Friday, 30 June 2017

Let’s talk about…SEX

This week, Project Cataloguing Archivist Clair talks about what she's been finding in her case note collection...

As has been mentioned in previous blogs I am working as part of the wider University Collections Facility rationalisation project to continue cataloguing work on some of LHSA’s case note collections. In particular, these are sexual dysfunction case notes from the Gynaecological Out-Patient Department at the Royal Infirmary of Edinburgh (RIE) which date from 1973 – 1994. We have around 1249 individual patient case notes from this period, and I have had the opportunity to learn from this primary source about the types of medical conditions and treatments that these patients experienced. This is an important collection because it is a very different medical specialism in comparison to other case note collections that have already been catalogued at LHSA. The case notes come from a more modern period and are structured slightly differently, which is reflected in their content. The circumstances relating to sexual dysfunction were often a combination of physical and psychological conditions and required a different medical approach.

The history of sex and sexuality is an area in which I have done a little studying before, but reading through the case notes has given me another perspective of both sexuality within a medical context and the relationship between sexual activity and physical and psychological health. Gaining insight into any topic relating to sex is interesting because of its importance to the human existence, being such a natural part of the human condition, yet historically the freedom to discuss sex and sexuality has been inhibited by values and beliefs through the ages. Although the sexual dysfunction case note collection covers a relatively late period, they give us a snapshot about how discussions surrounding sex and sexual identities are constantly evolving. In reading the case notes, I have reflected on my visit to the ‘Institute of Sexology’ exhibition at the Wellcome Library in 2015, which revealed a vast and varied selection of archival material, art, film and artefacts tracing the evolution of the way in which sex is studied. The exhibition showcased the work of many key sexologists including Sigmund Freud, Marie Stopes and Alfred Kinsey and showed how they lifted sexual taboos, developed a legitimate area of study and created a place for sexual health within mainstream clinical practice. Although the exhibition is finished, here is a short film of what was a fascinating tour.
Throughout the period reflected in the case notes (1973-1994), there are a broad range of issues addressed at the sexual dysfunction clinic. Many common medical conditions (for example, dyspareunia - pain during intercourse - or erectile dysfunction) were documented, and could often be treated successfully with a course of sexual therapy, drug treatment or, frequently for women, a minor gynaecological surgical procedure. However, the case notes also demonstrate that many sexual problems faced by patients manifested within the context of sexual relationships. Common sexual issues could be directly related to stressful relationships, living conditions and occupations, as well as ignorance or fear of sexual feelings. Some of the content of the case notes was upsetting to read because some of the patients had gone through traumatic experiences. Moreover, social attitudes towards sexuality or lack of sex education was sadly a common factor for many patients that came for help, who feared that they were sexually 'deviant', or risked being stigmatised because of their ‘unconventional’ sexual feelings.
Sexual problems categorised as a ‘dysfunction’, including frigidity, sexual unresponsiveness, loss of libido and orgasm disorders, were regarded as symptoms of emotional, psychological and personality disorder and thus were often treated thorough a course of sexual/marital/couples or individual therapy. Each patient visiting the clinic presented their own set of very personal and specific problems, so it is difficult to generalise or pick out cases that are representative of many. However, below are redacted extracts from two of the case notes that provide an indication of the complexity and array of deep-rooted issues experienced by patients.
PR1.552 (1)
PR1.552(2) These extracts come from the same file and show how attitudes towards sex and sexual feelings can be established from an early age and the way it was often seen as a taboo subject. Negative connotations of sexual activity as wrong or dirty appear as problems for many patients amongst the case notes. Bad feelings about sex often inhibited patients to form loving, healthy sexual relationships.   

PR1.555 This extract reveals the difficulties that some patients faced surrounding sexuality and gender identity.
 Patients were often referred by their GP or could make a direct appointment to be seen by one of the specialist at the sexual dysfunction clinic, based within the Gynaecological Out-Patient Department at the RIE. Key figures in the Department were Dr John Bancroft, Psychiatrist, and Philip Myerscough, Consultant Gynaecologist. Although I have struggled to find out more about Myerscough and his career, it appears that after Bancroft’s time in Edinburgh he became Director of The Kinsey Institute for Research in Sex, Gender and Reproduction at Indiana University. His research and work can be found spans many titles, including Human Sexuality and its Problems (1983). From a quick skim of this book, one can see reflections of his working practice and ideology seen in the case notes. Although it is often recorded that patients were too embarrassed to attend their appointment at the clinic or came in secrecy for fear of others finding out, the progressive nature of physicians such as Bancroft and Myerscough made many patients feel at ease. In his book Bancroft describes the feelings that many patients have which contribute to their sexual problems, including anxiety, anger, insecurity, guilt and low self-esteem. This level of understanding of all factors that affecting patients and his impartial approaches are revealed in the case notes, particularly when treatment programs or courses were tailored to meet specific patient needs.

Cataloguing these case notes using a similar methodology to other LHSA case note cataloguing projects has been really interesting because of the trends that can be spotted over time and the impressions that can be gained about a particular topic. Dr Gayle Davis, Senior Lecturer in the History of Medicine at the University of Edinburgh, used the sexual dysfunction case notes before they were catalogued for her research into the medical response to infertility in late 20th century Scotland. Therefore, we already know that there is an interest in using this primary source material and we can aid research by creating catalogues as a better way in to the collection. We hope that the way in which the case notes are described in the catalogue will help to highlight other potential areas of interest to the research community. The case notes can be explored without revealing anything biographical or medical which could identify those who were treated - this is not only important because of the information legislation surrounding health records, but also due to their sensitive subject matter.
This catalogue will go further in making our growing collections on sexual health, gender and sexuality accessible - collections that cover women's health and activism, reproductive health, LGBTQ+ health, HIV and AIDS awareness and the treatment of venereal disease.

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