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Women have long been seen as at the mercy of their biology.

In the ancient medical world it was believed that a 'wandering womb' caused suffocation and death. Menstruation and pregnancy were thought to make women the weaker sex, both physically and mentally. By the late nineteenth century, it was deemed scientifically proven that women’s biology made them less rational than men, unfit to participate in many areas of public life.

Rising above these attitudes, a century ago, women began securing the right to vote in the UK. Around the same time, nursing was formalised as a predominantly female profession. Since then, nurses have taken a leading role in challenging assumptions of women’s health.

Yet myths and misconceptions remain widespread. Social changes continue to alter women’s biology, as they start periods earlier and live longer beyond the menopause. What is ‘normal’ for women? And why has women’s health long been considered 'dirty' nursing'?

Did you know: Gynaecology is a Greek term literally meaning 'the study of women'. And hysteria is derived from 'hystera' meaning womb. This linguistic association between women’s health and hysteria is still in use today in the term hysterectomy.

Artwork

Title text saying: Blood and biology

Decisions about women’s health have historically been made by men.

For the Victorians, the menstrual cycle was considered a disease. Women found all sorts of ways to find out more about their periods and learnt from female relatives. Some would even source secret texts on women’s health, often disguised in the dust jacket of more ‘acceptable’ reading material.

How did nursing change this? As the role of women in health care grew, so did an understanding about women’s health and biological cycles. Nurses became advocates for women, in a position to air previously hidden topics. 

The introduction of the contraceptive pill in 1961 changed when and how much women bleed. It helped move away from medically assumed norms to cycle lengths and flows unique to the individual. More and more women were able to better predict the symptoms of their own biology.

Women today have more control over their periods than ever. Bolder attitudes have seen campaigns to abolish the ‘tampon tax’ and charities working to ensure all women get access to menstrual supplies. Nurses play an important part in this changing atmosphere. As more non-surgical options have become available for women, like mirena coils and hysteroscopy, nurses have been at the  forefront of embracing and delivering these treatments.

 

Image: Diagrams of the female pelvic organs, 1960s. From the 1940s, big brands made educational kits for schools. This one was produced by Tampax, New York. RCN Archive.
Advice pamphlets for periods and contraception 1950s and 1960s RCN Archive. Photo credit: Justine Desmond. Dr Williams pink pills for pale people, late nineteeth century. Advertised as an iron rich tonic for the blood, these pills claimed to be a miracle cure for a variety of ailments, including anaemia, hysteria and ‘change of life.’ Loaned from the Royal Pharmaceutical Society. Photo credit: Phil Coomes. The Works of Aristotle the Famous Philosopher 1855. The dust jacket disguises this book’s contents, which cover uterine dropsy, labour and ‘testicles in women.’ Today, information is much easier to find. Photo credit: Phil Coomes. Sample from Jubilee, by Pharmacopoeia, 2000. Jubilee is a dress made using 6, 279 contraceptive pills; the number of pills needed to provide contraception for a woman from the age of 22 to 50 years old. Loaned by Pharmacopoeia Liz Lee and Susie Freeman. Photo credit: Justine Desmond.

title text saying: hot flush

Nursing today focuses on the holistic management of menopause. This can include managing lifestyle changes and advising on prescribed medication such as Hormone Replacement Therapy. Because the effects of menopause are so complex, Clinical Nurse Specialists (CNS) are key at this advanced level of practice. Taking time to understand individual patient concerns and providing tailored support are crucial nursing skills.

A Victorian woman going through the menopause was often considered to be emotionally unstable. During this 'climacteric period', she may well have been prescribed leeching or bloodletting from the ankle. Her doctor would have advised against reading novels, going to parties and dancing. For a 45 – 50 year old Victorian woman, an onslaught of instability and madness was considered inevitable. 

In the Victorian age men were also diagnosed with climacteric insanity, as something that was defined as a broad spectrum of 'changes' in life. But men were not diagnosed as frequently as women. Today, the possibility of 'man periods' or the 'male menopause' are widely discussed, as hormone fluctuations in men are also recognized.

Womens health hot flush

Image: From the cover of pamphlet on 'The Change of Life in Women', 1950, issued by the Central Council for Health Education. RCN Archive.
Jean Wilson's nursing notebook, 1929. Gynaecological illustrations of the female genitals. RCN Archive. Amulet to prevent miscarriage, Egypt, nineteenth century. Wearing this amulet was believed to protect a pregnant woman from complications during pregnancy and birth, including miscarriage. Loaned from the Science Museum. Photo credit: Phil Coomes. Jar containing Lapis Aetites the Eagle Stone early eighteenth century. Believed to ‘facilitate birth if tied to the thigh of a woman in labour' and 'hinder miscarriages if tied to the arm.’ Loaned from the Royal Pharmaceutical Society. Photo credit: Phil Coomes. Menformon Organon ampoules, c1938. This oestrogenic hormone is an early example of hormone replacement therapy, prescribed for 'climacteric symptoms' as well as to prevent 'premature birth.' Loaned from the Royal Pharmaceutical Society. Photo credit Justine Desmond.

Hidden loss

Pregnancy loss is more common than is discussed.

Even today, some causes of miscarriage are not known. Plenty of preventative measures have been tried and tested by women all over the world for centuries. Ancient Egyptian women were known for placing protective amulets in the vulva and women of Ancient Greece would avoid bitter foods. Practically any action taken by a woman in the Middle Ages could be seen to prompt a miscarriage, making her choices wholly responsible for the outcomes of her pregnancy.

In the nineteenth century, anything from exercise, worry, even failure to meet the demands of home life was blamed. Whilst these beliefs are centuries past, the idea of miscarriage as being the ‘fault’ of the woman still exists. Stigma around miscarriage and ectopic pregnancy continues

Nurses are breaking this stigma.

The focus has shifted from the physical health of women to their emotional health. Specialist nurses within Early Pregnancy Units are leading on assessing, scanning and undertaking treatments. Counselling and strong links with support groups and charities are all part of providing expert care for their patients.


"By allowing my own experience to be reported I hope…that I might contribute in a small way to a future climate in which these matters are respected as entirely personal – rather than pored over and speculated about as they are now.”

- Scotland’s First Minister Nicola Sturgeon, 2016

Title text saying: Gynaecology and cancer

In 1895, Dublin nurse Alice Beatty took her surgeon, Charles Cullingworth, to court.

Cullingworth operated on Beatty for 'ovarian disease', but removed both her ovaries rather than the one she had consented to. Beatty, engaged to be married and keen to start a family, claimed damages for a wrongly performed operation. She lost the case.

Victorian surgery, prescribed and performed by men, was often extreme. Hysterectomy was the treatment of choice for cervical cancer, even when death rates were high. Consent and the social and psychological effects on women were barely acknowledged. 

With the advent of new procedures, such as endometrial ablation, hysterectomy is no longer the only option. Now, Clinical Nurse Specialists (CNS) are essential in delivering and supporting these new treatments and at the same time, ensuring the rights and wishes of their patients are met. 

Gynaecological cancers are complex and the nursing role is expanding. Nurses take the majority of smear tests. They have a large role in the diagnosis of cervical cancer, from screening through to colposcopy, as well as spotting cancer reoccurrence. A CNS remains with their patient for the whole journey, from diagnosis, treatment and managing the long term effects. Unlike Alice Beatty, women now have increasing opportunities to take more control over their own care.

 

Image: Surgical instruments for the dilatation of the cervix and curettage of the uterus, Gynaecology for Nurses, 1943. RCN Archives.
Sims, Fergusson and Weiss specula 19th century. Various designs of specula have been tried and tested over the years. A speculum is used to hold vaginal walls open for procedures including cervical smears. Loaned from the Royal College of Obstetricians and Gynaecologists. Photo credit: Phil Coomes. Robert Barnes' notebook on cancers in women, 1859. Research notes and illustrations compiled by gynaecologist Robert Barnes, including urogenital and breast cancers. Loaned from the Royal College of Obstetricians and Gynaecologists. Robert Barnes' notebook on cancers in women, 1859. A look at the inside. Loaned from the Royal College of Obstetricians and Gynaecologists. Marvel Whirling Spray vaginal douche c1900. The booklet describes vaginal douching as ‘woman’s best safeguard against uterine cancer’ and asserts that ignorance of the use and importance of vaginal douching leads to ‘misery, woe and utter despair’. Loaned from the Royal Pharmaceutical Society. Photo credit: Phil Coomes. Marvel Whirling Spray vaginal douche c1900. The booklet describes vaginal douching as ‘woman’s best safeguard against uterine cancer’ and asserts that ignorance of the use and importance of vaginal douching leads to ‘misery, woe and utter despair’. Loaned from the Royal Pharmaceutical Society. Photo credit: Phil Coomes.

Title text saying: Do you find any of this dirty?

We all need to speak more openly about intimate health issues.

Women's biology has long been subject to speculation, comment and often control by others. It is now time for menstruation and menopause to be understood and celebrated as a normal part of female biology. 

In a field previously dominated by the perspectives of male doctors and physicians, all nurses now have a responsibility to advocate for women today. It is up to healthcare workers to recognise that each woman is different and that ‘normal’ means healthy.

Perhaps for the nurse, it is the ‘dirty’ nature of gynaecology which makes the role so unique, helping to transform a woman’s experience.

A stylised image of a uterus, tubes and ovaries with a multi-coloured background
This exhibition was curated by the RCN Women's Health Forum, the History of Nursing Society and Library and Archive Service. With thanks to our lenders: The Science Museum Group; Royal College of Obstetricians and Gynaecologists;  Royal Pharmaceutical Society and Pharmacopoeia duo Liz Lee and Susie Freeman. Exhibition webpage built by Kat Black.