The Creation and Circulation of Evidence and Knowledge in American Medicine through the Lens of the "Husband's Stitch".

Physicians in the twentieth century routinely used episiotomy-a cut made during childbirth-to better facilitate labor, using the evidence of their experiences that it was useful. But physicians were not alone in producing evidence regarding episiotomy and its repair. Here I consider how three groups-male physicians, husbands, and laboring women-were involved in creating evidence and circulating knowledge about episiotomies, specifically, the intention of its repair, the so-called "husband's stitch," to sexually benefit men. By doing so I seek to consider the meanings of evidence within medicine, evidence as a basis for challenging the hegemony of medicine by lay women, and how medical knowledge is produced and shared among physicians and non-physicians.

Female sexuality and consent in public discourse: James Burt's "love surgery".

Beginning in the mid-1960s, gynecologist and obstetrician James Burt developed what he called "love surgery" on unknowing women after they gave birth. It was, he later told them, a modification of episiotomy repair. In the mid-1970s, Burt began promoting love surgery as an elective sexual enhancement surgery and women came to his clinic in hopes of a surgically-enabled better sex life. But though Burt now offered love surgery, he continued to perform it on patients who did not come to him for it through the late 1980s. Over the course of more than two decades, discourse on love surgery occurred twice nationally. In the late 1970s, feminists and sex therapists attacked love surgery as altering a woman's body for male sexual pleasure. Though Burt never hid his continued use of love surgery on women who had not elected for it, the public discourse at this time focused on love surgery as a reflection of larger cultural ideas about female sexuality. In the late 1980s, when Burt's love surgery again appeared in the national media, the issue of informed consent, largely absent from the discourse about love surgery in the late 1970s, moved to the center. Though significant activity happened within the local medical and legal communities beginning in the mid-1970s regarding Burt and his practice of love surgery, my interest here is on these two periods when the discourse regarding love surgery, female sexuality, and informed consent occurred within a national frame.

Expanding Underrepresented in Medicine to Include Lesbian, Gay, Bisexual, Transgender, and Queer Individuals.

In 2003, the Association of American Medical Colleges (AAMC) stopped using the term "underrepresented minority" and instead adopted "underrepresented in medicine." This was not the first time the AAMC revised this definition. In this article, the authors call on the AAMC to revise and expand this definition to include another group that is underrepresented in medicine: lesbian, gay, bisexual, transgender, and queer (LGBTQ) individuals. It is difficult to know whether LGBTQ populations are underrepresented in medicine; however, the data that do exist suggest a significant lack of LGBTQ representation in medicine. It is unclear if this underrepresentation is due to a true numerical lack of LGBTQ physicians, to LGBTQ physicians not publicly self-identifying due to anti-LGBTQ sentiments and reactions, or to both. The authors urge the AAMC to take 3 actions: to anonymously and sensitively poll physicians nationwide to obtain a better estimate of the current number of LGBTQ physicians, to formulate improved standards for an LGBTQ health curriculum for all medical trainees to consistently produce LGBTQ-competent physicians, and to once again expand its definition of underrepresented in medicine to include LGBTQ populations. Such a change to this definition would likely lead to concerted efforts to increase the number of LGBTQ physicians, which could then lead to increased visibility, inclusivity, and mentorship programs where LGBTQ trainees could thrive. With these 3 actions, the authors believe that the AAMC has the opportunity to forge a path forward that is not only beneficial to LGBTQ trainees but also to LGBTQ patients who currently face a myriad of health disparities due to the lack of LGBTQ-identifying and LGBTQ-competent physicians.

Conceiving wholeness: women, motherhood, and ovarian transplantation, 1902 and 2004.

Scholars have shown that organ transplantation may transform ideas about one's body, with recipients feeling that they are receiving not just a body part but also a part of the donor's identity. This article focuses on a different way in which organ transplantation shapes recipient identity: the idea of becoming whole. We present the case studies of two women separated by a century (one in 1902 and the other in 2004) who sought ovarian transplantation, and examine how ovarian transplantation can engender a sense of wholeness on the individual, the familial, and the cultural levels, due to its ability to enable a recipient to naturally conceive and experience pregnancy.

Pathways toward the future: points to consider for oncofertility oversight.

INTRODUCTION: In September 2007, Northwestern University's Feinberg School of Medicine received a $21.1 million dollar, 5-year grant from the National Institutes of Health to fund the Oncofertility Consortium (OFC). Over the course of the grant, those engaged with the psychological, legal, social, and ethical issues arising from oncofertility provided recommendations to the OFC. The inclusion of serious, real-time consideration of ethical issues as a funded focus of the grant and the work of scholars in law, bioethics, and economics was a key part of the process of research. Now that this grant has ended, this commentary points to some of the issues that came forward during the 5 years of this project. Because of the emerging status of oncofertility, these issues are ones that need continued discussion and clarification, prompting our call for an oversight mechanism to provide guidance for how this technology should proceed. METHODS: An initial draft of this commentary arose from notes taken during a small colloquium held to discuss the oversight of oncofertility following the conclusion of the grant. This colloquium occurred in the fall of 2011. Using these notes as a starting point, the draft was then sent to other researchers who had been involved with the OFC in considering the psychological, legal, social, and ethical issues related to fertility preservation for cancer patients during the course of the grant. Finally, this commentary was further framed by the authors' review of existing published and gray literature regarding issues concerning fertility preservation for cancer patients. RESULTS: We provide several points to consider and then offer two suggestions for an oversight mechanism for research as it continues. DISCUSSION/CONCLUSIONS: We assert the need not just for guidelines for the clinical practice of oncofertility, but also for oversight of the scope of this emerging technology because of its profound implications. We recognize that many long to a have a child and form a family and that, for some, cancer interrupts this path. With the conclusion of this grant, we call for the creation of a permanent oversight mechanism to thoughtfully and earnestly consider how to guide oncofertility to allow this emerging technology to be carefully considered as it develops. IMPLICATIONS FOR CANCER SURVIVORS: The circumstances in which fertility preservation should be discussed and the patients for whom fertility preservation would be most suitable are important guideline issues for people who survive cancer and for their treatment team. Oversight of the field of oncofertility would strengthen the rights of cancer patients and help protect them from abuses as well as alert health care professionals to their correlative duties to these vulnerable patients and families.