Until just a few weeks ago, Polyendocrine metabolic ovarian syndrome was reduced to ovarian cysts, much to the frustration and confusion of many patients with this systemic endocrine condition. The struggles of people with endometriosis to access patient-centred and appropriate care continue in many countries.
These are examples of the despair many patients report when they try to access hormonal and reproductive healthcare, as described by the Australia Institute.
This is not simply a matter of a few bad clinicians. It is part of a long pattern in which medicine has repeatedly treated women’s testimony as unreliable, women’s pain as less urgent and women’s reproductive bodies as peculiarly available for unwarranted surgical intervention.
One of the clearest ways to describe the problem is as an injustice over whose knowledge counts. Women are often wronged not only in what is done to their bodies but in their status as the knowers of those bodies. Their bodily experience is doubted and psychologised, and their accounts of symptoms and mistreatment are dismissed. They are insufficiently informed because their consent is assumed from silence or trust.
This problem has deep historical roots in the emergence of western biomedicine. For centuries, medicine in Europe treated women’s bodies as governed by reproductive organs that were understood to be volatile. In the 1700s, women were still thought to be ruled by nervous disorders such as “the vapours”. In the 1800s, they were defined as the “sicker sex”, their ageing reduced to menopause, and they were made targets for experimental treatments and commercial exploitation.
The underlying logic has proved remarkably durable: women’s health is fodder for profit-based medicine while their symptoms are put down to hormones, nerves, emotions or reproductive organs. Contemporary complaints about gaslighting in medicine, obstetric violence, the exploitation of young women’s bodies as egg factories for IVF and the growth of privacy-invading femtech industries are not radical breaks from this history so much as new chapters in it.
The issue is also built into the making of medical knowledge. Modern biomedical research has used men’s bodies while treating women’s bodies as deviations from the norm. That has meant both chronic under-research into conditions that disproportionately affect women (such as breast cancer), and the application to women of treatments tested only on men.
Gynaecology offers a particularly powerful case example because its history so starkly reveals the fusion of innovation, authority and violation. That history is important because it disrupts a common myth: that radical gynaecological surgery is an unavoidable answer to women’s suffering.
The first potentially survivable hysterectomies using antiseptic measures were performed in the 19th century on women with benign fibroid tumours who were often not told what surgery they were receiving or that their tumours were not cancer. More than half died. There have been vigorous debates, competing treatments and repeated warnings about unnecessary mutilation throughout the history of hysterectomy. Patients have often been told little, and what counted as consent was often shaped by misogynist assumptions about marital authority and medical prerogative rather than by the patient’s autonomous choice.
Through the rise of modern gynaecology, women’s reproductive organs came even more to be treated as the cause of wide-ranging illness – and disposable once they seemed redundant. By the late 20th century, that attitude resulted in more than a third of all women in the west having hysterectomies by the time they reach old age.
When hysterectomy rates in the west began to decline, some medical researchers warned that cancer rates would rise if women were allowed to keep their uteruses. As late as the 1970s, US surgeons proposed hysterectomy as the treatment of choice for women of the lower classes whom they thought couldn’t manage their own contraception. The same rationale contributed to the sterilisation of First Nations and Black women in many countries.
Certainly, hysterectomy has not been one stable intervention with one stable meaning. It has served, in different contexts, variously as therapy, cancer prophylaxis, gender transition surgery, covert Catholic contraception, population management and administrative convenience. That is why its history cannot be traced by technical refinement alone.
Seen in this longer frame, present-day complaints about women and gender-diverse people being steered too quickly towards hysterectomy for benign uterine tumours are not unfortunate residues on the margins of an otherwise settled system. They belong to a pattern in which patients are not fully informed of alternatives, the long-term effects of radical intervention are downplayed and clinical authority still too readily replaces dialogic consent. This is troubling because it may shortcut proper decision-making and ignore new evidence of long-term consequences for ageing and wellbeing.
Australian concern about aggressive pelvic surgery and the dismissal of women’s pain should therefore be read in a wider historical and intellectual context. When women report feeling herded into procedures they did not fully understand, or later discovering that pathology did not support the scale of intervention undertaken, this should not be dismissed as anecdotal dissatisfaction. It raises the question of whether medicine has relinquished one of its oldest habits – of treating patients not as persons but as units in a population quantum.
This is not to claim that nothing has changed, of course. Surgery is certainly much safer than it was, many clinicians are deeply reflective and caring, and standards of consent are better developed. But historical scholarship makes one point clear: progress in technique does not automatically produce justice in care.
If medicine is to confront medical misogyny seriously, it must do more than improve bedside manner. It must reckon with the histories through which women were made into unreliable witnesses of their own experience.
Alison Downham Moore is a professor of history and medical humanities at Western University Sydney. She is a member of the Australian Historical Association
