Introduction to the Psychology of Gynecology

Adapted excerpts from "Novas Perspectivas em Ginecologia"

Nelson Soucasaux

Nelson Drawing 1976

Initially I must explain that by the Psychology of Gynecology I mean the study of the psychological dynamics of the gynecologist-patient relationship, as well as of the several psychological features of the male and female physicians who practice Women's Medicine and also of the patients. The therapeutic relationship between woman ( patient ) and gynecologist of the male or female sex is, usually, replete with subtleties and extremely problematic, frequently acquiring neurotic patterns. This situation is aggravated because a great part of the psychological dynamics of this therapeutic relationship often remains at subconscious or unconscious levels, not only on the part of the patients but also on the part of the male or female doctors. As already stated, it is obvious that the peculiarities of this psychological dynamics greatly differ according to the gynecologist's gender.

The Psychology of Gynecology must also seriously consider the study of the entire medical, scientific, psychological and socio-cultural context in which Women's Medicine has been defined and practiced, because the characteristics of such context are, to a great extent, determined by the psychological attitudes and systems of values of most physicians in this area. This context is replete with conceptual distortions and errors that come from long ago, as, for instance, the traditional tie of Gynecology to Obstetrics and Surgery. Such misconceptions have serious implications on the extremely restricted manner through which mostly Gynecology has been practiced. ( On this subject, for instance, see my articles "The Traditional Tie of Gynecology to Obstetrics and Surgery: Deep rooted conditioning coming from the past and devoid of scientific basis" and "The Obstetric Strategy in Women's Medicine".)

A very important and totally unexplored aspect of Women's Medicine psychology is the one related to the real motivations, at the deep psychological level, that lead doctors of the male or female sex to become gynecologists and/or obstetricians. Nevertheless, on this subject we still have to confine ourselves to the construction and elaboration of hypothesis based, of course, on the observation of facts, experience, analysis and deduction.

It is a very well-known fact that a great number of men have considerable psychological problems in relation to women, as well as that the male psyche is naturally directed towards the female sex. According to C.G. Jung, in men's psychology there is the Anima archetype, which corresponds to the primal images of women, to the inner women who "inhabit" and energize male psychology. About Anima, M. Jacoby observes that "... she is the principle of Eros, because the development of a man's Anima becomes manifest in the way he relates himself to women" ( Jacoby, M. - "O Encontro Analítico - Transferência e Relacionamento Humano" [ "The Analytic Encounter - Transference and Human Relationship" ] - Cultrix, São Paulo, Brazil, 1984 ).

A man needs to acquire a better knowledge and understanding of women to enter into the mysteries of female nature; this is a demand of the Anima archetype. Medicine can be one of the ways to achieve this aim. I believe that here we find some of the reasons that attract many male doctors to Gynecology. However, considering that the knowledge and practice of Medicine grant a specific "power" to the medical class ( hence the origin of the frequent "fantasies of omnipotence" found in many physicians' psychology ), it is also possible that some male gynecologists make use of the speciality as a way of feeling themselves exerting some "power" over the female sex.

By the way, I have emphasized the existence of a very typical "longing for omnipotence" in Women's Medicine, leading almost all physicians dedicated to it to the absurdity of simultaneously practicing Gynecology, Gynecologic Surgery and Obstetrics - that is, three technically very different medical specialities. Nevertheless, that attitude seems to have no relation to the physician's gender, since it is found both in male and female doctors dedicated to Women's Medicine. In this way, it is part of the psychology of all Women's Medicine.

Regarding some of the reasons that may attract doctors of the female sex to Gynecology, one of them must be the search for a better understanding and control of their own nature and bodies. Maybe some delusions of "protection" against the development of gynecologic disorders and diseases are also present. However, I think that here the interference of the Animus archetype ( the male side of the female psyche, according to Jung ) may also exert considerable influence. Some female gynecologists seem to possess a very exacerbated Animus.

As to those patients who only accept to be treated by gynecologists of the female gender and their respective female doctors, I would like to express my opinion that the "groups" constituted by some female gynecologists together with their patients look like some radical feminist groups where any male presence is absolutely not allowed.

Concerning the choice of Obstetrics by men I believe that, besides an influence of the mostly maternal side of the Anima archetype, a psychological need of male interference during pregnancy and childbirth may perhaps be present. There is also the possibility of the existence of psychological problems related to the very process of birth of the human being and, who knows, even of unconscious personal traumas resulting from their own birth.

In this respect, indications of the existence of unconscious contents, most of them traumatic and possibly related to the phases of one's own birth, are revealing themselves in modern psychical research. Such contents are associated to archetypal and mythological themes and, according to Stanislav Grof, they belong to a perinatal realm of the unconscious. Grof observes that "... though the total spectrum of the experiences that happen at this level cannot be reduced to a revival of biological birth, the birth trauma seems to represent an important nucleus of the process" ( Grof, S. - "Beyond the Brain - Birth, Death and Transcendence in Psychotherapy" - McGraw-Hill, U.S.A., 1988 ).

As for female obstetricians, it is highly probable that the reason that lead them to the speciality can just be related to this exclusively female endowment which is pregnancy and childbirth ( in a similar way to the midwives in the past ).

However, in the area of Obstetrics there is a psycho-socio-cultural factor that greatly influences both male and female doctors on their choice of the speciality: it is the extremely deep-rooted and archaic view of women that they were "mainly destined to have children". Regrettably, this presupposition still has a strong influence on our culture. It is what I call "the obstetric view of women", an assumption that insists on considering motherhood as the main purpose of female existence. This point of view is in entire disagreement with reproductive and existential reality, especially of modern women.

As Fritjof Capra observed, "... Medicine is practiced in many different ways by men and women with different personalities, attitudes and beliefs" ( Capra, F. - "The Turning Point - Science, Society and the Rising Culture" - Flamingo, London, 1983). I also would like to remark that I think that most of the male and female doctors who practice Women's Medicine are not entirely aware of the real motivations that led them to this area and, if we ask them why have they chosen to practice Gynecology and/or Obstetrics, they will give conventional medical reasons.

Does Women's Medicine actually possess a psychology of its own, and which is even unknown to most of its practitioners? Yes, after many, many years of practice, experience, observation and study, I am sure it does.

Nelson Soucasaux is a gynecologist dedicated to Clinical, Preventive and Psychosomatic Gynecology. Graduated in 1974 by Faculdade de Medicina da Universidade Federal do Rio de Janeiro, he is the author of several articles published in medical journals and of the books "Novas Perspectivas em Ginecologia" ("New Perspectives in Gynecology") and "Os Órgãos Sexuais Femininos: Forma, Função, Símbolo e Arquétipo" ("The Female Sexual Organs: Shape, Function, Symbol and Archetype"), published by Imago Editora, Rio de Janeiro, 1990, 1993.

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