Imagine this scenario: you are a black woman and you lay uncomfortably flat on your back with your legs strapped open. Slowly, you wake up from the poor anesthesia you were lucky to receive. You feel the cold sensation of the metallic instruments being inserted into your vagina and feel violated because you see someone who is not your doctor performing a medical procedure without your consent. This situation was not uncommon for the women of the twentieth century. Drexel University professor and former gynecological teaching associates (GTA), Dr. Kelly Underman, writes in her scholarly monograph, “Feeling Medicine: How the Pelvic Exam Shapes Medical Training,” on the horrific history and evolution of the pelvic exam. Dr. Underman analyzes life before gynecological training associates, the impact of the Women’s Health Movement in shaping modern-day pelvic exams, and the importance of building a doctor-patient relationship.
Kelly Underman is a woman from Rittman, Ohio who received her Ph.D. in Sociology from the University of Illinois at Chicago. She is a qualitative researcher and has an interest in researching medical sociology and how sociology plays a key role in the institution of medical schools. Her inspiration to conduct this research is derived from her first-hand experience of observing communities that have had the strength to grow and flourish despite living in the 1950s, where women were objectified for the purpose of gaining medical knowledge. Underman explains this throughout “Feeling Medicine: How the Pelvic Exam Shapes Medical Training,” where she highlights the Women’s Health Movement and how supporters of this movement challenged the healthcare system by drawing attention to issues that specifically women faced in medical practice. The Women’s Health Movement was powerful enough to defeat outdated practices that harmed women.
Before GTAs were introduced, medical students learned how to perform a pelvic exam from random patients in a waiting room, who were then treated as objects to gain knowledge. In chapter 1 of her monograph, Dr. Underman explains “A woman waiting in a public clinic…medical students examine her in exchange for her ‘free’ healthcare…become an object under medical gaze.” (25) During the 1970s and 1980s, women who were patients were dehumanized and not treated with appropriate care. Since medical students pursued a career to help people who are sick and improve their health, they should care about each patient they encounter, but this was not the reality for most women. Dr. Underman also elaborates on how medical students learned to do pelvic examinations on prostitutes and cadavers. The majority of the students cared more about receiving hands-on experiences on how to perform an examination rather than the importance of how their actions and attitude toward a patient influence a patient’s experience. The author argues that the students were not taught to be delicate with the instrument such as the vaginal spectrum and how inserting it the wrong way could potentially harm a patient. In Chapter 1, Dr. Underman states “… the expectation that women deserved to be in pain or could tolerate it without complaint – while those who could not [were] considered psychologically abnormal” (31). However, later in the book, you learn the risks that come along with poorly performed pelvic exams, which includes increased chances of infection if a physician does not wash their hands before treating a patient. In Chapter 3, “Other GTA’s told stories about students whose nails had not been properly trimmed and who, as a result, scratched their vaginal walls (107). Further, women of color were treated with less care than white women because doctors believed that Black people did not feel pain in the same manner because of the abuse they went underwent as slaves (29). Women who were mistreated by medical students rose up together and started a movement to help with the improvement of pelvic exams.
Dr. Underman argues how the history of enduring painful pelvic exams led to the uprising of the Women’s Health Movement during the 1970s. Feminist activists were frustrated by how horrible the gynecology system was and advocated for change. They learned how to perform abortions and pelvic exams on one another and developed the fundamental components that would later shape the creation of gynecological training associates. Followers of the Women’s Health Movement were taught how to properly take care of a woman during an examination. In Chapter 1, Underman states “In 1975, feminist activists embarked on a new way of teaching the pelvic exam…[to] challenge the dehumanization of patients during the exam” (34-35). Because of these activists, women now receive better pelvic exams than in the 20th century. In addition, in chapter 4, Dr. Underman quotes Lena, a GTA who states, “We’re there because we want to improve healthcare…” (136). Lena and other GTAs have heard multiple stories of women who have had a pelvic exam and details about how uncomfortable it was for them. Through these narratives, it motivated the GTAs to continuously put their genitals on the line to instruct medical students to positively alter the experiences of patients. This will make future patients less anxious to receive a pelvic exam and reassure them that the physician knows what they are doing and that they will be treated with empathy. Not only does GTA teach students how to do a pelvic exam, but also how to reduce their anxiety and increase their confidence, which in turn, decreases the chances of harming the patient. Thus, Dr. Underman thoroughly argues in her monograph how imperative it is to shape great physicians through the assistance of GTAs.
Dr. Underman elaborates on the importance of the doctor-patient relationship and how it was never taught until the creation of GTA. The experience for women used to be that physicians executed only their medical responsibilities, but the women were never given information about the procedure that was done on their bodies. However, GTAs teach their students the significance of “neutral touch,” which means placing a hand on the knee and providing a verbal warning before touching or inserting an instrument into the genitals (87). Having a connection between a doctor and a patient also improves the patient’s experience because having a conversation allows them to know what the physician is doing and enhances their level of comfort (123). Thus, the doctor-patient relationship is essential to ensuring patient comfort.
In my opinion, Dr. Underman does a great job of explaining her arguments and providing primary sources to support her claim. In every chapter, the author includes a quote from a medical professional like gynecological teaching associates and doctors or students to bring validity to her claims. Quotes directly from someone in the field also makes her arguments in the monograph more trustworthy and reliable because her interviewers give her direct information that reinforces her claims. The quotes that Dr. Underman provides are highly qualitative, but the reader may be persuaded more by numerical evidence.
A weakness of this source is that the author hardly uses statistical evidence. In the monograph, she elaborates on the enhancement of the pelvic exam but does not provide data on its impact nationwide. I believe that through statistics, the reader can understand more about how GTAs have improved the experiences of women compared to the early twentieth century. It would have been helpful to see a chart that analyzed women’s opinions on current-day pelvic exams, to see how much it has changed over time. For example, Dr. Underman could have researched data of the number of women involved in the Women’s Health Movement during the late 1970s compared to the 21st century after methods were improved. Including these statistics would have made Dr. Underman’s arguments stronger because her words would become more valuable and factual.
Overall, I enjoyed reading this book because, although it had flaws, it was still well-written and held my attention. I like books that make me stop and think and even frustrate me because it pushes me to continue reading. Through her inclusion of personal experiences and direct quotes from medical professionals, Dr. Underman showcased the history of the pelvic exam and the Women’s Health Movement. Anyone who is interested in reading about how the medical system has evolved would benefit from reading this book. Also, those who care about how training medical students in the medical field shape how they practice medicine and how their actions impact their patients would enjoy Underman’s work.
“Kelly Underman, Ph.D.” College of Arts and Sciences, Accessed 20 November 2022 https://drexel.edu/coas/faculty-research/faculty-directory/sociology/underman-kelly/#:~:text=Kelly%20Underman%20received%20her%20PhD,joining%20the%20faculty%20at%20Drexel.
“Kelly Underman.” STS Infrastructures, Accessed 20 November 2022 https://stsinfrastructures.org/content/kelly-underman/essay.
Underman, Kelly. Feeling Medicine: How the Pelvic Exam Shapes Medical Training. New York University Press, 2020.