Prescription for Heterosexuality: Sexual Citizenship in the Cold War Era (review)

Those inclined to wax nostalgic for the good old days of the family practitioner would do well to read Prescription for Heterosexuality, which traces the postwar development of family medicine and its accompanying policing of heterosexuality and sexual behavior. Relying on a broad array of sources, including medical journals, popular periodicals, and marriage and sex manuals, Lewis makes a compelling case that the white men in the lab coats reinforced their authority and professionalism by linking heterosexuality to citizenship and femininity to submission, sexual and otherwise.

In the aftermath of World War II, physicians in the United States attempted to claim greater cultural authority and stake out their territories. An identity crisis in the profession pitted general practitioners against the specialists who had bolstered their levels of expertise and their fee structures during the war. In 1950, for example, general practitioners earned only 30 percent of that earned by specialists. With the Freudian turn in the culture, generalists garnered the opportunity to transform their work into a new form of specialization, family medicine. Americans developed a greater willingness both to address what had previously been deemed personal or family issues, including sexuality, and to solicit expert advice from a growing array of secular rather than religious figures. This, coupled with physicians' own increasing ability to speak with authority about issues moral as well as scientific, pushed the process along. At the same time, doctors claimed a role as defenders of an American way of life; with their help, everyday citizens would claim physical and sexual health a fundamental bulwark against the elusive but seemingly ever-present communist threat.

In a series of four chapters, Lewis explores frigidity, impotence, the premarital pelvic exam, and artificial insemination. The discussion of female frigidity typifies her approach, which is to reveal the tensions between Americans' increasingly liberalized practices of sexuality and the cultural imperative, driven by cold war fears, to reign in behaviors. In the case of frigidity, the medical community sided with the "followers of Freud" rather than the "disciples of Kinsey" (p. 67) and declared the vaginal orgasm the mark of a mature, sexually satisfied woman. As a result, they were met with increasing numbers of so-called frigid women and significant resistance to their dictates. Medical journals reveal a slow and gradual untethering of this imperative, but while physicians acknowledged clitoral pleasure they largely attempted to keep it, and by extension women, subservient to the fairly passive, vaginal orgasm. In doing so, ironically, they also kept men, already deemed vulnerable to the emasculating dictates of communism, hostage to an almost impossible definition of masculinity. In this formula, real men ensured their wives' overall happiness by bringing them to vaginal orgasm on a fairly regular basis.

Lewis by and large explores territory already covered by historians of the long decade of the 1950s, but by paying close attention to a variety of sources from the medical community she adds to our understanding of the complicated context in which this prescriptive literature asserted its credibility. Readers will likely be familiar with the work of Helen Deutsch, for example, but less familiar with Nadina Kavinoky, who developed the model for the premarital pelvic exam, and Myrtle Mann Gillett, who argued that women's lack of sexual desire was often due to neglect by their husbands rather than any psychosexual shortcomings inherent in American femininity. Lewis also explores in detail issues some might have thought emerged later than this period, including the treatment of infertility. Her discussion of heterologous artificial insemination (AID) reveals a fascinating interplay between physicians' roles as scientists and as arbiters of gender relations in families.

Prescription for Heterosexuality is a slim volume, however, and the reader is left wishing for a bit more to distinguish this work from its predecessors. Further attention to race and social class, by making better use of Rickie Solinger's work, and by widening the net of popular...