Strata–gies
Published in

Strata–gies

Practice Makes Patients: Diagnosing
the Design of the Pelvic Exam

CORNELIA SMITH

Language interpellates; it is codified and bound by a cultural lexicon that assigns identity to something or someone.¹ Someone is a patient because they become a patient. Naming someone a patient assigns them a carefully defined status within the medical world.

The modern English term “patient” derives from the Latin noun patientia: “the quality of suffering or enduring; submission; indulgence, leniency; humility; submissiveness; submission to lust.”²

The patient, much like the physician, performs a role systematized by medical pedagogy. Patients must submit to the gaze of the physician, whose expertise they know little about, and relinquish themselves as specimens to an expert inquiry.

Latin for “mirror,” a speculum is a reflective device, a critical tool used in medicine to shed light within a body otherwise invisible to an outside gaze. During a pelvic exam, a speculum is inserted into the vaginal canal in order to push open, and keep open, the walls of the vagina. Made of either plastic or metal, the speculum is constructed from two curved blades, and hinged to form a cylindrical cavity — like a long-beaked mouth, or a steampunk duckbill. It opens and closes by way of a spring handle, and locks in place by the tightening of a screw.

In her 1997 book Public Privates: Performing Gynecology From Both Ends of the Speculum, performer, scholar, and health educator Terri Kapsalis characterized the pelvic exam as a systematized performance, the “pelvic theater.”³ The staging and execution of the pelvic exam determines the roles of spectator, audience, and spectacle — an ensemble, Kapsalis argues, directed by two dominating forces: the medical establishment and the reigning cultural ideology of the female body.

Blocking is a necessary component in the execution of this performance. The patient, naked from the waist down with a wisp of cloth draped over their knees, lies back on the table, legs open. The physician sits on a wheeled stool between the patient’s legs, next to a tray of tools. The recumbent patient is now in a fixed position, while the upright physician is able to move freely. An imbalance of power results from this well-defined spatial relationship: The patient is immobile and cannot see what is happening, resulting in a loss of control that is then leveraged by the physician.

The physician has a clear view and easy access to the patient’s internal and external genitalia. This act of seeing-through is a one-sided endeavor, shielded from the patient by way of the drape sheet, which Kapsalis describes as a “screen” separating the doctor (onstage) from the patient (backstage). The sheet functions as a curtain, and the open legs the flanks of the stage. Patient is performer and prop, spectacle and audience.

[1] In her essay-turned-book Illness as Metaphor, Susan Sontag focuses on tuberculosis and cancer as two diseases that have incurred an abundance of metaphorical descriptions. She decries the use of metaphor to describe disease, writing: “The healthiest and most truthful way of being ill is resistant to metaphoric thinking.” She argues that metaphorical thinking, when it comes to disease, is a dangerous practice of victim-blaming. A person with a disease becomes a diseased person when discussed in popular discourse. Susan Sontag, Illness as Metaphor (New York: Farrar, Straus & Giroux, 1978).

[2] Douglas Harper, “s.v. patience (n.),” Online Etymology Dictionary (Accessed April 24, 2022), https://www.etymonline.com/word/patience#etymonline_v_10152.

[3] Terri Kapsalis, Public Privates: Performing Gynecology from Both Ends of the Speculum (Durham and London: Duke University Press, 1997), 15.

CORNELIA SMITH (she/her) is a writer and aspiring muse based in Brooklyn, NY. Her background is in contemporary art: in the year between graduating from undergrad and enrolling at SVA, Cornelia spearheaded the editorial team for Pollinate Art, a community-based arts platform, and later joined Artsy as a full-time editorial content coordinator, where she tracked art market trends, wrote about emerging artists, and conducted interviews with artists and collectors.

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