicit: “Medicine has insisted on pathologizing ‘femaleness,’ and by extension womanhood.”

Cleghorn, framing her argument in terms of Western medicine, starts with Hippocrates, the Greek physician of antiquity who refocused medical science on the imbalances of the body rather than the will of the gods. Hippocrates understood that women’s bodies were different from those of men, but in his view, and for millenniums to come, those differences could be reduced to a single organ: the uterus. A woman’s purpose was to procreate; if she wasn’t well, it was probably her womb that was to blame. One Roman writer described the uterus as “an animal within an animal,” with its own appetites and the capacity to wander through the body in search of satisfaction. Most female afflictions could be reduced to “hysteria,” from the Greek word for womb. “The theory that out-of-work wombs made women mad and sad was as old as medicine itself,” Cleghorn notes. The standard cure was marriage and motherhood. As Hippocratic medicine was refracted through the lens of Christianity, the female anatomy was additionally burdened with the weight of original sin.

Moving steadily through the centuries, Cleghorn lays out the vicious circles of women’s health. Taught that their anatomy was a source of shame, women remained in ignorance of their own bodies, unable to identify or articulate their symptoms and therefore powerless to contradict a male medical establishment that wasn’t listening anyway. Menstruation and menopause were — and often still are — understood as illness rather than aspects of health; a woman’s constitution, thus compromised, could hardly sustain the effort required for scholarship or professional life. A woman with the means and the talents to contemplate such ambitions soon bumped up against the rigid shell of the domestic sphere. Her frustration and despair could cause physical symptoms, which her doctor would then chalk up to her unnatural aspirations. Conversely, a perfectly healthy woman who agitated for radical change — a suffragist, say — was clearly suffering from “hysteric morbidity.”

Though hormones eventually replaced wandering wombs as central to understanding women’s health, “old ideas about women’s bodies being naturally defective and deficient still pulsed through endocrinological theories,” Cleghorn writes. The marketing for early forms of hormone replacement therapy to relieve the discomforts of menopause was often directed at men. One horrifying magazine ad showed a radiant older woman laughing alongside male companions, with the tagline “Help Keep Her This Way.” Was hormone replacement therapy a way of liberating women from their reproductive biology, or keeping them cheerful for their husbands? And, as questions grew about estrogen and cancer, at what cost?

The intersection of class and race complicates things further. As early as 1847, the Scottish physician James Young Simpson argued in favor of anesthesia during labor and delivery, contradicting the age-old belief that the pain of birth was part of God’s judgment. (To this day, women who opt for an epidural instead of “natural childbirth” can feel a nagging sense of failure.) But even liberal-minded men like Simpson believed that what he called the “civilized female” needed his revolutionary innovation more than her less privileged sisters. Black women were thought to be less sensitive to pain and working-class women were considered hardier in general; certainly no one worried about whether these women could work while menstruating.

Each scientific advance came with its own shadow. Margaret Sanger may have campaigned for contraception “as a way for women to reclaim their bodies and lives from medical and social control” — but for women of color, birth control was presented more as a duty than a right, a weapon against overpopulation and poverty requiring the policing of women. The postwar advent of the National Health Service in Britain heralded a new era of comprehensive prenatal care for pregnant women, but the N.H.S. “also inherited the legacy that women were child-bearers, first and foremost, so their health care needs pivoted around their reproductive functions.” Women saw their doctors when they got pregnant, but illnesses unrelated to reproductive health might go undiagnosed and unchecked.

Especially illnesses with ambiguous symptoms. “The age-old question of what to do with women’s pain, now that diagnoses could be made by biomedical evidence rather than speculations and assumptions, was raising its rather inconvenient head,” Cleghorn writes. When women of an earlier era might have been subjected to clitoridectomies or ovariectomies to address their mysterious symptoms, 20th-century patients sometimes faced a lobotomy “when the extent of their pain exceeded their physicians’ patience.” Cleghorn is unsparing in her examples of women suffering unimaginable and unnecessary horror at the hands of doctors who were unwilling either to listen closely or to admit when they were stumped.

It’s impossible to read “Unwell Women” without grief, frustration and a growing sense of righteous anger. Cleghorn’s prose is lively, and she has marshaled an enormous amount of material. But her decision to organize it chronologically rather than thematically can slow her momentum, forcing her to circle back to certain topics repeatedly. There are occasional detours — into the eugenic implications of abortion and birth control, for example — that aren’t strictly relevant to the thesis of a “culture of mystification” that compromises women’s health. And Cleghorn’s definition of that culture of mystification is tricky. She is rightfully advocating for a better understanding of diseases that disproportionately affect women and a re-examination of clinical norms centered on men. But in this era of ever-increasing medical specialization, byzantine insurance regulations and rushed office visits, women are not the only victims of mystification.

Cleghorn saves for her conclusion her most powerful illustration: her own experience. It started with leg pain and swelling. Her doctor suggested gout, or maybe she was pregnant? “I can see nothing wrong with you,” he said. “It’s probably just your hormones.” Doubting the significance of her own concerns, she endured seven years of pain and tachycardia, finally landing in the emergency room. Even then, her diagnosis was linked to the baby she had just delivered: “toxic postpartum heart disease.” An observant rheumatologist at last identified her disease as lupus.

“The lives of unwell women depend on medicine learning to listen,” Cleghorn concludes. And also on women claiming their right, as Cleghorn has, to speak.

Janice P. Nimura is the author, most recently, of “The Doctors Blackwell: How Two Pioneering Sisters Brought Medicine to Women — and Women to Medicine.”

UNWELL WOMEN Misdiagnosis and Myth in a Man-Made World By Elinor Cleghorn 386 pp. Dutton. $28.

Explore More in Books

Want to know about the best books to read and the latest news start here..

How did fan culture take over? And why is it so scary? Justin Taylor’s novel “Reboot” examines the convergence of entertainment , online arcana and conspiracy theory.

Jamaica Kincaid and Kara Walker unearth botany’s buried history  to figure out how our gardens grow.

A new photo book reorients dusty notions of a classic American pastime with  a stunning visual celebration of black rodeo.

Two hundred years after his death, this Romantic poet is still worth reading . Here’s what made Lord Byron so great.

Harvard’s recent decision to remove the binding of a notorious volume  in its library has thrown fresh light on a shadowy corner of the rare book world.

Bus stations. Traffic stops. Beaches. There’s no telling where you’ll find the next story based in Accra, Ghana’s capital . Peace Adzo Medie shares some of her favorites.

Each week, top authors and critics join the Book Review’s podcast to talk about the latest news in the literary world. Listen here .

Jones Publishes Articles, Presents at National Women's Studies Conference

January 19, 2016

Share Options

• Share to Twitter
• Share to Facebook
• Share to Linkedin

Visiting Assistant Professor of Women’s Studies Cara E. Jones published a paper titled “Wandering Wombs and “Female Troubles”: The Hysterical Origins, Symptoms, and Treatments of Endometriosis” in the journal Women ’ s Studies: An Interdisciplinary Journal.

She also co-authored paper titled “Women’s Studies and Contingency: Between Exploitation and Resistance” in the journal Feminist Formations,  and presented a paper titled “Embodied Precarity: Disability and Contingent Labor” at the 2015 National Women's Studies Association conference, held in November in Milwaukee.

Help us provide an accessible education, offer innovative resources and programs, and foster intellectual exploration.

Site Search

Your web browser is outdated and may be insecure

The RCN recommends using an updated browser such as Microsoft Edge or Google Chrome

Women have long been seen as at the mercy of their biology.

In the ancient medical world it was believed that a 'wandering womb' caused suffocation and death. Menstruation and pregnancy were thought to make women the weaker sex, both physically and mentally. By the late nineteenth century, it was deemed scientifically proven that women’s biology made them less rational than men, unfit to participate in many areas of public life.

Rising above these attitudes, a century ago, women began securing the right to vote in the UK. Around the same time, nursing was formalised as a predominantly female profession. Since then, nurses have taken a leading role in challenging assumptions of women’s health.

Yet myths and misconceptions remain widespread. Social changes continue to alter women’s biology, as they start periods earlier and live longer beyond the menopause. What is ‘normal’ for women? And why has women’s health long been considered 'dirty' nursing'?

Did you know: Gynaecology is a Greek term literally meaning 'the study of women'. And hysteria is derived from 'hystera' meaning womb. This linguistic association between women’s health and hysteria is still in use today in the term hysterectomy.

Decisions about women’s health have historically been made by men.

For the Victorians, the menstrual cycle was considered a disease. Women found all sorts of ways to find out more about their periods and learnt from female relatives. Some would even source secret texts on women’s health, often disguised in the dust jacket of more ‘acceptable’ reading material.

How did nursing change this? As the role of women in health care grew, so did an understanding about women’s health and biological cycles. Nurses became advocates for women, in a position to air previously hidden topics. 

The introduction of the contraceptive pill in 1961 changed when and how much women bleed. It helped move away from medically assumed norms to cycle lengths and flows unique to the individual. More and more women were able to better predict the symptoms of their own biology.

Women today have more control over their periods than ever. Bolder attitudes have seen campaigns to abolish the ‘tampon tax’ and charities working to ensure all women get access to menstrual supplies. Nurses play an important part in this changing atmosphere. As more non-surgical options have become available for women, like mirena coils and hysteroscopy, nurses have been at the  forefront of embracing and delivering these treatments.

Nursing today focuses on the holistic management of menopause. This can include managing lifestyle changes and advising on prescribed medication such as Hormone Replacement Therapy. Because the effects of menopause are so complex, Clinical Nurse Specialists (CNS) are key at this advanced level of practice. Taking time to understand individual patient concerns and providing tailored support are crucial nursing skills.

A Victorian woman going through the menopause was often considered to be emotionally unstable. During this 'climacteric period', she may well have been prescribed leeching or bloodletting from the ankle. Her doctor would have advised against reading novels, going to parties and dancing. For a 45 – 50 year old Victorian woman, an onslaught of instability and madness was considered inevitable. 

In the Victorian age men were also diagnosed with climacteric insanity, as something that was defined as a broad spectrum of 'changes' in life. But men were not diagnosed as frequently as women. Today, the possibility of 'man periods' or the 'male menopause' are widely discussed, as hormone fluctuations in men are also recognized.

Hidden loss

Pregnancy loss is more common than is discussed.

Even today, some causes of miscarriage are not known. Plenty of preventative measures have been tried and tested by women all over the world for centuries. Ancient Egyptian women were known for placing protective amulets in the vulva and women of Ancient Greece would avoid bitter foods. Practically any action taken by a woman in the Middle Ages could be seen to prompt a miscarriage, making her choices wholly responsible for the outcomes of her pregnancy.

In the nineteenth century, anything from exercise, worry, even failure to meet the demands of home life was blamed. Whilst these beliefs are centuries past, the idea of miscarriage as being the ‘fault’ of the woman still exists. Stigma around miscarriage and ectopic pregnancy continues

Nurses are breaking this stigma.

The focus has shifted from the physical health of women to their emotional health. Specialist nurses within Early Pregnancy Units are leading on assessing, scanning and undertaking treatments. Counselling and strong links with support groups and charities are all part of providing expert care for their patients.

"By allowing my own experience to be reported I hope…that I might contribute in a small way to a future climate in which these matters are respected as entirely personal – rather than pored over and speculated about as they are now.”

In 1895, Dublin nurse Alice Beatty took her surgeon, Charles Cullingworth, to court.

Cullingworth operated on Beatty for 'ovarian disease', but removed both her ovaries rather than the one she had consented to. Beatty, engaged to be married and keen to start a family, claimed damages for a wrongly performed operation. She lost the case.

Victorian surgery, prescribed and performed by men, was often extreme. Hysterectomy was the treatment of choice for cervical cancer, even when death rates were high. Consent and the social and psychological effects on women were barely acknowledged. 

With the advent of new procedures, such as endometrial ablation, hysterectomy is no longer the only option. Now, Clinical Nurse Specialists (CNS) are essential in delivering and supporting these new treatments and at the same time, ensuring the rights and wishes of their patients are met. 

Gynaecological cancers are complex and the nursing role is expanding. Nurses take the majority of smear tests. They have a large role in the diagnosis of cervical cancer, from screening through to colposcopy, as well as spotting cancer reoccurrence. A CNS remains with their patient for the whole journey, from diagnosis, treatment and managing the long term effects. Unlike Alice Beatty, women now have increasing opportunities to take more control over their own care.

We all need to speak more openly about intimate health issues.

Women's biology has long been subject to speculation, comment and often control by others. It is now time for menstruation and menopause to be understood and celebrated as a normal part of female biology. 

In a field previously dominated by the perspectives of male doctors and physicians, all nurses now have a responsibility to advocate for women today. It is up to healthcare workers to recognise that each woman is different and that ‘normal’ means healthy.

Perhaps for the nurse, it is the ‘dirty’ nature of gynaecology which makes the role so unique, helping to transform a woman’s experience.

Academia.edu no longer supports Internet Explorer.

To browse Academia.edu and the wider internet faster and more securely, please take a few seconds to  upgrade your browser .

Enter the email address you signed up with and we'll email you a reset link.

• We're Hiring!
• Help Center

WANDERING WOMBS AND " FEMALE TROUBLES " : THE HYSTERICAL ORIGINS, SYMPTOMS, AND TREATMENTS OF ENDOMETRIOSIS

Little scholarship outside of medical science examines endometriosis, and there are surprisingly few feminist analyses of endometriosis as a cultural construction. Building on the handful of recent feminist cultural analyses of this gynecological condition that is routinely called an enigma, riddle, or mystery by clinicians, researchers, and patients alike, in this article, I map the origins, symptoms, and treatments of endometriosis using feminist body studies, the study of the body as a cultural construction that is gendered, raced, classed, and sexed, as a lens. Drawing on the body of interdisciplinary scholarship about the enigmatic late nineteenth-century diagnosis of hysteria known as hysteria studies, I argue that from its inception in 1921 to representations in self-help literature as recently as 2011, endometriosis has taken up a diagnostic and cultural location once occupied by hysteria: each disease pathologizes not only certain physical symptoms, but also social and cultural deviations from female gender norms. Although I investigate the relationship between endometriosis and hysteria, I go beyond merely claiming that hysteria morphed into endometriosis. Rather, I argue that a specter of hysteria’s wandering womb haunts medical and self-help literature in the late twentieth and early twenty-first centuries, reinforcing traditional 55 gender and social roles, and at times, prescribing these roles as a cure for illness.

Related Papers

Book chapter

Rachelle Chadwick

American Quaterly 52:2

Laura Briggs

Narelle Warren

Cara E Jones

Disability scholars have critiqued medical models that pathologize disability as an individual flaw that needs treatment, rehabilitation, and cure, favoring instead a social-constructionist approach that likens disability to other identity categories such as gender, race, class, and sexuality. However, the emphasis on social constructionism has left chronic illness and pain largely untheorized. This article argues that feminist disability studies (FDS) must attend to the common, chronic gynecological condition endometriosis (endo) when theorizing pain. Endo is particularly important for FDS analysis because the highly feminized and sexualized nature of endo pain is a major source of disability. Because medical treatments of endo enhance fertility rather than provide pain relief, those with endo must not only have access to medical services to manage their pain, but also demand better medical management of their pain as well as disability accommodations for their pain. Thus, I propose a pain-centric model of disability that politicizes pain through social-constructionist and medical models of disability by attending to the lived experiences of pain.

Health Communication

Emily Krebs

Despite advances in biomedical technology, endometriosis remains a disease that is inefficiently diagnosed and treated. American women often suffer from debilitating symptoms for a decade before being diagnosed. Addressing this deficiency is crucial if women are to live well with endometriosis. Framed by relational dialectics theory 2.0, the current study analyzes women’s experiences of endome- triosis diagnoses via online narrative postings. Results reveal two centripetal (dominant) discourses: (a) the discourse of psycho-abnormality, and (b) the discourse of biological normality. Narrators’ invocation of the discourse of psycho-abnormality disqualifies women’s suffering as imagined and “all in their heads,” whereas invocation of the discourse of biological normality naturalizes women’s suffering as “just part of being a woman.” The discourse of psycho-abnormality and the discourse of biological normality, both rooted in patriarchal influences, hinder diagnosis and subsequently treatment and rehabilitation of endometriosis. Encouragingly, a third (though marginalized) discourse emerged: the discourse of reclaiming expertise. Narrators’ invocation of this discourse directly opposes the discourses of psycho-abnormality and biological normality by inciting validation of embodied knowledge in medical encounters and urging patients to enact agency in healthcare settings. This project discusses the interplay of these three discourses, and aims to improve diagnostic efficacy as a result.

Marci Cottingham

Interrogating Gendered Pathologies

Leslie R Anglesey

Patricia Tovar

Luna Dolezal

Kate Lister

This paper will reveal how cultural beliefs and superstitions associated with the female body, as communicated by the medical profession, had a profound impact on the image of the mad or violent women in nineteenth-century texts. The theory of menstrual madness held a tight grip on the understanding of even the most prominent of nineteenth-century physicians. Dr. William Rowley, professor of medicine at Oxford University and member of the Royal College of Physicians, eagerly wrote of the 'passio hysterica' repressed menstruation, or amenorrhea, could bring about in women in 1800: 'The tongue falters, trembles, and incoherent things are spoken; the voice changes; some roar, scream or shriek immoderately; others sigh deeply, weep or moan plaintively'. Menstruation, in whatever form it took was considered dangerous because of its associations with madness and the mysterious condition known as 'hysteria'. Dr Jacobi wrote in 1868 that 'At such times, a woman is undoubtedly more prone than men to commit any unusual or outrageous acts'. Whilst medical texts argued that menstruation weakens the body, their continual references to madness, violence, irrationality and superstitious associations with the moon, suggest otherwise. This paper will focus on representations of mad women, such as Bertha Rochester in Jane Eyre, as well as the violent murderesses of Victorian sensation and crime fiction and show how their 'madness' is linked to sociological constructs of the body and in particular, to menstruation. I will explore the nineteenth-century idea that all women have the capacity for menstrual madness within them and were culturally repressed as a result. I intend to reveal a link between medical understanding of menstruation and the representation of women as unstable in literature.

RELATED PAPERS

Environmental Health

Ruth Mubeezi

david massone

The Astrophysical Journal

Jose Contreras

gita fitria

Alessandra dos Santos

Redes de Ingeniería

Gina Sierra

Revista Venezolana De Economia Y Ciencias Sociales

Pablo Dávalos

JEANETTE SOARES

Diversité urbaine

Deirdre Meintel

Podall Publicacio De Cultura Patrimoni I Ciencies

Sergio García Catalán

Journal of Integrative Neuroscience

Research on Child and Adolescent Psychopathology

Laura Machlin

Carmela Cordero

Zeitschrift für orthomolekulare Medizin

Sus Herbosch

JMIR Research Protocols

Olivia Wood

HADJ MOSTEFA Adda

AULA 3 AUTORIDADE ESPIRITUAL DE JESUS

rossi aguiar

Journal of Continuing Education in the Health Professions

Arian Gholami

INDIAN RESEARCH JOURNAL OF PHARMACY AND SCIENCE

Mohammad K Uddin

BMC Health Services Research

Ernieda Md Hatah

Manuele Faccenda

nicole ortega

hbgjfgf hyetgwerf

International Journal of Business and Economics Research

markos Kidane

办UOA毕业证成绩单办理新西兰奥克兰大学假文凭定制 QQ微信1989 88881

RELATED TOPICS

•   We're Hiring!
•   Help Center
• Find new research papers in:
• Health Sciences
• Earth Sciences
• Cognitive Science
• Mathematics
• Computer Science
• Academia ©2024

• Craft and Criticism
• Fiction and Poetry
• News and Culture
• Lit Hub Radio
• Reading Lists

• Literary Criticism
• Craft and Advice
• In Conversation
• On Translation
• Short Story
• From the Novel
• Bookstores and Libraries
• Film and TV
• Art and Photography
• Freeman’s
• The Virtual Book Channel
• Behind the Mic
• Beyond the Page
• The Cosmic Library
• The Critic and Her Publics
• Emergence Magazine
• Fiction/Non/Fiction
• First Draft: A Dialogue on Writing
• The History of Literature
• I’m a Writer But
• Lit Century
• Tor Presents: Voyage Into Genre
• Windham-Campbell Prizes Podcast
• Write-minded
• The Best of the Decade
• Best Reviewed Books
• BookMarks Daily Giveaway
• The Daily Thrill
• CrimeReads Daily Giveaway

Hysteria, Witches, and The Wandering Uterus: A Brief History

Or, why i teach "the yellow wallpaper".

I teach “The Yellow Wallpaper” because I believe it can save people. That is one reason. There are more. I have taught Charlotte Perkins Gilman’s 1891 story for nearly two decades and this past fall was no different. Then again, this past fall was entirely different.

In our undergraduate seminar at the School of the Art Institute of Chicago, we discussed “The Yellow Wallpaper” in the context of the nearly 4,000-year history of the medical diagnosis of hysteria. Hysteria, from the Greek hystera or womb. We explored this wastebasket diagnosis that has been a dump-site for all that could be imagined to be wrong with women from around 1900 BCE until the 1950s. The diagnosis was not only prevalent in the West among mainly white women but had its pre-history in Ancient Egypt, and was found in the Far East and Middle East too.

The course is titled “The Wandering Uterus: Journeys through Gender, Race, and Medicine” and gets its name from one of the ancient “causes” of hysteria. The uterus was believed to wander around the body like an animal, hungry for semen. If it wandered the wrong direction and made its way to the throat there would be choking, coughing or loss of voice, if it got stuck in the the rib cage, there would be chest pain or shortness of breath, and so on. Most any symptom that belonged to a female body could be attributed to that wandering uterus. “Treatments,” including vaginal fumigations, bitter potions, balms, and pessaries made of wool, were used to bring that uterus back to its proper place. “Genital massage,” performed by a skilled physician or midwife, was often mentioned in medical writings. The triad of marriage, intercourse, and pregnancy was the ultimate treatment for the semen-hungry womb. The uterus was a troublemaker and was best sated when pregnant.

“The Yellow Wallpaper” was conceived thousands of years later, in the Victorian era, when the diagnosis of hysteria hit its heyday. Medical attention veered from the hungry uterus and was placed on a woman’s so-called weaker nervous system. Nineteenth-century physician Russell Thacher Trail approximated that three-quarters of all medical practice was devoted to the “diseases of women,” and therefore physicians must be grateful to “frail women” (read frail white women of certain means) for being an economic godsend to the medical profession.

It was believed that hysteria, also known as neurasthenia, could be set off by a plethora of bad habits including reading novels (which caused erotic fantasies), masturbation, and homosexual or bisexual tendencies resulting in any number of symptoms such as seductive behaviors, contractures, functional paralysis, irrationality, and general troublemaking of various kinds. There are pages and pages of medical writings outing hysterics as great liars who willingly deceive. The same old “treatments” were enlisted—genital massage by an approved provider, marriage and intercourse—but some new ones included ovariectomies and cauterization of the clitoris.

It is no accident that such a diagnosis took off just as some of these same women were fighting to gain access to universities and various professions in the US and Europe. A decrease in marriages and falling birth rates coincided with this medical diagnosis criticizing the New Woman and her focus on intellectual, artistic, or activist pursuits instead of motherhood. Such was the downfall of Gilman’s narrator in “The Yellow Wallpaper.”

Good chance you read the story in school, but in case you didn’t or have forgotten, here is a synopsis. Following the birth of her first child, the narrator says she feels sick, but her physician husband has dismissed her complaints as a “temporary nervous condition—a slight hysterical tendency.” He has rented a country house and has put her to rest in the former nursery. She explains,

So I take phosphates or phosphites—whichever it is, and tonics, and journeys, and air, and exercise, and am absolutely forbidden to “work” until I am well again.

Personally, I disagree with their ideas.

Personally, I believe that congenial work, with excitement and change, would do me good.

But what is one to do?

The narrator’s work is that of a writer. She sneaks paragraphs here and there when she is not being observed by her husband or his sister who is “a perfect and enthusiastic housekeeper, and hopes for no better profession.” The story documents the narrator’s frustrations with her so-called treatment and her husband’s resolve that she only needs to exercise more will and self-control in order to get better. “‘Bless her little heart!’ said he with a big hug, ‘she shall be as sick as she pleases.'”

We witness the narrator’s steady decline as she becomes increasingly obsessed with the room’s ghastly wallpaper: “the bloated curves and flourishes—a kind of ‘debased Romanesque’ with delirium tremens— go waddling up and down in isolated columns of fatuity.” Gilman—a prolific writer of fiction, poetry and profound and progressive books, including Women and Economics, a woman who drew large crowds as she made the national lecture circuit in her day—is masterful at showing us how things fall apart for her protagonist. In the final scene of the story, the narrator creeps along the edges of the former nursery amidst shreds of wallpaper, stepping over her crumpled husband who has fainted upon discovering his wife in such a state.

A number of 19th-century practitioners gained fame as hysteria doctors. S. Weir Mitchell, a prominent Philadelphia physician, was one of them. He championed what he called “the rest cure.” Sick women were put to bed, ordered not to move a muscle and instructed to eschew intellectual or creative work of any kind, fed four ounces of milk every two hours, and oftentimes required to defecate and urinate into a bed-pan while prone. Mitchell was so renowned he had his own Christmas calendar.

Mitchell was Charlotte Perkins Gilman’s physician. His rest cure was prescribed to some of the great minds of the time, including Edith Wharton and Virginia Woolf. Scores of white women artists and writers were diagnosed as hysterics in a period when rebelliousness, shamelessness, ambition, and “over education” were considered to be likely causes. Too much energy going up to the brain instead of staying in the reproductive organs and helping the female body do what it was supposed to do. As Mitchell wrote, “The woman’s desire to be on a level of competition with man and to assume his duties is, I am sure, making mischief, for it is my belief that no length of generations of change in her education and modes of activity will ever really alter her characteristics.”

Transgressing prescribed roles would make women sick. British suffragettes, for instance, were “treated” as hysterics in prison. Outspoken proponents for women’s rights were often characterized as the “shrieking sisterhood.” In our seminar discussion, we made the comparison to the numbers of African American men diagnosed as schizophrenics at a State Hospital for the Criminally Insane in Ionia, Michigan in the 1960s and 70s as documented in psychiatrist Jonathan Metzl’s powerful book The Protest Psychosis: How Schizophrenia Became a Black Disease . A diagnosis can be a weapon used as a way to control and discipline the rebellion of an entire demographic.

As we discussed “The Yellow Wallpaper” and its historical context, I could see that Allie was becoming more and more outraged. She looked as if she might bolt from her classroom seat. Her hand shot up, “Would you believe that my high school English teacher told us, ‘If this woman had followed her husband’s instructions, she wouldn’t have gone crazy?!'”

If I’d had a mouth full of something, I would have done a spit take. In all my years of teaching the story, I cannot remember ever hearing this jaw-dropping explanation. But Allie opened the flood gates. Bec raised her hand, “We read it in eighth grade. We were all concerned and confused, especially the girls. And disturbed by the ending. No one understood what was wrong with the woman. The story didn’t seem to make any sense.”

Max added, “In my A.P. Psychology class, our teacher asked us to use the DSM 4 to diagnose the woman in “The Yellow Wallpaper.” I remember a number of student guesses, like Major Depressive Disorder, General Anxiety Disorder, as well as OCD, Schizophrenia, and Bipolar with Schizotypal tendencies.”

Noëlle said she remembered a fellow high school student describing the narrator as “animalistic” and the teacher writing it on the board. There was no discussion of what “hysteria” actually meant.

Keeta encountered the story in a college literature seminar titled “Going Mad.” Class discussion focused on the insane and unreliable narrator. “A missed opportunity for me to learn about something very real and current, and in some ways I feel wronged by that,” Keeta said. They explained that they had a similar feeling when watching the film Beloved in middle school. “Here’s your heritage, and it’s dumped in your lap, and you have no idea why this enslaved woman killed her child. If you had more information about the history of slavery and reproductive resistance, then you would be able to make better sense of what you were seeing.”

Cristina hadn’t read “The Yellow Wallpaper” before but said, “In the fourth grade in my all-girls Catholic school in Bogotá, my religion teacher told the class that we should only show our bodies to our husbands and doctors. Meaning they are the only ones that can touch our bodies. I think there is some connection here, no?”

I am always moved by the associations students make between the history of hysteria and their own lives and circumstances. We discussed how it is startling to learn about nearly four millennia of this female double bind, of medical writings opining cold, deprived, frail, wanting, evil, sexually excessive, irrational, and deceptive women while asserting the necessity of disciplining their misbehaviors with various “treatments.”

“What about Hillary?” Bec chimed in.

This wasn’t just any fall semester. There couldn’t have been a more appropriate time to consider the history of hysteria than September 2016, the week following Hillary Clinton’s collapse from pneumonia at the 9/11 ceremonies, an event that tipped #HillarysHealth into a national obsession. Rudolph Giuliani said that she looked sick and encouraged people to google “Hillary Clinton illness.” Trump focused on her coughing or “hacking” as if the uterus were still making its perambulations up to the throat.

For many months, Hillary had been pathologized as the shrill shrew who was too loud and outspoken, on the one hand, and the weak sick one who didn’t have the strength or stamina to be president on the other. We discussed journalist Gail Collins’ assessment of the various levels of sexism afoot in the campaign. On the topic of Hillary’s health, Collins wrote, “this is nuts, but not necessarily sexist.” We, in the Wandering Uterus, wholeheartedly disagreed. But, back in September, we did not understand how deeply entrenched these sinister mythologies had already become.

We returned to the Middle Ages to help us understand what we were witnessing unfold during the campaign. By way of the church, the myth flourished that women were evil. Lust and carnal pleasures were the problem with women who were, by nature, lascivious and deceptive. Female sexuality, once again, was the problem. So-called witches were accused of making men impotent; their penises would “disappear” and it was claimed that witches would keep said penises in a nest in a tree. Unholy spirits were the cause of bewitchment, a condition that sounded a lot like earlier descriptions of hysteria. Its “treatment” led to the death of thousands of women. In their 1973 groundbreaking treatise, Witches, Midwives, and Nurses , Barbara Ehrenreich and Deirdre English argue that the first accusations of witchcraft in Europe grew out of church-affiliated male doctors’ anxieties about competition from female healers. The violence promoted by the church allowed for the rise of the European medical profession.

In class, we continued to discuss the construction of she-devil, foul-mouthed Crooked Hillary who extremists berated with hashtags like #Hillabeast and #Godhilla and #Witch Hillary. How could we not compare the campaign season to the witch-hunts when folks at rallies started chanting “hang her in the streets” in addition to the by-then familiar “lock her up.” In short order, we witnessed a shift from the maligned diagnosis of a single individual to an all-out mass hysterical witch-hunt against a woman who dared to run for presidential office. We discussed the brilliant literary critic Elaine Showalter whose book Hystories , written in the 1990s, focuses on end-of-the-millennium mass hysterias. Prior to the existence of social media, Showalter presciently wrote, “hysterical epidemics. . . continue to do damage: in distracting us from the real problems and crises of modern society, in undermining a respect for evidence and truth, and in helping support an atmosphere of conspiracy and suspicion.”

We discussed the fact that social media had allowed for this rapid circulation of Hillary mythologies. I explained that the witch-hunts in Early Modern Europe happened to correspond to the invention of the social media of their day. First published in 1486, Malleus Maleficarum or The Hammer of Witches by Reverends Heinrich Kramer and James Sprenger became the ubiquitous manual that spread the church’s methods of identifying witches through questioning and torture in large part by means of the contemporaneous invention of the printing press. For nearly two centuries, this witch handbook was reprinted again and again, disseminating sentences that would later inspire the anti-Hillary playbook, “She is an imperfect animal who always deceives.” “When a woman thinks alone, she thinks evil.”

By midterm presentations, we talked about the ways in which hysteria had gone viral with other women candidates, like Zephyr Teachout, a law professor and activist running for Congress, who found herself on the receiving end of attack ads that featured a close-up of her face with a red-lettered CRAZY stamped on it.

Upon closer investigation, this form of political slander was not limited to the current election season or the US. In Poland, women who marched against a recent abortion ban were called feminazis, prostitutes, whores, witches, and crazy women. While in 2013, Russian news reports suggested that members of the band Pussy Riot were “witches in a global satanic conspiracy in cahoots with the Secretary of State Hillary Clinton.” That should have been a clue to what would follow.

During the weeks running up to the election we veered from the topic of hysteria and discussed the history of gynecology and enslaved women as experimental subjects, sexual anatomy and disorders of sexual development, and queer and trans health care, but we still began each class by sharing recent developments from the campaign trail: Muslim registries, pussy grabbing/sexual assault, and bullying. We discussed Trump’s remarks that soldiers living with PTSD are not “strong enough,” echoing medical and military attitudes from the previous century that associated male hysteria with WWI and “shell shock.”

The Sunday before the election, I was invited by students belonging to the school feminist group, Maverick, to meet at the Hull-House Museum. We sat on the floor of Jane Addams’ bedroom which houses her 1931 Nobel Peace Prize as well as her thick FBI file, evidence of the one-time moniker “most dangerous woman in America.” We talked about the founding of the Settlement House, that Addams knew that “meaningful work” was important for this first generation of white women that had received a college education. At the Hull-House, Addams and other young women residents worked together with some of the poorest immigrants to improve living conditions, to promote child labor laws, to build playgrounds. They celebrated various immigrant traditions over large shared meals and Italian opera and Greek tragedy.

I told the group that Charlotte Perkins Gilman visited the Hull-House on a number of occasions. It was at the Hull-House that she developed some of her ideas about women and economics, about group kitchens and shared domestic responsibilities. I told them how amazed I was to learn that, as a young woman, Addams, as well as a number of Hull-House residents, had also been under the care of the famed Dr. Mitchell.

I read them excerpts of Addams’ writings during WWI when she was blacklisted for her promotion of peace; her health failed, and she hit the depths of depression. Remarking on her colleagues’ suffering, she wrote: “The large number of deaths among the older pacifists in all the warring nations can probably be traced in some measure to the peculiar strain which such maladjustment implies. More than the normal amount of nervous energy must be consumed in holding one’s own in a hostile world.”

When our class met two days following the election, we talked about deportations, anti-Muslim hate crimes, LGBTQ vulnerabilities, and climate change. A number of us confessed that we were physically ill as we watched the returns come in. I mentioned one friend who wrote me that he felt as though he were drinking poison. Two other friends were struck down by bouts of diarrhea and dry heaves on election night. When they went to their doctor, she said that she had seen an inordinate number of sick people. Something was going around.

For many of these students, the election results were just an added stress to that of a long-time civil war back home, to having undocumented family, to losses from gun violence, or to being targeted when walking down the street because of race and/or gender presentation and/or sexuality and age. For some of us, this next administration would be yet another thing to get through. For more of us, we were only beginning to understand that our democracy and our rights were fragile things.

I didn’t tell them that I was waking up each morning feeling nauseated, my belly distended. I knew I was clenching my gut as if I had been sucker-punched. This clenching plus many surges of adrenaline had set off an old familiar pain in my gallbladder area. A friend told me about his neck pain. Another said her hip pain had returned. I was reminded of Showalter again: “We must accept the interdependence between mind and body and recognize hysterical syndromes as a psychopathology of everyday life before we can dismantle their stigmatizing mythologies.” Who could ever claim that mind-derived illness is not true illness? Pain is not fiction.

The readings for the class immediately following the election included Billye Avery on her creation of the National Black Women’s Health Project. She wrote about the importance of really listening to each other, that issues like infant mortality are not medical problems, they are social problems. We also discussed an excerpt from Audre Lorde’s Cancer Journals , words that were remarkably fresh some 30 years later: “I’ve got to look at all my options carefully, even the ones I find distasteful. I know I can broaden the definition of winning to the point where I can’t lose. . . We all have to die at least once. Making that death useful would be winning for me. I wasn’t supposed to exist anyway, not in any meaningful way in this fucked-up whiteboys’ world. . . Battling racism and battling heterosexism and battling apartheid share the same urgency inside me as battling cancer.” We took heart in Lorde’s reference to, “The African way of perceiving life, as experience to be lived rather than as a problem to be solved.”

Our syllabus continued to portend current events even though it had been composed back in August before the start of the semester. At the escalation of the Standing Rock water protectors’ protests, we discussed Andrea Smith’s “Better Dead than Pregnant,” in her book Conquest: Sexual Violence and American Indian Genocide , about how the violation of indigenous women’s reproductive rights is intimately connected to “government and corporate takeovers of Indian land.” We discussed Katsi Cook’s “The Mother’s Milk Project” and the notion of the mother’s body as “first environment” in First Nations cultures, which led environmental health activists to the understanding that “the right to a non-toxic environment is also a basic reproductive right.”

The week the students were to begin their final presentations, we discussed the Comet Ping Pong Pizza conspiracy, that a man actually stormed a DC pizza parlor with an assault weapon because of fake news claiming that this establishment was the locus of Hillary’s child sex slave ring. I would not have been surprised if the fake news writers had taken inspiration from the Malleus Maleficarum and reported that the parlor also served Hillary the blood of unbaptized children.

Emma said she was tired of Facebook and where was the best place to get news?

A good deal of the election’s fake news had been dependent on the power of a nearly 4,000-year-old fictional diagnosis. Both news and medical diagnosis masqueraded as truth, but they were far from it. How to make sense of this fake diagnosis in relation to the idea that illness can be born from our guts and hearts and minds? Is there anything truer? And yet, psychosomatic illness continues to be deemed an illegitimate fiction.

We know that the social toxins of living in a racist, misogynist, homophobic, and otherwise economically unjust society can literally make us sick, and that sickness is no less real than one brought on by polluted air or water. In actuality, both social and environmental toxins are inextricably intertwined as the very people subject to systemic social toxins (oppression, poverty) are usually the same folks impacted by the most extreme environmental toxins. And the people who point fingers and label others “hysterical” are the ones least directly impacted by said toxins.

Then there are the lies leveled at fiction. What of the fake criticism students had encountered during their former studies of “The Yellow Wallpaper”? Our histories provide us with scant access to the so-called hysteric’s words or thoughts. But Gilman was outspoken about her experience. She wrote about it in letters, in diaries, in the ubiquitous “The Yellow Wallpaper” and in a gem of a 1913 essay titled “Why I Wrote ‘The Yellow Wallpaper.'” In this 500-word piece , required reading for anybody assigning”The Yellow Wallpaper,” Gilman describes her experience with a “noted specialist in nervous diseases,” who, following her rest cure, sent her home with the advice to “‘live as domestic a life as far as possible,’ to ‘have but two hours intellectual life a day,’ and ‘never to touch pen, brush, or pencil again’ as long as I lived.” She obeyed his directions for some months, “and came so near the borderline of utter mental ruin that I could see over.” Then she went back to work—”work, the normal life of every human being; in which is joy and growth and service”—and she ultimately recovered “some measure of power” leading to decades of prolific writing and lecturing. She explains that she sent her story to the noted specialist and heard nothing back. The essay ends,

But the best result is this. Many years later I was told that the great specialist had admitted to friends of his that he had altered his treatment of neurasthenia since reading”The Yellow Wallpaper.”

It was not intended to drive people crazy, but to save people from being driven crazy, and it worked.

I teach “The Yellow Wallpaper” because it is necessary to know and to revisit. I teach “The Yellow Wallpaper” because a deep consideration of this story in relation to its historical and medical context teaches us how much more we can learn about every other narrative we think we already know, be it fact or fiction. I teach this story because I believe it can save people.

The semester is over and New Year’s Day 2017 has passed. I am struck with a nasty flu that lingers for weeks. There is a pulling pressure in my head, a stuck feeling in my ears, unpredictable flushes. I can’t focus. I can barely write the sentences required to finish the letters of recommendations that are due.

Surfing online scratches some productivity itch. Like an obsessed survivalist chipmunk, I stock up on nuts and canned goods and vitamins that will line basement shelves. I donate to a hodgepodge of organizations and causes. . . NRDC, Standing Rock, IRC, African Wildlife Foundation, and more. I sign online petitions as quickly as they enter my inbox. I cough my way through calls to my members of Congress, imploring them to reject various cabinet picks. I come across an article about the surge of visits to therapists for “post-election stress disorder” and “post-election depression syndrome.” The fever continues and still there is that loss of appetite, all laced with a deep sense of foreboding. I sleep through President Obama’s farewell speech.

I wake up the next morning from a fever-induced delirium and am convinced that it is of the utmost importance to locate PVC-free window film. Once the right product is identified, I will affix these decorative wallpaper-like opaque sheets to the bottom sashes in the kitchen so that pedestrians on the nearby sidewalk cannot see in. Suddenly, I must have more privacy. But I want privacy and light. I look at various patterns. One pattern is called “atomic energy.” It is lovely but would probably prove monotonous. I finally land on “rhythm” for its non-descript pattern. In the end, I decide that the wood blinds that are already there work just fine.

I blow my nose and steam my head through more news of Russian election intervention and continued nasty tweets, this time aimed at civil rights legend John Lewis. As Inauguration Day inches closer, I lie on the couch under a blanket, looking out my Chicago window at the rain that should be snow.

A friend on the phone tells me that a fever is the releasing of anger. I feel semi-human. I am haunting my own couch. I leave the house only twice in 17 days to see Frank, the acupuncturist, who tells me that he is treating scores of people with the same upper respiratory thing. He has seen an uptick in ailments since the election. Maybe things will be better after the inauguration, he says hopefully, maybe the anticipation is worse.

I hear myself say aloud to my body, “Please work with me here.”

I read about Jan Chamberlin, a member of the Mormon Tabernacle Choir who refuses to sing at the inauguration. A CNN anchor says that her comparison of Trump to Hitler sounds “kind of hysterical. . . ”

I recall one student from a few years ago. She raised her hand and said that the diagnosis of hysteria was like being called a “crazy girl.” “I am called that all the time,” she said. I was confused. Crazy girl? But as she continued on about that label, many of her classmates nodded emphatically. “If I get upset about something said in conversation or on social media,” she said, “I’m dismissed as ‘crazy girl.'”

Class projects are piled on the floor of my office. There is Max’s poem about the horrifying beating he experienced as a teenager, a hate crime at a mall witnessed by his boyfriend and dismissed by the police. There is Virginia’s small book that she made for her teenage nieces, advice for being a young Latinx person in this country. There is Sylvie’s project, an artist’s book collaboration with her dead mother’s journal writing. Noëlle’s educational coloring book for kids with diabetes that she made with her eight-year-old brother as adviser. I imagine that most, if not all, of these amazing young people would have qualified at one time or another as hysterics because of gender presentation and/or sexuality, and their artistic, scholarly, or activist pursuits. Me too. We are all part of a long history, members of tribes that have been, at times, misinterpreted, misunderstood, or worse.

The misunderstandings have not stopped. Each semester that I teach this class, a few students share stories of bodily symptoms, their own or a family member’s, that could not be explained by organic causes according to conventional Western medicine. Inevitably they were told by a healthcare provider that the problem is all in their heads. These stories contribute to conversations about the power of the mind and how many great ideas and possibilities arise from the very “irrational” place that has been and continues to be so often undervalued.

That is another reason I teach “The Yellow Wallpaper.”   Gilman’s text reminds us that we must defy Mitchell’s treatment; we must use our minds, our critical faculties, and our imaginations more than ever to question and to act.

The fever has lifted, but I still cancel my trip to DC. Standing in the cold for hours would be a bad idea given what my body has been through. I know I must rest. But I can finally focus again. And write. I am so grateful. As Gilman says, “work, the normal life of every human being; in which is joy and growth and service.”

I refuse to tune in for the inauguration. I cannot bear to watch it by myself. After it is over, I read the transcript of the apocalyptic “carnage” speech and witness comparison photos between the last inauguration and this one, proving the small number of people in attendance, a fact that will become the focus of more lies. These “alternative facts” are aided and abetted by Trump’s adviser Kellyanne Conway who will be increasingly subject to strikingly familiar misogynist bitch and witch-based attacks of her own. Hysteria is a bipartisan weapon.

The following day, I watch videos and livestream of millions of participants assembled for Women’s Marches all over the world. A proliferation of photos collect online in a blink. My stomach releases a bit.

From my couch, I work on my syllabi for spring semester while reading Hannah Arendt on tyranny, Michel Foucault on defending society, and bell hooks on love. I am not teaching “The Yellow Wallpaper” this semester. But it will be on my syllabus next fall. And the following fall. And again. And again.

• Share on Facebook (Opens in new window)
• Click to share on Twitter (Opens in new window)
• Click to share on Google+ (Opens in new window)
• Click to share on LinkedIn (Opens in new window)
• Click to share on Reddit (Opens in new window)
• Click to share on Tumblr (Opens in new window)
• Click to share on Pinterest (Opens in new window)
• Click to share on Pocket (Opens in new window)

Terri Kapsalis

Previous article, next article, support lit hub..

Join our community of readers.

to the Lithub Daily

Popular posts.

Follow us on Twitter

How Many Shakespeares Were There?

• RSS - Posts

Literary Hub

Created by Grove Atlantic and Electric Literature

Sign Up For Our Newsletters

How to Pitch Lit Hub

Advertisers: Contact Us

Privacy Policy

Support Lit Hub - Become A Member

Become a Lit Hub Supporting Member : Because Books Matter

For the past decade, Literary Hub has brought you the best of the book world for free—no paywall. But our future relies on you. In return for a donation, you’ll get an ad-free reading experience , exclusive editors’ picks, book giveaways, and our coveted Joan Didion Lit Hub tote bag . Most importantly, you’ll keep independent book coverage alive and thriving on the internet.

Become a member for as low as $5/month

The Wandering Womb

by Chris LaMountain | Jul 23, 2018 | Uncategorized

Of all the medical constructions of the female body, the wandering womb stands out as one of the most distant from the contemporary understanding of female anatomy. With this, it should be analyzed significantly, as it is through these historical cracks of comprehension that shines the truest cultural perspectives from the time.

The hodos ​was what Hippocratic physicians identified as the full body channel that spanned the nostrils to the vagina, as a unique part of the female body. Hippocratic treatises detail the lack of ligaments or tendons tethering the womb down, so we can think of the hodos as a path upon which the womb could move or “wander” throughout the body. The womb, unlike the rest of the female flesh was considered dry, and therefore could be considered an entirely separate entity from the wet body that houses it. Plato, a relative contemporary of Hippocratic practitioners, details this in his Timaeus, where he describes the womb as “like an animal living inside an animal.” The remains of this animalistic characterization of the female reproductive organs can be seen in contemporary use of anatomical vocabulary, such as labia (lips) and cervix (neck), that construct the female body to have a second set of anatomical features. Hippocratic philosophy develops these ideas by saying that the womb wanders around the loose female flesh in search of moisture from especially wet organs, such as the heart or the liver. Hippocratic treatises even assign discrete sensitivity to the womb, detailing a cure for a wandering womb should be through placing pleasant smelling perfumes near a woman’s cervix and foul smells near the nostrils. Hippocratic physicians explained that a womb that drifted too far from its pelvic home can endanger the female body, as it will remove vital fluids from the important organs and will not have access to its the vagina, which was the primary and preferred orifice of menstruation. In such a case, blood would build up in the womb, thereby causing abnormal amounts of blood to collect in the chest, which was thought to lead to agitation, epilepsy, and eventually suicidal behavior. The word “hysterical” comes from this exact physis of the female body, as the Greek word for uterus is “hystera,” and according to Hippocratic treatises “the womb is the origin of all diseases in women.”

The doctors of the time aptly provide a solution for women suffering from wandering wombs and hysteria: sexual intercourse. Ejaculation into the womb was thought to be a means of moistening the womb, which would weigh it down and prevent it from further drifting in the body. From this, it can be deduced that to be a woman in ancient Greece meant that penetration from a man was a requirement for your health and continued life. Hippocratic treatises and practices told women that they were objects that needed men not only to cure them, but to protect them from the vicious animal that lived within them.

QUICK LINKS

• Advising Request
• E-Newsletter Sign-up
• Workshops & Info Sessions