In “the gynecological standard”, the sociologist Aurore Koechlin looked at what appears as a medical imperative, which she questions after having met patients and caregivers. She describes her work in an interview with the “world”.
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Sociologist Aurore Koechlin presents in her work the gynecological norm (Amsterdam, 320 pages, 20 euros) the result of several years of survey of health professionals and patients in medical gynecology. As a feminist researcher and militant, she examines the mechanisms of gynecological monitoring and its effects.
What is “gynecological norm”?
I define it as the standard that enjoins women to regularly consult a health professional for gynecological monitoring, focused on contraception and screening (smear, palpation of breasts). The particularity of this follow -up is triple: it is regular – ideally once a year – it is not based on a specific reason for consultation, finally, it takes the healthy body throughout life.
Gynecological consultation is often presented as a banal act, ranging from self. However, this prolonged medicalization produces effects on patients, according to your analysis?
Gynecological consultation is a fundamentally ambiguous space for women. It makes it possible to screen for diseases and cancer potentially extremely serious. It provides a sometimes significant resource in terms of information and body knowledge, contraception, etc. But at the same time, she makes the vector of little questioned social standards.
One of them, the preventive standard (which implies that any individual must be tested when he has a behavioral at risk or when he is part of a population at risk) results in extreme empowerment of patients in the management of their bodies and their health. They are thus placed in an in-between between the ability to act on health and maintain the status of layman, which is precisely the source of anxiety, even presents in a diffuse manner, in a large part of them.
In your book, you wonder about cases of gynecological violence. The very term, however, is recent: how to define them? What, in the relationship between the patient and the practitioner, makes their existence possible?
A central element to define gynecological violence is the non-compliance with the patient’s consent to the acts performed, in particular the gynecological examination. As for the conditions of possibility of these situations (very minority), I develop three in the work: first, the consultation itself, which constitutes a habitation to pain, which can then be perceived as normal as much by the or the professional only by the patient. Second, working conditions, which, when they are accelerated, strengthen the automatisms of gynecologists and make it more difficult to analyze the situation. And finally, medical universalism, this ideal of neutrality and non-judgment which is at the foundation of the modern definition of the doctor. Even if it starts from a good intention, this universalism has the paradoxical effect of wanting to treat genitals like any organ. But that goes against the tide of the feelings of some of the patients, who say they live the consultation as a moment whose gendered and potentially sexualized dimension can never be completely erased.
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