History shows that for better or worse, Alabama was the birth place and slavery the mother, of modern gynecology.

If building the great pyramids had required the physical labor of women, gynecology would have been invented thousands of years ago. Instead, the birth of gynecology would have to wait centuries, for a prime time in history when women and men were equally subjected to punishing labor, to a time when one less bended back in the field meant cotton unpicked and money unearned, to a time when early and frequent slave pregnancy provided a master with more able bodies to be worked or sold, to a time when women unavailable for the field due to childbirth and its complications lowered productivity, to a time when the enterprising capitalist gentlemen of the antebellum south felt enough of a squeeze in the pocketbook to look into what could be done to combat those pesky women’s problems. History shows that for better or worse, Alabama was the birthplace and slavery the mother, of modern gynecology.

For the slave states it was good economics to minimize the complications of childbirth. After 1808, the US Congress forbade further importation of slaves to the US and as a result the only new blood for the system arose from the reproductive capacity of those already in bondage. Without access to new slaves from abroad, reproduction was the sole means of maintaining both the slave labor pool and the southern way of life. For their owners slave women were doubly valuable as laborers and as breeding stock. A doctor would often contract with a slaveholder to provide medical care for indentured women thus ensuring both slave fertility and the slaveholder’s profits. One such doctor was Marion Sims. Practicing in Alabama in the 1840’s, Sims was nothing if not innovative. Today, when a patient is positioned for a rectal examination they assume the Sims position, a left lateral position with the right knee drawn up and flexed. When a vaginal or cervical examination is performed on a female in 2013, the speculum used is not dissimilar from the Sims prototype devised from 2 bent spoons. When a patient has a wound sutured the principle of using a sterilized silver suture comes from Sims. All of these techniques have their origin in the experiments Sims performed on slave women suffering from the complications of labor.

The conundrum associated with medical advancements under such circumstances is that they were achieved disregarding the principles of beneficence and autonomy, that is, indentured women had no choice. For example, while refining the technique for a new procedure (incontinence repair) Sims operated on one particular woman on 30 occasions (He purchased a number of his slave patients from their slave holders for easier access.) over a 3-year period. Although ether was available, its use was not considered necessary for slaves although it was regularly used for the same procedures on white women of “a better class”. By today’s standards the ethics of Sims’ advancements in the field of gynecology leave much to be desired. Nevertheless, if you are interested, you will find a statue of Marion Sims near Central Park, NYC as well as in Alabama and South Carolina.

Until Marion Sims, women and their obstetrical/gynecologic problems were largely ignored. The Romans took interest for a time, creating an obstetrical treatise entitled (I’m not kidding) Soranus. Civilized societies used this same manual for all things female for the next 14 centuries. True, that it was updated in 1540 to become The Byrthe of Mankynde, but that was pretty much it until Sims came along. There are, however, a few important updates that have occurred over the centuries that are worth mentioning. These include the forceps delivery (pioneered by Peter Chamberlen (1560-1631) and then kept secret by his descendants for the next 125 years), and the discovery that hand washing between vaginal examinations proved to be an effective way to reduce infection complications (fetal and maternal death) in obstetrical patients.

History shows that female circumcision was also advocated in 19^th century Western liberal democracies in the form of clitoridectomies. Victorian physicians proposed removal of the clitoris as a cure for “female hysteria, nymphomania and the dangers of female masturbation”. In 1858, British physician Isaac Baker-Brown, championed removal of the clitoris stating: “intractable women become wives; rebellious teenage girls settle back into the bosom of their families and married women formerly averse to sexual duties become pregnant”. Medical textbooks discontinued such recommendations, but shockingly, not before 1937.

When women look back on the medical history surrounding their sexuality and “female problems”, they will discover it is a troubling history at best. Upon reflection, we all must quietly remember and give thanks to the exploited slave women who suffered for our benefit. Much progress has been made in the field of women’s reproductive health but it would not be unrealistic to admit that for most of history, women and their issues have been both ignored and misunderstood.