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By Stacy Tessler Lindau, MD, MAPP

I am 20 years into a career as an American gynecologist, with a specialty in helping women with cancer recover their sexual function. I practice in a predominantly Black community on Chicago’s South Side, with mostly Black nurses and many (but not enough) Black colleagues and trainees, and have both trained and worked at elite academic medical schools. Beyond my clinical practice, I have engaged in research, community advocacy and philanthropic activities aimed at mitigating racism and marginalization in our society.

Yet, for all this experience, I have been ignorant of the specific ways that enslaved Black women and girls were exploited by this nation’s early gynecologists – mostly white men who built their careers and credentials on the foundation of female bondage.

This changed just a few months ago, when I read medical historian Deirdre Cooper Owens’ Medical Bondage: Race, Gender, and the Origins of American Gynecology (University of Georgia Press, 2017), which chronicles how and why the white “fathers” and founders of gynecology built the field on enslaved Black and also marginalized Irish immigrant bodies, beginning in the 19th century.

In this powerful book, Professor Cooper Owens exposes the horrifying origins of the modern gynecologic examination, routinely performed and perfected on Black women by white men gynecologists for white slave owners “to ascertain whether a woman would be an economically sound investment.”

Also chilling: The founding fathers of gynecology joined with other slave owners to espouse the dangerous and enduring myth that Black women are not only impervious to pain, but they lack the ability “to distinguish between corporeal pleasure and pain.” This myth was used to justify exploitation of Black bodies to study gynecologic diseases and innovate “sexual procedures” - like repairing holes between the bladder and vagina - and other surgical treatments without anesthesia or consent.

As Professor Cooper Owens recounts, white gynecologists promulgated a “hypersexuality” myth to explain high birth rates among Black women who, in fact, were forced to the limits of reproduction – including by rape – for their enslavers’ economic and sexual benefits. Indeed, as Professor Cooper Owens writes, “[e]nslaved women’s anatomies would determine if an owner’s wealth increased through her sale or whether a physician’s good reputation stayed intact.” Thus, a gynecologist’s reputation – and presumably his wealth – was built on the ability of his gynecologic exam to predict the sexual and reproductive success of the vagina, uterus and ovaries of his Black enslaved subject. When he discovered defects, the early gynecologist profited again by subjecting slaves to surgical and medical experiments that attracted students and advanced his scientific reputation. Later, once freed from slavery and therefore no longer of economic value to white men, Black women and girls were subjected to coerced sterilization.

Professor Cooper Owens’ book should be required reading in medical education and practice. Really, anyone who benefits from Ob/Gyn consultation or care should know this history.

Caring for Black women with sexual, reproductive and other gynecologic concerns includes laying our hands on their bodies, performing internal gynecologic exams and speaking to them about the details of their sexual lives. Do doctors and nurses recognize that, when we examine or query a Black patient, she has legitimate cause to question her safety? Do white clinicians consider that the history and myths might lead her to think our interrogation is a way we determine whether she is worthy of our concern? In the words of Dr. Monica Christmas, my Ob/Gyn colleague and an expert on menopause: “The legacy of slavery negatively shapes how the world sees Black women and, unfortunately, how we see ourselves.”

Could these medical myths about Black women help explain outrageously high rates of Black maternal mortality two centuries later? I think it’s likely so.

As we celebrate Black History Month, I’m reminded that my white son’s birth 20 years ago benefited from lessons white doctors learned on and from my Black sisters and their mothers and daughters. Our lives cannot be separated from their unimaginable suffering and the legacy of cruel injustice. While we should be inspired by the strong will, “audaciousness,” “resilience and physical prowess,” of the women whose bodies birthed the Ob/Gyn profession – that, too, is part of their story, as Cooper Owen makes clear – we can never repay the deep debt. What we can do is learn from this history and teach it.

Recently, Professor Cooper Owens addressed the University of Chicago Department of Ob/Gyn, part of a grand rounds series focused on racism in women’s healthcare, and afterwards, I had a chance to I ask her whether there was any movement for reparations or truth and reconciliation by the Ob/Gyn profession with Black women. I understood her answer to mean that such a movement is needed. I agree, and the time is now.

What might this look like? To start, repair would require us to examine whether we might unconsciously ascribe less suffering to a Black woman’s loss – whether it’s her sexual function, her fertility or her pregnancy. Truth demands we examine the ways that myths about Black women’s sexuality and pain might bias our care.

In nearly 15 years of caring for a wide diversity of women with cancer seeking help to recover lost sexual function, I have seen no difference in patterns of sexual desires or difficulties by the color of anyone’s skin. In fact, the lesson in the privilege of caring for my patients is how much alike we all are. We all want to feel whole, human, feminine, desire and desirable. We want to be loved and to love. We want pleasure, not pain. We want safety, not danger. Even in the face of life-threatening illness, often times complicated by financial strain, loss of employment, emotional distress, we prioritize our sexual and reproductive functions because they are so essential to our physical and emotional and social health. In my experience, these feelings know no racial or ethnic or political or religious bounds. They are unifying, human feelings.

Our shared mission must be a health care system rooted in the truth of our common humanity, while owning our sordid past. Professor Cooper Owens’ work, by teaching us where we have been, helps us know where we have to go.

Stacy Tessler Lindau, MD, MAPP, is a tenured professor and practicing physician at the University of Chicago, where she leads the Program in Integrative Sexual Medicine. A practicing gynecologist, she is also the director of WomanLab, a virtual platform to promote preservation and recovery of female sexual function after cancer and across the lifespan.

She wishes to acknowledge Doriane Miller, MD and Priscilla Agbeo, BA for their review of earlier drafts of this essay.