The expense of spirit in a waste of shame

Why do we always think of our era as special, or at least particularly enlightened? Are we really so advanced that all other times are primitive in comparison? Are we actually different from those on whose shoulders we stand? Did the peasants in the Middle Ages have dissimilar genes? Unrecognizable urges? Hormones that were unlike our own?

I have only recently retired after more than forty years as a gynaecologist, but I can still remember one of my first patients after I opened my consulting practice. I was obviously much younger then, and still a bit uncomfortable about delving too deeply into the sexual practices of my patients to address the complaints for which some of them had come to me.

Lenore was having none of it, though. An elderly lady with uterine prolapse -a condition in which the uterus is unable to be maintained in its usual position in the pelvis and so travels down, and sometimes out of the vagina with the slightest increase in abdominal pressure- she was not at all shy about her problem.

“My husband is afraid to touch me anymore,” she explained. “He thinks I’m too much like him now,” she added with a wink. And then she giggled like a little girl. “For god’s sake, doctor, stop blushing. Sex has always been like that; it’s often a fine balance between pleasure and problem.”

Sometimes our view of the past is conditioned by our own Weltanschauung: we are who we are in spite of it as much as because of it. A good example of our naïveté was illustrated in an essay in Aeon by Katherine Harvey, a medieval historian and a Wellcome Trust research fellow in the department of history, classics and archaeology at Birkbeck University, London:

As she puts it, ‘In the popular imagination, the history of sex is a straightforward one. For centuries, the people of the Christian West lived in a state of sexual repression, straitjacketed by an overwhelming fear of sin, combined with a complete lack of knowledge about their own bodies. Those who fell short of the high moral standards that church, state and society demanded of them faced ostracism and punishment.’

‘Many prevailing presumptions about the sex lives of our medieval ancestors are rooted in the erroneous belief that they lived in an unsophisticated age of religious fanaticism and medical ignorance. While Christian ideals indeed influenced medieval attitudes to sex, they were rather more complex than contemporary prejudices suggest. Christian beliefs interacted with medieval medical theories to help shape some surprising and sophisticated ideas about sex, and a wide variety of different sexual practices, long before the sexual revolution.’

I must confess that I had never thought much about medieval sexual beliefs, let alone conduct, until I came across the article -a title like The Salacious Middle Ages coupled with a rather puerile drawing of a naked woman riding a two-eared, grinning phallus is hard to ignore. And as Harvey explains, ‘Medieval people feared death by celibacy as much as venereal disease, and practiced complex sexual regimens.’ Although that sounded a touch New Age to me,  I was enticed headlong into the essay.

But why would we be surprised to discover that they had similar proclivities to our own? Yes, they were wrong about the sexual transmission of leprosy,  but their concern may have stemmed more from guilt than suspicion. And anyway, they did correctly recognize the risks of other sexually transmitted conditions: ‘a set of regulations from 15th-century Southwark banished women with a ‘burning sickness’ (probably gonorrhoea) from the local stews (brothels).’

Actually, physicians of the time were concerned as much about the amount as about the  the act: ‘Conventional wisdom held that several noblemen died of sexual excess.’ In those days, though, physicians saw the world through the lens of humours. There were four of them -blood, phlegm, black bile and yellow bile- each one corresponding to the four temperaments: Blood, or sanguine (social, or active), Phlegm (apathetic), Yellow bile (aggression), and Black bile (melancholy). And the idea was that health required each of them to be kept in equilibrium. Illness resulted from imbalance.

‘Humours were balanced, and good health maintained, through the expulsion of various bodily fluids, including semen. Regular sexual intercourse was thus part of a healthy life for most men, but moderation was key. Too much sex would leave the body depleted; in the most serious cases it could have fatal consequences.’

And women didn’t escape the tyranny of the humours either: ‘According to contemporary medical theory, both sexes produced seed that was necessary for conception – and just like semen, the female seed needed to be expelled from the body during regular sexual intercourse. In a woman who was not sexually active, the seed would be retained within her body; as it built up, it would cause suffocation of the womb. The symptoms of this condition included fainting and shortness of breath, and in the most serious cases it could be fatal. For women, as for men, the best way to avoid death by celibacy was to get married and have regular, Church-sanctioned intercourse with one’s spouse.’

‘For women lacking regular sexual relations, they offered a variety of treatments … Such treatments were particularly suitable for women who were suffering from suffocation of the womb.’ Although I won’t mention all of the treatments prescribed (both for males and females with similar sicknesses), I will say that ‘The 14th-century English physician John of Gaddesden thought that such a woman should try to cure her condition through exercise, foreign travel and medication.’ I think that still works.

So, despite the obvious historical gaps in what and who has been recorded, and despite the many different lenses we have used to understand the past, it’s hard to believe that people have changed very much through the years. Sexual activity of some kind is probably necessary for most adults, and it often continues to wear the same patina of guilt or shame. As Harvey points out, the problem is still how to preserve the vital bodily equilibrium without exposing ourselves to either disease or sin. ‘Discourses about sex still revolve around conflicting demands of health, social pressures and personal inclination. As it was in the Middle Ages, sex in the 21st century remains both a pleasure and a problem.’

A fine balance -just like Lenore said…

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