Inventing Female Anatomy in the Early Modern Period: Dissections and Interpretations of the Uterus

Annagiulia Gramenzi^*

https://orcid.org/0000-0002-0183-7668
Independent researcher
formerly Associate Professor of Internal Medicine
at Alma Mater Studiorum, University of Bologna, Italy
annagiulia.gramenzi@unibo.it

Représenter le sexe féminin dans la première modernité : dissections et interprétations de l’utérus

Here ye shall understand, that these three words, the Matrix, the Mother, and the Womb, do signify but one thing: that is to say, the place wherein the seed of man is conceived, foetified, conserved, nourished and augmented, unto the time of deliverance, in Latine named Uterus et Matrix^[1].

Speaking of female genitalia, the nomenclature has historically been a point of concern. Indeed, the choice of anatomical terminology has never been an arbitrary or random operation, as it reflects the cultural and ideological approach of the writer or speaker and deeply marks the distinction between academic, trained professionals and lay people. A salient example of this process is the term pudendum used to describe external genitalia, which was only officially eliminated from the Terminologia Anatomica in 2019, a decision that emerged in response to objections concerning the Latin root of the word pudēre, meaning to be ashamed, which carries connotations of shame and disgrace.^[2] During the early modern period, the study of anatomy which was based on the dissection of human cadavers, led to a problematic semantic remapping of the human body “magnified by the printing press’s ability to broadcast ideas and images to wider audiences.”^[3] This period marked a significant intersection of ongoing refinement in the study of human anatomy with an unprecedented and plural interest for women that transcended their role as corpses to be dissected. This interest encompassed their experiences as patients affected by morbi muliebres (women’s ailments) and their role as recipients of obstetrical and midwifery textbooks written in Latin, but predominantly in the vernacular languages. Consequently, terms traditionally employed for womb, such as mother, matrix, and uterus acquired novel meanings, symbolisms, metaphors, and reference as well as ambiguity and allusions. This phenomenon was further exacerbated by the escalating moral rigidity characteristic of Reformation and Counter-Reformation Europe. As Hélène Cazès observes in the introduction to the Tota mulier in utero online portal, “the lexicon of shame, modesty, eroticism, duplicity and sin” informed – and at times significantly constrained – the development of anatomical nomenclature.^[4] A passage from Erasmus of Rotterdam 1526 Christiani Matrimonii Institutio may be cited in this context:

No part of the body is shameful, since God created them all good and beautiful; yet in some cases decency demands that they be concealed, and even that they should not be named directly, but indicated by some modest circumlocution. “Vulva” is a blameless word, and so is “womb”, and yet the ignorant consider them disgusting. You may say “a woman’s nature” without giving offence, when you mean her pudenda.^[5]

Despite the inherent limitations of different vernacular languages and the challenges posed by translations from Latin, Greek, and Arabic, early modern medical literature continued to employ a well-established set of synonyms such as mother, matrix, womb, and uterus, as evidenced by the quotation from Thomas Raynalde’s “The Birth of Mankind” cited at the beginning of this text. Yet, this generalization requires some qualification. Specifically, while the terms womb and mother were more commonly used in popular medical writings intended for lay audiences, matrix and uterus were typically employed in academic discourse to more precisely designate the female generative organs. In addressing this issue, it is crucial to exercise caution when comparing terms that may appear similar and familiar to contemporary readers, as their historical meanings and connotations do not necessarily align with present-day understandings. However, as the equivalent expression matrix and mother suggest, the uterus has long been associated with both gestation and the mystery of female generation. Indeed, Raynalde states that the uterus is “the place wherein the seed of man is conceived, fortified, conserved, nourished, and augmented,” in other words a mere receptacle for active male generative force. This framework reinforced the idea that women played a passive role in reproduction, with the womb merely seen as the place where brute matter is worked and shaped by masculine form. This persistent view, originating with Aristotle^[6], holds that women provide the matter, while men provide the seed, thus reinforcing the gendered nature of reproductive roles, with women defined by their passive receptivity to the masculine creative principle. In this regard, the printed engravings and illustrations depicting the fetus in the uterus^[7] in sixteenth- and seventeenth-century obstetrical and midwifery textbooks are emblematic of a long visual tradition in which the womb, fully detached from the female body, is represented in simple and schematic terms as a container: a balloon, a flask, or an inverted vessel often devoid of anatomical detail. Within this space, improbably developed fetuses with curly hair, rounded limbs and chubby bellies are shown floating freely, dancing or attempting to break free. These representations, shaped by dominant male gazes and perspectives, render the maternal body silent and invisible as if it were a disruptive presence, an interference in gestation.^[8]

The passive role of the womb, mother, matrix, is further reinforced through analogy^[9], particularly via agricultural and botanical metaphors and symbols. At the time, it was not unusual to conceive of human reproduction in terms of plant reproduction: the generative process was imagined as analogous to sowing seed, rooting, and vegetative growth. As described in “The Compleat Midwifes Practice,” a compilation of earlier texts on childbearing first published in 1656 and expanded in subsequent revised editions, man “doth naturally draw his Original and Beginning, from the sperm and seed of Man, projected and cast forth into the Womb of Woman, as into a Field.”^[10] In his obstetrical treatise, the sixteenth-century Zurich physician and surgeon Jakob Rüff describes the infant in the womb as a flower, while Jacques Duval in his 1612 book about conception, childbirth, and the nature of hermaphrodites similarly explains that “children in their mother’s womb are like tender plants rooting in a garden.”^[11]

In verdant, vegetative analogies, if the fetus was imagined as a plant, a tender flower, a tree blossom, or a fruit, then the womb must necessarily be understood as Earth, a field, or a garden: the place in which the male seed is sown and germinates. This imagery was not merely metaphorical but deeply embedded in anatomical and medical literature of the early modern period. In Isagogae breues (1521), Jacopo Berengario da Carpi refers to the uterus as the “field of nature” and the anatomist Alessandro Benedetti (d. 1512) describes the uterine interior as a secluded garden in which the seed begins to sprout.

This analogy is presented in the seventeenth century as verbal metaphor by Veslingus describing “the fruit… inclosed in its secundines”, and as visual metaphor in one of the copper plates of Adriaan van der Spieghel’s De formato foetu published in 1627. A sleeping fully developed fetus is shown attached via the umbilical cord to the placenta, surrounding which like petals are the dissected parts of the chorion and the membranes of the uterus. The fetus lies in the center of this array as though emerging from a flower (as indeed fruit does developmentally).^[12]

A similar botanical image appears in “The Midwives Book: or the Whole Art of Midwifry Discovered” (1671), where the English midwife Jane Sharp likens the opening of the pregnant womb to the blooming of a flower. These printed representations offer a limited but revealing perspective on early modern conceptions of the female reproductive body, a vision shaped predominantly by male authors, and deeply entangled with classical and medieval traditions.^[13] Yet, such depictions were not necessarily negative. In “Vernacular Bodies”, Mary Fissell observes that early modern understandings of conception and gestation – especially prior to the Reformation –sometimes portrayed the womb as a “marvelous structure” and a site of wonder, since the pregnancy was imagined to echo, albeit faintly, the Virgin Mary and the miracle of the Incarnation. Viewed through this lens, the uterus was regarded as a generous and stunning space capable of “making seed into life.” Conversely, well into the early modern period – and with particular virulence in certain misogynist contexts – the uterus continued to be metaphorically described also as a cloaca, a sewer, a latrine, or a sink, assigned the role of collecting and retaining impure and poisonous menstrual blood before its periodic evacuation. This conceptualization which framed the womb as an excretory organ, can be traced back to Avicenna and later transmitted in the De Secretis Mulierum, a thirteenth- and fourteenth-century treatise attributed to pseudo-Albertus Magnus, according to which the uterus fulfilled an emunctory and purgative function.^[14]

Medical discourse has long suggested that the female body harbors powerful secrets. Indeed, females conceal within their bodies what males display outwardly; thus, the womb was the secret of secrets. As une partie du corps appartenante seulement à la femme^[15] (part unique to woman), it was considered the organ most divergent from the perfect and normative male form, and for a long time it remained beyond the reach of equally “perfect” male knowledge. Consequently, as previously discussed, when male anatomists and physicians attempted to envision the hidden interior of the female body – deemed inherently imperfect – fantasy, curiosity, wonder, and anxieties about reproduction, paternity, and family destinies gave rise to colonization and unconventional representations that were profoundly influenced by cultural concerns.

According to humoral theory which remained dominant in Europe throughout the early modern period, women – with their cold and moist bodies – were particularly vulnerable to fluid imbalances and their womb was the organ most at risk and indeed the source of all their health problems, including dropsy, melancholia, madness^[16], and “at least six-hundred miseries and innumerable calamities,” as the French physician Lazare Rivière noted in the mid-seventeenth century.^[17]

The French surgeon Ambroise Paré “referred to the womb as amarry, which translates as a thing filled with sorrow.”^[18] Moreover, this pathogenic organ was also believed to be intimately connected with all parts of the female body through direct and/or sympathetic links.^[19] Thus, it was no surprise that women were believed to suffer from more infirmities than men, as clearly stated by the English physician Edward Jorden^[20] and by the midwife Jane Sharp.^[21] In essence, a woman’s health depended heavily on the state, disposition, and desires of her unreliable perishable, ambiguous, and corruptible womb, an organ that required constant attention, surveillance, and control. By framing the womb as an unstable organ in constant need of regulation, medical narrative reinforced the perceived necessity of surveilling women’s bodies. The cultural anxiety surrounding women’s bodies at the time permeated the concept of the womb, suggesting its detrimental effects.

A metonym for the entire female body, the uterus lacks a fixed complexion: it is an animal within an animal, as classical doctrine asserted, “a fierce beast” according to Gilbertus Anglicus in his Compendium Medicinae (1240), and a wild, untamed creature (fiera indomabile) as described by Giovanni Marinello in the second half of the sixteenth century in one of the first printed obstetrical manuals written in the Italian vernacular.^[22] It is also a monster and a mysterious entity set apart from the rest of the body, as noted by the Elizabethan astrological physician Simon Forman (1552-1611). Unsurprisingly, the uterus has often been anatomically represented in zoomorphic terms or described using an animalistic lexicon: it has a neck, one or two mouths, a snout (the “snout of the tench,” still used today in anatomical terminology to refer to the portion of the cervix that protrudes into the vagina), lips, a crest, two horns like a veal, suckers or cotyledons, wings or nymphs.^[23] This animalized matrix was also believed to possess powerful sensory faculties, especially olfactory ones; it was sensitive to both cold and heat, it had an appetite, and it was particularly fond of male seed^[24], which it attracted through sympathy or magnetism. In the secrecy of the womb, physicians and midwives found strange and curious objects: stones as large as duck eggs, hair resembling wool, as well as animalcules, fish, snakes, earthworms, and, naturally, monsters.^[25]

But more than anything, the womb was endowed with a disturbing autonomy of movement: it shifted, it dislocated, it roamed, potentially corrupting the entire female body, even suffocating and strangling it. This invention, as ancient as Western philosophy and medicine, underpinned the interpretation of a pathological condition that was elusive and ambiguous, systemic, and potentially lethal, variously referred to as uterine suffocation, mother’s pain (or simply “The Mother”), hysteria, hysterical passion, always originating from the womb, ὑστήρος in Greek, the supreme morbid manifestation of disorder, irrationality, and female indiscipline. Uterine wanderings could even simulate demonic possession, as the English physician Edward Jorden attempted to demonstrate in 1602 in a famous witchcraft trial and later in a treatise entitled “A Briefe Discourse of a Disease Called the Suffocation of the Mother”.

Due to its deeply embedded and nearly inaccessible location, as well as its elusive and mysterious nature, the uterus became one of the most frequently examined organs on the dissection table. Indeed, until the advent of modern imaging techniques, no one could know what – or who – was hidden within the female body, except at the moment of a possible expulsion or upon death, followed by the opening of the corpse. As Jennifer Kosmin points out, “it was the image of the anatomist laying bare the (un)pregnant female body and revealing its secrets that Vesalius chose to introduce readers to his masterpiece.” The empty uterus, prominently shown on the frontispiece of the Fabrica, would become, for generations to come, a symbol of “masculine scientific investigation and triumph over the unruly female body.” ^[26]

A systematic observation of the female genitalia began at the end of the fifteenth century and continued in anatomical theatres, where the horridum spectaculum, as the anatomist Alessandro Benedetti described it in the late fifteenth century, was put on stage. The question remains: what exactly did anatomists observe? What did they expect – or want – to see? And, perhaps more crucially, what did they touch, given that in this context vision and touch were both essential tools, as Berengario da Carpi emphasized in 1521?^[27] Without doubt, male imagination and bias played a crucial role even in the “simple” description of bodies, where one saw (and touched) only what one wanted to see (or touch), sought only what one intended to find, and represented only what was deemed important or worthy of note. At the threshold of the early modern era, anatomical observation, public lectures, and printed texts continued to be shaped by long-standing assumptions about female anatomy and physiology.

From the very beginning, human cadaveric dissection confirmed that the uterus functioned as metonymic stand-in for the female body (tota mulier in utero^[28]), as clearly shown by the image “On Woman” in the Fasciculo de Medicina in Volgare (1494), attributed to Johannes de Ketham, one of the first printed medical compendium to include anatomical illustrations.^[29] In this depiction, the uterus is not simply one organ among others: its central placement and visual prominence, accentuated by fan-shaped lines labeled Fumosità de la Matrice (“fumes of the matrix”), establish it as the organ that entirely represents the female anatomy.

Not only metonymic, since in many early modern medical texts, depictions of female anatomy served the sole function of illustrating the reproductive system; all other aspects of corporeality were represented through the standard, normative male body. Within this limited reproductive framework, the uterus/womb/vagina occupied an exceptionally prominent position, often at the expense of other female pelvic viscera. This emphasis is evident in full-body depictions of women, frequently shown seated with legs apart so as to unveil, visually display, or deliberately indicate the uterus, whether empty or gravid. These images circulated widely in midwifery manuals, anatomical treatises, and fugitive sheets throughout the 16^th and 17^th centuries. Some fugitive sheets even allowed readers to lift flaps of the abdominal wall, offering a direct view into the womb.

The dominant reading of female physiology in early modern medical texts reflects the enduring influence of Galenic theory. According to this legacy, the internal location of female genitalia was explained as the result of an arrested development. Fully formed genitals, the “true” genitals, were, of course, the penis and testicles. Woman remained, so to speak, “half-baked.” Within this framework, the womb was essentially conceived as an inverted and underdeveloped version of the testicles. As such, the uterus did not escape the mirroring of the ideal male model, not even when it was finally under the gaze of the emerging anatomical science. Notably, although empiric observation had begun to challenge the classical theory of a matrix internally segmented into seven distinct cells, distributed in two compartments – one on the right and one on the left – in line with traditional testicular analogies, even Berengario da Carpi, who twenty years before Vesalius had observed and described a single cavity (uterus simplex), continued to represent the uterus in the shape of a heart. In a passage, he acknowledges the existence of a single cavity, which, however appears partially divided into two sections, almost as if there were two wombs.^[30]

Other prominent anatomists active between the sixteenth and seventeenth centuries, such as Jean Fernel, Gaspard Bauhin, André Du Laurens, Spigelius, and Jean Riolan, also reflected this enduring cultural residue of sexual isomorphism. In the Fabrica, Vesalius firmly asserts the uniqueness of the uterus as a single cavity, yet he concedes that there might be a kind of suture, a slight prominence, intriguingly likened to the scrotum.^[31] Even when describing observable features, there remains, as always, a reference to, or analogy with the male form, which continues to serve as the only possible frame of reference. This old and long-standing practice of establishing the male as the standard and the female as the variant or the deviation, is deeply embedded in medical thought and practice and persists to this day.

Even after direct observation on the dissection table confirmed that the womb was securely anchored in the pelvis, this homeless and restless mother/matrix organ continued to be imagined and conceptualized as wandering through female body with malevolent intent when unfulfilled, disrupting the function of other internal organs. By the late seventeenth century, anatomical evidence had unequivocally demonstrated that the womb could neither literally suffocate nor roam freely within the body. Nonetheless, physicians redefined its pathological potential: rather than wandering, the womb was now considered capable of disturbing the female brain.

Finally, in the continuum of male investigation and colonization of the female body, an important shift must be acknowledged: the growing medical attention to sexual differences and the specificity of female anatomy. By 1500, initially in Italy, then in France, and later across Europe, many physicians writing on anatomy or morbi muliebres, began to transform and redefine the representation and status of women and their bodies as Gianna Pomata^[32] and Hélène Cazes^[33] have pointed out. The classical ideal of bodily perfection, of Aristotelian-Scholastic derivation long aligned with the male form, was increasingly questioned and reframed through the anatomical lens. Rather than regarding woman as a mere inferior, erroneous, and defective variant of man, these physicians began to assert a model of sexual difference in which both sexes were considered equally necessary for reproduction, each perfect in its own right. In 1579, the Spanish physician Luis Mercado wrote:

I don’t believe that the female is more imperfect than the male. The perfection of all natural things has to be investigated in relation to Nature’s intention […]. And considering the goal for which woman has been created, I am led to believe that she is equally as perfect as man.^[34]

This emerging vision must be situated within the broader context of evolving discourses on gender and reproduction in the early modern period. The “scientific” definition of sexual difference needed to be framed in a way that remained consistent with the teleological principle that “Nature does nothing in vain.” This is why André Du Laurens (1646) deemed it necessary to write: “We believe instead that Nature intends to generate both female and male. Saying that woman is an error, or false step, of Nature, is unworthy of a true philosopher – it is a barbarous opinion.”^[35] Such a statement requires grounding in the very nature of woman herself. What, then, could be the principal organ of her specificity, legitimizing her irreplaceable role in Nature, if not the womb, the receptacle in which, according to Ambroise Paré “a small creature of God” is formed? Even in this context, the uterus remains unequivocally central to the definition of the female body, yet here it is regarded as necessary and noble, deserving admiration and reverence especially for its remarkable role in procreation.^[36] However, this particular focus is not enough to clear the field of suspicions and ambiguity. As has been extensively discussed, the uterus will continue to carry the weight of ambiguity, pathogenicity, and harmfulness for many years to come, unsettling and perturbing the bodies of the women, stirred by passions, the cycles of the moon, desires, perversions, moralism, and male inventions.