June 3, 2025 • 56 mins
For many of us, pelvic exams are a routine part of our healthcare. Of course, that doesn’t mean we don’t await them with some dread or anxiety; naturally, these exams evoke a wide range of emotions. But they are a cornerstone in gynecological preventative care - a relatively new one at that. In this TPWKY book club episode, we sit down with Dr. Wendy Kline, Historian of Medicine at Purdue University, to discuss her book Exposed: The Hidden History of the Pelvic Exam. Dr. Kline takes readers through various chapters in the story of this exam: its murky origins at the hands of J. Marion Sims, its stint as a psychological diagnostic tool used by some misogynistic doctors, and its reclamation by feminist physicians and activists who sought to connect with their own bodies. Tune in for a fascinating conversation that exposes all sides of the pelvic exam, with heroes, villains, and more.
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Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:44):
Hi, I'm Aaron Welsh and this is This Podcast Will
Kill You. Welcome to the latest episode of the tp
w k Y book Club series, where I interview authors
of popular science and medicine books about their latest work.
We've started out very strong this season and we've got
such a great lineup for the rest of the year.
(01:05):
These are honestly some of my favorite episodes to put together.
If you'd like to get a sneak peek at the
upcoming books that we'll be featuring on these book club episodes,
head over to our website This Podcast Will Kill You
dot com, where you can find a link to our
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you're on our bookshop page, you can see various TPWKY booklists,
(01:29):
including one for this book club series. I'll be posting
more books there throughout the season, so check in regularly
to see which books will be featured in the upcoming
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(01:49):
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(02:10):
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Speaker 2 (02:21):
Drop.
Speaker 1 (02:22):
With that business out of the way, I am so
excited to introduce this episode's author and book. This week
I got to sit down with doctor Wendy Klein, professor
of history at Purdue University and author, to discuss her book,
Exposed the Hidden History of the pelvic Exam. If you've
(02:42):
ever had a pelvic exam, you know the drill, the discomfort,
the vulnerability, the waiting for it to be over. There
are myriad ways that people feel about these routine exams,
from neutral to dread, and yet we don't really talk
that much about them. We put up with them, or
maybe we avoid them, but at least speaking for myself,
(03:05):
we don't question their existence, how they originated, or ways
they can improve. We just accept them as a fact
of life. But as doctor Klein demonstrates and exposed routine
pelvic exams are a relatively recent addition to preventative care guidelines,
guidelines which are currently being revisited. To understand the present
(03:27):
day landscape of routine pelvic exams, we have to explore
their past, a past fraud with abuse and concealment. Doctor
Clin takes readers through the murky history of pelvic exams,
and in doing so, reveals how the field of gynecology
has been shaped both by those who use shame as
a weapon as well as those who seek to empower
(03:49):
women through knowledge about their own bodies. Exposed is so
much more than a history and current assessment of one
of the most commonly performed medical procedures. It reveals how
the paternalistic view that medicine has held for women harms
rather than helps, and it also highlights some of the
(04:09):
incredible advocacy groups working to ask the crucial question, how
can we make things better? I had such a fantastic
time chatting with doctor Klein, and I am thrilled to
be sharing this conversation with you all. I do want
to note before we get into things, that this episode
does feature discussions of abuse and medical trauma, so please
(04:30):
keep that in mind. With that, let's take a break
and then get started. Klein, thank you so much for
(05:01):
joining me today.
Speaker 2 (05:02):
It is my pleasure. I'm delighted to be here.
Speaker 1 (05:05):
In your book Exposed, you take readers through the history
of one of the most commonly performed medical procedures, the
pelvic exam. And before we get into the murky origins
of this exam, I would love for you to set
the stage just by taking us through how a pelvic
exam is done today, kind of just an overview step
by step, and importantly why they are performed.
Speaker 3 (05:28):
So a public exam consists of three parts. The first
is the examination of external genitalia and then second is
the speculum exam, and that's typically accompanied by a pap
smear to test for cervical cancer. And then the third
part is a bi manual exam, and that is when
(05:50):
the healthcare provider inserts one to two fingers into the
vagina while using the other hand to press on the
abdomen with the other hand in order to evaluate organs.
Speaker 2 (06:01):
Fairly standard procedure. It hasn't changed a whole.
Speaker 3 (06:04):
Lot over the last century or so, and the primary
purpose is to test for cervical cancer, but there are
other aspects as well, right, just to look for any abnormalities, discomfort,
and opportunity to talk with a provider if you have
any questions, either about sex or discomfort or anything else.
Speaker 1 (06:26):
It is really remarkable and maybe a bit alarming, how
little it seems to have changed since it was first introduced.
And I would love for you to take me through
the origins of how this exam came to be, especially
the role that was played by the so called father
of gynecology, James Mary and Simms.
Speaker 3 (06:46):
Right, yeah, And of course I could talk all day
about this, right, And I mean it's such an interesting conversation.
But I mean, if you think about it, for centuries,
women's genitalia was hidden, right, unlike male genitalia, which is
quite obvious, It was very difficult for anybody to see
(07:07):
or know what a woman's reproductive organs actually looked like.
And that all changes in the nineteenth century. James mary
and Simms was a doctor in Alabama, and he claims he.
Speaker 2 (07:24):
Takes credit right for discovering quote a class covering speculum
in actuality.
Speaker 3 (07:30):
There were other types of speculums in France in the
eighteen thirties, for example. But Simms was a master showman
and took all the credit for this. He gets the
idea when he's looking peering into.
Speaker 2 (07:44):
A patient's vagina.
Speaker 3 (07:45):
She's fallen off a horse, and she's in all kinds
of discomfort, and.
Speaker 2 (07:49):
He gets the idea of using a.
Speaker 3 (07:51):
Spoon and bending it to kind of reflect and inserting
it into her vagina. And he says this like, I
find it rather hilarious. He says in his memoir introducing
the bent handle of the spoon, I saw everything as
no man had ever.
Speaker 2 (08:08):
Seen before, right.
Speaker 3 (08:10):
So he kind of lays his flag this idea of
this new territory that he had essentially claims right. And
so it was in fact a fairly revolutionary concept that
you could actually see what had been hidden for centuries
and centuries.
Speaker 2 (08:28):
And you know, on the one hand, it's saved probably
millions of lives. It's changed how we understand gynecology. But
there are some repercussions.
Speaker 3 (08:41):
And I will also say that it didn't go uncontested.
I mean, even many physicians or budding gynecologists in the
mid nineteenth century were really uncomfortable with the idea because
what's happening in the nineteenth century when you think about
upper middle class white womanhood, Victorian morality, and this idea
(09:03):
that it was appropriate to appear inside a woman's vagina
was highly problematic. So there was actually debates among gynecologists
about whether touch was more appropriate than the gaze, right,
and that what a good provider should be able to
sense from their fingers rather than the visual gaze. And
it's debated among these doctors like should we should we
(09:26):
go ahead and welcome this new tool or should we
disdain it?
Speaker 2 (09:31):
And I think that's a really fascinating conversation and debate
between these doctors.
Speaker 3 (09:35):
The other thing is some of them are concerned that
it's going to turn women into like sex maniacs.
Speaker 2 (09:41):
They're going to start loving.
Speaker 3 (09:43):
Having this speculum put inside their vagina and it will
essentially corrupt women. So anyway, it wasn't immediately accepted as
the ideal tool, but it was gradually accepted and promoted
by people like James Mary and Simms.
Speaker 1 (10:02):
We've come a long way in some in some ways
and not so much in others. But you know, when
I was reading your book, I found myself thinking a
lot of course about public exams and how I relate
to them and my experience with pelvic exams. And I
was wondering, you know, what your experience was like with
pelvic exams or is like, and whether that's changed as
(10:24):
you have as you worked on this book.
Speaker 3 (10:26):
You know, that's a great question eron and I'm surprised,
like nobody's ever asked me that before. Again, a lot
of talks, and that is not a question I've actually
I've had. And so, you know, I feel lucky because
I feel like I'm one of those people that doesn't
particularly enjoy it. It's unpleasant, but it hasn't been traumatic
(10:48):
for me. I'm fairly comfortable with my body. I tend
to have good relationships with the doctors that I visit.
Speaker 2 (10:55):
The ob ginds.
Speaker 3 (10:57):
I'll talk about what I'm researching as they're probing inside
of me.
Speaker 2 (11:02):
You know, I love that. But so I wasn't.
Speaker 3 (11:06):
Drawn to the topic because of some horrible thing that
happened to me, which is I know for some people
it's raised their curiosity about it.
Speaker 2 (11:14):
For me, it was more, you know, why are we
not talking about this procedure? Right? So many people endure
this on a regular.
Speaker 3 (11:23):
Basis, and so someone like me, it's unpleasant, but for
some people it's hugely traumatic, painful, terrifying, And yet we're.
Speaker 2 (11:33):
Not really supposed to talk about it for many reasons.
Speaker 3 (11:36):
And so that kind of raised the question, why is
it something that we just don't talk about it when
it's something that we all experience.
Speaker 1 (11:45):
Yeah, just the expectation of this is what you have
to do and that's it, and you just endure it. Yeah,
and you know, but going back to the history of
the pelvic exam and how it initially when it was introduced,
it was not like you said something that a lot
of people were like, absolutely, let's do this. And so
who were the people who were likely to receive a
(12:08):
public exam in these early decades and who was not
likely to receive one?
Speaker 3 (12:13):
Yeah, great question and really important to this story. The
first patients were basically the first guinea pigs.
Speaker 2 (12:20):
And you can probably yes who they were not.
Speaker 3 (12:24):
They were not white, middle class women, and this is
fairly well known in the historiography. But James Mary and
Zims did most of his procedures first unenslaved patients, and
we know about three, in particular, Lucy, Betsy and anarka
who endured multiple procedures countless times over a period of
(12:45):
nearly four years without anesthesia. In part I should add
that anesthesia was incredibly dangerous and not frequently used in
the eighteen forties when he was doing this.
Speaker 2 (12:58):
But still, you know, extremely painful. These were enslaved women
who had all were all suffering from besico vaginal fistulas,
basically a tear between the vagina and the bladder as
a result of prolonged childbirth, and possibly also the use
(13:19):
of forceps. We don't know specifically in these.
Speaker 3 (13:22):
Instances, but you know, talk about tools that can actually
really damage. Yeah, and so he claims that what they
were suffering was worse than death. So it was in
their interest to kind of endure these procedures because he
was he believed to be helping them, but he was
(13:43):
equally made the point that he was restoring labor to
these women's quote unquote owners. Right, but regardless, and there's
so much we don't know, because of course those voices
are silenced. We only know through the absurd and through
Sims himself what they experienced. And even if they were consenting,
(14:07):
they can't consent by virtue of the fact that they
had no power to do so. They were enslaved women.
So what does it mean that a procedure that's considered
immoral or an ethical or just distasteful to do on
a white middle class woman is done on these bodies,
but with the idea that if they could be perfected,
(14:29):
then right then it would be appropriate to.
Speaker 2 (14:32):
Use on these other bodies.
Speaker 3 (14:34):
And that's basically what happens enslaved women, sex workers, basically
women who were disempowered. And of course, if you think
about it, one of the reasons Sims is interested in
taking these tools and then applying them to the white
middle and upper classes is money, right, That's where he's
(14:56):
going to get his client tele that's where the concern
learn about suffering and alleviating suffering.
Speaker 2 (15:03):
It's going to be focused on. But he needs the tools. First.
Speaker 1 (15:08):
Let's take a quick break, and when we get back,
there's still so much to discuss. Welcome back everyone. I've
(15:30):
been chatting with doctor Wendy Kline about her book exposed
the hidden history of the pelvic exam. Let's get back
into things. And then once he had those tools, you know,
still though the pelvic exam, the speculum was not, as
you said, widely adopted immediately. And so then what were
some of the things that led to its increase in popularity,
(15:54):
I guess, or it's acceptability.
Speaker 3 (15:56):
Yeah, I mean, there's a basic shift that occurs over
roughly like a fifty to seventy year period, from the
emergence of gynecology as a medical specialty, which I should
add comes hand in hand with the development of the speculum, right, it.
Speaker 2 (16:11):
Was the tool that justified.
Speaker 3 (16:13):
The need for a male medical model to differentiate themselves
from say, female midwives. So most of their work was
done either with obstetrics with childbirth or with patients.
Speaker 2 (16:27):
That are suffering, not on healthy women.
Speaker 3 (16:30):
Gradually, there's a shift from pathological or surgical gynecology to
preventive gynecology, and there are a couple of reasons for that.
The most kind of blatant in terms of developing gynecology
as a specialty is obvious. They want to expand their
patient base, right, They don't want it to be up
(16:51):
to the patient to determine when they think they need
to see a doctor. By pushing for preventive medicine and
an case, preventive gynecology, you're widening your patient base. You're
encouraging you know, every woman of reproductive age should see
a doctor on a regular basis, and boom, suddenly you've
got a much wider patient population.
Speaker 2 (17:13):
Now, I mean, that's the cynical part. Obviously.
Speaker 3 (17:15):
You know, they believe that they were helping, and oftentimes
they were so, but it was a smart way to
expand their patient base. I have an entire chapter about
one doctor, doctor Robert Dickinson, who is the president of
the American Gynecological Society in nineteen twenty, and he makes
a big case. He's, you know, like, what separates us
(17:37):
from surgeons. We need to define ourselves as something other
than surgeons of the female reproductive tract or organs, and
we should be talking about sex and birth control and
all these topics that male doctors, because most of them
were male, are kind of skirting around as kind of
(17:58):
again inappropriate. We shouldn't be talking about these things. We
want to show that we are morally upright, upstanding citizens.
We're not perverts, and therefore we should avoid talking about
these things. Dickinson's like, no, that's exactly what we should
be doing. We should step in and he basically suggests
that doctors. Gynecologists should also be marriage counselors. They should
(18:22):
be talking about sexual discomfort, they should be asking about
birth control, et cetera, et cetera. And again it's a
way of widening their base of asserting their authority. But
it paves the way for this notion of prevented gynecology.
Then on top of that you have the development of
the pap smear, right, and so that's a little bit later.
(18:43):
It becomes kind of standardized in the early nineteen forties.
George Papa Nicolau, that's why we have the name figures out.
He's not even looking for this, but when he's taking
cervical smears first out of guinea literal guinea pigs, and
then he uses his wife, who volunteers cervical smears daily
(19:04):
for decades decades.
Speaker 4 (19:06):
I couldn't get over that. It was like literally.
Speaker 3 (19:09):
Human gay pig in the name of science, and realizes
that by taking these smears, by looking at the fluid,
you can determine whether there are any signs of cancer,
basically of tumors. So once that is established, then there's
a very clear reason why preventive gynecology makes sense. Right,
(19:31):
This is a way of early detection, trying to see
if there's any signs. So it's kind of a gradual process,
but I'm really interested in those kind of those years
in the twenties up to the forties where there is
talking as much about sex as they are about vaginal health,
I would say, and offering, among other things, pre marital
(19:52):
pelvic exams, like getting a woman ready for her wedding
night to ensure that she will kind of be comfortable
with sex, et cetera.
Speaker 1 (20:02):
That was a fascinating chapter about Dickinson and that quote
that you include where he says there is never a
precise way of separating the woman from the doctor's idea
of her. It just has been rattling around in my
head ever since reading that.
Speaker 2 (20:23):
Yeah, he kept me up.
Speaker 3 (20:24):
There are many nights that I did not sleep when
I was doing research for that chapter.
Speaker 2 (20:29):
And it came gradually because he has.
Speaker 3 (20:31):
Terrible handwriting, and all of this was scratched, scribbled onto
tiny little note cards that I found in the archive,
and so it took a long time to piece together
exactly what he was saying and how he was saying it,
and so the horror was kind of gradually emerging. You
know and until I was realizing that he was in
(20:53):
fact sexually abusing some of his patients and acknowledging it
in his own handwriting. And he's also a great case
for a historian because he took prolific notes of every
because he saw his patients as case studies.
Speaker 2 (21:09):
He was kind of.
Speaker 3 (21:11):
Interested in learning from them, and so as soon as
he would examine them, he would write down, describe what happened.
He would even quote the conversation. He would quote, supposedly
verbat him what the patient had said to him. So
even though we don't have.
Speaker 2 (21:26):
A record of these individual women.
Speaker 3 (21:28):
Most of the time, we have his quoting his memory
of what took place, and he's very upfront about what
he's doing. So yeah, that was really really disturbing in
terms of that. I also just want to add on
top of it because I think this is really interesting
because my first book was a history of the eugenics movement. Well,
(21:52):
Dickinson was a eugenicist, and he embraced not only sterilizing
certain women, but encouraging the right time of women to
have more children. And that's why he was so interested
in pre marital pelvic exams and the idea that he's
a marriage counselor because he wants to ensure that these
women stay in stable marriages, why so they have more children,
(22:15):
And it's the quote unquote right kind of children. Right,
So that's partly why he's kind of putting his foot
in the door opening this like wider conversation about women's roles,
believing that gynecologists should in fact be these moral arbiters
that come in and help stabilize marriages by having these
(22:36):
kind of hidden conversations to ensure that women continue to
have sex and reproduce.
Speaker 4 (22:44):
That lens I feel like is so important.
Speaker 1 (22:47):
You know, his work or ideas or notes or practice
and abuse didn't happen in a vacuum, like he was
a product of that, how eugenics was had a hand
in every everything. He seems to approach his patients from
this framework of I am not going to believe what
they say, like I am already doubting what this person
(23:08):
is going to say to me. And I feel like
this is again part of this larger trend that was
happening around this time with the speculum and then other
instruments being utilized by physicians to learn about their patient's
bodies without having to actually talk to, or listen to,
or believe the patient themselves. And what do you feel
(23:29):
like were the consequences of this shift where suddenly a
woman becomes an unreliable narrator about her own body.
Speaker 3 (23:36):
I think it's a really important shift, which is again
one of the reasons why I wrote this book. I mean,
if I just step back for a moment and we
think about science and technology doesn't happen in a vacuum.
It is all about context and agendas and professionalization and
attitudes about women in a particular time and place. So
(23:59):
if you take a particular tool or procedure and you
track it over the time, while the procedure may not
change that much, I mean, that's one of the first
things we said. The tool is pretty much the same,
the examination is pretty much the same, and yet the
meaning behind it changes radically depending on different contexts. So
in a time period in which eugenics was extremely popular,
(24:23):
the tool and the procedure.
Speaker 2 (24:25):
Are going to be used in a very different way.
So back to your.
Speaker 3 (24:30):
Question about moments in which tools kind of replace listening
to the patient, in this case, the female patient. I
think it's a reminder of the extent to which this
was a paternalistic, fairly misogynistic culture in which women's voices
(24:51):
were not always taken seriously.
Speaker 2 (24:55):
And they weren't always believed.
Speaker 3 (24:57):
And so for Dickinson, it's like, your genitals can tell
me the truth more than your voice or your experience.
And that's a very disturbing message, right, And this is
among white, educated, middle class women. This isn't even you know,
(25:19):
wouldn't it be great if Sims had kept a diary
the way Robert Dickinson did. What was he saying about
Lucy Betsy and Anarcha?
Speaker 2 (25:28):
Right?
Speaker 3 (25:29):
And what were they thinking? I mean, this is historians
greatest tool and biggest frustration is the clues and then
the absence of clues and what we wish we knew,
And there's so much we don't know, but we can expect.
You know that the power differential wasn't just my male female.
It was white black, It was enslaved slaveholder because Sim's
(25:51):
himself owned slave. So this kind of dismissal is so
much linked to power. Yea, the more disempowered a person is,
the less likely their voice is going to be taken seriously.
So my point is that even among white middle class women,
they were not necessarily listened to. The tools became kind
(26:14):
of the translator almost or the interpreter to kind of
displace the voice of the woman herself, and in turn,
very gradually, this disempowering makes women less confident that they
have the right to say, or that maybe they don't
understand their bodies or what's going on, they need the
(26:35):
doctor or the tool to kind of explain to themselves.
I'm jumping ahead, but that's what eventually leads to the
feminist movement kind of pushing back and saying, hold on
a minute, we do know what we're doing. These are
our bodies, so we are the experts of our own
bodies because we embody them. We don't need your interpretation,
(26:56):
which we believe to be misogynistic, inaccurate, etc.
Speaker 2 (27:00):
Et cetera.
Speaker 1 (27:01):
Let's take a quick break here, we'll be back before
you know it. Welcome back, everyone, I'm here chatting with
the wonderful doctor Wendy Klein about her book Exposed. Let's
(27:24):
get into some more questions. How did it go from
like an informational perspective of you seek a gynecologist because
you need it to then preventive care. How did women
learn or like come across that that's what they should do?
Speaker 2 (27:40):
Ooh, that's such a good question.
Speaker 3 (27:42):
You know before obviously there was cervical cancer existed before
the pathsmerror right, uh, right to have a diagnostic screening
procedure was really exciting, right, genuinely exciting. It did save
a ton of lives even before that takingsygnostic tool. There's
a recognition that just being seen by a doctor and
(28:05):
examined an internal examination, even without the smear test, could
save some lives. The problem, as you've said, is how
do you spread the word? Okay, So, like in the
nineteen twenties nineteen thirties, you have gynecologists trying to push
for early prevention and preventive gynecology, but they're not allowed
to talk about it.
Speaker 2 (28:25):
Right.
Speaker 3 (28:26):
So a doctor at Johns Hopkins is complaining because he
wants to publish information in newspapers and journals, but he's
told the newspapers really don't want to see the words smear,
cervical fluid, men sees, cervix uterus, right, I mean all
(28:47):
of these words that have all the stigma attached to it.
And he's like well, how do I get the word
out if I'm not even allowed to talk about it?
So he hires an assistant. Her name's Florence Becker, and
basic says, you know, it's up to you go spread
the word in women only circles, like tell your friends,
organize women's groups to talk about it, kind of behind
(29:13):
people's backs because it's not seen as appropriate to talk
about it. Do you see how we get to where
we are today where we still can't talk about it, right?
Speaker 2 (29:21):
I mean, this is the problem. People were told they
can't talk about it, so it becomes.
Speaker 3 (29:26):
This like women telling their friends their sisters, you should
really see a doctor.
Speaker 2 (29:32):
It saved my life.
Speaker 3 (29:33):
And that's still kind of a message in cervical cancer
advocacy today. And I'm not saying it's a bad message,
but it was the only way to spread the word
because these doctors, you know, couldn't talk about it. Once
you have the paps mirror, I think they have more evidence,
scientific evidence to kind of prove, and they're able to
(29:54):
be a little bit more open about it. But it
was it was essentially a word of mouth campaign decades.
Speaker 1 (30:00):
Of course, that word of mouth doesn't make it everywhere,
and so you see these disparities both historically and today
in who is getting access to papsmeres, and there are
I mean, there's a myriad of factors that determine whether
or not someone can get a pap smeer has access
to a perapsmere, doesn't want to get a papsmere. But
(30:21):
you know, what were some of these disparities that emerged
with these early studies trying to examine who was getting
routine public exams and who wasn't.
Speaker 2 (30:30):
Huge massive racial disparities.
Speaker 3 (30:32):
And I think there are a couple of reasons for that,
accessibility and racism. So and they're obviously overlapping, but by
racism I also mean mistrust that even campaigns to kind
of reach out to women of color were problematic because
(30:53):
black women understood historically how racism and mistrust had led
to all kinds of problems. If most of the providers
and scientists and practitioners are white and white men, of
course there's going to be a reluctance what do you
really want from me?
Speaker 2 (31:12):
And why, right, I shouldn't trust you?
Speaker 3 (31:15):
But primarily access, you know, health insurance, availability, access to
any kind of treatment, right, particularly in regions in which
a two tiered healthcare system which prevented these women from
entering most hospitals. So that combination meant that this was
(31:36):
primarily reaching white women. Oh, I should add the third
is who are the women primarily with some exceptions of course,
who are spreading the word. When I talk about the
word of mouth campaign, Florence Becker is going to talk
to university women, I forget is that the American Association
of University Women.
Speaker 2 (31:54):
I think she.
Speaker 3 (31:55):
Talks to a primarily white, middle class educated group.
Speaker 2 (31:58):
Right. They're spreading the words their friends, their sisters, their
club groups, right, but not among others.
Speaker 3 (32:06):
Again, there are some exceptions to that and some awareness,
which is why you get some black women being tested
and seeking treatment.
Speaker 2 (32:15):
But it's to a much smaller extent.
Speaker 1 (32:18):
All problems that still exist in some form or another today.
And I want to talk about that in a bit.
But I also want to get back into this idea
of how the feminist movement and women sort of reclaiming
the knowledge that should have been theirs all along, and
so who were some of the pivotal players in this time?
(32:39):
And I would love for you to tell me more
about self help clinics and how they came to be
and how those also changed the patient doctor relationship.
Speaker 3 (32:49):
Yeah, oh my gosh, well do you have like seventeen hours,
because that's how long I can talk about it.
Speaker 2 (32:55):
I've written a lot about this and other books as well.
Speaker 3 (32:59):
I think it's more to set the stage to how
we get to this moment.
Speaker 2 (33:03):
So I talked about Robert Dickinson in general.
Speaker 3 (33:07):
These gynecologists until nineteen seventy are male, primarily white male.
Ninety three percent of all gynecologists in nineteen seventy were male,
which is very different from today right, where the majority
are female, And so these are women that are going
to see male doctors. Nineteen sixty of the introduction of
(33:29):
the birth control pill, it's intended for.
Speaker 2 (33:32):
Married women only, so a lot of women are.
Speaker 3 (33:35):
Going to the gynecologist only to get access to the
birth control pill.
Speaker 2 (33:40):
Or that's a primary motivator.
Speaker 3 (33:42):
And initially the requirements of getting the pill included getting
a pelvic exam. That has since been uncoupled, right, but
that was the rule. And so you've got millions of
women going on the birth control which means there are
also millions of appointments made right and millions of PEPs.
(34:03):
Marriage pelvic exams, and many of these doctors have inherited
this kind of marriage counselor role, so they think it
is their right to make moral claims about why this
woman is seeking the birth control pill.
Speaker 2 (34:19):
Is she married?
Speaker 3 (34:20):
Some women would actually wear fake rings and pretend they
were married, but more generally just being paternalistic, making all
kinds of claims about a woman's sexual behavior because she's
seeking birth control pill. So, you know, that's the beginning
of the sixties A. We all know it's a turbulent decade.
And by the end of it, it becomes clear that
(34:42):
sexual liberation isn't necessarily liberating for women. There's an expectation
to be sexually available. It isn't always in their best interest.
Speaker 2 (34:53):
So out of that springs a lot of.
Speaker 3 (34:55):
Anger about what is happening in the gynecologist's office. And
there's a meeting at a workshop on women's liberation in
nineteen sixty nine in a college in Boston, Emmanual College,
and there's a two hour meeting and the topic is
women and their bodies, and it's twelve women and they're
just all they want to do is come up a
(35:17):
list of reasonable ob guns in the Boston area, and
they realize they can't come up with a single name,
literally a single name, and then they decide to keep meeting,
and eventually that group evolves into the Boston Women's Health
Book Collective That Rights Our Bodies, Ourselves, and it's really
(35:37):
the first women's health manual written by women for women,
not by medical professionals, accessible information about their own bodies
that they research themselves. But part of this anger is fueled,
I mean they see the gynecologists is sort of emblematic
of all the problems of misogyny in American society. There's
(35:58):
a great quote in Vaginal Politics and it opens with
a description of her first visit to a gynecologist where
she says, I was naked, he was clothed. I was
lying down, he was standing up. I was silent, he
was speaking. It just kind of captured in this tiny
little narrative everything that was silencing women and basically robbing
(36:21):
them of their identity.
Speaker 2 (36:23):
So you fast forward to two options.
Speaker 3 (36:25):
One fight against medical school quotas that are keeping women
out of medical school. But secondly, many people realized that
wasn't going to be good enough. Now you start having
more women going to medical school, they're subjected to jokes,
they're ridiculed. They've got their professors putting up Playboy cartoons
kind of mocking them, sexualizing the procedure, et cetera, et cetera.
(36:50):
And so you have other women that are creating these
kind of lay feminist women's health organizations, lay, meaning they're
not run by MD's. And that's where the birth of
self help. That was a long winded way of me
getting to self help.
Speaker 4 (37:04):
Oh I loved it. I loved it.
Speaker 3 (37:07):
So the idea is you are the expert of your
own body, and you don't need someone, you know, an intermediary,
a so called expert, to show you or tell you things.
And the way you do it is by spreading your legs,
getting a mirror in a flashlight and a plastic speculum,
(37:27):
and suddenly, voila, you see your own cervix, your own vagina,
the walls of your vagina. And for many this was
incredibly revolutionary because of the fact that they could suddenly
that gaze which had started with Sims right saying introducing
the backhandle, this soon I saw things as no man
ever seen before. They turn that on its head and
(37:49):
basically see the speculum as a potential form of women's liberation.
There's a great cartoon I have in the Book of
Wonder Woman holding the speculum, this feminist tool of empowerment.
Speaker 2 (38:02):
We don't need these men to tell us. We can have.
Speaker 3 (38:06):
Access to that information ourselves. Now, some of these women
didn't just look. They did things right, including perform abortions.
They're the collective in Chicago, Jane taught each other how
to do abortions. So it was very politically motivated at times,
and very radical and empowering as well.
Speaker 1 (38:28):
Thinking about that period made me sort of wonder, what
are the components of a good pelvic exam?
Speaker 2 (38:35):
Rika?
Speaker 4 (38:36):
What makes a good pelvic exam?
Speaker 1 (38:38):
I think it's easy to think of ways that a
pelvic exam is bad, but what are the good components?
Speaker 2 (38:44):
Yeah, and in.
Speaker 3 (38:45):
Fact, a lot of what we experienced today are a
result of the women's health movement kind of putting their
foot down and saying here are some demands. So another group,
the Women's Community Health Center, which was a feminist women's
health collector in Boston, partnered remarkably with Harvard Medical School
(39:05):
for this kind of experiment. It doesn't last long. This
is in nineteen seventy four. I believe that basically some
of female Harvard medical students go to the center and say,
we're not comfortable with how we're.
Speaker 2 (39:18):
Learning how to do a public exam.
Speaker 3 (39:20):
In general, medical students in this time period, like in
the fifties and sixties, are either learning on simulated plastic
pelvisist or on anesthetized patients, or on prostitutes who are
being paid to do the exam, and there's a lot
of debate about, you know, is this appropriate.
Speaker 2 (39:41):
So suddenly you.
Speaker 3 (39:43):
Have the emergence of these women going to more women
going to medical schools as these quotas are eliminated, and
the women are not comfortable with how they're learning it,
and they go to the community Health center and say,
could you help us here? Could you volunteer your own bodies.
If we could convince Harvard that you teach it and
we learn how to do a public exam on you guys,
(40:04):
and you instruct us, then we can have a better
sense of what's appropriate. And among the things I do
is they come up with a list of guidelines that
they require everybody at Harvard to use, and things that
now are so obvious, like warm the speculum right before
(40:25):
you insert it.
Speaker 2 (40:26):
Make eye contact with your patients.
Speaker 4 (40:29):
Oh my gosh, that that had to be written out.
Speaker 2 (40:31):
Yeah.
Speaker 4 (40:31):
The instruction is.
Speaker 3 (40:33):
Introduce yourself, like just basic things to set the woman
at ease so that it is slightly less traumatic. Those
are the things that are now ideally commonplace and it's
a result of that. But if you think about it,
and I tell my students this, other than the ethical problems,
but from a teaching perspective, what's the problem with teaching
(40:54):
someone how to do an exam this sensitive on an
anesthetis unconscious patient or on a plastic pelvis.
Speaker 4 (41:04):
There's no feedback, right right, Yeah, But the.
Speaker 3 (41:07):
Message is it doesn't matter if it hurts, right that,
what matters is that you do the exam, You see
what you need to see.
Speaker 1 (41:14):
Right, wh cares about the patient. It's the patient's body
part that you're interested.
Speaker 2 (41:19):
In, exactly.
Speaker 3 (41:20):
And so that kind of humanistic part that had been
lost that required an active, conscious body that could provide
some feedback, help to kind of change some of those
attitudes that there are ways to do this that are
less traumatic, and we should be talking about that, not
(41:41):
just getting an accurate paps mirror whatever else.
Speaker 1 (41:44):
Right, actually incorporating the patient into the goals of a
pelvic exam. Speaking of using and esthetized women to train
for pelvic exams, where do we stand with that today?
Speaker 4 (41:57):
In the US?
Speaker 3 (41:59):
The fortunate thing is we're talking about it, and there's
been legislation. It changes regularly, but now certain states have
legislation on the books preventing the training of medical students
on women without their consent who are under anesthesia for
a procedure in which it's unnecessary. But on top of it,
(42:22):
now recently Health and Human Services have said that teaching
hospitals that receive federal aid are required to get consent
for these procedures. When that story came out, people were
either totally got it and said this is how.
Speaker 2 (42:40):
Can this be?
Speaker 3 (42:41):
Like I'm horrified, I didn't even know this was happening,
And others were like, oh God, one more consent for him?
Speaker 2 (42:48):
Can we do nothing? Can we accomplish nothing?
Speaker 3 (42:50):
And if you looked at the comments, there was pretty
clearly a gender divide.
Speaker 2 (42:55):
Right, not entirely, but.
Speaker 3 (42:57):
It just it speaks to this idea comes out of
the history of medicine and how we train doctors that
apprenticeship model or this idea you have to you have
to learn, you have to practice.
Speaker 2 (43:09):
How are you going to do it?
Speaker 3 (43:10):
Do you need permission every time you look inside a
mouth or an ear? But of course the vagina is
a very different type of orifice. Right The boundaries between
what's sex and what's medicine become very easily blurred when
you're talking about penetrating vagina. And we know that because
(43:31):
of cases like Larry Nasar and others. I talk about
them in the book as white coat predators. These are
people that have basically learned to take advantage of the
system to violate women for their own sexual desire rather
than in the interest of the patient. And the problem is,
even though most kindecologists aren't doing this, but we've created
(43:52):
an environment.
Speaker 2 (43:53):
Where it's the potential is there.
Speaker 3 (43:56):
And it goes back to that silencing and the fact
that we don't talk about what goes on in the exam,
or what should go on the exam, or any of that,
because we just don't talk about it.
Speaker 1 (44:07):
And shame is such a huge part of this silencing,
because we're taught to feel ashamed about our bodies. We're
taught that it's not polite to talk about, and I
want to sort of ask about, like how this shame
then has played such a huge role in making it
difficult to recognize when something is an abuse, when something
(44:28):
is crossing a line.
Speaker 3 (44:29):
It's a huge problem. It's a huge problem, and it's
such a double standard, right, I mean, if we go
all the way back to pre James, Mary and Sims
of the fact that these women's body parts were secret
because they were hidden, and medieval Christian laws prevented looking.
Speaker 2 (44:47):
At talking about these things.
Speaker 3 (44:49):
So it's I mean, it's got a very long history,
but in contemporary society it's still the case.
Speaker 2 (44:54):
I mean, studies show, for.
Speaker 3 (44:56):
Example, there was a study done in twenty fourteen in
the UK.
Speaker 2 (45:00):
That showed that a majority of women.
Speaker 3 (45:02):
In the UK between the ages of sixteen and twenty
five have a problem with using the term vagina or volpa.
Speaker 2 (45:09):
They just they don't want to say it.
Speaker 3 (45:12):
And this, of course leads to a basic lack of
anatomical knowledge. It's not just that they're uncomfortable, they don't know.
Only half of women between the ages twenty five and
thirty six surveyed in the same study could accurately identify
parts of the vagina on a simple diagram, and then
nearly one third of the younger women admitted they avoided
going to the gynecologists altogether due to shame and embarrassment.
(45:36):
So there's a direct link this discomfort because we're encouraged
from basically the day we're born not to not to
talk about these body parts and to be ashamed of them,
and et cetera, et cetera, and sometimes for protective reasons, right,
but it's still the same problem that we don't talk
about it, and this literally costs women's lives when they
(45:58):
don't see a gain of call just and they develop
cancer and that was preventable, but they're just so uncomfortable.
So that shame is very much still with us, and
it's political as well. I write about how this twenty
twelve Michigan state representative was banned. This is Lisa Brown,
banned from speaking in the House for using the term
(46:20):
vagina in a debate over an anti abortion bill because
her Republican colleague found it offensive to use the term vagina.
Speaker 2 (46:29):
So what does she do.
Speaker 3 (46:31):
She and other fellow female congresswomen speak outside the steps
of the on the steps of the state capital, they
read the vagina model right as just a way of.
Speaker 2 (46:42):
Like, what else do you want me to call it right?
So it's become politicized and that adds to that kind
of discomfort, which again translates to a silencing around the
procedure itself and how it's supposed to happen. Who is
supposed to be in the room, how are you supposed
to be touched, the fact that gloves should be used,
(47:03):
all of these things that when the abuse occurs, it's
often with young women who have no idea because they
haven't been told, and they're you know, it's through these
duplicitous men that.
Speaker 3 (47:14):
Know how to get away with it, you know, if
it doesn't help. But another survey, twenty seventeen study asking
hundreds of women just after getting a pelvic exam, the
question do you know why this examination is performed? Half
of them couldn't answer that question. There's a lot of
confusion about what it.
Speaker 2 (47:35):
Is, why it's done. There's debates.
Speaker 3 (47:38):
The American College of Physicians in twenty fourteen determined that
it should the procedures shouldn't even be done anymore under
for healthy asymptomatic non pregnant women. But the American College
of obstractions, and ganecologists still promotes it, So there's I
think that confusion has filtered down to more more general
(47:59):
popular you know, why do I need it?
Speaker 2 (48:01):
What should I do? What is it? And why do
I do it? And I don't understand my own body part.
Speaker 3 (48:07):
And one of the things I hope people get out
of my book is how important it is to have
those conversations to talk about it and talk about it
with your gynecologists when you go in, what your expectations
are and if you're afraid and pain and all.
Speaker 2 (48:23):
Of these other things that were sort of discouraged for
advocating for ourselves.
Speaker 1 (48:28):
And I feel like that's such a huge part of
this is advocacy, word of mouth, raising awareness, just sort
of making this knowledge and information accessible. And that's, you know,
something that you your book is doing, and it's also
something that you highlight in your book the work of
some advocacy groups like Survivor that really have done so
(48:49):
much to provide this information, this baseline in a way
that's not so you know, fraught with all of the
problems of walking into an exam room for the very
first time knowing what to expect, and so I'd love
for you to just talk about some of these advocacy
groups and the work that they're doing.
Speaker 2 (49:07):
Sure.
Speaker 3 (49:07):
Yeah, And actually I was just speaking at the Survivor's
Annual Cervical Cancer Summit in Washington, d C.
Speaker 2 (49:13):
About three weeks ago.
Speaker 3 (49:15):
Survivor for those listening is spelled ceer vivo R right.
So Survivors of Cervical Cancer an organization created by Tamika Felder,
who is amazing, very powerful, brilliant woman and a.
Speaker 2 (49:30):
Survivor herself, of course, But.
Speaker 3 (49:33):
At this summit, which was sort of equally informational but
also about creating a sense of community, enabling survivors to
come together and tell their stories, talk about spreading the word,
but Shane kept coming up over and over again.
Speaker 2 (49:48):
I was really struck by this.
Speaker 3 (49:49):
So many of the people that got up to speak
said that when they found out they were diagnosed with
cervical cancer, first of all, many of them wouldn't use
the term. They were shamed because it's a female reproductive part.
But second because it's HPV. It's caused by a sexually
transmitted disease, so there's this shame around. You know, how
(50:12):
one gets the virus that can lead to cervical cancer,
So that that deep level of shame, even when it's
about something that you're a victim of, Right, you didn't
cause it. Anyone can get HPV, you know, all it
takes is one sexual encounter.
Speaker 2 (50:29):
But that level of shame, you know.
Speaker 3 (50:31):
And so when I got up and did my reading,
I said, let's let's go back even further.
Speaker 2 (50:36):
You know, it's not just cervical cancer, but shame more
general about reproductive parts that we need to be talking about,
and we need to be sharing stories.
Speaker 3 (50:44):
They're very much about sharing stories, and I saw my
role as the only historian in the room of saying
the stories that matter are absolutely the people in the room,
but also historically, how can we breathe life into you know,
generations of women who have encountered this. So they're doing
amazing work and recognizing that we need funding, we need
(51:07):
federal funding, and we need studies done.
Speaker 2 (51:10):
We need to.
Speaker 3 (51:10):
Continue these studies in this political climate. But we also
need to allow people to feel entitled to speak about
it and share stories and not be dismissed more generally.
Speaker 1 (51:24):
Yeah, and so we are entering in a very frightening
period for women's reproductive rights here in the US, and
I would love to hear your perspective on what we
can learn from the past to help us better navigate
what might be a very dangerous present in future.
Speaker 3 (51:45):
Oh boy, wouldn't I like to know the secret to that?
Speaker 2 (51:50):
Well, here's one way I like to think about it.
Speaker 3 (51:53):
There are people who were not going to change everyone's minds,
certainly on certain issues. This is a divided country, divided
world when it comes to things like pregnancy, fertility, infertility, abortion.
Speaker 2 (52:06):
Et cetera. But everybody should agree that access to basic
health care.
Speaker 3 (52:12):
Women's healthcare should be a fundamental right that should never
leave the table. Women need to have access to basic
health care. And if you start dismissing funds but also
criminalizing to the extent that they are, it's detrimental to
the field of kinnecological care right. And you're going to
(52:35):
see not only maternity healthcare deserts where it's very difficult
to find an obguin in certain areas, but more generally
women's healthcare deserts where it will be harder and harder
for women in particular parts of the country to find
to literally just find anybody to get a passmerr or
(52:56):
basic health care right, and that is a vomitable that
is abominable.
Speaker 2 (53:02):
We're talking half the population, you know.
Speaker 3 (53:05):
I can't think of a better way to define misogyny
than basically take away the ability for women to get
basic healthcare.
Speaker 4 (53:16):
Could not have said it better.
Speaker 1 (53:17):
It's I think we can look at the past to
think about what we might see if this is taken away.
Speaker 4 (53:23):
It could be a very scary time going forward.
Speaker 1 (53:25):
But yeah, I loved your book, and I think it's
so important to provide this broader context of this thing
that so many of us experience all like regularly and
don't think more about it. Maybe, or we do think
more about it, but we don't know about the larger
history of it, right, And.
Speaker 3 (53:42):
We don't have the language or the opportunity to kind
of talk about it or see it as that it's
a valid topic of conversation, you know, because if it
was about men's healthcare, it would be I even had
I had an academic, male academic when he asked.
Speaker 2 (53:58):
Me the title of my BOOKOK, And I told him and.
Speaker 3 (54:00):
He said, well, that's a pretty niche topic, isn't it.
I'm like, oh, yeah, spoken by someone who's never encountered this, right,
I mean, hello, thank you.
Speaker 2 (54:10):
Sex is of one oh one. Right, So it's dismissed
by people who.
Speaker 3 (54:15):
Can't identify with it, and they don't even recognize that
that dismissal is a political act. Yeah right, and it's
a way of again silencing Oh right.
Speaker 2 (54:26):
Oh, I'm sorry. I guess I shouldn't be talking about
this because you don't find it interesting.
Speaker 3 (54:33):
So yeah, I mean even just to be able to
talk about it, you know, read the book, share it
with a friend, have a conversation.
Speaker 1 (54:41):
Well, I really want to thank you so much for
taking the time to chat with me today.
Speaker 4 (54:46):
I really appreciate it my pleasures.
Speaker 2 (54:49):
I love talking about this stuff.
Speaker 1 (55:11):
A big thank you again to doctor Wendy Klin for
taking the time to chat with me. This conversation felt
so meaningful to me. And if you enjoyed today's episode
and would like to learn more, check out our website
this podcast will kill You dot Com. We're I'll post
a link to where you can find exposed the hidden
history of the pelvic Exam, as well as a link
(55:32):
to doctor Klein's website where you can find her other
incredible work. And don't forget you can check out our
website for all sorts of other cool things, including but
not limited to, transcripts, Quarantini and Placibrita, recipes, show notes
and references for all of our episodes, links to merch
our bookshop dot org, affiliate account, our Goodreads list, a
(55:53):
first hand account, form and music by Bloodmobile. Speaking of which,
thank you to Bloodmobile for providing the music for this
episode and all of our episodes. Thank you to Leana
Scuilacci and Tom Bryfogel for our amazing audio mixing, and
thanks to you listeners for listening. I hope that you
liked this episode and our loving being part of the
(56:14):
TPWKY book Club. And a special thank you, as always
to our fantastic patrons. We truly appreciate your support. Well
until next time, keep washing those hands,
Hi, I'm Aaron Welsh and this is This Podcast Will
Kill You. Welcome to the latest episode of the tp
w k Y book Club series, where I interview authors
of popular science and medicine books about their latest work.
We've started out very strong this season and we've got
such a great lineup for the rest of the year.
(01:05):
These are honestly some of my favorite episodes to put together.
If you'd like to get a sneak peek at the
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head over to our website This Podcast Will Kill You
dot com, where you can find a link to our
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you're on our bookshop page, you can see various TPWKY booklists,
(01:29):
including one for this book club series. I'll be posting
more books there throughout the season, so check in regularly
to see which books will be featured in the upcoming
weeks and months. As always, we love hearing from you
all about these and our other episodes, and so if
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(01:49):
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Two last things before moving on to the book of
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(02:10):
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Speaker 2 (02:21):
Drop.
Speaker 1 (02:22):
With that business out of the way, I am so
excited to introduce this episode's author and book. This week
I got to sit down with doctor Wendy Klein, professor
of history at Purdue University and author, to discuss her book,
Exposed the Hidden History of the pelvic Exam. If you've
(02:42):
ever had a pelvic exam, you know the drill, the discomfort,
the vulnerability, the waiting for it to be over. There
are myriad ways that people feel about these routine exams,
from neutral to dread, and yet we don't really talk
that much about them. We put up with them, or
maybe we avoid them, but at least speaking for myself,
(03:05):
we don't question their existence, how they originated, or ways
they can improve. We just accept them as a fact
of life. But as doctor Klein demonstrates and exposed routine
pelvic exams are a relatively recent addition to preventative care guidelines,
guidelines which are currently being revisited. To understand the present
(03:27):
day landscape of routine pelvic exams, we have to explore
their past, a past fraud with abuse and concealment. Doctor
Clin takes readers through the murky history of pelvic exams,
and in doing so, reveals how the field of gynecology
has been shaped both by those who use shame as
a weapon as well as those who seek to empower
(03:49):
women through knowledge about their own bodies. Exposed is so
much more than a history and current assessment of one
of the most commonly performed medical procedures. It reveals how
the paternalistic view that medicine has held for women harms
rather than helps, and it also highlights some of the
(04:09):
incredible advocacy groups working to ask the crucial question, how
can we make things better? I had such a fantastic
time chatting with doctor Klein, and I am thrilled to
be sharing this conversation with you all. I do want
to note before we get into things, that this episode
does feature discussions of abuse and medical trauma, so please
(04:30):
keep that in mind. With that, let's take a break
and then get started. Klein, thank you so much for
(05:01):
joining me today.
Speaker 2 (05:02):
It is my pleasure. I'm delighted to be here.
Speaker 1 (05:05):
In your book Exposed, you take readers through the history
of one of the most commonly performed medical procedures, the
pelvic exam. And before we get into the murky origins
of this exam, I would love for you to set
the stage just by taking us through how a pelvic
exam is done today, kind of just an overview step
by step, and importantly why they are performed.
Speaker 3 (05:28):
So a public exam consists of three parts. The first
is the examination of external genitalia and then second is
the speculum exam, and that's typically accompanied by a pap
smear to test for cervical cancer. And then the third
part is a bi manual exam, and that is when
(05:50):
the healthcare provider inserts one to two fingers into the
vagina while using the other hand to press on the
abdomen with the other hand in order to evaluate organs.
Speaker 2 (06:01):
Fairly standard procedure. It hasn't changed a whole.
Speaker 3 (06:04):
Lot over the last century or so, and the primary
purpose is to test for cervical cancer, but there are
other aspects as well, right, just to look for any abnormalities, discomfort,
and opportunity to talk with a provider if you have
any questions, either about sex or discomfort or anything else.
Speaker 1 (06:26):
It is really remarkable and maybe a bit alarming, how
little it seems to have changed since it was first introduced.
And I would love for you to take me through
the origins of how this exam came to be, especially
the role that was played by the so called father
of gynecology, James Mary and Simms.
Speaker 3 (06:46):
Right, yeah, And of course I could talk all day
about this, right, And I mean it's such an interesting conversation.
But I mean, if you think about it, for centuries,
women's genitalia was hidden, right, unlike male genitalia, which is
quite obvious, It was very difficult for anybody to see
(07:07):
or know what a woman's reproductive organs actually looked like.
And that all changes in the nineteenth century. James mary
and Simms was a doctor in Alabama, and he claims he.
Speaker 2 (07:24):
Takes credit right for discovering quote a class covering speculum
in actuality.
Speaker 3 (07:30):
There were other types of speculums in France in the
eighteen thirties, for example. But Simms was a master showman
and took all the credit for this. He gets the
idea when he's looking peering into.
Speaker 2 (07:44):
A patient's vagina.
Speaker 3 (07:45):
She's fallen off a horse, and she's in all kinds
of discomfort, and.
Speaker 2 (07:49):
He gets the idea of using a.
Speaker 3 (07:51):
Spoon and bending it to kind of reflect and inserting
it into her vagina. And he says this like, I
find it rather hilarious. He says in his memoir introducing
the bent handle of the spoon, I saw everything as
no man had ever.
Speaker 2 (08:08):
Seen before, right.
Speaker 3 (08:10):
So he kind of lays his flag this idea of
this new territory that he had essentially claims right. And
so it was in fact a fairly revolutionary concept that
you could actually see what had been hidden for centuries
and centuries.
Speaker 2 (08:28):
And you know, on the one hand, it's saved probably
millions of lives. It's changed how we understand gynecology. But
there are some repercussions.
Speaker 3 (08:41):
And I will also say that it didn't go uncontested.
I mean, even many physicians or budding gynecologists in the
mid nineteenth century were really uncomfortable with the idea because
what's happening in the nineteenth century when you think about
upper middle class white womanhood, Victorian morality, and this idea
(09:03):
that it was appropriate to appear inside a woman's vagina
was highly problematic. So there was actually debates among gynecologists
about whether touch was more appropriate than the gaze, right,
and that what a good provider should be able to
sense from their fingers rather than the visual gaze. And
it's debated among these doctors like should we should we
(09:26):
go ahead and welcome this new tool or should we
disdain it?
Speaker 2 (09:31):
And I think that's a really fascinating conversation and debate
between these doctors.
Speaker 3 (09:35):
The other thing is some of them are concerned that
it's going to turn women into like sex maniacs.
Speaker 2 (09:41):
They're going to start loving.
Speaker 3 (09:43):
Having this speculum put inside their vagina and it will
essentially corrupt women. So anyway, it wasn't immediately accepted as
the ideal tool, but it was gradually accepted and promoted
by people like James Mary and Simms.
Speaker 1 (10:02):
We've come a long way in some in some ways
and not so much in others. But you know, when
I was reading your book, I found myself thinking a
lot of course about public exams and how I relate
to them and my experience with pelvic exams. And I
was wondering, you know, what your experience was like with
pelvic exams or is like, and whether that's changed as
(10:24):
you have as you worked on this book.
Speaker 3 (10:26):
You know, that's a great question eron and I'm surprised,
like nobody's ever asked me that before. Again, a lot
of talks, and that is not a question I've actually
I've had. And so, you know, I feel lucky because
I feel like I'm one of those people that doesn't
particularly enjoy it. It's unpleasant, but it hasn't been traumatic
(10:48):
for me. I'm fairly comfortable with my body. I tend
to have good relationships with the doctors that I visit.
Speaker 2 (10:55):
The ob ginds.
Speaker 3 (10:57):
I'll talk about what I'm researching as they're probing inside
of me.
Speaker 2 (11:02):
You know, I love that. But so I wasn't.
Speaker 3 (11:06):
Drawn to the topic because of some horrible thing that
happened to me, which is I know for some people
it's raised their curiosity about it.
Speaker 2 (11:14):
For me, it was more, you know, why are we
not talking about this procedure? Right? So many people endure
this on a regular.
Speaker 3 (11:23):
Basis, and so someone like me, it's unpleasant, but for
some people it's hugely traumatic, painful, terrifying, And yet we're.
Speaker 2 (11:33):
Not really supposed to talk about it for many reasons.
Speaker 3 (11:36):
And so that kind of raised the question, why is
it something that we just don't talk about it when
it's something that we all experience.
Speaker 1 (11:45):
Yeah, just the expectation of this is what you have
to do and that's it, and you just endure it. Yeah,
and you know, but going back to the history of
the pelvic exam and how it initially when it was introduced,
it was not like you said something that a lot
of people were like, absolutely, let's do this. And so
who were the people who were likely to receive a
(12:08):
public exam in these early decades and who was not
likely to receive one?
Speaker 3 (12:13):
Yeah, great question and really important to this story. The
first patients were basically the first guinea pigs.
Speaker 2 (12:20):
And you can probably yes who they were not.
Speaker 3 (12:24):
They were not white, middle class women, and this is
fairly well known in the historiography. But James Mary and
Zims did most of his procedures first unenslaved patients, and
we know about three, in particular, Lucy, Betsy and anarka
who endured multiple procedures countless times over a period of
(12:45):
nearly four years without anesthesia. In part I should add
that anesthesia was incredibly dangerous and not frequently used in
the eighteen forties when he was doing this.
Speaker 2 (12:58):
But still, you know, extremely painful. These were enslaved women
who had all were all suffering from besico vaginal fistulas,
basically a tear between the vagina and the bladder as
a result of prolonged childbirth, and possibly also the use
(13:19):
of forceps. We don't know specifically in these.
Speaker 3 (13:22):
Instances, but you know, talk about tools that can actually
really damage. Yeah, and so he claims that what they
were suffering was worse than death. So it was in
their interest to kind of endure these procedures because he
was he believed to be helping them, but he was
(13:43):
equally made the point that he was restoring labor to
these women's quote unquote owners. Right, but regardless, and there's
so much we don't know, because of course those voices
are silenced. We only know through the absurd and through
Sims himself what they experienced. And even if they were consenting,
(14:07):
they can't consent by virtue of the fact that they
had no power to do so. They were enslaved women.
So what does it mean that a procedure that's considered
immoral or an ethical or just distasteful to do on
a white middle class woman is done on these bodies,
but with the idea that if they could be perfected,
(14:29):
then right then it would be appropriate to.
Speaker 2 (14:32):
Use on these other bodies.
Speaker 3 (14:34):
And that's basically what happens enslaved women, sex workers, basically
women who were disempowered. And of course, if you think
about it, one of the reasons Sims is interested in
taking these tools and then applying them to the white
middle and upper classes is money, right, That's where he's
(14:56):
going to get his client tele that's where the concern
learn about suffering and alleviating suffering.
Speaker 2 (15:03):
It's going to be focused on. But he needs the tools. First.
Speaker 1 (15:08):
Let's take a quick break, and when we get back,
there's still so much to discuss. Welcome back everyone. I've
(15:30):
been chatting with doctor Wendy Kline about her book exposed
the hidden history of the pelvic exam. Let's get back
into things. And then once he had those tools, you know,
still though the pelvic exam, the speculum was not, as
you said, widely adopted immediately. And so then what were
some of the things that led to its increase in popularity,
(15:54):
I guess, or it's acceptability.
Speaker 3 (15:56):
Yeah, I mean, there's a basic shift that occurs over
roughly like a fifty to seventy year period, from the
emergence of gynecology as a medical specialty, which I should
add comes hand in hand with the development of the speculum, right, it.
Speaker 2 (16:11):
Was the tool that justified.
Speaker 3 (16:13):
The need for a male medical model to differentiate themselves
from say, female midwives. So most of their work was
done either with obstetrics with childbirth or with patients.
Speaker 2 (16:27):
That are suffering, not on healthy women.
Speaker 3 (16:30):
Gradually, there's a shift from pathological or surgical gynecology to
preventive gynecology, and there are a couple of reasons for that.
The most kind of blatant in terms of developing gynecology
as a specialty is obvious. They want to expand their
patient base, right, They don't want it to be up
(16:51):
to the patient to determine when they think they need
to see a doctor. By pushing for preventive medicine and
an case, preventive gynecology, you're widening your patient base. You're
encouraging you know, every woman of reproductive age should see
a doctor on a regular basis, and boom, suddenly you've
got a much wider patient population.
Speaker 2 (17:13):
Now, I mean, that's the cynical part. Obviously.
Speaker 3 (17:15):
You know, they believe that they were helping, and oftentimes
they were so, but it was a smart way to
expand their patient base. I have an entire chapter about
one doctor, doctor Robert Dickinson, who is the president of
the American Gynecological Society in nineteen twenty, and he makes
a big case. He's, you know, like, what separates us
(17:37):
from surgeons. We need to define ourselves as something other
than surgeons of the female reproductive tract or organs, and
we should be talking about sex and birth control and
all these topics that male doctors, because most of them
were male, are kind of skirting around as kind of
(17:58):
again inappropriate. We shouldn't be talking about these things. We
want to show that we are morally upright, upstanding citizens.
We're not perverts, and therefore we should avoid talking about
these things. Dickinson's like, no, that's exactly what we should
be doing. We should step in and he basically suggests
that doctors. Gynecologists should also be marriage counselors. They should
(18:22):
be talking about sexual discomfort, they should be asking about
birth control, et cetera, et cetera. And again it's a
way of widening their base of asserting their authority. But
it paves the way for this notion of prevented gynecology.
Then on top of that you have the development of
the pap smear, right, and so that's a little bit later.
(18:43):
It becomes kind of standardized in the early nineteen forties.
George Papa Nicolau, that's why we have the name figures out.
He's not even looking for this, but when he's taking
cervical smears first out of guinea literal guinea pigs, and
then he uses his wife, who volunteers cervical smears daily
(19:04):
for decades decades.
Speaker 4 (19:06):
I couldn't get over that. It was like literally.
Speaker 3 (19:09):
Human gay pig in the name of science, and realizes
that by taking these smears, by looking at the fluid,
you can determine whether there are any signs of cancer,
basically of tumors. So once that is established, then there's
a very clear reason why preventive gynecology makes sense. Right,
(19:31):
This is a way of early detection, trying to see
if there's any signs. So it's kind of a gradual process,
but I'm really interested in those kind of those years
in the twenties up to the forties where there is
talking as much about sex as they are about vaginal health,
I would say, and offering, among other things, pre marital
(19:52):
pelvic exams, like getting a woman ready for her wedding
night to ensure that she will kind of be comfortable
with sex, et cetera.
Speaker 1 (20:02):
That was a fascinating chapter about Dickinson and that quote
that you include where he says there is never a
precise way of separating the woman from the doctor's idea
of her. It just has been rattling around in my
head ever since reading that.
Speaker 2 (20:23):
Yeah, he kept me up.
Speaker 3 (20:24):
There are many nights that I did not sleep when
I was doing research for that chapter.
Speaker 2 (20:29):
And it came gradually because he has.
Speaker 3 (20:31):
Terrible handwriting, and all of this was scratched, scribbled onto
tiny little note cards that I found in the archive,
and so it took a long time to piece together
exactly what he was saying and how he was saying it,
and so the horror was kind of gradually emerging. You
know and until I was realizing that he was in
(20:53):
fact sexually abusing some of his patients and acknowledging it
in his own handwriting. And he's also a great case
for a historian because he took prolific notes of every
because he saw his patients as case studies.
Speaker 2 (21:09):
He was kind of.
Speaker 3 (21:11):
Interested in learning from them, and so as soon as
he would examine them, he would write down, describe what happened.
He would even quote the conversation. He would quote, supposedly
verbat him what the patient had said to him. So
even though we don't have.
Speaker 2 (21:26):
A record of these individual women.
Speaker 3 (21:28):
Most of the time, we have his quoting his memory
of what took place, and he's very upfront about what
he's doing. So yeah, that was really really disturbing in
terms of that. I also just want to add on
top of it because I think this is really interesting
because my first book was a history of the eugenics movement. Well,
(21:52):
Dickinson was a eugenicist, and he embraced not only sterilizing
certain women, but encouraging the right time of women to
have more children. And that's why he was so interested
in pre marital pelvic exams and the idea that he's
a marriage counselor because he wants to ensure that these
women stay in stable marriages, why so they have more children,
(22:15):
And it's the quote unquote right kind of children. Right,
So that's partly why he's kind of putting his foot
in the door opening this like wider conversation about women's roles,
believing that gynecologists should in fact be these moral arbiters
that come in and help stabilize marriages by having these
(22:36):
kind of hidden conversations to ensure that women continue to
have sex and reproduce.
Speaker 4 (22:44):
That lens I feel like is so important.
Speaker 1 (22:47):
You know, his work or ideas or notes or practice
and abuse didn't happen in a vacuum, like he was
a product of that, how eugenics was had a hand
in every everything. He seems to approach his patients from
this framework of I am not going to believe what
they say, like I am already doubting what this person
(23:08):
is going to say to me. And I feel like
this is again part of this larger trend that was
happening around this time with the speculum and then other
instruments being utilized by physicians to learn about their patient's
bodies without having to actually talk to, or listen to,
or believe the patient themselves. And what do you feel
(23:29):
like were the consequences of this shift where suddenly a
woman becomes an unreliable narrator about her own body.
Speaker 3 (23:36):
I think it's a really important shift, which is again
one of the reasons why I wrote this book. I mean,
if I just step back for a moment and we
think about science and technology doesn't happen in a vacuum.
It is all about context and agendas and professionalization and
attitudes about women in a particular time and place. So
(23:59):
if you take a particular tool or procedure and you
track it over the time, while the procedure may not
change that much, I mean, that's one of the first
things we said. The tool is pretty much the same,
the examination is pretty much the same, and yet the
meaning behind it changes radically depending on different contexts. So
in a time period in which eugenics was extremely popular,
(24:23):
the tool and the procedure.
Speaker 2 (24:25):
Are going to be used in a very different way.
So back to your.
Speaker 3 (24:30):
Question about moments in which tools kind of replace listening
to the patient, in this case, the female patient. I
think it's a reminder of the extent to which this
was a paternalistic, fairly misogynistic culture in which women's voices
(24:51):
were not always taken seriously.
Speaker 2 (24:55):
And they weren't always believed.
Speaker 3 (24:57):
And so for Dickinson, it's like, your genitals can tell
me the truth more than your voice or your experience.
And that's a very disturbing message, right, And this is
among white, educated, middle class women. This isn't even you know,
(25:19):
wouldn't it be great if Sims had kept a diary
the way Robert Dickinson did. What was he saying about
Lucy Betsy and Anarcha?
Speaker 2 (25:28):
Right?
Speaker 3 (25:29):
And what were they thinking? I mean, this is historians
greatest tool and biggest frustration is the clues and then
the absence of clues and what we wish we knew,
And there's so much we don't know, but we can expect.
You know that the power differential wasn't just my male female.
It was white black, It was enslaved slaveholder because Sim's
(25:51):
himself owned slave. So this kind of dismissal is so
much linked to power. Yea, the more disempowered a person is,
the less likely their voice is going to be taken seriously.
So my point is that even among white middle class women,
they were not necessarily listened to. The tools became kind
(26:14):
of the translator almost or the interpreter to kind of
displace the voice of the woman herself, and in turn,
very gradually, this disempowering makes women less confident that they
have the right to say, or that maybe they don't
understand their bodies or what's going on, they need the
(26:35):
doctor or the tool to kind of explain to themselves.
I'm jumping ahead, but that's what eventually leads to the
feminist movement kind of pushing back and saying, hold on
a minute, we do know what we're doing. These are
our bodies, so we are the experts of our own
bodies because we embody them. We don't need your interpretation,
(26:56):
which we believe to be misogynistic, inaccurate, etc.
Speaker 2 (27:00):
Et cetera.
Speaker 1 (27:01):
Let's take a quick break here, we'll be back before
you know it. Welcome back, everyone, I'm here chatting with
the wonderful doctor Wendy Klein about her book Exposed. Let's
(27:24):
get into some more questions. How did it go from
like an informational perspective of you seek a gynecologist because
you need it to then preventive care. How did women
learn or like come across that that's what they should do?
Speaker 2 (27:40):
Ooh, that's such a good question.
Speaker 3 (27:42):
You know before obviously there was cervical cancer existed before
the pathsmerror right, uh, right to have a diagnostic screening
procedure was really exciting, right, genuinely exciting. It did save
a ton of lives even before that takingsygnostic tool. There's
a recognition that just being seen by a doctor and
(28:05):
examined an internal examination, even without the smear test, could
save some lives. The problem, as you've said, is how
do you spread the word? Okay, So, like in the
nineteen twenties nineteen thirties, you have gynecologists trying to push
for early prevention and preventive gynecology, but they're not allowed
to talk about it.
Speaker 2 (28:25):
Right.
Speaker 3 (28:26):
So a doctor at Johns Hopkins is complaining because he
wants to publish information in newspapers and journals, but he's
told the newspapers really don't want to see the words smear,
cervical fluid, men sees, cervix uterus, right, I mean all
(28:47):
of these words that have all the stigma attached to it.
And he's like well, how do I get the word
out if I'm not even allowed to talk about it?
So he hires an assistant. Her name's Florence Becker, and
basic says, you know, it's up to you go spread
the word in women only circles, like tell your friends,
organize women's groups to talk about it, kind of behind
(29:13):
people's backs because it's not seen as appropriate to talk
about it. Do you see how we get to where
we are today where we still can't talk about it, right?
Speaker 2 (29:21):
I mean, this is the problem. People were told they
can't talk about it, so it becomes.
Speaker 3 (29:26):
This like women telling their friends their sisters, you should
really see a doctor.
Speaker 2 (29:32):
It saved my life.
Speaker 3 (29:33):
And that's still kind of a message in cervical cancer
advocacy today. And I'm not saying it's a bad message,
but it was the only way to spread the word
because these doctors, you know, couldn't talk about it. Once
you have the paps mirror, I think they have more evidence,
scientific evidence to kind of prove, and they're able to
(29:54):
be a little bit more open about it. But it
was it was essentially a word of mouth campaign decades.
Speaker 1 (30:00):
Of course, that word of mouth doesn't make it everywhere,
and so you see these disparities both historically and today
in who is getting access to papsmeres, and there are
I mean, there's a myriad of factors that determine whether
or not someone can get a pap smeer has access
to a perapsmere, doesn't want to get a papsmere. But
(30:21):
you know, what were some of these disparities that emerged
with these early studies trying to examine who was getting
routine public exams and who wasn't.
Speaker 2 (30:30):
Huge massive racial disparities.
Speaker 3 (30:32):
And I think there are a couple of reasons for that,
accessibility and racism. So and they're obviously overlapping, but by
racism I also mean mistrust that even campaigns to kind
of reach out to women of color were problematic because
(30:53):
black women understood historically how racism and mistrust had led
to all kinds of problems. If most of the providers
and scientists and practitioners are white and white men, of
course there's going to be a reluctance what do you
really want from me?
Speaker 2 (31:12):
And why, right, I shouldn't trust you?
Speaker 3 (31:15):
But primarily access, you know, health insurance, availability, access to
any kind of treatment, right, particularly in regions in which
a two tiered healthcare system which prevented these women from
entering most hospitals. So that combination meant that this was
(31:36):
primarily reaching white women. Oh, I should add the third
is who are the women primarily with some exceptions of course,
who are spreading the word. When I talk about the
word of mouth campaign, Florence Becker is going to talk
to university women, I forget is that the American Association
of University Women.
Speaker 2 (31:54):
I think she.
Speaker 3 (31:55):
Talks to a primarily white, middle class educated group.
Speaker 2 (31:58):
Right. They're spreading the words their friends, their sisters, their
club groups, right, but not among others.
Speaker 3 (32:06):
Again, there are some exceptions to that and some awareness,
which is why you get some black women being tested
and seeking treatment.
Speaker 2 (32:15):
But it's to a much smaller extent.
Speaker 1 (32:18):
All problems that still exist in some form or another today.
And I want to talk about that in a bit.
But I also want to get back into this idea
of how the feminist movement and women sort of reclaiming
the knowledge that should have been theirs all along, and
so who were some of the pivotal players in this time?
(32:39):
And I would love for you to tell me more
about self help clinics and how they came to be
and how those also changed the patient doctor relationship.
Speaker 3 (32:49):
Yeah, oh my gosh, well do you have like seventeen hours,
because that's how long I can talk about it.
Speaker 2 (32:55):
I've written a lot about this and other books as well.
Speaker 3 (32:59):
I think it's more to set the stage to how
we get to this moment.
Speaker 2 (33:03):
So I talked about Robert Dickinson in general.
Speaker 3 (33:07):
These gynecologists until nineteen seventy are male, primarily white male.
Ninety three percent of all gynecologists in nineteen seventy were male,
which is very different from today right, where the majority
are female, And so these are women that are going
to see male doctors. Nineteen sixty of the introduction of
(33:29):
the birth control pill, it's intended for.
Speaker 2 (33:32):
Married women only, so a lot of women are.
Speaker 3 (33:35):
Going to the gynecologist only to get access to the
birth control pill.
Speaker 2 (33:40):
Or that's a primary motivator.
Speaker 3 (33:42):
And initially the requirements of getting the pill included getting
a pelvic exam. That has since been uncoupled, right, but
that was the rule. And so you've got millions of
women going on the birth control which means there are
also millions of appointments made right and millions of PEPs.
(34:03):
Marriage pelvic exams, and many of these doctors have inherited
this kind of marriage counselor role, so they think it
is their right to make moral claims about why this
woman is seeking the birth control pill.
Speaker 2 (34:19):
Is she married?
Speaker 3 (34:20):
Some women would actually wear fake rings and pretend they
were married, but more generally just being paternalistic, making all
kinds of claims about a woman's sexual behavior because she's
seeking birth control pill. So, you know, that's the beginning
of the sixties A. We all know it's a turbulent decade.
And by the end of it, it becomes clear that
(34:42):
sexual liberation isn't necessarily liberating for women. There's an expectation
to be sexually available. It isn't always in their best interest.
Speaker 2 (34:53):
So out of that springs a lot of.
Speaker 3 (34:55):
Anger about what is happening in the gynecologist's office. And
there's a meeting at a workshop on women's liberation in
nineteen sixty nine in a college in Boston, Emmanual College,
and there's a two hour meeting and the topic is
women and their bodies, and it's twelve women and they're
just all they want to do is come up a
(35:17):
list of reasonable ob guns in the Boston area, and
they realize they can't come up with a single name,
literally a single name, and then they decide to keep meeting,
and eventually that group evolves into the Boston Women's Health
Book Collective That Rights Our Bodies, Ourselves, and it's really
(35:37):
the first women's health manual written by women for women,
not by medical professionals, accessible information about their own bodies
that they research themselves. But part of this anger is fueled,
I mean they see the gynecologists is sort of emblematic
of all the problems of misogyny in American society. There's
(35:58):
a great quote in Vaginal Politics and it opens with
a description of her first visit to a gynecologist where
she says, I was naked, he was clothed. I was
lying down, he was standing up. I was silent, he
was speaking. It just kind of captured in this tiny
little narrative everything that was silencing women and basically robbing
(36:21):
them of their identity.
Speaker 2 (36:23):
So you fast forward to two options.
Speaker 3 (36:25):
One fight against medical school quotas that are keeping women
out of medical school. But secondly, many people realized that
wasn't going to be good enough. Now you start having
more women going to medical school, they're subjected to jokes,
they're ridiculed. They've got their professors putting up Playboy cartoons
kind of mocking them, sexualizing the procedure, et cetera, et cetera.
(36:50):
And so you have other women that are creating these
kind of lay feminist women's health organizations, lay, meaning they're
not run by MD's. And that's where the birth of
self help. That was a long winded way of me
getting to self help.
Speaker 4 (37:04):
Oh I loved it. I loved it.
Speaker 3 (37:07):
So the idea is you are the expert of your
own body, and you don't need someone, you know, an intermediary,
a so called expert, to show you or tell you things.
And the way you do it is by spreading your legs,
getting a mirror in a flashlight and a plastic speculum,
(37:27):
and suddenly, voila, you see your own cervix, your own vagina,
the walls of your vagina. And for many this was
incredibly revolutionary because of the fact that they could suddenly
that gaze which had started with Sims right saying introducing
the backhandle, this soon I saw things as no man
ever seen before. They turn that on its head and
(37:49):
basically see the speculum as a potential form of women's liberation.
There's a great cartoon I have in the Book of
Wonder Woman holding the speculum, this feminist tool of empowerment.
Speaker 2 (38:02):
We don't need these men to tell us. We can have.
Speaker 3 (38:06):
Access to that information ourselves. Now, some of these women
didn't just look. They did things right, including perform abortions.
They're the collective in Chicago, Jane taught each other how
to do abortions. So it was very politically motivated at times,
and very radical and empowering as well.
Speaker 1 (38:28):
Thinking about that period made me sort of wonder, what
are the components of a good pelvic exam?
Speaker 2 (38:35):
Rika?
Speaker 4 (38:36):
What makes a good pelvic exam?
Speaker 1 (38:38):
I think it's easy to think of ways that a
pelvic exam is bad, but what are the good components?
Speaker 2 (38:44):
Yeah, and in.
Speaker 3 (38:45):
Fact, a lot of what we experienced today are a
result of the women's health movement kind of putting their
foot down and saying here are some demands. So another group,
the Women's Community Health Center, which was a feminist women's
health collector in Boston, partnered remarkably with Harvard Medical School
(39:05):
for this kind of experiment. It doesn't last long. This
is in nineteen seventy four. I believe that basically some
of female Harvard medical students go to the center and say,
we're not comfortable with how we're.
Speaker 2 (39:18):
Learning how to do a public exam.
Speaker 3 (39:20):
In general, medical students in this time period, like in
the fifties and sixties, are either learning on simulated plastic
pelvisist or on anesthetized patients, or on prostitutes who are
being paid to do the exam, and there's a lot
of debate about, you know, is this appropriate.
Speaker 2 (39:41):
So suddenly you.
Speaker 3 (39:43):
Have the emergence of these women going to more women
going to medical schools as these quotas are eliminated, and
the women are not comfortable with how they're learning it,
and they go to the community Health center and say,
could you help us here? Could you volunteer your own bodies.
If we could convince Harvard that you teach it and
we learn how to do a public exam on you guys,
(40:04):
and you instruct us, then we can have a better
sense of what's appropriate. And among the things I do
is they come up with a list of guidelines that
they require everybody at Harvard to use, and things that
now are so obvious, like warm the speculum right before
(40:25):
you insert it.
Speaker 2 (40:26):
Make eye contact with your patients.
Speaker 4 (40:29):
Oh my gosh, that that had to be written out.
Speaker 2 (40:31):
Yeah.
Speaker 4 (40:31):
The instruction is.
Speaker 3 (40:33):
Introduce yourself, like just basic things to set the woman
at ease so that it is slightly less traumatic. Those
are the things that are now ideally commonplace and it's
a result of that. But if you think about it,
and I tell my students this, other than the ethical problems,
but from a teaching perspective, what's the problem with teaching
(40:54):
someone how to do an exam this sensitive on an
anesthetis unconscious patient or on a plastic pelvis.
Speaker 4 (41:04):
There's no feedback, right right, Yeah, But the.
Speaker 3 (41:07):
Message is it doesn't matter if it hurts, right that,
what matters is that you do the exam, You see
what you need to see.
Speaker 1 (41:14):
Right, wh cares about the patient. It's the patient's body
part that you're interested.
Speaker 2 (41:19):
In, exactly.
Speaker 3 (41:20):
And so that kind of humanistic part that had been
lost that required an active, conscious body that could provide
some feedback, help to kind of change some of those
attitudes that there are ways to do this that are
less traumatic, and we should be talking about that, not
(41:41):
just getting an accurate paps mirror whatever else.
Speaker 1 (41:44):
Right, actually incorporating the patient into the goals of a
pelvic exam. Speaking of using and esthetized women to train
for pelvic exams, where do we stand with that today?
Speaker 4 (41:57):
In the US?
Speaker 3 (41:59):
The fortunate thing is we're talking about it, and there's
been legislation. It changes regularly, but now certain states have
legislation on the books preventing the training of medical students
on women without their consent who are under anesthesia for
a procedure in which it's unnecessary. But on top of it,
(42:22):
now recently Health and Human Services have said that teaching
hospitals that receive federal aid are required to get consent
for these procedures. When that story came out, people were
either totally got it and said this is how.
Speaker 2 (42:40):
Can this be?
Speaker 3 (42:41):
Like I'm horrified, I didn't even know this was happening,
And others were like, oh God, one more consent for him?
Speaker 2 (42:48):
Can we do nothing? Can we accomplish nothing?
Speaker 3 (42:50):
And if you looked at the comments, there was pretty
clearly a gender divide.
Speaker 2 (42:55):
Right, not entirely, but.
Speaker 3 (42:57):
It just it speaks to this idea comes out of
the history of medicine and how we train doctors that
apprenticeship model or this idea you have to you have
to learn, you have to practice.
Speaker 2 (43:09):
How are you going to do it?
Speaker 3 (43:10):
Do you need permission every time you look inside a
mouth or an ear? But of course the vagina is
a very different type of orifice. Right The boundaries between
what's sex and what's medicine become very easily blurred when
you're talking about penetrating vagina. And we know that because
(43:31):
of cases like Larry Nasar and others. I talk about
them in the book as white coat predators. These are
people that have basically learned to take advantage of the
system to violate women for their own sexual desire rather
than in the interest of the patient. And the problem is,
even though most kindecologists aren't doing this, but we've created
(43:52):
an environment.
Speaker 2 (43:53):
Where it's the potential is there.
Speaker 3 (43:56):
And it goes back to that silencing and the fact
that we don't talk about what goes on in the exam,
or what should go on the exam, or any of that,
because we just don't talk about it.
Speaker 1 (44:07):
And shame is such a huge part of this silencing,
because we're taught to feel ashamed about our bodies. We're
taught that it's not polite to talk about, and I
want to sort of ask about, like how this shame
then has played such a huge role in making it
difficult to recognize when something is an abuse, when something
(44:28):
is crossing a line.
Speaker 3 (44:29):
It's a huge problem. It's a huge problem, and it's
such a double standard, right, I mean, if we go
all the way back to pre James, Mary and Sims
of the fact that these women's body parts were secret
because they were hidden, and medieval Christian laws prevented looking.
Speaker 2 (44:47):
At talking about these things.
Speaker 3 (44:49):
So it's I mean, it's got a very long history,
but in contemporary society it's still the case.
Speaker 2 (44:54):
I mean, studies show, for.
Speaker 3 (44:56):
Example, there was a study done in twenty fourteen in
the UK.
Speaker 2 (45:00):
That showed that a majority of women.
Speaker 3 (45:02):
In the UK between the ages of sixteen and twenty
five have a problem with using the term vagina or volpa.
Speaker 2 (45:09):
They just they don't want to say it.
Speaker 3 (45:12):
And this, of course leads to a basic lack of
anatomical knowledge. It's not just that they're uncomfortable, they don't know.
Only half of women between the ages twenty five and
thirty six surveyed in the same study could accurately identify
parts of the vagina on a simple diagram, and then
nearly one third of the younger women admitted they avoided
going to the gynecologists altogether due to shame and embarrassment.
(45:36):
So there's a direct link this discomfort because we're encouraged
from basically the day we're born not to not to
talk about these body parts and to be ashamed of them,
and et cetera, et cetera, and sometimes for protective reasons, right,
but it's still the same problem that we don't talk
about it, and this literally costs women's lives when they
(45:58):
don't see a gain of call just and they develop
cancer and that was preventable, but they're just so uncomfortable.
So that shame is very much still with us, and
it's political as well. I write about how this twenty
twelve Michigan state representative was banned. This is Lisa Brown,
banned from speaking in the House for using the term
(46:20):
vagina in a debate over an anti abortion bill because
her Republican colleague found it offensive to use the term vagina.
Speaker 2 (46:29):
So what does she do.
Speaker 3 (46:31):
She and other fellow female congresswomen speak outside the steps
of the on the steps of the state capital, they
read the vagina model right as just a way of.
Speaker 2 (46:42):
Like, what else do you want me to call it right?
So it's become politicized and that adds to that kind
of discomfort, which again translates to a silencing around the
procedure itself and how it's supposed to happen. Who is
supposed to be in the room, how are you supposed
to be touched, the fact that gloves should be used,
(47:03):
all of these things that when the abuse occurs, it's
often with young women who have no idea because they
haven't been told, and they're you know, it's through these
duplicitous men that.
Speaker 3 (47:14):
Know how to get away with it, you know, if
it doesn't help. But another survey, twenty seventeen study asking
hundreds of women just after getting a pelvic exam, the
question do you know why this examination is performed? Half
of them couldn't answer that question. There's a lot of
confusion about what it.
Speaker 2 (47:35):
Is, why it's done. There's debates.
Speaker 3 (47:38):
The American College of Physicians in twenty fourteen determined that
it should the procedures shouldn't even be done anymore under
for healthy asymptomatic non pregnant women. But the American College
of obstractions, and ganecologists still promotes it, So there's I
think that confusion has filtered down to more more general
(47:59):
popular you know, why do I need it?
Speaker 2 (48:01):
What should I do? What is it? And why do
I do it? And I don't understand my own body part.
Speaker 3 (48:07):
And one of the things I hope people get out
of my book is how important it is to have
those conversations to talk about it and talk about it
with your gynecologists when you go in, what your expectations
are and if you're afraid and pain and all.
Speaker 2 (48:23):
Of these other things that were sort of discouraged for
advocating for ourselves.
Speaker 1 (48:28):
And I feel like that's such a huge part of
this is advocacy, word of mouth, raising awareness, just sort
of making this knowledge and information accessible. And that's, you know,
something that you your book is doing, and it's also
something that you highlight in your book the work of
some advocacy groups like Survivor that really have done so
(48:49):
much to provide this information, this baseline in a way
that's not so you know, fraught with all of the
problems of walking into an exam room for the very
first time knowing what to expect, and so I'd love
for you to just talk about some of these advocacy
groups and the work that they're doing.
Speaker 2 (49:07):
Sure.
Speaker 3 (49:07):
Yeah, And actually I was just speaking at the Survivor's
Annual Cervical Cancer Summit in Washington, d C.
Speaker 2 (49:13):
About three weeks ago.
Speaker 3 (49:15):
Survivor for those listening is spelled ceer vivo R right.
So Survivors of Cervical Cancer an organization created by Tamika Felder,
who is amazing, very powerful, brilliant woman and a.
Speaker 2 (49:30):
Survivor herself, of course, But.
Speaker 3 (49:33):
At this summit, which was sort of equally informational but
also about creating a sense of community, enabling survivors to
come together and tell their stories, talk about spreading the word,
but Shane kept coming up over and over again.
Speaker 2 (49:48):
I was really struck by this.
Speaker 3 (49:49):
So many of the people that got up to speak
said that when they found out they were diagnosed with
cervical cancer, first of all, many of them wouldn't use
the term. They were shamed because it's a female reproductive part.
But second because it's HPV. It's caused by a sexually
transmitted disease, so there's this shame around. You know, how
(50:12):
one gets the virus that can lead to cervical cancer,
So that that deep level of shame, even when it's
about something that you're a victim of, Right, you didn't
cause it. Anyone can get HPV, you know, all it
takes is one sexual encounter.
Speaker 2 (50:29):
But that level of shame, you know.
Speaker 3 (50:31):
And so when I got up and did my reading,
I said, let's let's go back even further.
Speaker 2 (50:36):
You know, it's not just cervical cancer, but shame more
general about reproductive parts that we need to be talking about,
and we need to be sharing stories.
Speaker 3 (50:44):
They're very much about sharing stories, and I saw my
role as the only historian in the room of saying
the stories that matter are absolutely the people in the room,
but also historically, how can we breathe life into you know,
generations of women who have encountered this. So they're doing
amazing work and recognizing that we need funding, we need
(51:07):
federal funding, and we need studies done.
Speaker 2 (51:10):
We need to.
Speaker 3 (51:10):
Continue these studies in this political climate. But we also
need to allow people to feel entitled to speak about
it and share stories and not be dismissed more generally.
Speaker 1 (51:24):
Yeah, and so we are entering in a very frightening
period for women's reproductive rights here in the US, and
I would love to hear your perspective on what we
can learn from the past to help us better navigate
what might be a very dangerous present in future.
Speaker 3 (51:45):
Oh boy, wouldn't I like to know the secret to that?
Speaker 2 (51:50):
Well, here's one way I like to think about it.
Speaker 3 (51:53):
There are people who were not going to change everyone's minds,
certainly on certain issues. This is a divided country, divided
world when it comes to things like pregnancy, fertility, infertility, abortion.
Speaker 2 (52:06):
Et cetera. But everybody should agree that access to basic
health care.
Speaker 3 (52:12):
Women's healthcare should be a fundamental right that should never
leave the table. Women need to have access to basic
health care. And if you start dismissing funds but also
criminalizing to the extent that they are, it's detrimental to
the field of kinnecological care right. And you're going to
(52:35):
see not only maternity healthcare deserts where it's very difficult
to find an obguin in certain areas, but more generally
women's healthcare deserts where it will be harder and harder
for women in particular parts of the country to find
to literally just find anybody to get a passmerr or
(52:56):
basic health care right, and that is a vomitable that
is abominable.
Speaker 2 (53:02):
We're talking half the population, you know.
Speaker 3 (53:05):
I can't think of a better way to define misogyny
than basically take away the ability for women to get
basic healthcare.
Speaker 4 (53:16):
Could not have said it better.
Speaker 1 (53:17):
It's I think we can look at the past to
think about what we might see if this is taken away.
Speaker 4 (53:23):
It could be a very scary time going forward.
Speaker 1 (53:25):
But yeah, I loved your book, and I think it's
so important to provide this broader context of this thing
that so many of us experience all like regularly and
don't think more about it. Maybe, or we do think
more about it, but we don't know about the larger
history of it, right, And.
Speaker 3 (53:42):
We don't have the language or the opportunity to kind
of talk about it or see it as that it's
a valid topic of conversation, you know, because if it
was about men's healthcare, it would be I even had
I had an academic, male academic when he asked.
Speaker 2 (53:58):
Me the title of my BOOKOK, And I told him and.
Speaker 3 (54:00):
He said, well, that's a pretty niche topic, isn't it.
I'm like, oh, yeah, spoken by someone who's never encountered this, right,
I mean, hello, thank you.
Speaker 2 (54:10):
Sex is of one oh one. Right, So it's dismissed
by people who.
Speaker 3 (54:15):
Can't identify with it, and they don't even recognize that
that dismissal is a political act. Yeah right, and it's
a way of again silencing Oh right.
Speaker 2 (54:26):
Oh, I'm sorry. I guess I shouldn't be talking about
this because you don't find it interesting.
Speaker 3 (54:33):
So yeah, I mean even just to be able to
talk about it, you know, read the book, share it
with a friend, have a conversation.
Speaker 1 (54:41):
Well, I really want to thank you so much for
taking the time to chat with me today.
Speaker 4 (54:46):
I really appreciate it my pleasures.
Speaker 2 (54:49):
I love talking about this stuff.
Speaker 1 (55:11):
A big thank you again to doctor Wendy Klin for
taking the time to chat with me. This conversation felt
so meaningful to me. And if you enjoyed today's episode
and would like to learn more, check out our website
this podcast will kill You dot Com. We're I'll post
a link to where you can find exposed the hidden
history of the pelvic Exam, as well as a link
(55:32):
to doctor Klein's website where you can find her other
incredible work. And don't forget you can check out our
website for all sorts of other cool things, including but
not limited to, transcripts, Quarantini and Placibrita, recipes, show notes
and references for all of our episodes, links to merch
our bookshop dot org, affiliate account, our Goodreads list, a
(55:53):
first hand account, form and music by Bloodmobile. Speaking of which,
thank you to Bloodmobile for providing the music for this
episode and all of our episodes. Thank you to Leana
Scuilacci and Tom Bryfogel for our amazing audio mixing, and
thanks to you listeners for listening. I hope that you
liked this episode and our loving being part of the
(56:14):
TPWKY book Club. And a special thank you, as always
to our fantastic patrons. We truly appreciate your support. Well
until next time, keep washing those hands,
Hosts And Creators
Erin Welsh
Erin Allmann Updyke
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