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: https://aeon.co/essays/getting-down-and-medieval-the-sex-lives-of-the-middle-ages

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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The Obstetrical Celibate

Celibacy seems so counterintuitive and aberrant to me that I’m constantly amazed how close to the surface it seems to float. Its etymology comes from a Latin word meaning ‘unmarried’ and that, in turn, is an amalgam of two proto-Indo-European words meaning ‘to live alone’, but its exact definition seems contextually influenced. For example, despite the fact that it is not the exclusive prerogative of one sex, we tend think of male Catholic priests as the prime examples, even though nuns –their female counterparts- also live a celibate life.  It is also variably regarded as being either the condition of living alone and being sexually abstinent, or merely sexually abstinent. In the Catholic church, although it was only mandated for priests in 1130 A.D., it included both lack of partner and sexual gratification of any kind.

Celibacy is usually seen in a religious context, but it need not be. A more contemporary view tends to focus on the sexual abstinence aspect or on the lack of a regular partner. It may be a temporary phenomenon and not one that is intended to be pursued, or a lifestyle choice. It is seldom related to the condition of asexuality in which the reason for the abstinence is one of indifference or lack of sexual drive –as I have discussed in a previous essay: https://musingsonwomenshealth.wordpress.com/2014/07/03/the-asexual/

Now I don’t wish to sound so dismissive as to reject the concept of celibacy out of hand. We all make decisions based on our wants and needs, often guided by doctrines or beliefs which make sense to us at the time. In a free and open society, what the rest of us may think of the decisions should be of little consequence so long as adhering to them has no adverse effects on any except the participants. Witness the spate of publicity surrounding the late Pope John Paul II and his relationship with the married Polish-born philosopher Anna-Teresa Tymieniecka, before and during his papacy: http://www.bbc.com/news/magazine-35552997  That a very human side was able to successfully coexist with his deeply religious beliefs is both touching and laudable –especially in a pope.

But this prologue was by way of an introduction to Ann, a patient of mine shortly before I retired.

As she sat in my office that first time, she seemed unusually nervous. She had short brown hair and was smartly dressed in a white blouse and grey pant suit. Ann seemed the perfect model of a corporate executive on her lunch break –which indeed she was. But she was perched bolt upright on the edge of her chair like a bird about to launch from a branch. Her face was taut and unnaturally shiny; her lips were frozen in a straight line as if she were trying, unsuccessfully, to fabricate a smile. Only her eyes betrayed a profound mistrust, bordering on aggression.

“You seem rather nervous, Ann,” I said with a smile of my own to break the ice.

She nodded politely, but remained silent. Only her proximity to the edge of her chair changed. I wondered how long she’d be able to stay balanced on it.

I have to say that the laptop screen on my desk is a wonderful tool. It not only provides me with information –consult letters, lab data, and so on- it also gives me something to hide behind when the patient has sent her eyes on a predatory mission. It is a type of blind, I suppose. I pulled up the consultation note from her GP on the screen more for something to do than for information –the day sheet from my secretary had already disclosed the secret: Ann was pregnant.

The note from the GP was rather terse I thought: ‘Pregnant. Angry’. I took a deep, albeit disguised, breath and peeked out from behind the screen. “So, your family doctor says you are pregnant, Ann. Congratulations!” This initial praise for the achievement usually disarms patients -well, confuses them, anyway. But it did nothing to Ann but harden her expression. She mouthed the obligatory ‘thank you’ silently and with barely a movement of her lips. This wasn’t the easiest consultation I’d ever been sent.

I decided to be more direct. “Are you angry about being pregnant, Ann? Or are you angry with me?”

That obviously caught her by surprise, because she suddenly dropped her eyes onto the table –her armour had been chinked.

Then, she broke her fast of silence. “Doctor, I have to explain something to you,” she said, slowly and disdainfully, again with lips that barely moved. I began to wonder if they’d been botoxed, or something. “I am 37 years old, unmarried, and unattached!” She said the last word carefully and slowly, lest I misunderstand. I could feel the exclamation mark from right across my desk. “Further, I am not in a lesbian relationship, nor am I ever intending to be dependent upon a partner for assistance.”

At this point her face actually narrowed and I could sense its muscles trying to avoid spasm. She liberated the predatory falcons of her eyes once again. “I am a celibate by choice, not necessity, doctor,” she said, this time between obviously clenched teeth. “My career is paramount…”

Her minute pause emboldened me to ask the obvious: “And the pregnancy isn’t…?”

It was not intended to be a profound rejoinder, merely an question, but her eyebrows immediately jumped up as she recalled the falcons to their home roost. They watched me from the shadows of their cage as her face gradually softened. An embarrassed smile crept slowly across the once angry lips and I thought I even detected a blush.

“I’m sorry, doctor,” she said, after a rather reluctant sigh. “It’s just that the men at work have been giving me a hard time.” She stared up at a picture hanging on the wall for a moment. “Word somehow got out that I was considering becoming pregnant…” She closed her eyes briefly to decide how to explain. “Men don’t seem to understand that…” She glanced at me quickly, and then corrected herself. “Many people –not just men- don’t seem to understand that wanting a baby is not the same as wanting sex, or a partner, or even a calculated one-night stand.” She retreated inside herself again to pick the words she wanted. “I don’t hate men, and I don’t disparage relationships, I have simply chosen to live my life differently from most: a celibate life…”

She took a deep and stertorous breath before continuing. “You wouldn’t believe the whispering in my office when the rumour spread that I was going to pay for IVF when there were so many willing donors around… The men would wink suggestively whenever I passed by, the women would get that silly smile on their faces…

“Anyway, I decided to take a few weeks off for the in vitro fertilization process, only half expecting it to succeed on the first cycle. But when it did, I didn’t know if I could stand the censure that most men would exhibit when they hear that I did it voluntarily -in other words, without them.” She shrugged and looked out of the window behind me for a minute or two. “So, I asked my GP if she knew of any female obstetricians she could send me to, but for some reason she chose you.

I hate this kind of situation –being blamed for something over which I have no control. A false negative, as it were. I linked eyes with her for a moment. “Sorry,” I said, smiling innocently. “I can probably find you a female Ob if you’d like.”

She sat back in her chair and thought about it. It almost felt like I was at a job interview and my CV was being inspected. After a few seconds, she smiled –warmly, for a change- and sent out her eyes again –this time rather than circling for a kill, however, they perched softly on my face. “After all that anger, would you still be willing to see an obstetrical celibate?”

I nodded. “I’ve always been nonpartisan.”