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Translated by Chloé Sautter-Léger
In light of the sociohistorical context in which the speculum was created and the way it was first used in North America and Europe on marginalized bodies, i.e. those of black women and women whose sexuality was judged to be deviant—the identity of the speculum is political. Beyond a medical instrument, this object contributed to the establishment of gynecology as a medical specialization in its own right, and as medicine of the intimate (Vuille, 2016).
By making the private visible, the speculum emphasizes issues that are intrinsically tied to its usage in a pelvic examination—who looks and who penetrates? Who does the instrument belong to? Is a subversive usage of the speculum possible?
A subversive usage of the tool is only possible by tackling the discourse it contends to challenge. Firstly, the discourse surrounding women’s bodies and gynecology will be substantiated under the angle of performance, i.e. underlining the ways in which the pelvic exam constitutes a spectacle, carried out with an actor and a spectator. Secondly, the pelvic exam as an act of show will be explored from the angle of medical education and the discourse it carries. Thirdly (in Part III of this series), this “Instruction Manual for a Subversive Usage of the Speculum” will provide an example of how women, through performance and individual and collective ownership of their sexual health, reclaimed the speculum and of the pelvic exam.
The Pelvic Examination as Show
Eloquent yet irreverent, the title of Terri Kapsalis’ 1997 book Public Privates: Performing Gynecology from Both Ends of the Speculum alone, is enough to demonstrate the issues of power and visibility related to this medical exam. Kapsalis’ professional, academic, and artistic career serves to illustrate how she came to conceive the examination of female genitalia from a performance angle. Kapsalis graduated in Performance Studies, worked as a gynecology teaching associate (GTA), was a member of a collective for women’s health, and an actor in an experimental theatre troupe. She possesses the theoretical and practical knowledge to highlight the power relations in play when a woman’s body is scrutinized in this particular setting.
Just like other feminist approaches in art history and drama or film studies (Rennes, 2016), Kapsalis (1997) assigns different roles to the observed woman and the one observing--the subject and the object. The one gazing, or rather, the person who claims the power of looking for themself, determines who is active and who is passive, in a sense similar to the “top and bottom” sexual dynamic that determines who penetrates. Traditionally, during a pelvic exam, the woman takes up a passive position both symbolically and literally, by taking place on the examination table in the lithotomy position, while the physician, by contrast, assumes an active position (Kapsalis, 1997). The frame of analysis of performance serves to highlight which presentation is judged acceptable for the patient-woman-object when she unveils her genitalia:
“In the public exam, the “exposure” is of the most troublesome and troublesome variety. The shame associated with an exposed vulva, or the mere suggestion of displaying the private part, is excruciating.” (Kapsalis, 1997).
The author Chimamanda Ngozi Adichie (2014) reiterates how shame and the fear of revealing one’s body is transmitted to women from childhood: “We teach girls shame. Close your legs. Cover yourself. We make them feel as though by being born female, they are already guilty of something.”
Medicine and the Construction of the Female
As previously explained (Part I), another parallel movement in the 19th century contributed to establish the gendered roles of object and subject: doctors’ appropriation of the knowledge and practices of midwives when gynecology was established as a discipline. From then on, the speculum became one of the most prominent symbols of medical power (traditionally male) over the female body (Kapsalis, 1997; Löwy, 2011). For other authors such as Marilène Vuille (2016), the existence itself of a specific medical field focused on the female body shows that gynecology is “an effective instance of the codification of femininity, of its cycles and stages.” Furthermore, researcher Ornella Moscucci (1990) questioned why an equivalent science that studies and considers men doesn’t exist (Vuille, 2016).
The pelvic exam, thus, is not only permeated by social attitudes towards the female body and sexuality—it also serves to reproduce these attitudes (Davis, 2011; Kapsalis, 1997).
The way in which male homosexuality was pathologized by psychiatrists in the 20th century exemplifies how medical declarations that are presented as scientific facts are sometimes rather an indicator of historical power discrepency and moral judgment. Despite power relations that are historically gendered, (male-physician and woman-patient), the professional title of gynecologist seems to be a greater element in determining the attitude of the examinator rather than the gender of the doctor (Kapsalis, 1997; Pizzini, 1991).
From Corpse-Woman to Teaching Assistant
The object of the gaze that is chosen in medical teaching leads us to situate the pelvic exam as the product of repetition; just like a play in theatre is the fruit of actions and words repeated many times. As a GTA, Terri Kapsalis is at once a teacher and an activist teaching the pelvic examination, by sharing knowledge about how the female body has been explored and treated historically. In the lithotomy position, women have been expected to embrace a passive posture and maintain their composure during gynecological exams. Implicitly, she is expected to be the ideal—or rather idealized—patient. The ideal patient is obedient, passive, and compliant (Kapsalis, 1997). Historically, she exists under various forms: the woman slave, the woman under anaesthesia, the corpse-woman, or the plastic woman (mannequin). Nowadays, model patients used for medical studies include mannequins, corpses, professional actors or GTAs. All, except the GTAs, are disadvantaged in the context of medical instruction, since they are devoid of emotion (feelings), sensorial perception (feeling), or are unable to authentically demonstrate these.
GTAs, on the other hand, play an active and curious role when applying their learnings: by playing the role of the patient, they have the opportunity to give feedback to other students and guide them during the pelvic examination. Through their role as instructor, they transfer theoretical and embodied knowledge of female anatomy. By teaching, the GTA encourages interaction with patients during future examinations:
“The GTA encourages students to continuously communicate with the patient, informing her as to what they are doing, how they are doing it, and why they are doing it.” (Kapsalis, 1997).
Including GTAs in medical teaching represents an effort to include the thoughts, feelings, and ideas of patients in medical education. This inclusion, however, has certain limits, in regards to the representation of the female body and sexuality in medical fields, according to Kapsalis. Although she shares technical and gynecological knowledge, the GTA must take up the passive role of object-woman, subjected to the clinical gaze.
Part III of this Manual proposes a brief analysis of Public Cervix Announcement, a performance work by Annie Sprinkle that makes use of the female body as a place of creation and subversion, outside of the medical field. Furthermore, many contemporary practices, inspired by the woman’s health movement and a DIY ideology, show that when used by feminists, the speculum can be a tool to question relations of gender and domination: it is an instrument that magnifies in order to better scrutinize them.
Adichie, C.N. (2014). We should all be feminists. New York: Anchor Books.
Davis, G. (2011). Health and Sexuality dans Jackson, M. (dir.), The Oxford Handbook of the History of Medicine. Oxford: Oxford University Press.
Kapsalis, T. (1997). Public privates: performing gynecology from both ends of the speculum. Durham: Duke University Press.
Löwy, I. (2011). A Woman’s Disease: The History of Cervical Cancer. Oxford: Oxford University Press.
Pizzini, F. (1991). Communication Hierarchies in Humour: Gender Differences in the Obstetrical/Gynaecological Setting. Discourse & Society, 2(4), 477-488. DOI: 10.1177/0957926591002004008.
Rennes, J. (2016). Introduction. La chair des rapports sociaux dans Encyclopédie critique du genre. Paris : Éditions La découverte, 13-25.
Vuille, M. (2016). Gynécologie dans Encyclopédie critique du genre. Paris : Éditions La découverte, 283-292.