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

A paradox exists in the field of the history of sexuality: more scholarly research has been devoted to understanding behavior considered “abnormal” and “deviant” than that considered normative. This is partly explained by the pioneering role of scholars of gay and lesbian history in the field. Another factor is the availability of source material, since court records, medical works, and even popular cultural texts tend to define the norm mostly by what they criminalize, pathologize, or marginalize.

In Prescription for Heterosexuality: Sexual Citizenship in the Cold War Era, Carolyn Herbst Lewis attempts to overcome this imbalance by studying the ways in which the medical profession helped to construct notions of sexual health and normality for white, middle-class Americans. Building on the extensive literature that establishes a connection between sexuality, gender, and the cold war state, Lewis looks at the role of family physicians in bolstering the heterosexual nuclear family—how they gave “sexual citizenship a biological and medical foundation” (6). Lewis’s major contribution is to historicize the notion of heteronormativity, demonstrating that doctors not only tried to contain deviant sexual practices but that they proactively sought to manage their patients’ sexual and gender roles in order to ensure their individual health, the success of their marriages, and by extension, the stability of the nation.

Outlining a history of the relationship between the medical profession and cold war sexual politics, Lewis argues doctors set themselves up as experts on “sexual defense” as part of their continuing efforts at professionalization. Doctors who practiced “general medicine” were becoming practitioners of “family medicine,” a designation that more closely paralleled other prestigious specialty fields. Asserting their moral authority over the sex lives of their patients was an integral part of this process. They were also trying to sure up their authority from those outside the medical profession who claimed to be experts on matters sexual, such as Alfred Kinsey. Lewis organizes her study by focusing on how doctors viewed four specific topics related to gender and sexuality—female frigidity, male impotence, premarital pelvic examinations, and artificial insemination.

Given the increasing influence of Freudian theories of psychosexual development, physicians in this period defined frigidity as a failure to achieve vaginal orgasm in the missionary position. They distained the clitoral orgasm as “purely physical” while lauding the vaginal orgasm as “predicated on emotional involvement” (61). Emphasizing female passivity as the road to maturity and good health, they maintained that women could not fake a vaginal orgasm—by sensing involuntary contractions, the man could tell when one had occurred. While they blamed women for this “failure”—allegedly experienced by at least one quarter of American women—they found that marriages “mixed” either by race, religion, or class contributed to the problem. As Lewis writes, “the ability to experience exclusively vaginal orgasms served as evidence of the extent to which a woman had adjusted to her role as wife and mother” within her proper social context (49).

If the vaginal orgasm was considered the key not only to domestic stability but to national security, as Lewis argues, male “erectile power” was a close second. When the much-discussed crisis of masculinity manifested itself in the bedroom, imaginative doctors proposed outrageous cures such as the “Coitus Training Apparatus” that guided the flaccid penis into the vagina or hypnotizing the wife to make her believe that one minute was really ten (91). Rather than blaming men, Lewis argues that doctors searched for ways to cushion the effects of male impotence and literally bolster their fragile sense of masculinity.

The use of artificial insemination for married couples where the husband was infertile offers a more complex case. By dispensing with the need for heterosexual intercourse, artificial insemination threatened to undermine the foundations of a monogamous, heterosexual domesticity. Yet physicians managed to use it to bolster cold war notions of domesticity by limiting the procedure to carefully screened married couples that modeled proper gender roles. Men...