Pathologization of normal female reproductive physiology

This presentation is part of the “Female Complaints”: Medicine, Markets and Women\u27s Health track. Given that sexism is a global phenomenon, is pathologization and medical ‘treatment’ of species typical aspects of and variations in women’s reproductive physiology epistemically and ethically justified? This paper begins the work of addressing that question by examining two interesting and problematic cases of medicalization of normal variations in and aspects of women’s reproductive physiology. The first case study is about the medicalization of species typical variation in labia size. ‘Treatment’ for labia that are considered abnormally large takes the form of surgical intervention termed labiaplasty (or labioplasty). The surgical procedure generally entails reduction in the size of the labia minora. Over the past decade, in the US and in various other nations, the number of women who have undergone the surgery has grown exponentially. That increase is attributable is no small part to heterosexual male oriented pornography that presents a particular version of the labia as the ideal and any variation as abnormal and undesirable. Popular television shows about cosmetic surgery, such as Dr. 90210, have showcased the procedure, contributing to its cultural acceptance. Radio, web, and billboard advertisements by plastic surgeons and gynecologists who perform the procedure have also played a role in mainstreaming the procedure. The language used in those advertisements frame women’s decision to have labiaplasty as an empowering choice that reflects a desire for self-improvement. While the primary reason women give for undergoing labiaplasty is aesthetic, some opt for the procedure because of functional impairment issues. Those women report pain or discomfort during intercourse, riding a bicycle, exercising, or wearing fitted pants. The cost of the surgery ranges between US $3,500 to $8,000 and it is usually not covered by health insurance. Risks from the surgery include infection and loss of sensation. The labiaplasty case study will track the history of this procedure in the US. Moreover, the justification given by medical practitioners who perform the procedure will be assessed in light of the larger cultural narratives about women’s bodies and sexuality. The overall aim of the case study is to historicize and contextualize the practice, with the end of enabling its considered and rigorous interrogation. The second case study examines a 20th century medical theory that conceptualizes monthly menstruation, a species typical aspect of women’s reproductive physiology, as a pathological condition. According to the proponent of that theory, menstruation is a pathological evolutionary aberration that necessarily requires medical intervention in the form of menstrual suppressant contraceptives. In broad strokes, the argument takes the following form: Premise 1: Humans are primates. Premise 2: Non-human female primates do not menstruate on a monthly basis. Premise 3: Monthly menstruation is a recent evolutionary development in human females. Premise 4: Human females of primitive societies do not menstruate every month. Premise 5: Monthly menstruation is correlated with the incidence of certain forms of cancer. Premise 6: Monthly menstruation means blood loss that could further compromise malnourished women in poor nations. Premise 7: Women with pre-menstrual symptoms are compromised in terms of their ability to function socially. Conclusion: Monthly menstruation is a pathological evolutionary aberration that should be treated in all women by means of menstrual suppressant contraceptives, barring those contemplating pregnancy. The menstruation case analysis will evaluate the research cited in support of the theory. In addition, the epistemic merits of the theory will be evaluated. The normative background assumptions mediating the gap between the theory’s hypotheses and data will be identified. Moreover, the cultural context within which R.V. Short, the researcher who formulated the theory, was working will be discussed. The larger aim of the case study is to identify the complex of normative concerns shaping the theory. The choice of the two problematic cases might suggest that this paper assumes that the pathologization and medical ‘treatment’ of species typical variations in and aspects of women’s reproductive physiology is never justified; the natural should be accepted and not pathologized or subject to medical intervention. But that is not the case. This project is not committed to the uncritical valorization of the natural. The use of the two problematic cases is deliberate as the aim is to begin a dialogue about the epistemic and moral responsibilities of medical researchers and practitioners whose work focuses on women’s reproductive physiology in global order where sexism remains deeply entrenched