The sociologist Aurore Koechlin presents in her book The Gynecological Standard (Amsterdam, 320 pages, 20 euros) the result of several years of investigation among health professionals and patients in medical gynecology. As a researcher and feminist activist, she examines the mechanisms of gynecological follow-up and its effects.
What is the “gynecological standard”?
I define it as the norm that enjoins women to regularly consult a health professional for gynecological follow-up, centered on contraception and screening (smear, breast palpation). The particularity of this follow-up is threefold: it is regular – ideally once a year –, it is not based on a specific reason for consultation, finally, it focuses on the healthy body throughout life.
The gynecological consultation is often presented as a banal, self-evident act. Does this prolonged medicalization produce effects on patients, according to your analysis?
The gynecological consultation is a fundamentally ambiguous space for women. It makes it possible to screen for potentially extremely serious diseases and cancers. It provides a sometimes significant resource in terms of information and knowledge about the body, contraception, etc. But at the same time, it becomes the vector of social norms that are little questioned.
One of them, the preventive norm (which implies that every individual must be screened when he behaves at risk or when he belongs to a population at risk) translates into an extreme empowerment of patients in the management of their body and their health. They are thus placed in an in-between between the ability to act on health and maintaining the status of profane, which is precisely the source of anxiety, present even in a diffuse way, in a large part of them.
In your book, you wonder about cases of gynecological violence. The term itself, however, is recent: how to define them? What is it about the relationship between patient and practitioner that makes their existence possible?
A central element in defining gynecological violence is the non-respect of the patient’s consent to the acts performed, in particular to the gynecological examination. As for the conditions of possibility of these situations (very few), I develop three of them in the book: firstly, the consultation itself, which constitutes a habituation to pain, which can then be perceived as normal both by the the professional than by the patient. Secondly, the working conditions, which, when they are accelerated, reinforce the automatisms of the gynecologists and make it more difficult to analyze the situation. And finally, medical universalism, this ideal of neutrality and non-judgment which is the basis of the modern definition of the doctor. Even if it starts from a good intention, this universalism has the paradoxical effect of wanting to treat the genitals like any other organ. But this goes against the grain of the feelings of some of the patients, who say they experience the consultation as a moment whose gendered and potentially sexualized dimension can never be completely erased.
You have 40.04% of this article left to read. The following is for subscribers only.