Modern historians' knowledge of ancient Roman gynecology and
obstetrics
Obstetrics is the field of study concentrated on pregnancy, childbirth and the postpartum period. As a medical specialty, obstetrics is combined with gynecology under the discipline known as obstetrics and gynecology (OB/GYN), which is a surgi ...
primarily comes from
Soranus of Ephesus
Soranus of Ephesus ( grc-gre, Σωρανός ὁ Ἑφέσιος; 1st/2nd century AD) was a Greek physician. He was born in Ephesus but practiced in Alexandria and subsequently in Rome, and was one of the chief representatives of the Methodic s ...
' four-volume treatise on
gynecology
Gynaecology or gynecology (see spelling differences) is the area of medicine that involves the treatment of women's diseases, especially those of the reproductive organs. It is often paired with the field of obstetrics, forming the combined are ...
. His writings covered medical conditions such as uterine prolapse and cancer and treatments involving materials such as herbs and tools such as
pessaries
A pessary is a prosthetic device inserted into the vagina for structural and pharmaceutical purposes. It is most commonly used to treat Stress incontinence, stress urinary incontinence to stop urinary leakage and to treat pelvic organ prolapse to ...
.
Ancient Roman doctors believed that
menstruation
Menstruation (also known as a period, among other colloquial terms) is the regular discharge of blood and mucosal tissue from the inner lining of the uterus through the vagina. The menstrual cycle is characterized by the rise and fall of hor ...
was designed to rid the female body of
excess fluids. They believed that menstrual blood had special powers. Roman doctors may also have noticed conditions such as
premenstrual syndrome
Premenstrual syndrome (PMS) refers to emotional and physical symptoms that regularly occur in the one to two weeks before the start of each menstrual period. Symptoms resolve around the time menstrual bleeding begins. Different women experienc ...
.
Techniques
Uterine prolapse
Uterine prolapse
Uterine prolapse is when the uterus descends towards or through the opening of the vagina. Symptoms may include vaginal fullness, pain with sex, trouble urinating, urinary incontinence, and constipation. Often it gets worse over time. Low back ...
is a medical condition in which the
uterus
The uterus (from Latin ''uterus'', plural ''uteri'') or womb () is the organ in the reproductive system of most female mammals, including humans that accommodates the embryonic and fetal development of one or more embryos until birth. The uter ...
extends towards the vaginal opening. It is possible that this condition was the origin of the
belief that the womb could move around. Ancient Roman gynecologists treated this condition by suspending the patient upside down from a ladder. This treatment was not universally accepted by ancient Roman doctors. Soranus of Ephesus criticized this treatment method.
Another treatment at the time involved wrapping ''
aetites
In the magico-medical tradition of Europe and the Near East, the aetites (singular in Latin) or aetite (anglicized) is a stone used to promote childbirth. It is also called an eagle-stone, aquiline, or aquilaeus. The stone is said to prevent spo ...
'', which were magic stones used to protect the fetus and ease
childbirth
Childbirth, also known as labour and delivery, is the ending of pregnancy where one or more babies exits the internal environment of the mother via vaginal delivery or caesarean section. In 2019, there were about 140.11 million births globall ...
, in the skin of
sacrificed animals. The only known mention of a
hysterectomy
Hysterectomy is the surgical removal of the uterus. It may also involve removal of the cervix, ovaries (oophorectomy), Fallopian tubes (salpingectomy), and other surrounding structures.
Usually performed by a gynecologist, a hysterectomy may b ...
comes from the work ''Gynecology''. Soranus writes that a woman with an inverted uterus infected with
gangrene
Gangrene is a type of tissue death caused by a lack of blood supply. Symptoms may include a change in skin color to red or black, numbness, swelling, pain, skin breakdown, and coolness. The feet and hands are most commonly affected. If the ga ...
had her uterus and bladder removed.
Abortion and incontinence
There were surgical procedures for
abortion
Abortion is the termination of a pregnancy by removal or expulsion of an embryo or fetus. An abortion that occurs without intervention is known as a miscarriage or "spontaneous abortion"; these occur in approximately 30% to 40% of pregn ...
in ancient Rome, but they were rarely used, and most abortions were conducted using herbs or other drugs.
When surgery was used, it involved the usage of surgical instruments to penetrate the mother. Usually, this procedure ended with both the fetus' and the mother's death.
Soranus of Ephesus wrote that purging, carrying heavy weights, and the injection of olive oil into the vagina or uterus, were all procedures used to carry out abortions.
Ancient Roman doctors, including Soranus, believed that abortion was forbidden by the
Hippocratic Oath
The Hippocratic Oath is an oath of ethics historically taken by physicians. It is one of the most widely known of Greek medical texts. In its original form, it requires a new physician to swear, by a number of healing gods, to uphold specific e ...
, which forbade giving a woman "a
pessary
A pessary is a prosthetic device inserted into the vagina for structural and pharmaceutical purposes. It is most commonly used to treat Stress incontinence, stress urinary incontinence to stop urinary leakage and to treat pelvic organ prolapse to ...
to cause abortion". According to Soranus, the only exception was when pregnancy threatened the life of the mother.
Both
Galen
Aelius Galenus or Claudius Galenus ( el, Κλαύδιος Γαληνός; September 129 – c. AD 216), often Anglicized as Galen () or Galen of Pergamon, was a Greek physician, surgeon and philosopher in the Roman Empire. Considered to be one of ...
, a Greek doctor, and
Hippocrates
Hippocrates of Kos (; grc-gre, Ἱπποκράτης ὁ Κῷος, Hippokrátēs ho Kôios; ), also known as Hippocrates II, was a Greek physician of the classical period who is considered one of the most outstanding figures in the history of ...
described the usage of pelvic floor muscle training, now known as
Kegel exercise
Kegel exercise, also known as pelvic-floor exercise, involves repeatedly contracting and relaxing the muscles that form part of the pelvic floor, now sometimes colloquially referred to as the "Kegel muscles". The exercise can be performed many ti ...
s, to treat
urinary incontinence
Urinary incontinence (UI), also known as involuntary urination, is any uncontrolled leakage of urine. It is a common and distressing problem, which may have a large impact on quality of life. It has been identified as an important issue in geria ...
. These techniques were theorized to be beneficial for one's physical, spiritual, and sexual health.
Menstrual cycle
Ancient Roman doctors such as
Aetius believed that
amenorrhea
Amenorrhea is the absence of a menstrual period in a woman of reproductive age. Physiological states of amenorrhoea are seen, most commonly, during pregnancy and lactation (breastfeeding). Outside the reproductive years, there is absence of menses ...
,
or the absence of a
menstrual cycle
The menstrual cycle is a series of natural changes in hormone production and the structures of the uterus and ovaries of the female reproductive system that make pregnancy possible. The ovarian cycle controls the production and release of eggs a ...
, was caused by a "hot temperament". Soranus noticed
psychosomatic
A somatic symptom disorder, formerly known as a somatoform disorder,(2013) hymen
The hymen is a thin piece of mucosal tissue that surrounds or partially covers the external vaginal opening. It forms part of the vulva, or external genitalia, and is similar in structure to the vagina.
In children, a common appearance of the h ...
. This therapy was also used to treat
dysmenorrhea
Dysmenorrhea, also known as period pain, painful periods or menstrual cramps, is pain during menstruation. Its usual onset occurs around the time that menstruation begins. Symptoms typically last less than three days. The pain is usually in the ...
, which the Romans called "retention of the menstrual flux". It is a menstrual disorder characterized by pelvic, abdominal, or back pain resulting from menstruation.
Chamomile
Chamomile (American English) or camomile (British English; see spelling differences) ( or ) is the common name for several plants of the family Asteraceae. Two of the species, ''Matricaria recutita'' and ''Anthemis nobilis'', are commonly us ...
is a type of daisy-like plant that ancient Roman woman used to treat dysmenorrhea. Venipuncture through leeches was another kind of treatment for this disorder. In ancient Rome, women with heavy menstrual bleeding would be treated by applying ligatures to the groin and to the armpits, thus blocking off blood flow throughout the body. It was theorized this also resulted in the reduction of blood flow to the uterus. Following this, blunt corks, liquid pitch, and pessaries soaked with
alum
An alum () is a type of chemical compound, usually a hydrated double salt, double sulfate salt (chemistry), salt of aluminium with the general chemical formula, formula , where is a valence (chemistry), monovalent cation such as potassium or a ...
, plant sap, or the yolk of roasted eggs were inserted inside the vagina.
Cancer
Ancient Roman physicians noticed that
breast cancer
Breast cancer is cancer that develops from breast tissue. Signs of breast cancer may include a lump in the breast, a change in breast shape, dimpling of the skin, milk rejection, fluid coming from the nipple, a newly inverted nipple, or a re ...
and
ovarian cancer
Ovarian cancer is a cancerous tumor of an ovary. It may originate from the ovary itself or more commonly from communicating nearby structures such as fallopian tubes or the inner lining of the abdomen. The ovary is made up of three different c ...
occurred more frequently in some families than others. Galen believed that menstruation would rid a woman of their
black bile
Melancholia or melancholy (from el, µέλαινα χολή ',Burton, Bk. I, p. 147 meaning black bile) is a concept found throughout ancient, medieval and premodern medicine in Europe that describes a condition characterized by markedly dep ...
, and therefore could cure
melancholia
Melancholia or melancholy (from el, µέλαινα χολή ',Burton, Bk. I, p. 147 meaning black bile) is a concept found throughout ancient, medieval and premodern medicine in Europe that describes a condition characterized by markedly dep ...
, which is a historical term for depression. Galen concluded that
menopause
Menopause, also known as the climacteric, is the time in women's lives when menstrual periods stop permanently, and they are no longer able to bear children. Menopause usually occurs between the age of 47 and 54. Medical professionals often d ...
, or the cessation of the menstrual cycle, would lead to an excess of black bile and therefore breast cancer. The treatment for breast cancer consisted of
bloodletting
Bloodletting (or blood-letting) is the withdrawal of blood from a patient to prevent or cure illness and disease. Bloodletting, whether by a physician or by leeches, was based on an ancient system of medicine in which blood and other bodily flu ...
and
cupping therapy
Cupping therapy is a form of alternative medicine in which a local suction is created on the skin with the application of heated cups. Its practice mainly occurs in Asia but also in Eastern Europe, the Middle East, and Latin America. Cupping has ...
.
Aulus Celsus described the stages of breast cancer in his treatise ''
De Medicina
''De Medicina'' is a 1st-century medical treatise by Aulus Cornelius Celsus, a Roman encyclopedist and possibly (but not likely) a practicing physician. It is the only surviving section of a much larger encyclopedia; only small parts still survive ...
''. In the first stage, when the cancer was limited to a lesion,
caustics were used, followed by an incision, then cauterization. This stage was called ''cacoethes''. Celsus considered this treatment effective only in the early stages. During the later ones it was thought to merely hasten the patient's death. While Celsus did not advocate for the removal of the
pectoral muscles
Pectoral muscles (colloquially referred to as "pecs") are the muscles that connect the front of the human chest with the bones of the upper arm and shoulder. This region contains four muscles that provide movements to the upper limbs or ribs.
Pe ...
, Galen believed the only way to get rid of breast cancer was to excise all infected regions from the body.
Cervical cancer
Cervical cancer is a cancer arising from the cervix. It is due to the abnormal growth of cells that have the ability to invade or spread to other parts of the body. Early on, typically no symptoms are seen. Later symptoms may include abnormal ...
was believed to be a disease that primarily affected married women, widows, and prostitutes. It was also believed that nuns and virgins would remain unaffected. The Romans' association between cervical cancer and frequent sexual intercourse may have been because a virus known as
human papillomavirus
Human papillomavirus infection (HPV infection) is caused by a DNA virus from the ''Papillomaviridae'' family. Many HPV infections cause no symptoms and 90% resolve spontaneously within two years. In some cases, an HPV infection persists and res ...
is known to cause cervical cancer and is sexually transmitted.
Caesarean sections
During a Roman
Caesarean section
Caesarean section, also known as C-section or caesarean delivery, is the surgical procedure by which one or more babies are delivered through an incision in the mother's abdomen, often performed because vaginal delivery would put the baby or mo ...
, the doctors would make an incision into the abdomen and uterus of the mother. Following this, the baby was removed. This practice could also be conducted on dead mothers in order to remove the babies from their corpses. It was rare for doctors to perform this operation, as it had a high mortality rate. According to
Roman religion
Religion in ancient Rome consisted of varying imperial and provincial religious practices, which were followed both by the people of Rome as well as those who were brought under its rule.
The Romans thought of themselves as highly religious, ...
the god
Asclepius
Asclepius (; grc-gre, Ἀσκληπιός ''Asklēpiós'' ; la, Aesculapius) is a hero and god of medicine in ancient Religion in ancient Greece, Greek religion and Greek mythology, mythology. He is the son of Apollo and Coronis (lover of ...
was born through a Caesarian section. Roman historians
Suetonius
Gaius Suetonius Tranquillus (), commonly referred to as Suetonius ( ; c. AD 69 – after AD 122), was a Roman historian who wrote during the early Imperial era of the Roman Empire.
His most important surviving work is a set of biographies ...
and
Pliny the Elder
Gaius Plinius Secundus (AD 23/2479), called Pliny the Elder (), was a Roman author, naturalist and natural philosopher, and naval and army commander of the early Roman Empire, and a friend of the emperor Vespasian. He wrote the encyclopedic '' ...
also record
Julius Caesar
Gaius Julius Caesar (; ; 12 July 100 BC – 15 March 44 BC), was a Roman general and statesman. A member of the First Triumvirate, Caesar led the Roman armies in the Gallic Wars before defeating his political rival Pompey in a civil war, and ...
as being born by Caesarian section. However, the veracity of these claims is debated.
Scientific understanding
Menstruation
Ancient Greek and Roman gynecologists believed that women were naturally more prone to
humoral imbalance and therefore illness. For example, women were more likely to become "moist". It was believed that the female body had more water than the male body. Ancient doctors thought that puberty, specifically the
menarche
Menarche ( ; ) is the first menstrual cycle, or first menstrual bleeding, in female humans. From both social and medical perspectives, it is often considered the central event of female puberty, as it signals the possibility of fertility.
Gir ...
, could be caused through an excess of fluid buildup in the female body, and thus menstruation was the body's way of regulating its fluid and humoral balance. This idea led to Roman doctors not taking notice of problematic menstrual cycles; excessive and minimal menstruation were medical problems noticed by doctors.
Pliny the Elder
Gaius Plinius Secundus (AD 23/2479), called Pliny the Elder (), was a Roman author, naturalist and natural philosopher, and naval and army commander of the early Roman Empire, and a friend of the emperor Vespasian. He wrote the encyclopedic '' ...
, a Roman naturalist, wrote that menstrual fluid could wither fruit, cause insanity in dogs, dull mirrors, rust iron and bronze, kill bees, pollute purple fabrics, cause miscarriages in horses and humans, and sour crops.
He also believed that if a woman menstruated during a solar or lunar eclipse, sexual intercourse could result in death. Pliny also stated that the touch of a menstruating woman could treat medical conditions such as
gout
Gout ( ) is a form of inflammatory arthritis characterized by recurrent attacks of a red, tender, hot and swollen joint, caused by deposition of monosodium urate monohydrate crystals. Pain typically comes on rapidly, reaching maximal intensit ...
, fevers,
erysipelas
Erysipelas () is a relatively common bacterial infection of the superficial layer of the skin ( upper dermis), extending to the superficial lymphatic vessels within the skin, characterized by a raised, well-defined, tender, bright red rash, t ...
,
scrofula,
skin cancer
Skin cancers are cancers that arise from the skin. They are due to the development of abnormal cells that have the ability to invade or spread to other parts of the body. There are three main types of skin cancers: basal-cell skin cancer (BCC) ...
, and
bites from rabid dogs. Aside from medicinal uses, Pliny listed a number of supernatural uses. For example, magi could not perform any magic feats if their doorsteps had been touched by menstrual blood. It was also believed that menstrual fluid could contaminate entrances, and therefore households.
Vaginal bleeding and discharge
Vaginal bleeding
Vaginal bleeding is any expulsion of blood from the vagina. This bleeding may originate from the uterus, vaginal wall, or cervix. Generally, it is either part of a normal menstrual cycle or is caused by hormonal or other problems of the reproductiv ...
is the expulsion of blood from the vagina. Galen described a woman suffering from this condition, or what he described as the "female flux". Other names for this condition included the "abnormal flux", "menstrual flux", and "hemorrhage of the uterus".
Juvenal
Decimus Junius Juvenalis (), known in English as Juvenal ( ), was a Roman poet active in the late first and early second century CE. He is the author of the collection of satirical poems known as the ''Satires''. The details of Juvenal's life ...
was a Roman poet notable for his
''Satires''. In these works, he occasionally described what we know to be vaginal discharge, which is the collection of cells, bacteria, and liquid used to protect and lubricate the vagina.
He wrote about a "great torrent of sheer lust" running down a woman's legs at the idea of engaging in "energetic" interactions with a man. Juvenal also stated that "No woman will say no to her moist vulva", and he describes an adulteress coming home with a fluid on her dress, possibly semen or vaginal discharge.
Premenstrual syndrome
Modern doctors define
premenstrual syndrome
Premenstrual syndrome (PMS) refers to emotional and physical symptoms that regularly occur in the one to two weeks before the start of each menstrual period. Symptoms resolve around the time menstrual bleeding begins. Different women experienc ...
as a syndrome resulting in several abnormalities in women before menstruation. These abnormalities consist of symptoms such as irritability and mood changes. Ancient Roman doctors may have noticed this disease in women. They stated that menstruation occurs all at once in a specific moment each month, it is possible this theory was designed to account for the syndrome.
Childbirth
Childbirth
Childbirth, also known as labour and delivery, is the ending of pregnancy where one or more babies exits the internal environment of the mother via vaginal delivery or caesarean section. In 2019, there were about 140.11 million births globall ...
in ancient Rome had a high mortality rate for the mothers. Modern estimates are that 17 women died in childbirth for every 1,000 births. It is possible that this was due to the
young age of marriage in Rome. Roman doctors believed that the fetus could be injured through a "faulty fetus". Ancient gynecologists also thought that the fetus could harm the mother's health.
Hippocrates
Hippocrates of Kos (; grc-gre, Ἱπποκράτης ὁ Κῷος, Hippokrátēs ho Kôios; ), also known as Hippocrates II, was a Greek physician of the classical period who is considered one of the most outstanding figures in the history of ...
divided
gestation
Gestation is the period of development during the carrying of an embryo, and later fetus, inside viviparous animals (the embryo develops within the parent). It is typical for mammals, but also occurs for some non-mammals. Mammals during pregna ...
into forty-day periods. The first period represented the time where the risk of miscarriage was the highest, the last forty days was when the fetus was the most active. Soranus wrote that during pregnancy women began craving to eat materials such as charcoal. Amulets and other magical items were used to ensure the mother would give birth on time.
See also
*
Medicine in ancient Rome
Medicine in ancient Rome was highly influenced by ancient Greek medicine, but also developed new practices through knowledge of the Hippocratic Corpus combined with use of the treatment of diet, regimen, along with surgical procedures. This was mo ...
References
{{Ancient Roman medicine
History of medicine
Ancient Roman medicine
History of anatomy
Gynaecology
Women in ancient Rome