Prescription for Heterosexuality: Sexual Citizenship in the Cold War Era

CHAPTER 4. The Premarital Pelvic Examination

Chapter 4 The Premarital Pelvic Examination In 1956 Henry B. Sa≠ord, the regular medical advice columnist for the Ladies’ Home Journal, related the story of a couple who came to his practice three months after their marriage, desperate for his help. After first talking with the husband and wife individually and as a pair and then performing a thorough gynecologic exam on the wife, Sa≠ord concluded that the couple’s troubles could be traced to a variety of factors inhibiting the wife’s sexual function. The physical condition of her excessively rigid and intact hymen was compounded by her fears of pregnancy and a deplorable lack of adequate sexual education. “If I could have had you here for premarital examination a few months ago,” the doctor chastised, “I believe a great deal of trouble could have been avoided.”1 Once the woman’s problems had been explained and corrected, the couple was able to start anew on the path to marital happiness. Their marriage had been saved, and someday they would be able to become parents and help raise another generation of healthy and well-­ adjusted Americans. Other couples, Sa≠ord warned, were not so lucky. Intervention— ​ if it happened at all— ​ was often too little, too late. The moral of this lewis—final pages 95 96 the premarital pelvic examination article seemed to be that, in the matter of marital sexual adjustment, an hour of prevention could ensure a lifetime of satisfaction, not only for the sake of the couple but for the nation as well. Numerous articles published in medical journals by Sa≠ord’s colleagues echoed this opinion. In the postwar decades, physicians’ commitment to premarital counseling centered on a state-­ mandated venereal disease (vd) screening, and by 1954 thirty-­ five states had laws that required couples seeking marriage licenses to present a health certificate from their physician. “Thus,” wrote the editors of jama, “the legal machinery is set up to bring young people to the physician before marriage, at a time when ignorance and fear about sex can be evaluated most easily and, hopefully, overcome.”2 Although control of vd was the original intent of the laws, physicians acknowledged that, in their view, “the clear objective [of the premarital consultation was] to foster and preserve a sound family unit, a happy marriage, and healthy children.”3 The enthusiasm that general practitioners, as well as obstetrician-­ gynecologists such as Sa≠ord, expressed for the premarital consultation reflected the profession’s concern with the family as the locus of psychosexual development. In the postwar decades, expectations of psychological health expanded to include not only an absence of insanity but also of maladjustment . In particular, sexual behavior became an indicator of overall psychological health.4 The rejection of more than 1 million men from military service due to mental and neurological disorders, coupled with those dismissed for being homosexuals, suggested to many in positions of power that the mental and sexual health problems of individuals were adversely a≠ecting the nation. As gynecologist Nadina Kavinoky observed in a lecture given to medical students during the Second World War, “Wartime with its mobilization of millions of men reveals the failure of many parents in preparing their sons for life.”5 As a whole, the medical profession was in agreement that prevention was just as important as treatment. Because the family played a pivotal role in Freudian theories of psychosexual development, the home quickly became the main bastion against homosexuality and other psychosexual disturbances , such as frigidity. This focus on the family made general practitioners the primary source of medical intervention. Obstetrician-­ gynecologists, who had only recently split from general surgery, were a close second. If they were successful, the thinking went, then the healthy families they produced lewis—final pages 96 the premarital pelvic examination 97 would nurture healthy individuals. These families would serve as the building blocks of a healthy community and, by extension, a healthy nation. These concerns were expressed in the physician’s construction of the premarital consultation, a program of medical-­ based sexual instruction that physicians envisioned as a means of ensuring both the psychosexual adjustment of their patients and the stability of their patients’ marriages. Although not all doctors favored the state-­ mandated premarital examinations, the strongest voices were those that advocated using the premarital consultation— ​ particularly the pelvic exam that it included— ​ as part of a larger program...