At the girls’ grammar school I attended in the early 1970s, most of my peers’ most hated subject was Latin, which was generally considered to be super-hard, super-boring, and of no practical use whatsoever. I too found it pretty tedious, but there were several subjects I hated more, including geography, PE and, above all, domestic science. So I was content, if not exactly ecstatic, to plod on with Latin until O Level, the ancient equivalent of today’s GCSE. The school encouraged us to do this if there was a chance we might go on to university, and especially if we aspired to study medicine. Whenever we complained about the uselessness of Latin, we’d be told that ‘Latin trains the mind’, followed by ‘and you’ll need it if you want to be a doctor’.
Today’s medical students are not expected to have studied Latin, but they still need to learn a technical vocabulary which is heavily reliant on it. In anatomy, for instance, much of the standard terminology dates back to the Renaissance, when Latin was the language of learning across Europe. And sometimes, decoding medical Latin reveals that it isn’t just the language that’s ancient.
Last year the New York Times reported on the experience of Allison Draper, who as a first-year medical student came across a reference to the ‘pudendal nerve’. Not knowing the word ‘pudendal’, she consulted a dictionary of anatomy. She was shocked to learn that it derived from the Latin verb ‘pudere’, meaning ‘to be or make ashamed’, and that ‘pudendum’, a gerundive form meaning, roughly, ‘thing to be ashamed of’, was the standard anatomical term for the outer female genitalia. She decided to write a paper arguing that such terms had no place in modern medicine. Her (male) anatomy professor supported her, though he admitted that before she raised it he had never given the matter any thought.
Another male anatomist, Bernard Moxham, had already concluded that ‘pudendum’ was a problem. To his mind it was not only sexist but also unscientific, putting moral judgment in place of description. Moxham had previously served as president of the international organisation that oversees the standard reference work on anatomical terms, Terminologia Anatomica, and he proposed that organisation’s terminology group should consider replacing ‘pudendum’ and ‘pudendal’ with more objective, descriptive alternatives.
He was surprised when this proposal met with resistance. Some members of the group maintained that the terms weren’t really sexist: they could be interpreted as referring not to the negative concept of shame but to the ‘positive’ concepts of modesty and virtue (though it’s hard to see what’s positive about locating women’s virtue in their genitals). Others warned darkly of a slippery slope: if ‘pudendum’ went, how many other traditional terms might also have to go because they were scientifically uninformative or out of tune with modern sensibilities? Eventually the group agreed that ‘pudendum’ should be removed from Terminologia Anatomica, but ‘pudendal’, as in ‘pudendal nerve’, should stay; they were concerned that its removal might cause difficulty for colleagues in other branches of medicine. However, a pain-management specialist who regularly performs the procedure known as a ‘pudendal block’ told the Times she found its survival ‘incredible’. ‘What’, she asked, ‘does that say about the medical establishment and their attitudes to women?’
The story of ‘pudendum’ does say something about the sexism of medicine as an institution, but arguably it says at least as much about the culture in which medicine exists. In the 21st century it may seem crassly offensive to label women’s genitals ‘the thing to be ashamed of’, but historically that label served the same purpose which is more often served today by using vague expressions like ‘undercarriage’ or ‘bits’. These are forms of polite avoidance, ways of not directly naming the offensive thing itself. And what’s behind that is not a specifically medical prejudice, but a far more general and culturally pervasive view of female sexuality, and the associated body-parts, as a source of shame and disgust. That view remains widespread among women themselves: surveys have found that many or most of those questioned regard terms like ‘vulva’ and ‘vagina’ as embarrassing and offensive.
But while medical terminology reflects the prejudices of the surrounding culture, the authority and prestige of medicine give its language a particular power to define the realities it speaks of—including the female body and the processes which affect it. Challenging that power, and medical authority more generally, has been an important feminist project more or less throughout the history of the movement. But as the case of ‘pudendum’ shows, it isn’t easy (even for insiders) to shift the norms of a linguistic register whose traditions are so revered and so jealously guarded. How changes happen, when they do, is a complicated question–as we see if we consider an earlier challenge to the language used by doctors about women’s bodies.
In 1985 the UK medical journal The Lancet published a letter from a group of senior obstetricians calling on the profession to stop using the term ‘abortion’ to refer to both induced terminations of pregnancy and ‘spontaneous’ or involuntary pregnancy loss. The letter stated that in the writers’ experience, women who had experienced pregnancy loss found the use of ‘abortion’ distressing and offensive. It proposed, on ‘humanitarian grounds’, that non-induced cases should instead be called by women’s own preferred term, ‘miscarriage’.
Research has shown that ‘miscarriage’ did subsequently become more common in medical usage. But there has been some debate on the role played by the Lancet letter. Was it the letter that changed doctors’ attitudes, and thus their linguistic choices, or was a gradual shift from ‘abortion’ to ‘miscarriage’ already happening in response to external pressure? Patient-led groups and women’s health activists had established a clear preference for ‘miscarriage’ before 1985: in 1982, when a charity was set up to support affected women, its founders named it the Miscarriage Association. Might these ongoing developments, led by women outside the profession, have played a more important role than the letter in shifting the professional consensus over time?
That question has recently been revisited in an article by the corpus linguist Beth Malory, who investigated the use of ‘abortion’ and ‘miscarriage’ in the titles of articles published in three UK medical journals (The Lancet, the British Medical Journal and the British Journal of Obstetrics and Gynaecology) between 1975 and 1995. Using a statistical modelling technique called ‘change point analysis’, which is designed to identify sudden (rather than gradual) changes in an established pattern, she found that in this case there had been a moment when the pattern abruptly changed, and there was an 85% probability that this occurred in 1986—within months of the publication of the Lancet letter. In Malory’s view this is strong evidence that the letter played a pivotal role in the shift towards ‘miscarriage’.
That doesn’t mean external pressure played no role: the letter was, by its authors’ own account, a response to the concerns expressed by patients and organisations representing them (the letter cites a survey conducted by the Miscarriage Association in which 85% of respondents opposed the then-current medical use of ‘abortion’). But it does seem likely that the effect of the letter reflected the authors’ status as eminent members of the medical profession, which enabled them to make the case for ‘miscarriage’ more authoritatively than the women they spoke for could have done. So, in this case as in the case of ‘pudendum’, the moral of the story seems to be that changing the language of medicine is not something sisters can do for themselves: they may be instrumental in preparing the ground, but ultimately they need the support of high-ranking insiders. (Who will often, as in these cases, be men.)
Nearly 40 years have passed since the Lancet letter, but the issue it addressed hasn’t gone away. ‘Miscarriage’, once recommended as a compassionate and respectful choice, is increasingly under fire itself. And this time women are voicing their objections from a platform that didn’t exist in the 1980s.
In 2020, after the model and media personality Chrissy Teigen shared the news of her recent pregnancy loss on Instagram, the response quickly spread across social media, and then to mainstream publications like Glamour magazine, which ran an article headed ‘Women are calling for the word “miscarriage” to be banished for good’. The article reproduced a Twitter exchange in which a woman expressed her appreciation for Teigen’s use of the term ‘pregnancy loss’, observing that ‘“Miscarried” is such an awful description…it’s like you did something wrong’. Other women agreed: ‘miscarry = mishandle’, tweeted one, while another added, ‘you’re so right…it’s no wonder so many women carry feelings of shame and guilt after their loss’. Many women commented that the term ‘pregnancy loss’ was new to them, and said they planned to start using it instead of ‘miscarriage’.
This change already had some professional support. In 2011 the US journal Obstetrics and Gynecology published a paper entitled ‘Nomenclature for pregnancy outcomes: time for a change’ (note: no question-mark), which argued that new terms were needed to reflect both advances in scientific knowledge and what it called ’emotional considerations’. The authors’ own list of suggested terms contained several that included the word ‘loss’ (e.g. ‘embryonic loss’ and ‘early pregnancy loss’). ‘Pregnancy loss’ also appeared in some of the article titles in the paper’s bibliography, showing that some specialists had already adopted it.
Though it hasn’t happened yet, it wouldn’t surprise me if ‘pregnancy loss’ became the dominant term in the not-too-distant future. Personally I think it’s a good term: it’s straightforward, transparent and acknowledges what the experience means to those affected by it. But it’s still striking, as Beth Malory also comments, how fast and how far ‘miscarriage’ has fallen. The responses to Chrissy Teigen suggested that it is now widely seen as a woman-blaming term (in the words of the tweet quoted earlier, ‘miscarry = mishandle’). That isn’t just a lay view, either: in 2015 a doctor writing in the Toronto Globe & Mail argued that ‘miscarriage’ was a harmful term because the ‘mis-’ prefix leads women to believe their pregnancies have ‘gone wrong’ (when in reality it’s more likely they were never viable) and that this must be because of something they did wrong.
This argument implies that the negative associations of ‘miscarriage’ are–and always were–an integral part of its meaning. Yet if we look back to the 1980s, there is no reason to think it was perceived as negative. In those days it was championed by feminists, patient groups, charities and eventually doctors; it was presented as the term women themselves preferred. One of the advantages it was said to have over ‘abortion’ was that it didn’t carry a stigma, or make women feel they were being blamed. Evidently that’s changed during the last 40 years; but what has happened to change it?
The short answer is that changes in word-meaning may reflect changes in the surrounding culture, and in this case I can think of two developments which might be relevant. One is the increasingly aggressive promotion of the idea that individuals are responsible for their own health, and the associated tendency to blame any problems on people’s own unhealthy choices; in the case of pregnant women, whose choices also affect their unborn children, this attitude is particularly punitive (think of all the total strangers who feel entitled to intervene if they see a pregnant woman drinking alcohol). The other is the rise in popular culture of a new ideal of perfect motherhood, embodied by celebrities and social media influencers who plot an exemplary and very public course from conception (which happens exactly as planned) through a radiantly healthy pregnancy to birth (ideally ‘natural’), after which they have no trouble bonding with the baby, and quickly shed any excess weight. For the great majority of women (maybe all of them) this ideal is unattainable, but that doesn’t stop them feeling guilty for falling short.
Of course it’s true that pregnant women in the 1980s—and for that matter the 1880s—were nagged about their health and presented with unrealistic images of motherhood; it’s also true that women who lost a pregnancy were always susceptible to feelings of shame and guilt. But I’m suggesting that the pressure on prospective mothers to be ‘perfect’ has been massively ramped up in recent decades, and that this may at least partly explain why ‘miscarriage’ has taken on more negative, judgmental or accusatory overtones. It’s a projection of our feelings about the thing onto the word that names it. And one question that might raise is whether changing the word will solve the problem.
Critics of this kind of change are fond of pointing to cases where terms which were introduced to replace a stigmatising label rapidly became pejorative themselves, necessitating a further change in the approved terminology (‘handicapped’ replaced ‘crippled’, and was replaced in its turn by ‘disabled’; ‘lunatics’ became ‘insane’ and then ‘mentally ill’). New terms are corrupted by the persistence of old attitudes, turning the project of reforming language into an endless game of whack-a-mole. My response to this is ‘yes, but…’. Changing linguistic labels may not eliminate social stigma, but that’s not an argument for sticking with terms that have become pejorative. You wouldn’t tell someone suffering from chronic headaches that they shouldn’t take a painkiller today because it won’t stop them getting another headache tomorrow. Temporary relief is still relief.
But when feminists get involved in debates about medical terminology, we should be clear about what renaming can and can’t achieve. Terms which were targets of feminist criticism in the past, like ‘hysteria’ and ‘frigidity’, may no longer appear in doctors’ diagnostic manuals, but they live on as everyday sexist insults (also, how enthusiastic are we about replacements like ‘female sexual dysfunction’, which arguably just repackage the old sexist ideas under a new, blander label?) What we’re ultimately fighting is not a war on words, but a battle against oppressive beliefs and practices. Language can play a part in that, but it isn’t the only thing we need to change.
I’m grateful to Beth Malory for sending me her article (which I hope those of you with access will read for yourselves), but she should not be held responsible for the opinions expressed in this post.