(Denial) Infertility as Failure: Eugenics, Hysteria, and the Medicalization of Endometriosis, 1861–1949

This chapter traces the emergence of endometriosis as a pathological diagnosis between 1861 and 1949, revealing how modern gynecology developed through a gendered, racialized, classist, and ableist lens. Drawing on archival research and feminist disability studies, it argues that endometriosis was not simply discovered: it was constructed through the anxieties of patriarchal medicine, which pathologized infertility, pain, and deviance from reproductive norms. Physicians from Carl von Rokitansky to John A. Sampson laid the groundwork for clinical recognition of the disease, but it was Harvard gynecologist Joseph Vincent Meigs who redefined endometriosis as a moral and social failure of educated, childfree white women. His eugenic framing transformed the disease into a disciplinary mechanism that punished feminist agency and class mobility. The chapter examines how medical narratives dismissed pain as hysteria, enforced reproduction as cure, and ultimately positioned infertility as disability. By situating endometriosis within broader debates around normalcy, biopower, and reproductive citizenship, this chapter demonstrates how the disease has historically been used to regulate gender, ability, and whiteness. These early constructions continue to shape diagnostic pathways and clinical assumptions today. Through a critical analysis of medical texts, cultural tropes, and disability theory, this chapter reframes endometriosis as a historically contingent and politically charged site of embodied control. Access this chapter Tax calculation will be finalised at checkout Purchases are for personal use only Similar content being viewed by others Notes - 1. “Nulliparous” is a medical term that refers to a person AFAB who has never been pregnant. - 2. Countless women died due to these accusations of witchcraft in the Middle Ages, and later, in the twenty-first century, media discussions of endometriosis have postulated that the disease is still caused by having sex with demons. President Donald Trump retweeted a statement by the physician Stella Immanuel on July 26, 2021, arguing that endometriosis and other common causes of infertility in women are caused by sexual contact with demons. Immanuel’s comments represent the larger cultural discourse on endometriosis: that the public should police women’s sexuality and bodily autonomy. - 3. Peritoneal endometriosis is one of the three main types of the disease, according to Nisolle and Donnez (2019), and involves superficial endometriosis that covers the thin lining of the organs in the pelvic cavity, such as the bladder. Peritoneal endometriosis is more difficult to treat than the other two forms of the disease: deep-infiltrating endometriosis and ovarian endometriosis. - 4. Endometriosis and adenomyosis were not known in the seventeenth and eighteenth centuries by those terms. It would not be until 1927 when the American physician, John A. Sampson, would first use these terms in medical literature to describe these diseases. I am using these terms here for simplicity’s sake. - 5. This notion is also an obstacle for many women in pain today: if a physician diagnoses a woman with dysmenorrhea without identifying the underlying cause, there is no impetus to treat the root of their pain. Approximately 70% of women with pelvic pain have endometriosis (Carter 1994, p. 43). - 6. Cullen’s use of the word “adenomyoma” is now classified under both endometriosis and adenomyosis, a disease where endometrial glands and stroma exist within the uterine wall (myometrium). Many patients with endometriosis also have adenomyosis. - 7. It is important to note, however, that Sampson’s theory is incorrect. It has been disproven countless times by endometriosis researchers, including David Redwine (2002), stating, “Endometriosis is dissimilar to eutopic endometrium and therefore lacks characteristics of an autotransplant. Sampson’s theory of origin of endometriosis is not supported by the results of this study” (p. 686). Sampson also notes in his 1927 study that “To me [menstrual regurgitation] was a most plausible theory but lacked proof” (p. 94). Redwine also notes that there is no visible evidence via surgical methods that menstrual regurgitation even occurs. - 8. “Endometriomas,” previously called “adenomyomas,” are ovarian cysts filled with endometriotic fluid. They are the most common form of endometriosis. They are often referred to as “chocolate cysts,” and are referenced in Sampson’s 1921 study. Endometriomas are considered late-stage of the disease and must be removed surgically. They can grow up to ten centimeters, at which point can become fatal (Kaponis et al. 2015, p. 183). - 9. This editorial, held by the Center for the History of Medicine at Countway Library at Harvard Medical School, has never been analyzed by any other scholars writing on the history of endometriosis. This chapter is the first analysis of this editorial.

Aëtius of Amida. 1950. The gynaecology and obstetrics of the VIth century A.D. Edited and translated by James Vincent Ricci and Janus Cornarius. Philadelphia: Blakiston. Armour, Mike, et al. 2019. The cost of illness and economic burden of endometriosis and chronic pelvic pain in Australia: A national online survey. PLoS One 14 (10): e0223316. https://doi.org/10.1371/journal.pone.0223316. Battey, Robert. 1876. Extirpation of the functionally active ovaries for the remedy of otherwise incurable diseases. Gynecological Transactions, vol. 1. Rome, GA. Baynton, Douglas C. 2016. Disability and the justification of inequality in American history. In The disability studies reader, ed. Lennard J. Davis, 17–34. New York: Taylor & Francis. Benagiano, Giuseppe, Ivo Brosens, and Donatella Lippi. 2014. The history of endometriosis. Gynecologic and Obstetric Investigation 78 (1): 1–9. Bingen, Hildegard. 1151 [1990]. Scivias. Translated by Mother Columba Hart and Jane Bishop. Mahwah, NJ: Paulist Press. Bingen, Hildegard. 2005. Selected writings. Edited and translated by Mark Atherton. New York: Penguin. Bougie, Olga, J. Healey, and S. S. Singh. 2019. Behind the times: Revisiting endometriosis and race. American Journal of Obstetrics and Gynecology 221 (1): 35.e1–35.e5. Bynum, Caroline Walker. 1991. Fragmentation and redemption: Essays on gender and the human body in medieval religion. New York: Zone. Carter, J. E. 1994. Combined hysteroscopic and laparoscopic findings in patients with chronic pelvic pain. Journal of the American Association of Gynecologic Laparoscopists 2 (1): 43–47. https://doi.org/10.1016/s1074-3804(05)80830-8. Cleghorn, Elinor. 2021. Unwell women: Misdiagnosis and myth in a man-made world. Penguin. Cullen, Thomas S. 1896. Adeno-myoma of the round ligament. In Johns Hopkins Hospital bulletin, 112–114. Baltimore, MD: Sheridan Libraries, Johns Hopkins University. Davis, Lennard J. 1995. Enforcing normalcy: Disability, deafness, and the body. New York: Verso. Dawson, B. F. 1885. Removal of the ovaries and tubes for extreme dysmenorrhea and mania. The American Journal of Obstetrics and Diseases of Women and Children 18:943–945. De Beauvoir, Simone. 1949. The second sex. Translated by Constance Borde and Sheila Malovany-Chevallier. Vintage, 2012. Deutsch, Helene. 1950. The psychiatric component in gynecology. In Progress in gynecology, ed. Joe V. Meigs and Somers H. Sturgis, vol. II, 207–217. Boston, MA: Grune and Stratton. Center for the History of Medicine, Countway Library Rare Books, Harvard Medical School. Dewees, William P. 1831. Treatise on the diseases of females. Philadelphia, PA: Carey and Lea. Foucault, Michel. 1978. The history of sexuality, vol. 1. Translated by Robert Hurley. Vintage, 1990. Gannon, Linda. 1998. The impact of medical and sexual politics on women’s health. Feminism and Psychology 8 (3): 285–302. Garland-Thomson, Rosemarie. 2011. Misfits: A feminist disability concept. Hypatia 26 (3): 591–609. Ghrist, Jennie. 1906. Dysmenorrhea in young girls. Reprinted from The Woman’s Medical Journal. Flick Pamphlets, box 30, pamphlet 64. Philadelphia, PA: The College of Physicians of Philadelphia, Mütter Museum. Goodall, James Robert. 1943. A study of endometriosis, endosalpingosis, endocervicosis, and peritoneo-ovarian sclerosis: A clinical and pathological study. Philadelphia, PA: J. B. Lippincott Co. The College of Physicians of Philadelphia, Mütter Museum. Gupta, Sajal, Avi Harlev, and Ashok Agarwal. 2016. Endometriosis: A comprehensive update. New York: Springer. Hippocrates. 1975. Hippocrates: ‘Diseases of women 1’. Edited by Ann Elis Hanson. Signs 1(2):567–584. Holmes, Walter R. 1950. Endometriosis. In Progress in gynecology, ed. Joe V. Meigs and Somers H. Sturgis, vol. II, 450–460. Boston, MA: Grune and Stratton. Center for the History of Medicine, Countway Library Rare Books, Harvard Medical School. Hsu, Albert L., et al. 2010. Invasive and noninvasive methods for the diagnosis of endometriosis. Clinical Obstetrics and Gynecology 53 (2): 413–419. https://doi.org/10.1097/GRF.0b013e3181db7ce8. Husby, Gunhild Kalleberg, Ragnhild Skipnes Haugen, and Mette Haase Moen. 2003. Diagnostic delay in women with pain and endometriosis. Acta Obstetricia et Gynecologica Scandinavica 82 (7): 649–653. https://doi.org/10.1080/j.1600-0412.2003.00168.x. Icard, Le D. S. 1890. La femme pendant la période menstruelle: Etude de psychologie morbide et dé médecine légale. Boston, MA: Alcan, Center for the History of Medicine, Countway Library Rare Books, Harvard Medical School. Ingersoll, Frances M. 1950. Dysmenorrhea. In Progress in gynecology, ed. Joseph V. Meigs, vol. II, 185–189. Boston, MA: Grune and Stratton. Center for the History of Medicine, Countway Library Rare Books, Harvard Medical School. Johnson, Jenell. 2016. American lobotomy: A rhetorical history. Ann Arbor, MI: University of Michigan Press. Jones, Cara E. 2015. Wandering wombs and “female troubles”: The hysterical origins, symptoms, and treatments of endometriosis. Women’s Studies 44 (8): 1083–1113. Jones, Cara E. 2016. The pain of endo existence: Toward a feminist disability studies reading of endometriosis. Hypatia 31 (3): 554–571. Kaponis, Apostolos, et al. 2015. Current treatment of endometrioma. Obstetrical and Gynecological Survey 70 (3): 183–195. Kempe, Margery. 1436 [2001]. The book of Margery Kempe. Translated by Lynn Staley. New York: Norton Critical Editions. Knapp, Vincent J. 1999. How old is endometriosis? Late 17th- and 18th-century European descriptions of the disease. Fertility and Sterility 72 (1): 10–14. https://doi.org/10.1016/s0015-0282(99)00196-x. Laganà, Antonio Simone, et al. 2017. Anxiety and depression in patients with endometriosis: Impact and management challenges. International Journal of Women’s Health 9:323–330. https://doi.org/10.2147/IJWH.S119729. Leeners, Brigitte, Fabia Damaso, Nicole Ochsenbein-Kölble, and Cindy Farquhar. 2018. The effect of pregnancy on endometriosis—Facts or fiction? Human Reproduction Update 24 (3): 290–299. https://doi.org/10.1093/humupd/dmy004. Love, I. N. 1890. Painful menstruation in virgins. The Medical Mirror. Reprinted in Flick Pamphlets, box 25, pamphlet 1. Philadelphia, PA: The College of Physicians of Philadelphia, Mütter Museum. Magnus, Pseudo-Albertus. 1992. Women’s secrets: A translation of pseudo-Albertus Magnus’s De secretis mulierum with commentaries. Translated by Helen Rodnite Lemay. Albany, NY: SUNY Press. McLeod, Carol. 2022. The right to reproduce. In The Routledge handbook of feminist bioethics, ed. W. A. Rogers, J. L. Scully, S. M. Carter, V. A. Entwistle, and C. Mills, 451–462. New York: Routledge. Meigs, Joe V. 1922. Endometrial hematomas of the ovary. The Boston Medical and Surgical Journal 187 (1): 1–13. Center for the History of Medicine, Joe Vincent Meigs Reprints, Harvard Medical School, Boston, MA. Meigs, Joe V. 1934. Tumors of the female pelvic organs. MacMillan surgical monographs. Boston, MA: Harvard Medical School, Countway Library Rare Books. Meigs, Joe V. 1938. Endometriosis, a possible aetiological factor. Surgery, Gynecology & Obstetrics 67:253–255. Meigs, Joe V. 1942. Endometriosis—Its significance. American Journal of Obstetrics and Gynecology 44 (1): 176–177. Center for the History of Medicine, Joe Vincent Meigs Reprints, Harvard Medical School, Boston, MA. Meigs, Joe V. 1949. The medical treatment of endometriosis and the significance of endometriosis. Surgery, Gynecology & Obstetrics 89 (3): 317–321. Center for the History of Medicine, Joe Vincent Meigs Reprints, Harvard Medical School, Boston, MA. Mosher, Clelia Duel. 1918. Health and the woman movement. New York: The Woman Press. Newman, Barbara. 1998. Symphonia: A critical edition of the Symphonia Armonie Celestium Revelationum [Symphony of the harmony of celestial revelations]. Ithaca, NY: Cornell University Press. Nielsen, Kim. 2012. A disability history of the United States. Boston, MA: Beacon Press. Nisolle, Michelle, and Jacques Donnez. 2019. Reprint of: Peritoneal endometriosis, ovarian endometriosis, and adenomyotic nodules of the rectovaginal septum are three different entities. Fertility and Sterility 112 (4): e125–e136. Phoenix, Ann, Anne Woollett, and Eva Lloyd, eds. 1991. Motherhood: Meanings, practices and ideologies. London: Sage. Purcell, John. 1707. A treatise of vapours or hysterick fits. Edward Place. Redwine, David Byron. 2002. Was Sampson wrong? Fertility and Sterility 78 (4): 686–693. Sampson, John A. 1918. The escape of foreign material from the uterine cavity into the uterine veins. The American Journal of Obstetrics and Diseases of Women and Children 1918 (78): 161–175. Sampson, John A. 1921a. Perforating hemorrhagic (chocolate) cysts of the ovary. American Journal of Obstetrics and Gynecology 2:526–528. Sampson, John A. 1921b. Perforating hemorrhagic (chocolate) cysts of the ovary: their importance and especially their relation to pelvic adenomas of endometrial type (“adenomyoma” of the uterus, rectovaginal septum, sigmoid, etc.). Archives of Surgery 3 (2): 245–323. Sampson, John A. 1924. Benign and malignant endometrial implants in the peritoneal cavity, and their relation to ovarian tumors. Surgery, Gynecology & Obstetrics 38 (3): 287–311. Sampson, John A. 1925. Heterotopic or misplaced endometrial tissue. American Journal of Obstetrics and Gynecology 10 (5): 649–664. Sampson, John A. 1927a. Metastatic or embolic endometriosis, due to the menstrual dissemination of endometrial tissue into the veinous circulation. The American Journal of Pathology 3 (2): 93–154. Sampson, John A. 1927b. Peritoneal endometriosis due to the menstrual dissemination of endometrial tissue into the peritoneal cavity. American Journal of Obstetrics and Gynecology 14:422–469. Sampson, John A. 1940. The development of the implantation theory for the origin of peritoneal endometriosis. American Journal of Obstetrics and Gynecology 40 (4): 549–557. Sayers, Janet. 1982. Biological politics: Feminist and anti-feminist perspectives. London: Tavistock. Selverstone, Bertram, and James C. White. 1950. Surgical treatment of the pain of pelvic disease. In Progress in gynecology, ed. Joe V. Meigs and Somers H. Sturgis, vol. II, 748–761. New York/Boston, MA: Grune and Stratton. Center for the History of Medicine, Countway Library Rare Books, Harvard Medical School. Shohat, Ella. 1992. “Lasers for ladies”: Endo discourse and the inscriptions of science. Camera Obscura 29:57–90. Shrön, Daniel. 1690. Disputatio inauguralis medica de ulceribus uteri, 6–17. Jena: Krebs. Signorile, Pietro G., et al. 2010. New evidence of the presence of endometriosis in the human fetus. Reproductive Biomedicine Online 21 (1): 142–147. https://doi.org/10.1016/j.rbmo.2010.04.002. Stoddard, Lothrop. 1920. The rising tide of color: The threat against White world-supremacy. New York: Charles Scribner’s Sons. Sturgis, Margaret Castex. 1942. Gynecology—Endometriosis (II). Margaret Castex Sturgis Papers (1885–1962), box 1, ser. 1–4, MSS 210020. Philadelphia, PA: The College of Physicians of Philadelphia, Mütter Museum. Tilt, Edward John. 1851. On diseases of menstruation and ovarian inflammation in connection with sterility, pelvic tumors, and affections of the womb. New York/Boston, MA: Samuel S. and William Wood/Center for the History of Medicine, Countway Library Rare Books, Harvard Medical School. Todd, Alexandra. 1989. Intimate adversaries: Cultural conflict between doctors and women patients. Philadelphia, PA: University of Pennsylvania Press. Von Recklinghausen, Friedrich. 1896. Die adenomyome und cystadenome der uterus und tubenwandung: ihre abkunft von resten des Wolff’schen Körpers. Berlin: Hirschwald. Von Rokitansky, Carl. 1860. Ueber uterusdrüsen-neubildung in uterus-und ovarial-sarcomen. London: Druck von Carl Ueberreuter. Zweifel, Paul. 1885. The treatment of blood extravasations behind the uterus (retro-uterine hematocele and subperioneal hematoma). The American Journal of Obstetrics and Diseases of Women and Children 18:221–222. Author information Authors and Affiliations Corresponding author Rights and permissions Copyright information © 2026 The Author(s), under exclusive license to Springer Nature Switzerland AG About this chapter Cite this chapter Rovito, M. (2026). (Denial) Infertility as Failure: Eugenics, Hysteria, and the Medicalization of Endometriosis, 1861–1949. In: Cripping Endometriosis. Palgrave Macmillan, Cham. https://doi.org/10.1007/978-3-032-15681-5_2 Download citation DOI: https://doi.org/10.1007/978-3-032-15681-5_2 Published: Publisher Name: Palgrave Macmillan, Cham Print ISBN: 978-3-032-15680-8 Online ISBN: 978-3-032-15681-5 eBook Packages: Social SciencesSocial Sciences (R0)