For centuries, medicine in Europe treated women's bodies as governed by reproductive organs that were understood to be volatile, according to Alison Downham Moore, a professor of history and medical humanities at Western Sydney University. In a new analysis, she argues that to counter medical misogyny, women can no longer be treated as unreliable witnesses of their own experience.
The History of Gynaecology and Its Problems
The history of gynaecology fuses innovation, authority, and violation, and radical surgery is not the unavoidable answer to suffering. Until recently, polyendocrine metabolic ovarian syndrome was reduced to ovarian cysts, frustrating many patients with this systemic endocrine condition. Similarly, struggles for people with endometriosis to access patient-centred care continue in many countries.
These examples highlight the despair many patients face when seeking hormonal and reproductive healthcare, as described by the Australia Institute. This is not merely a matter of a few bad clinicians; it is part of a long pattern where medicine has repeatedly treated women's testimony as unreliable, women's pain as less urgent, and women's reproductive bodies as available for unwarranted surgical intervention.
Whose Knowledge Counts?
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 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. 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 became targets for experimental treatments and commercial exploitation.
Durable Logic of Profit Over Care
The underlying logic has proved remarkably durable: women's health is fodder for profit-based medicine, while their symptoms are attributed to hormones, nerves, emotions, or reproductive organs. Contemporary complaints about gaslighting in medicine, obstetric violence, the exploitation of young women's bodies for IVF, and the growth of privacy-invading femtech industries are not radical breaks from history but new chapters.
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. This has led to 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: A Case Study
Gynaecology offers a powerful case example because its history starkly reveals the fusion of innovation, authority, and violation. This history disrupts the 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 shaped by misogynist assumptions about marital authority and medical prerogative rather than autonomous choice.
Rise of Modern Gynaecology
Through the rise of modern gynaecology, women's reproductive organs came to be treated as the cause of wide-ranging illness and disposable once they seemed redundant. By the late 20th century, this attitude resulted in more than a third of all women in the West having hysterectomies by old age. When hysterectomy rates began to decline, some medical researchers warned that cancer rates would rise if women kept their uteruses. As late as the 1970s, US surgeons proposed hysterectomy as the treatment of choice for lower-class women thought unable to manage contraception. The same rationale contributed to the sterilisation of First Nations and Black women in many countries.
Hysterectomy has not been one stable intervention. It has served as therapy, cancer prophylaxis, gender transition surgery, covert Catholic contraception, population management, and administrative convenience. Its history cannot be traced by technical refinement alone.
Present-Day Concerns
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 where patients are not fully informed of alternatives, long-term effects of radical intervention are downplayed, and clinical authority still 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 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, this should not be dismissed as anecdotal dissatisfaction. It raises the question of whether medicine has relinquished one of its oldest habits: treating patients not as persons but as units in a population quantum.
Progress and Justice
This is not to claim that nothing has changed. Surgery is safer, many clinicians are 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.
