Dr. Nelson Soucasaux , Brazilian gynecologist
As I observed in my first article on this subject published here at the MUM, by the Psychology of Gynecology I mean the study of the psychological dynamics of the gynecologist-patient relationship, as well as of the psychological peculiarities of the male and female physicians who practice Women's Medicine and also of the patients. I also emphasized that the Psychology of Gynecology must also seriously consider the study of the entire medical, scientific, psychological and socio-cultural context of Gynecology and Obstetrics, since the characteristics of such context are, to a great extent, determined by the psychological attitudes and systems of values of most physicians in these areas. As to this context, I always remark that it is replete with conceptual distortions and errors that come from long ago.
In most of my previous article, I have focused my attention on the analysis of the possible real motivations, at the deep psychological level, that lead physicians of the male and female gender to Gynecology and/or Obstetrics (the aforementioned study of the psychological peculiarities of the male and female doctors who practice Women's Medicine and their patterns of relationship with it). Now it is time to approach some of the other innumerable aspects of what I call the Psychology of Gynecology.
I have already observed that the psychological dynamics of the gynecologist-patient relationship is replete with subtleties and is extremely problematic, frequently acquiring neurotic patterns. In my book "Novas Perspectivas em Ginecologia" ("New Perspectives in Gynecology") I spoke about the existence of a considerable dissatisfaction with various aspects of the traditional gynecologic orientation on the part of many patients - not regarding its technical and scientific part but concerning the frequent absence of a more humanistic approach. The psychological dynamics of what happens between women (patients) and male and female gynecologists and/or obstetricians requires deeper and serious studies.
Women frequently change their gynecologist several times even in a short period of time, without "getting in tune with" or becoming satisfied with any one of them. Sometimes, this maladjustment is only due to one of the parties, but often it is reciprocal - not only does the male or female doctor not "get in tune with" the patient, but also the patient does not "get in tune with" the male or female doctor. Some of the reasons for this are: 1) the several distortions and errors that have been characterizing the practice of the speciality; 2) reasons of a personal kind due to a lack of affinity between the patient and gynecologist; 3) problems that frequently appear in the dynamics of the therapeutic relationship between them. Sometimes a relationship that should be therapeutic can become iatrogenic [doctor-caused problems].
As to the topic "affinity" between physician and patient, some important considerations must be done. Everybody agrees that, in Medicine, it is fundamental for patients to be "in tune" and feel well with their physicians and, if this does not happen, the patient who does not "get in tune" with a determined professional will search for another one sooner or later. The simple professional competence and qualification of the physician is not the decisive factor that determines the affinity or absence of affinity - though many people continue to be treated by a physician whom they do not "feel" very well with only because he or she is technically competent.
However, I want to make it clear that for the success of any therapeutic relationship in Medicine it is equally essential that the physician be "in tune," harmonize with, likes the person who he/she is treating or is going to treat, that the physician also have positive feelings of empathy in relation to the patient. It is also important that the doctor feels well assisting a determined person, in the same way that the person must feel well being assisted by him/her. The affinity must be reciprocal.
The importance of a reciprocal affinity between doctor and patient acquires very peculiar features in Gynecology. Therefore, in Women's Medicine we can say that, in the same way as there must be the "right" male or female gynecologist for determined patients, there must also be the "right" patients for a determined male gynecologist and for a determined female gynecologist.
A brief and introductory analysis of the possible real psychological motivations that lead male and female doctors to Gynecology and/or Obstetrics was made in my preceding article on the Psychology of Gynecology. In it I observed that I think that most of the male and female doctors who practice Women's Medicine are not entirely aware of these real motivations that led them to this area and that if we ask them why have they chosen to be gynecologists and/or obstetricians, they will answer presenting conventional medical reasons.
As to the very development of Women's Medicine, I believe that it could have started from the most varied motivations and reasons, many of them not strictly "medical" in the usual sense of the word. Concerning some of its possible origins, it is pertinent to quote an observation by Michel Foucault from his book "História da Sexualidade - A Vontade de Saber" ["The History of Sexuality - The Wish to Know"; read more about the book at the end of this article], in which he analyses several of the strategies used in the development of the knowledge about human sexuality. Foucault has described a process that he called "hysterization" of the woman's body, by means of which this body " was analyzed - qualified and disqualified - as a body completely saturated with sexuality." According to this author, "this body was integrated, under the effect of a pathology which would be intrinsic to it, to the field of medical practice."
To some extent this seems to me to be true, because there have always been strong psycho-socio-cultural factors that have contributed and continue to contribute to a "medicalization" of women. There is also a whole diffuse and polymorphic eroticism in this process. The only reservation I have is that Foucault did not take into consideration the existence of very important and real medical reasons, resulting from the complexity of female nature and which become manifest through the enormous quantity of disorders, diseases and gynecologic problems, that completely justify the special attention that Medicine has given to women in the course of its history.
However, an important detail to be emphasized here is that, in a culture that has always created interdictions against sex (though this is somehow attenuated nowadays), the physician is the professional who, through the practice of Medicine, has access to people's bodies - and, in the specific case of Gynecology and Obstetrics, to women's bodies.
Other aspects of the Psychology of Gynecology can help us understand the intricate and problematic dynamics of the gynecologist-patient relationship. The problems that the speciality deals with usually arouse the most varied reactions in people, including patients, male and female doctors and even laymen in general. This happens because Gynecology is obviously related to women and sex. Sexuality is a very important feature of human nature, and it always has considerable influence on the feelings, emotions and psychological attitudes of both sexes.
It is impossible for anybody to psychologically get rid of the sexual feelings and the emotions aroused by them. A person may not externalize, may not manifest what he/she is feeling, he/she may keep his/her feelings secret - according to the demands of situations in which the expression of some feelings is inappropriate or even inconvenient. Even so the person cannot avoid feeling them, as psychological phenomena that they are. Nevertheless, there is a mental "trick" which a lot of people, wrongly, make use of: it is to try to repress these feelings and emotions, pretending that they do not exist and throwing them into the unconscious. But now the problems multiply. Anything that is not brought to consciousness and exposed to reflection not only remains out of the control of consciousness and reason, but also starts acting as disturbing factors emerging from the unconscious. Frequently people do not realize that many troubles are caused by repressed feelings. A lot of prejudices aggravate the whole problem.
Gynecologic practice implies the exposition of the intimacy of the female body and the touch of parts of this body by the physician in order to perform the examination. This fact can arouse the most varied feelings, not only on the patients, but also in the male or female doctors, depending on the peculiarities of the individual psychology of each one of them. It is fundamental that gynecologists and patients are capable of dealing adequately with them at the psychological level.
Several kinds of projections, fantasies, conflicts and resistances appear on both sides of the gynecologist-patient relationship. Women frequently project on male gynecologists their problems concerning men and the way they view the male sex. Male gynecologists can also project on the patients their problems regarding women, as well as the peculiar way they view the female sex. Almost always, the psychological dynamics of these processes is not adequately brought to consciousness by either one of the parties and, because of this, several problems can appear, disturbing the treatment. As I already said, the gynecologist-patient relationship often acquires very neurotic patterns.
As I always emphasize, Gynecology is an extremely problematic speciality which, even so, neither becomes aware of this fact nor tries to place itself under discussion. It has always been astonishing to me that diverse subjects related to Women's Medicine are not discussed either within Gynecology or out of it. Some of the probable reasons for this can be: 1) the incapability to perceive determined facts and/or reflect about them; 2) not wanting to admit the existence of these facts, because they are "disturbing" for the present attitude of mind of most people; 3) the interests and conveniences of the medical ideologies and beliefs that dominate Women's Medicine.
*Foucault, M. - "História da Sexualidade - A Vontade de Saber" - Graal, Rio de Janeiro, 1980.
Note: the article above consists of excerpts from my book "Novas Perspectivas em Ginecologia" ("New Perspectives in Gynecology") ( http://www.nelsonginecologia.med.br/novas.htm ).
Copyright Nelson Soucasaux 1990, 2010.
Nelson Soucasaux is a gynecologist dedicated to clinical, preventive and psychosomatic gynecology. Graduated in 1974 by Faculdade de Medicina da Universidade Federal do Rio de Janeiro, Brazil, he is the author of several articles published in medical journals and of the books "Novas Perspectivas em Ginecologia" ("New Perspectives in Gynecology") and "Os Órgãos Sexuais Femininos: Forma, Função, Símbolo e Arquétipo" ("The Female Sexual Organs: Shape, Function, Symbol and Archetype"), published by Imago Editora, Rio de Janeiro, 1990, 1993. He has been working in his private clinic since 1975.
Web site: www.nelsonginecologia.med.br