The Marriage Relationship: Sexuality and Medicine

Sources

Ancient Medical Teachings. Some medieval ideas and values about human sexuality were inherited from ancient medicine. Because ancient medicine had developed prior to Christian morality and had remained for the most part independent of it, medical learning and conventional Christian morality were often at odds. Yet, throughtheirmon thly Middle Ages the two went through a process of mutual influence and accommodation. The medical knowledge of the ancients had been preserved in the eastern Roman Empire and was incorporated into Arabic learning with the spread of Islam. In the tenth century, Constantine the African translated many ancient medical texts from Arabic into Latin, thus making available to Europe a sophisticated body of medical knowledge.

Galen on Sexuality. The understanding of the human body and sexuality presented in medieval medical texts was based primarily on the teaching of the great second-century Greek physician, Galen. According to Galen, a woman’s body was composed of the same organs as a man’s, including the genitalia. The only difference was that a woman’s sex organs were inverted and inside her body, rather than external like a man’s organs: the ovaries were like testicles, and the vagina and uterus were like an inverted penis. As a result, Galen considered women to be basically the same as men, but somewhat inferior because their genitalia were internalized.

The Humors arid Sexuality. The “one-sex” theory of the human body greatly influenced how physicians understood human sexuality and reproduction—as did Galen’s theory of the bodily humors—blood, phlegm, yellow bile, and black bile—and their corresponding qualities—hot, cold, wet, and dry. According to this theory men and women had different sexual complexions because women were cold and wet, while men were hot and dry. The humors were thought to build up in a person and become unbalanced, so they needed to be released and balanced by such means as sweating, urination, and bloodletting. Women had a natural outlet for harmful humors through their monthly menses, while men expelled humors through the ejaculation of semen. Thus, from a medical point of view, some moderate sexual activity was a requirement for good health—a view that ran counter to the Church’s promotion of celibacy—but too much could potentially be dangerous. According to another medical theory, the conception of children required both the father and mother to ejaculate seed, preferably simultaneously, so both the man and the woman needed to experience sexual pleasure and orgasm in order to conceive. At the same time the Church urged married couples to restrain their desires and preached that too much sexual pleasure could lead to illness and might even prove fatal. Early medical treatises discussed these issues objectively and dispassionately without considering the moral implications of their advice.

Opposing Views. As the Church taught that sexual pleasure should be avoided as much as possible—while accepting the fact that without orgasm conception could not occur—medical writers of the Middle Ages gradually began to be influenced by moral considerations. Thus, by the thirteenth century, some writers were reporting what earlier medical authorities had advised but adding caveats about how this advice should be modified to correspond with the moral teaching of the Church. For example, rather than prescribing sexual intercourse as a treatment for an illness, these later authors prescribed marriage. This solution met the necessities of morality, while presumably resulting in intercourse, the appropriate cure. Theological and moral discussions of married life gradually incorporated the two-seed understanding of conception. Therefore, confessors were sometimes instructed to advise husbands to ensure their wife was sexually satisfied in order to promote procreation. On the other hand, clerical writers held out as examples to be emulated cases in which a holy person refused the medically advised treatment for an illness, preferring death to immoral activities. While, from the eleventh through thirteenth centuries, moral considerations were given increasing prominence in medical texts, religious and medical thought continued to coexist quite separately throughout the Middle Ages, influencing one another but remaining distinct in their understanding of the role of human sexuality.

Sources

Joan Cadden, Meanings of Sex Difference in the Middle Ages. Medicine. Science, and Culture (Cambridge: Cambridge University Press, 1993).

Danielle Jacquart and Claude Thomasset, Sexuality and Medicine in the Middle Ages, translated by Matthew Adamson (Princeton: Princeton University Press, 1988).

Jacqueline Murray, “Sexuality and Spirituality: The Intersection of Medieval Theology and Medicine,” Fides et Historia, 23 (1991): 20–36.