The neglect of female bodies in medicine has a long history. The male-default bias, writes Caroline Criado Perez in Invisible Women, “goes back at least to the ancient Greeks, who kicked off the trend of seeing the female body as a ‘mutilated male’ body (thanks, Aristotle)”:

The female was the male ‘turned outside in’. Ovaries were female testicles (they were not given their own name until the seventeenth century) and the uterus was the female scrotum. […] The male body was an ideal women failed to live up to.

As Criado Perez notes, this bias lives on in male-centric medical research and undifferentiated treatment recommendations. “Women are dying,” she notes, “as a result of the gender data gap.” The belief that there is nothing specifically different about female people — cut a bit here, add a bit there, and we’re the same as men — has led to our symptoms being ignored and our pain dismissed. 

Over the past few years, there have been a number of books — Elinor Cleghorn’s Unwell Women, Cat Bohannon’s Eve, Leah Hazzard’s Womb, to name a few — which have aimed to correct the imbalance. This is important both to save lives and ease suffering, and because, on a very basic level, it is insulting for half the human race to have our bodies treated as lesser, imperfect versions of a male ideal. We are more than that. We exist in our own right.

There are many in medicine, however, who still seem to think that Aristotle was right. Last week, for instance, the World Health Organisation announced it would be developing new guidelines into “the health of trans and gender diverse people”. While this might sound positive, as Eliza Mondegreen notes, many of those leading the development group hold highly regressive views about sex, gender and bodies. It is only possible to believe that a person could change sex if you have not given much consideration to the “second” sex at all.  

One of the oddities of trans healthcare is that it masquerades as progressive

One of the oddities of trans healthcare is that it masquerades as progressive despite having evolved from — and continuing to rely on — an understanding of sex difference which is regressive, male-centric and superficial. Because no one wants to admit it, this has led to a plethora of articles along the lines of “Here’s Why Human Sex Is Not Binary” and “Sex Redefined: The Idea of 2 Sexes Is Overly Simplistic”. While these claim to be adding extra detail and nuance to our understanding, what they do in practice is revert back to privileging the male default. Sex is all so varied, all so different, they tell us, we might as well not bother setting any standards for what counts as “femaleness”. We’re all just human, aren’t we? Only some bodies have tended to be considered more human than others. Rebranding “the male default” “the sex spectrum” is a sneaky way of insisting, once again, that female people are nothing more than males with a few minor tweaks. 

This is the new medical misogyny, built on the back of the old version. Unfortunately, because it positions itself as anti-conservative and even pro-feminist, many writers of texts that address the old version feel obliged to go along with the new. It’s not difficult to see why. Who wants their work to be undermined by bad faith accusations of transphobia? Isn’t it easier just to say “it’s clear that trans women are women” — as Bohannon has done — on the basis that at least this will enable you to challenge the centring of male bodies elsewhere? 

There is an obvious inconsistency here. One of the main ways in which writers seek to manage it is to use the misapplication of feminine stereotypes to female biology — which they are correct to call out — to claim that people only think male bodies cannot be female because such bodies fail to meet patriarchal standards for femininity. This is not an argument that makes any sense. Male bodies cannot be female because they are male, not because they are unfeminine. I think on some level everyone knows this, but pretending not to functions as a kind of offering – let me talk about this issue here, and I won’t raise it there – that those challenging medical misogyny are expected to make in order to have permission to speak at all. 

It is not good enough, though. Telling women we may now speak of periods, the menopause, post-partum injuries, differences in stroke and heart attack symptoms, providing we simultaneously concede that the female body is only tangentially related to having a language and politics specifically for women, involves giving with one hand and taking with another. “Over centuries,” writes Cleghorn, “medical knowledge about the organs and systems marked ‘female’ have been imbued with patriarchal notions of womanhood and femininity.” This is a way of fudging the issue. The truth is that female people — women, that is — and our female bodies have been constricted by femininity as a patriarchal ideal. There is absolutely nothing about stating that women are female which specifies that women must be feminine, or which leads to female biological processes being subject to misrepresentation. We cannot fully address medical misogyny while maintaining the sexist conflation of femininity and womanhood which got us here in the first place. 

Female people are not small male people who lack penises, but have breasts and an extra hole between the legs. We are not passive feminine creatures, receivers of the male life principle, potting soil for new humans, decorative objects, “a canvas for someone else’s fantasy”. Yet the pretence that sex can be changed suggests we are precisely that. It suggests that our bodies do not, as Criado Perez points out, “differ down to cellular level”, but that all differences are superficial, to be interpreted through the male gaze and presented via whatever narratives the male sees fit (and no, a modern-day postmodern narrative is not a step up from an Ancient Greek female reproduction-appropriating one). 

It is bizarre for the World Health Organisation to be receiving guidance on “gender-inclusive care” from people who do not recognise that female bodies remain female, regardless of whether you attempt to freeze them in time, crush them, dose them with hormones, or carry out surgery on them. It is bizarre that there seems to be no connection made with what is being done to desperately unhappy teenage girls right now, and a history of female bodies being cut, drugged, desexualised and modified supposedly in order to cure mental illness or fix aberrant, “unfeminine” behaviour. Those involved must know that their profession still holds tremendous power when it comes to defining what a female body is, and that such definitions are deeply political. Do they think that everyone in the past was sexist, but that they are objective? Are there good ways and bad ways of seeing that sex matters? How do you tell one from the other? 

There are two contradictory narratives running side by side, each claiming to be progressive. Medicine’s neglect of female bodies was terrible, says one, but there’s no way of clearly defining female biology and no need for a politics for the female-bodied, says the other. Plenty of people will tell you that if you squint a bit (and just be kind!), you can accommodate both, or even that the two can complement each other. This isn’t the case. Squinting means being willing to drop the idea that female bodies exist in their own right at all times. It means accepting we are always potentially nothing more than mutilated males, and that any pretensions we have to being more than that are provisionally granted, and could always be withdrawn should we take our feminist politics a little too far. 

I think we deserve better than that. We are constantly being told that knowledge about sex and gender has changed. It’s not 300 BC. Isn’t it about time those denying the importance of female biology caught up?