I vividly remember the day we discussed the biology behind the menstrual cycle in my fifth grade health class at an all-girls school. We were primed, almost through a process of desensitization, for the use of pads and tampons. As teachers passed around pads for us to look at and store in our lockers, almost every girl around me shrieked in disgust, hurling the supplies across the room. Some chose to leave the space entirely, refusing to educate themselves; most of us had already internalized menstruation as an onerous and dirty rite of passage. The less we knew about it, the better. With pads littered across the linoleum floor of the classroom, I left school that day feeling confused about my gender and body: why did a healthy, normal anatomical process trigger such embarrassment and shame?
While women obviously grow more comfortable with their periods after puberty, the general public continues to regard menstruation as unsanitary and culturally taboo. In March of this year, poet and activist Rupi Kaur’s photo-series, “period,” was repeatedly removed by the social media photography app, Instagram. The photos depict either Rupi or her sister, Prabh, performing ritualistic acts associated with menstruation. The images are strikingly beautiful and realistic; the only plausible reason for why Instagram deemed them inappropriate is their overt depiction of menstrual blood. Because Instagram took down Kaur’s photos a second time after she re-posted them, this clearly was not a simple mistake or misunderstanding, but a deliberate act of censorship and control. You can see Rupi’s response, which received over 78,000 likes, here.
Instagram’s removal of the photos demonstrates that menstruation still provokes disgust and female othering, in spite of the feminist advancements made in the field of women’s health. However, the many people and online communities who stand in solidarity with Kaur probably do not realize that negative depictions and constructions of menstruation can be traced back to Hippocrates — the “Father of Medicine” most widely revered for his Hippocratic Oath, a tradition still practiced by graduating medical students.
As an aspiring doctor with BA in Classics who is also passionate about women’s and adolescent health, I am particularly interested in how a language of medicine — hidden under an unassuming veil of science and rationality — can work in subtle ways to instantiate verbal violence, othering, and negative bodily perception.
Medical rhetoric has a surprising ability to socially construct marginalized bodies. Is it possible to talk and write about female anatomical difference (e.g., menstruation, menopause) without privileging the condition of one body (the male) and pathologizing the state of another body (the female)? Is there a modality through which we can see the other in a way that does not violently depict or wrongly characterize her? How can a physician-author, male or female, acknowledge or report women’s pain and suffering while concurrently normalizing these processes? In other words, can women-specific pain and disease ever be described in a fashion that does not create loci of difference and shaming?
Because the male body has been viewed as the standard and most efficient body throughout medical history, perhaps the reason why there is no normalizing rhetoric to describe highly fluctuating, periodic, and often painful processes is that men do not experience them. Since men have been the predominant authors and the standard, it is possible that a language created by and for them would misconstrue normal feminine anatomical processes as disease or disease-like. We see this “diseasing” of female biology in both ancient and modern rhetorics of menstruation.
The predominant medical theory in the ancient world, humoralism, espoused the belief that health was a manifestation of balance, moderation, and efficiency. Unlike modern biomedicine — where organs are the major players in the body — ancient medicine and therapy focused on the balance of four fluids (blood, phlegm, black bile, and yellow bile). Fluids could be used as clues into the inner workings of the body because those that seemed to be exiting the body could be used as a “guide to events inside of it.” Given ancient physicians’ lack of contemporary biological understanding, humoral theory is a relatively logical system. However, it was not very flexible in its definitions, so it lent itself to harmful categorizations that deemed only certain bodies — namely male bodies— normal and healthy.
The male reproductive system is emblematic of constant production and linearity. Women’s reproductive systems are periodic and hormonally variable; eggs are only released during ovulation, and hormonal surges and declines are integral to female reproductive homeostasis. Women’s bodies are variable and normal, but in ancient and modern alike, variability and normalcy are non-overlapping categories when it comes to bodies in general — to be variable and immoderate is to be unhealthy. In one of the more theoretical Hippocratic texts, On the Nature of Man, the author states (§4):
[Man] experiences/feels health especially whenever these things [the four humors] are held in moderation (μετρίως) to one another in strength and power and number, and have been well mixed (μεμιγμένα).
According to this Hippocratic treatise and humoral theory more broadly, fluctuating levels of fluids — a hallmark of the female body — can be construed as imbalanced forces. As a result, they are subject to pathologization.
Within the Hippocratic analytical framework, menstruation is viewed as an excessive process, one that is specific to women due to the porous, moisture-filled nature of their flesh. While the Hippocratics certainly view menstruation as necessary and integral to a woman’s ability to give birth, they also cast it off as a complicated, unrestrained process that reinforces a rhetoric of female difference and anatomical inefficiency. This characterization of menstruation is especially symbolic as a product of an exclusively male medical discourse, one that has perpetuated the idea of feminine immoderacy and irrationality through scientific justification.
In juxtaposing male and female anatomical function, the Hippocratic author of Diseases of Women I defines the male body, symbolic of moderation and productivity, through what the female body is not. Since the male body is “not overfilled, not soft, and not overstrained,” it is able to draw whatever amount is absolutely necessary for the nourishment of the body. Menstruation, on the other hand, is closely linked to “over” (ὑπερ) prefix verbs, which seem to be employed as a means of marking the process’ excessiveness. Only female bodies are subject to being overstrained and overfilled due to the excess fluid that accumulates in their inherently soft flesh, and the act of menstruation is a mechanism that releases woman’s intrinsic surplus. Menstruation is posited as a compensatory act, a process that must be completed in order to egest fluid that should not be there in the first place.
Outside of the Diseases of Women texts, Hippocratic authors perpetuated the idea that menstrual blood was a toxic substance, or that the process of menstruation was a means of expelling toxicity. The Hippocratics “argued that fermentation in the blood precipitated menstruation, because women lacked the male ability to dissipate the impurities in the blood…through sweat.” Because women could not disinfect their blood through sweating, a higher-level — and arguably less productive — process was needed for them. From these brief descriptions, it is clear that Hippocratic authors constructed the process of menstruation as a manifestation of women’s biologically unproductive and excessive nature.
We may laugh at humoral theory and ancient descriptions of menstruation due to their scientific inaccuracy. But the Hippocratic texts, when viewed in light of the medical texts from our near present, show several threads in common with the rhetoric used to characterize female anatomical processes.
When I turned my research toward modern rhetoric of menstruation, I expected to find more normalizing descriptions of this biological process due to the myriad advances made in the field of biomedical science since antiquity. Even though humoral theory is no longer the predominant framework for health and disease, modern incarnations of the language employed to describe menstruation are remarkably similar to the rhetoric of excessiveness and waste as put forth by the Hippocratics. Women’s healthy bodily processes are still talked about as structurally incomplete, inefficient, and even destructive.
Several scholars have studied modern medical textbooks with an emphasis on medical metaphors. In analyzing the texts of our near present, Emily Martin’s The Woman in the Body: A Cultural Analysis of Reproduction (1987) examines and relentlessly problematizes the “underlying metaphors contained in medical descriptions of menstruation” (p. 52). Through in-depth rhetorical examinations of biology and medical textbooks from the late 1980s and early 1990s, Martin shows how the scientists and physicians of her historical moment have negatively labeled and pathologized menstruation.
It is essential that we look at Martin’s work as an intermediate step between the Hippocratics and our contemporary moment. Because Martin’s texts of interest are from the 80s and 90s, you may think that the medical language presented in her analysis is now outdated. But if your doctor is forty or older, he or she was probably trained using these same textbooks!
The texts Martin analyzes employ verbs that equate menstruation with failure, loss, structural breakdown, and waste. For example, Martin writes that Dr. Arthur C. Guyton’s Textbook of Medical Physiology (1986) characterizes “the fall in estrogen that occurs during menstruation” as a means of “[depriving] the highly developed endometrial lining of its hormonal support.” . Guyton uses the following language to educate students about the onset menstruation: “constriction of the blood vessels leads to a diminished supply of oxygen and nutrients. [Next], disintegration starts, the entire lining begins to slough, and the menstrual flow begins.”
Guyton’s description may seem fairly benign due to its use of medical language, but if one looks more closely, it becomes clear that the drop in estrogen that occurs during menstruation — a perfectly normal and required part of this anatomical process — is framed negatively. A change in hormone level causes a cascade of events that “constrict” blood vessels, “diminish” the endometrium’s nutrient supply, and “disintegrate” the lining of the uterus.
Similarly to the Hippocratics and their description of women’s inability to sweat and rid their menstrual blood of impurities, a language of waste is also used to describe menstrual blood in Guyton’s text. Guyton writes that blood vessels in the endometrium “hemorrhage,” causing the menstrual flow “[to consist] of this blood mixed with endometrial debris.” Furthermore, this “loss” of hormonal stimulation leads to “necrosis,” a cell injury that results in the premature death of tissue.
Guyton employs a pathological rhetoric in his use of words that are emblematic of disease, such as “hemorrhage” and “necrosis.” What does it mean to describe menstrual blood as a consequence of hemorrhage? To experience a hemorrhage is to have blood escape from a ruptured blood vessel. This escaped blood is called menstrual flow, a liquid that comes to be via its escape from an already broken thing (the blood vessel). According to this rhetoric, women’s menstrual blood comes from a biological entity that is already corrupt, lacking, and potentially harmful. It is also a fluid that is deemed impure because it has been mixed with “endometrial debris” from the rupturing process.
To prove that the modern rhetoric of “breakdown and deterioration” was specific to menstruation, Martin looked at how the shedding of stomach lining (a non-gendered biological process) was described in her text(s) of interest. Rather than the negative characterizations of menstruation, she found a language that emphasizes the “periodic renewal of the lining of the stomach” (Martin, 50). What would it look like if menstruation were described with similar normalizing rhetoric? Could something as simple as a shift in language change the way women feel about their bodies and the necessary processes that occur within them?
Martin expertly reconstructs her description of menstruation as it could be seen in biology and medical texts. In her reiteration, she replaces the language of failure, waste, and degeneration with a vocabulary that succeeds in both accurately depicting and normalizing this feminine anatomical process (p. 52):
A drop in the formerly high levels of progesterone and estrogen creates the appropriate environment for reducing the excess layers of endometrial tissue. Constriction of capillary blood vessels causes a lower level of oxygen and nutrients and paves the way for a vigorous production of menstrual fluids. As a part of the renewal of the remaining endometrium, the capillaries begin to reopen, contributing some blood and serious fluid to the volume of endometrial material already beginning to flow.
Martin’s re-writing is staggeringly different from the earlier descriptions of menstruation. It carries a particular feeling within it, one of positivity and production rather than breakage and uselessness. Rather than have menstrual blood be construed as a product of hemorrhage or leakage, it is framed as a normal consequence of capillary blood vessel constriction. Additionally, reductions are not viewed negatively, but instead “pave the way for vigorous production of menstrual fluids.” Menstrual fluid is not a toxic byproduct or excessive substance as we saw in both ancient and modern texts, but a normal result of hormonal fluctuations.
Martin’s simple shifts in medical rhetoric are powerful, and, I believe, have the ability to alter conceptualizations of the way people, especially those who treat women, view the female body as a biological entity.
From this brief examination of Hippocratic and modern medical discourse, it is clear that new forms of knowledge about the female body must be produced, spread, and internalized. In antiquity, operating under strict dichotomies of what was considered health and disease, women were denied any picture of health and their bodies at baseline were understood as locations of excess. While women-specific diseases must be medically understood and characterized, the continued association of women with the word disease has had fundamentally negative consequences. The conceptualization of female as abnormal has led women to believe that their bodies are sites of war, degradation, un-health, and consistent instability.
Categorization is, of course, fundamental to science and medicine — we must group, label, and categorize in order to determine what will heal or harm a patient. However, increasing awareness about the subtle power of medical language allows us to better understand and work to destabilize the oppressive threads of continuity that run through anatomical descriptions of the female body.
Throughout this article I have supplied the term “woman” or “women” to communicate a certain level of collectivity, but I understand that this group may only represent “women” who are cis-gendered and/or menstruate. As we work to challenge the norms of the “textbook” biological female, the medical community, particularly health care professionals and health policy makers, needs to realize that definitions of womanhood are constantly changing. The female experience can embody many forms, and women who are trans or gender non-conforming deserve to receive accessible and affordable women’s healthcare, just like their cis-gendered counterparts.
Unlike ancient women, some contemporary women have wide audiences and access to many different types of resources about their bodies. Eradicating silence and advocating for productive discussion breaks down barriers and dislocates stereotypes. We can problematize and relentlessly question the structures that have caused us to think about our bodies in the ways that we do. We can understand that the principles of medicine and science are not fundamental truths, but rather, were established under particular societal forces that worked and continue to work to marginalize certain bodies.
I came to these conclusions most strongly, passionately, and clearly after studying these Hippocratic texts. The power that lies in the scientific study of the ancient world is unique in that it reveals the theories, evident truths, and methods of understanding that are usually disregarded or deemed irrelevant by modern standards. When ancient conceptualizations of the body align with modern ones, the importance of studying medical language’s lasting, pervasive, and often harmful effects becomes clear. The medical rhetoric that has been used to explain and other female bodies is in desperate need of attention, rethinking, and interrogation.
Zoe Adams received her BA in Classics from Vassar College in May 2015. This article is a condensed portion of her senior thesis, “Dis(ease): The Rhetoric of Illness in Depictions of the Healthy Female Body from Hippocrates to the Present.” She is currently studying for the MCAT, and hopes to continue to merge her interests in humanities and medical science through writing.
