Prescription for Heterosexuality: Sexual Citizenship in the Cold War Era by Carolyn Herbst Lewis (review)

Carolyn Herbst Lewis’s study of the role played by doctors and medical discourse in lending authority and scientific credibility to the sexual and gender norms of the Cold War era is a useful addition to the literature on this period. By 1945 American medicine had achieved a level of prestige and prosperity that had eluded all but a handful of practitioners in the profession’s earlier history. Effective new drugs, promising new cures, and well-funded research raised the visibility and the status of medicine and doctors to unprecedented levels. Medical consumers evinced a rising level of trust in medical experts and had more money to spend on medical care and advice than previous generations of Americans. For their part, doctors had become convinced that they had a civic mission in the Cold War to make sure the American population was healthy, numerous, and utterly prepared for the rigors of global competition with Communism, and they used their new authority to create standards and protocols that permitted them to intervene in the most intimate aspects of their married patients’ lives. Lewis has looked at an impressive number of national, regional, and state medical journals to sample mainstream medical opinion on the principal issues bearing on gender, marital fertility, and sexuality.

Lewis found that it was the general practitioners (GPs), with generally lower medical incomes and status, who led the way in offering medical advice to couples. GPs rechristened themselves specialists in “family medicine,” boned up on the behavioral sciences and psychoanalysis, and offered premarital and marital counseling to their patients. There was a vaguely eugenic aspect to all of it. Thirty-five states required venereal disease tests for the marriage license, and medical advisors focused on matters of sexual dysfunction such as impotence, sterility, and anatomical or emotional problems that could be treated with surgical or therapeutic procedures.

The greatest dangers to sexual competence and marital bliss were female frigidity and male impotence. Lewis makes it clear that for all the concern about premarital sex and adultery, postwar medical experts fully embraced sexual pleasure as a necessary bond in healthy marriages. Thus, despite resistance to the surprising rates of premarital sex and homosexuality cited by Kinsey in his studies of male and female sexuality, most physicians agreed that the dangers arising from sexual continence were as great as unrestrained lust. Though fewer women were virgins on their wedding night than before, medical advisors worried about the traumas that might result from a rapid or clumsy sexual initiation, leaving a damaged, sexually frigid wife and a resentful and frustrated husband. One of Lewis’s most original chapters explores the importance placed on a premarital pelvic exam, in which a woman’s fears about penile invasion might be allayed by “gentle” vaginal penetration designed to reassure her.

Indeed, Lewis has found that the sexual ideology that underlay the entire postwar project of sexual satisfaction, and thus marital stability itself, was the attainment of a woman’s vaginal orgasm and ejaculatory competence in men, in other words, sexual activity that maintained the historic tie of sexuality with reproduction. According to the medical acolytes of Freud, clitoral stimulation that led to orgasm was a potentially perverse and, in any case, less pleasurable alternative to the vaginal variety. It could conceal a woman’s secret fears or rejection of motherhood and affect her husband’s ability to achieve and maintain an erection. Despite much evidence that there was no meaningful distinction between clitoral and vaginal orgasms, the medical advice columns and sex manuals of the period widely endorsed this norm of sexual competence, together with blunt warnings about the deviations that could disrupt it. The list was long. A woman’s sexually aggressive behavior could provoke impotence in her spouse, but so could her commitment to a career, an interest in sports, traveling alone, or other departures from the gender norms of the era. Men...