Making Visible the Invisible: A Brief History of Gynecological Practice and Representation

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Making Visible the Invisible: A Brief History of Gynecological Practice and Representation
Bittiker, Allison
Mendoza, Valerie ( Mentor )
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Gainesville, Fla.
University of Florida
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Making Visible the Invisible: A Brief History of Gynecological Practice
and Representation

Alisson Bittiker

Women experience their realities in dialogue with the technologies and visual cultures that govern their bodies.

Our dichotomous culture situates the uniqueness of the gendered female as a function of her difference from

the male, i.e., normal/neutral body. A woman's sexual organs/reproductive system is the site of one of the

strongest divisions in Western Society. However there is tension between what is defined medically, socially

and politically and what is actually lived. It is within this fissure that a woman can both resist and recreate

their experiences of their bodies.

Since ancient times in the West until the early 20th century, it was a common held belief that a woman's

womb-meaning here any part involved with the reproductive system, because until the beginning of this

century, there was not much differentiation among the anatomical parts of this system--was the focus and source

of any perceived illness, mentally or physically. In the 19th century, this idea formed the underlying premise

for medical discourse on women and continues to influence medical practices in the present day. A long list

of neuroses was created by the medical establishment afflicting only women. Women displaying these

psychological deviations were diagnosed as hysterics. As discussed in Michel Foucault's History of Sexuality,

the problematization of the female body was the basis for its integration into the medical sphere "by reason of

a pathology intrinsic to it" (Foulcault 104). Meaning, an individual, by virtue of being a woman, was imagined to be

in constant danger of becoming a victim of her own saturated sexuality.

With the increase in the medicalization of women's bodies, and the birth of a medical discourse based on

the pathology of the female sexual/reproductive system, came an increase in new technologies to treat and

diagnose these very pathologies. Foucault notes that modern western medicine arose with the visualization

of pathology. As an example, in 1849, in an event that has achieved mythological status, J. Marion Sims,

an antebellum southern doctor, invented the speculum and thus became known as the Father of Modern

Gynecology. Sims first came involved with "women's problems" in his general practice. Although it wasn't

his specialty, and he particularly disdained "women's problems," he nevertheless became involved in

gynecology through the many black slave women who were brought to him for treatment because of their

impaired reproductive systems. Sims experimented on these women using different surgical techniques that

he invented on his own, practicing them on these women repeatedly without the use of anaesthetic. Having

difficultly accessing the vagina and cervix, Sims arrived at the idea for his speculum.

Kapsalis notes that "Sims was one of the earliest physicians to link female reproductivity with a kind of

technophilia, publishing extensively on each new innovation" (Kapsalis 49). Making visible that which was

invisible, the vagina, opened the possibility for surgical manipulation of women's reproductive systems, rendering

the reproductive system pathological, and creating a need for surgical intervention and technological

invention. Evidence of that is seen today with the assortment of fertility enhancing technologies, birth

control, surgeries and cancer treatments, and obstetrical methods.

The rise of the medical science of gynecology coincided with the other developments that helped to define

women's bodies, mainly the invention of photography and the beginning of the middle-class. Within all these

spheres-medicine, photography, and politics-women's bodies became objects of measure, regulatory sites

whose proper function ensured the fulfilment of the cultural roles prescribed to women. Serving a normative

function, these same emerging technologies and ideas were used as instruments to define others who

found themselves outside the "norm," namely black and lower class bodies.

Images and middle-class photography were used as an "objective" witness to support ideas that were already held

by the photographers and viewing audience. The use of photography replaced the observation of the doctor. In

order to satisfy previously foreseen social needs, cultures invest in and develop new machines and

technologies. Inventions are produced as a result of societies needs and wants. Photography was praised for

allowing medical visualization to be "objective," because it was mechanical and based in scientific

development. Photography was lent the power of proclaiming what was "true." Around the time of the

development of photography and the development of gynecology-the late 19th century-people, mainly the

newly formed middle- class, put great trust in science and technological progress. Medicine was

being institutionalized and standardized, drawing an end to lay practitioners like midwives, who were rapidly

being replaced by a patriarchal and rationalized scientific method.

Images play a role in the presentation of scientific truths about the female body. "Female privates enter the public

as spectacle predominantly in the forms of art, pornography, and medicine" (82). Pornographic and medical

images share similarities in subject matter. Both clearly depict female genitalia, the former interested in sex and

the latter interested in anatomy. Both are involved in making visible "privates"-one for the purpose of

medical intervention, the other for the purpose of sex. The difference between the two types of images is context.

A marked difference between the two, is that whereas porn always shows healthy genitalia, medical images

are seldom ever of healthy genitalia (85). Instead, there is an abundance of images of pathology within

medical photography. Medical discourse is pathology-oriented. Nowhere is this more visible than in discourse

on women, specifically in gynecology. "Because of the visibility of pathology, the body is coded as suitable for

medical visualization, penetration, and therefore clinical intervention" (83).

Female sexuality is thus problematized and pathologized. Any healthy looking images of female genitalia

therefore, be they medical or pornographic, become lies. The truth is not readily visible. Appearances

and photography may be deceptive. Because photographs are taken to be true then it must be the healthy

appearing female anatomy that lies. "Photography, a medium popularly believed to directly transcribe the

real, naturalizes the codes it employs to a far greater extent than do other forms of visual representation. In

seeking, therefore, to analyze the ways in which photographs produce their meanings, it is necessary to pay

close attention to the syntax, the rhetoric, the formal strategies by which their meanings are constructed

and communicated" (Solomon-Godeau 223-225). Photographic images are, in terms of semiotics, open signs.

They act as true and unmediated records, but they are always and already mediated. This is what

medical photography denies.

Kapsalis makes an interesting observation that it is common practice for medical students to view porn before

exams and demos. This is due to the failure of medical textbooks to give correct anatomical diagrams

and descriptions of healthy genitalia. The medical apparatus has been extremely slow and reluctant in

incorporating new ideas and views of women's bodies put forth by feminists beginning in the 1970's. During

this period, feminists began to critically question women's roles in society. One focus of this period was to

demystify medicine and reclaim a woman's power over her own body. To do this, many collectives formed

teaching women about their bodies. These groups created the space that let women practice gynecology

on themselves and thus gave these women a measure of power over their own bodies. In these self-help

groups, women were given speculums and taught how to do pelvic exams. Inspired by these groups, feminists

went on to form the Federation of Feminist Health Collectives which published the influential book, New View of

a Woman's Body. In this book, as the title implies, new views were offered that treated women's bodies

subjectively. Multiple color photographs were include that showed healthy female genitalia. An important impact

of these groups on medical discourse was their pressure on medical textbooks and on the medical establishment

to reform. Another important influence of these groups was that gynecological clinics began offering well

woman care. Well woman care is an important concept that treats the female body as a site of health rather than

as a site of pathology. Gynecology was reclaimed from being a medical specialty designed to control women to

one that helped women.

Realizing that medical and ideological perceptions have not changed much since the 19th century, some friends and

I have formed a collective called The Amoris Sideshow, which seeks to explore the impact today of these

rather archaic perceptions of women's bodies. Along with this we have created a performance/workshop entitled "D.

I.Y. Workshop on the Art of Women Looking." In this workshop we go beyond a didactic and one-sided

presentation by cultivating collaboration with our audience. Pelvic exams are demonstrated (inserting a speculum

and looking at the cervix, feeling the uterus, cervix and ovaries, feeling the labia and clitoris, etc.), speculums

are given out, and various topics are discussed by each member of the collective who has certain expertise in

them. A major component of the performance/workshop was a slide show consisting of work by other artists

who addressed the same issues, medical imagery, and photographs from previous wokshops/performances.

During the slide show I talked about issues of representation in art, porn, and medicine-discussing their

intersections and transgressions. For the photo shoot, participants were asked to think about dominant modes

of photographic representation and the tropes and codes inherent to them. The goal was to engage these

modes critically while thinking about the participants personal relationship to visual culture. The photo shoot

was modeled on the artist Jo Spence's "phototherapy" sessions. Spence along with her phototherapy partner,

Rosy Martin, explains phototherapy as "a form of phototheatre of the self; it is basically about the making visible

of psychic reality. It is not documentary photography because everything is stage-managed and deliberately placed

in images, though it could be called 'self-documentation'" (Spence 165). The particular transgression of the

Amoris photo shoots was the ability of the participant to have a photograph taken of their cervix, under

their direction.

The emphasis of the whole workshop was the rupture of the "objectivity of the sacrosanct medical sphere," caused

by non-medical practitioners using speculums, and touching and displaying female genitalia in public, around a

whole group of people watching, and more importantly, physically interacting (Kapsalis 83). Throughout

the workshop, modeled on 70's feminist self help groups, we encouraged women to become active participants

in their medical treatment. Our workshops, though opened to women only, extended the meaning of "women"

to include transgendered people-as an important reason for forming the group was to include issues we felt

were being ignored by many feminist groups today, like transgendered rights. We framed issues in terms

of colonialism, race, class and sexuality-important issues that are usually skirted by predominantly white

middle-class college-aged feminist groups. Important to this discussion is the fact that poor woman of color have

and continue to be used by gynecology as test subjects for new technologies and procedures, and sites

of reproductive regulation. They are still the foundation of virtually all developments in gynecology.

Classically, artistic representation has de-emphasized female genitalia, while pornography graphically depicts it,

and medical imagery has mainly focused on pathology and fetishization of these pathologies and the

technologies they involve. The Amoris Sideshow reclaims and recontextualizes female genitalia, from medical

practice and imagery, as well as heterosexual pornographic practices, noting and playing with the

intersecting boundaries of art, porn, and medicine to create sculptural space out of performative space.


Federation of Feminist Women's Health Centers. New View of a Women's Body. New York: Simon and Schuster, 1981.

Foucault, Michel. The Birth of the Clinic: An Archaeology of Medical Perception. Translated by A.M. Sheridan

Smith. New York: Random House,1973.

Foucault, Michel. The History of Sexuality: An Introduction. Translated by Robert Hurley. New York: Random

House, 1978.

Kapsalis, Terri. Public Privates: Performing Gynecology From Both Ends of the Speculum. Durham: Duke

University Press, 1997.

Solomon-Godeau, Abigail. Photography at the Dock: Essays on Photographic History, Institutions, and
Practices. Minneapolis: University of Minnesota Press, 1991.

Spence, Jo. Cultural Sniping: The Art of Transgression. London: Routledge, 1995.


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