Sexuality and Medicine: Bodies, Practices, Knowledges

By John Wiltshire, Paul A. Komesaroff and Philipa Rothfield

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• Language: English
• Publisher: Xlibris US
• Release date: Jul 29, 2004
• ISBN: 9781469105949

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Sexuality

and Medicine

BODIES, PRACTICES, KNOWLEDGES

Paul A. Komesaroff,

Philipa Rothfield,

John Wiltshire

Copyright © 2003 by Paul A. Komesaroff, P. Rothfield, J.Wiltshire.

All rights reserved. No part of this book may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording, or by any information storage and retrieval system, without permission in writing from the copyright owner.

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Contents

EXTENDING THE FRAME OF SEXUAL KNOWLEDGE

1

INTRODUCTION

SEXUALITY AND MEDICINE:

BODIES, PRACTICES, KNOWLEDGES

2

OUR SEXUALITY, OUR EROTICISM

3

SEX IN AMERICA

SEXUALITY IN THE CLINICAL SETTING

4

SEXUALITY UNDER CLINICAL MISMANAGEMENT

5

SEXUALITY AND ETHICS

IN THE MEDICAL ENCOUNTER

6

MEDICINE, SEXUALITY, AND ROMANCE:

OLIVER SACKS’ AWAKENINGS

SEXUAL INTERSUBJECTIVITIES

7

MEDICAL TECHNOLOGY AND

THE CLINICAL ENCOUNTER

8

PLEASURES OF THE BREAST

9

THE DENTAL GAZE:

LIVE ORAL IMAGING SYSTEMS IN THE PERFORMANCE OF DENTISTRY

PSYCHOANALYZING SEXUALITY

10

PERVERSION AND HYSTERIA

11

THE VIRGINITY OF PRESIDENT SCHREBER

ANTHROPOLOGY OF THE BODY

AND SEXUALITY

12

OTHER SELVES, OTHER BODIES:

THE FEMALE CIRCUMCISION CONTROVERSY

IN CULTURAL PERSPECTIVE

NOTES ON CONTRIBUTORS

NOTES

EXTENDING THE FRAME OF SEXUAL KNOWLEDGE

1

INTRODUCTION

SEXUALITY AND MEDICINE:

BODIES, PRACTICES, KNOWLEDGES

John Wiltshire, Paul Komesaroff, and Philipa Rothfield

Whenever I go into a house, I will go to help the sick and never with any intention of doing harm or injury. I will not abuse my position to indulge in sexual contacts with the bodies of women or of men, whether they be freemen or slaves.¹ At the inception of Western medicine, as this section of the Hippocratic Oath suggests, sexuality was recognised as inexorably inhabiting the clinical encounter. Yet at the same moment that sexuality was recognised, it was also feared, and warned against, proscribed. Such an inhibition about sexuality, at so foundational a moment, has influenced the subsequent history of medicine’s dealings with sex. It is this inhibition that this book, Sexuality and Medicine: Bodies, Practices, Knowledges, is designed to challenge.

Like all taboos and prohibitions, this early injunction reveals the allure of that which is abjured. Consultations between doctors and patients often involve the patient in revelations of feelings and displays of the body such as are normally only permitted between family members and intimates. (One might conjecture that part of the physician’s healing power is drawn from this situation of unusual physical and emotional proximity.) Hippocrates shows he understood that the professional relation he was defining was a potent site, in which proclivities of an intensely personal kind are liable to be in play. Such play may provoke emotions of a sensuous or sexual dimension, ones in which the doctor might well be caught up. In such an arena of exposed sensitivities, both psychological and corporeal, the patient’s sexuality is necessarily implicated. The physician’s response, however, must be of a special and guarded kind.

This taboo against sexual relations with patients has continued, rightly, to be enforced within the clinic. But it has contributed, we would argue, to a more fundamental inhibition or strangulation of thought about sexuality within medicine, a refusal of medicine even to contemplate or think about sexuality except under special and rigidly controlled conditions. This may seem a strange claim to make, for has not medicine, from the earliest times, undertaken to treat many conditions and dysfunctions associated with the sexual organs: impotence, sexually-transmitted diseases, excessive menstrual bleeding, to name a few? Such conditions were copiously discussed in both ancient and early modern medical treatises. With the development of psychiatric thought in the later years of the eighteenth century, moreover, medicine at once deepened its theoretical understanding of sexuality and brought a new range of conditions into its domain. Tissot’s work on masturbation, which shifted it from a sin to a mental disorder, is a salient and notorious example.² Sexual performances, functions, and preferences now became the legitimate objects of medical attention. Since the later nineteenth century and the era of Krafft-Ebing and Havelock Ellis, not to mention the work of Freud, sexual disorders, or variations of sexuality, have been extensively scrutinised and discussed within the framework of medicine.

Medicine, however, has tended to understand sexuality under the aegis, or within the framework, of biology or even botany. Hence, the very limited terms within which sexuality came to be articulated. According to the medical paradigm, the varieties or variants of sexuality are conceptualised as phenomena of the observed object, from which the observer is strictly segregated.³ Even Freud was only reluctantly and belatedly persuaded that sexuality might be thought about in modes other than the scientific. The result of modelling sexuality on biology is twofold. Firstly, it leads to a tendency to think of sexuality in terms of observable or observed phenomena, as a matter of features which can be described, and ultimately organised or catalogued, put into some form of nosological order. As can be seen in the twentieth-century developments of Krafft-Ebing’s work—the Kinsey, Masters, and Johnson and later surveys—sexuality is liable to become defined largely as a matter of sexual practices, of phenomena in a behavioral field. Sexuality or sex is defined as what you do, or what you prefer to do, and doing is tied ineluctably towards a genital aim. A further consequence is a tendency to define persons in terms of these sexual practices—as homosexual, pederast, voyeur. Instrumental and genital sexuality readily becomes mistaken for the whole domain of sexuality itself.

This leads to the second consequence, which is that sexuality, exclusively an attribute of the observed object, becomes simultaneously an object over which the observer has power—power which ideally would alter, perhaps, or cure—but which at the least, is exercised in terms of the epistemological ability to organise or understand. As Michel Foucault and a host of post-Foucauldian commentators have pointed out, this results in medicine positioning itself as a regulator of sexuality. Perhaps as a result of the need to recruit diminishing professional authority in the nineteenth century, medicine during that period increasingly claimed to arbitrate on the normality or perversity (or in other words the health or the pathology) of the sexual phenomena and practices that were brought to its attention. Within the field of sexuality thus defined, it was an easy shift from scientific authority to the authority of moral, ethical, and legal regulation. It is this shifting ground that is occupied by Freud’s Three Essays of 1905, a work which simultaneously liberates the field of sexuality from previous narrow constraints and reinscribes the notion of a teleological norm—standard or ideal of sexual attainment. Freud at once puts into circulation the conception of polymorphous perversity, of a largesse of sexual modalities, and simultaneously, as a post Darwinian, speaks of the ascent of man. In other words, Freud suggested that infants enjoy a plethora of perverse gratifications, yet are subjected to the need to organise this diverse scenario in relation to a narrow, reproductive norm.

The history of this form of knowledge—medical understanding and its grasp of sexuality—has been written by Foucault and his followers, and comprehensively covered by the now-conventional phrase, the medical gaze. Because of its association in Foucault’s original text, The Birth of the Clinic (1963), with the anatomical investigation of the corpse, this phrase has become synonymous with disregard of the patient as a speaking subject, and with the disappearance of the sick-man or woman from medical cosmology.⁴ Conflated with Foucault’s later work, with the brutal dissymmetry of visibility in the panopticon,⁵ it is understood as continuous with the disciplinary surveillance of bodies, and the institution of medicine is designated as the field in which such dominance was earliest and most systematically practiced. The medical gaze has become useful, too, as a reminder of the complicity of visual domination with the rise of modern medicine⁶ and the reliance of the contemporary clinic on monitors, screens, print-outs, of the conversion of bodily phenomena into particular renditions of the visual, a displacement, sinister perhaps, of the first-hand impressions of the senses.⁷

In medical sociology, the medical gaze has long abandoned its reference to the narrow focus, the intense concentration of the earliest anatomical observers. It now denotes the monitoring techniques of epidemiology, the scanning of populations, a certain mapping of the social space.⁸ For Foucauldian commentators even call for a re-humanising of medicine, for a patient-centered medicine, which inquires into personal history and family background, fall under the rubric of the gaze: such a social perspective, comments David Silverman, thus, seems to offer a totally unrestricted form of surveillance in which the medical gaze can roam freely. ⁹ He thus implies that, far from liberating and empowering its subjects, patient-centered medicine functions to license medical practitioners to take control of ever-widening areas of their patient’s lives. In cultural studies, the medical gaze, passing always from the more to the less powerful, stands for the denial of subjectivity to the patient, of energy to the body, and a reminder of the suspect institutional powers of rationalistic science. Thus, a commentator on Hervé Guilbert, without mentioning Foucault, speaks of patients’ submission to the inherent violence of a relationship that makes them the passive object of the medical gaze. This legitimates the subject/object relation and freezes it in the objectivity of medical discourse, a discourse constantly reinforced by the authority it enjoys far beyond the field of medicine.¹⁰ The medical gaze is now scripted into that melodrama in which much of the late twentieth-century critique of biomedicine was couched; that it is alienating, objectifying, terroristic in its denial of a voice, a subjectivity, to those at whom it stares and over whom it sweeps.¹¹

Though Foucault began by treating the history of what he called the clinical gaze, it is symptomatic of this debate that the term now commonly used is the more generalist, institution-encompassing, medical gaze. If the medical gaze denies the subjectivity of the patient, it can also be said that these critiques themselves tend to deny the subjectivity of the health-care practitioner. It is in fact a crucial part of Foucault’s conceptualisation of modern forms of power that the source of this power or knowledge is never personalised, is never embodied in a single corporeal being. The form of surveillance common to the clinic and the panopticon involves the obliteration of the personal body as the source of power. This, as he stresses, is in contrast to earlier forms of power. The body of the king, with its strange material and physical presence, Foucault writes in Discipline and Punish, with the force that he himself deploys or transmits to some few others, is at the opposite of this new physics of power represented by panopticism; the domain of panopticism is, on the contrary… a physics of a relational and multiple power, which has its maximum intensity not in the person or the king, but in the bodies that can be individualised by these relations.¹² This is a form of discipline or authority that may produce the body as a target of knowledge, but is no longer exercised through the body. Indeed, one might argue that it is a certain suspension of relations between bodies that makes this modality of power what it is.

The concept of the medical gaze as first discussed in The Birth of the Clinic and modified in Discipline and Punish thus assigns anonymity and disembodiment to the physician. The individual presence of the actual doctor in a room with a patient is dissolved into a generalized medicine which, however appropriate and productive it has been in the understanding of epidemiology and medicine as an institution, passes by without question the traditional assumptions of medical and professional impersonality. In this sense then, the Foucauldian critique of medicine fails to question medicine’s post-Hippocratic self-conception. A consequence of this is that whilst patients are intensely scrutinized, and in depths that include psychological and family relations, the doctor continues within discourse to inhabit a blank conceptual space, imagined as a neutral, uninvolved, and incorporeal, observer. If we couple the generalization and individualization of power through panopticism with the medical tendency to focus upon its object but not upon the medical subject him/herself, it comes as no surprise to note the lack of interest paid to the physician’s corporeality within the clinical setting, whether that corporeality is viewed in relation to sexual or other matters. But then, if we also add the Hippocratic exclusion of matters improper, the sexual dimension of the clinic is, if not unthinkable, then thinkable only in terms of moral probity.

The contemporary currency of the term sexuality, especially when paired with medicine, could be said to derive from two sometimes overlapping sources: feminism and Foucault’s later work. Feminists of sexual difference have addressed questions of female specificity, sexuality, desire, politics, and corporeality.¹³ These theorists have often critically engaged with psychoanalytic theory. Radical feminists have been at pains to critique the patriarchal tendencies of medicine, especially in relation to reproductive technologies.¹⁴ Although Foucault has been criticised for his general reluctance to deal with questions of sexual difference, his work has provided a critical basis for many critiques of sex, gender, and heterosexuality, Judith Butler’s being the most prominent of these. In particular, his influential History of Sexuality has become a backdrop—explicit or implicit—for such contemporary reflections on the conjunction of medicine and sexuality as are current. Yet, there are critical deficiencies in this account, too. The first volume of his study (La volonté de savoir) was published in France in 1976, and belongs therefore to the same moment in Foucault’s thought as Surveiller et punir (1975). There, Foucault tells the story of the construction of this object, sexuality. He traces the history by which, in the nineteenth century, a scientia sexualis developed. This was a whole bevy of medical practices and discourses which, connecting the ancient injunction of confession to clinical listening methods ¹⁵ produced or deployed something now broadly called sexuality. This sexual science is represented as the practice of ferreting out, and then listening to, speech, which is then translated into discourse, much as, in a later formulation, illness becomes disease.¹⁶ Medical science, thus, has a will to know, and it is this will to know which actually produces sexuality, which in turn produces the imaginary power that for contemporary individuals invests their sex. But for Foucault, as for the medical tradition, the listening ear that attends to speech, the inspecting eye that surveys and defines the various domains of sexuality, are each uncoupled from the body. Though he speaks of an entire micro-power concerned with the body, in effect, his own discussion operates at a very broad level of generality.

Several papers in this book argue, on the contrary, that the clinical setting persists as a place of intercorporality that Foucauldian terms and concepts bypass and fail to illuminate. Within the medical encounter, the doctor’s face and body, the whole performance of his or her own embodied being, is brought into play in relation to the patient. Whilst Foucault quite precisely depicts the rise of a particular technology of power, and while sovereign power may have shifted into a more ubiquitous modality, there is still an intercorporeal nexus between the body of the physician and that of the patient. The contributors in this book, whilst inevitably influenced by Foucault’s presentation of both sexuality and medicine, draw upon other epistemologies and intellectual traditions to throw light upon the experience of the medical encounter, both from the physician’s and the patient’s point of view. Rather than some scene of arousal, Paul Komesaroff, for example, argues that sexuality is a ground of communication, one which must enter the clinical scene for it to function at all. John Wiltshire suggests that some of the normally hidden aspects of medical interactions are revealed by the special circumstances of Oliver Sacks’s work. This is far from the familiar terrain of sexuality as it enters medical understanding.

It is as if sexuality and medicine have been defined as cultural antinomies of each other. Sexuality, thus, comes to be understood as that which is defined, regulated, and disciplined by the clinic, but does not, by definition, enter into the internal structure or processes of the clinic itself. In this way of thinking, the suggestion that the doctor might participate sexually in the clinical relation leads inevitably to the notion of participation in sexual acts. Medicine does of course attend to, and treat sexual functioning, and the medical profession, through the construction of pathological and non-pathological categories, would certainly be acknowledged as one of the social agencies with most authority to control and regulate this sphere of the body and psyche. But in contrast to this intense Foucauldian concentration on medical nosology as a social and intellectual force, little, if any, attention has been given to the intimate structure, or the inner dialectic, of the doctor and patient relationship. No room is left for meaning creation in dialogical or communicative settings and social relationships themselves no longer have any generative role.

Foucault has certainly opened up a potent critique of medicine’s affirmative and normalizing function. At the micro or local level, however, it might well be argued that medical practice can have a critical or even a subversive function. This is a possibility not catered for within the topography of normalization. The implications, with respect to the understanding of sexuality, are similar: while the notion of sexuality as a locus of power exposes its undeniable disciplinary function, it ignores the fluid and changing nature of sexual identities¹⁷ and denies sexuality’s creative and productive social role; in particular, and of critical importance for the arguments of this book, it eliminates the possibility of any constructive place for sexuality in the process of making sense of illness or in clinical communication itself.

Medical ethics, or more recently, bioethics, has traditionally been the arena in which medicine reflects upon its own practices, and so one might expect there to find such an investigation of the inner structure of the clinical encounter. Yet, bioethics is in general hampered by the generality and rigidity of its conceptualization of medical dilemmas and problems. Ethical and moral issues tend to be represented in schematic or diagrammatic form, and in narrative models which simplify the temporal and phenomenal matrix in which real medical decisions are made, and distort or ignore cultural circumstances. This isolation of specific issues from their context is compounded by the inhibition of the Hippocratic inheritance. The doctor is not to be imagined as possessing sexuality; instead, the notion of ethical authority tends to be predicated upon the absence of sexual feeling (and most certainly of sexual aim) in the physician.

Moreover, in its dealings with sexuality, bioethics is further stymied by two aspects of its inheritance from mainstream medical thought. The first is this tendency to imagine sexuality almost exclusively in terms of functionality or performance. The second, intimately connected, is to arbitrate upon the normality of such sexual preferences or practices. Thus, the bioethical literature contains much discussion of terms such as sexual deviation, dysfunctional sexuality, or sexual inadequacy, and apparent critique of their conceptual limitations, but is unable to substantiate an alternative conception of sexuality. The semantic tangle that is the term health does not help matters. Health, within the medical domain, and especially in physiology, is often configured as the normal as opposed to the pathological, the normal being defined as the precipitate, so to speak, of the pathological, as what the pathological is not.¹⁸ But the idea of the normal, when transposed to the realm of sexual practice, becomes the repository of cultural prescriptions and ideals. The normal is opposed to the perverse, a term always already loaded with ethical opprobrium. Moreover, the normal within a specific culture readily becomes assimilated to the natural, and thereby, in a continuous conceptual circuit rejoins biological thinking. When this complex cluster of notions in which biology, culture, and morality are caught up in each other, is called upon to arbitrate or discriminate in the realm of sexuality, there is immense confusion.

Although medicine treats sexuality on the model of biology, it also inherits from the broader cultural tradition a host of prescriptive ideals. Many bioethical philosophers work within acknowledged religious traditions and even those who do not, depend, consciously or otherwise, upon the formulations and ideas of Thomas Aquinas, St. Augustine, and Kant. These writers, among others, wrote memorably and passionately about admissible or valued forms of sexual expressivity. Out of the matrix of biologically-inspired functionality and these Thomist, Pauline, and Kantian traditions of thought, emerges such a notion as the currently much-deployed healthy sexuality. Yet the problem for a bioethics that wishes to say something authoritative about current sexuality, and the problematic forms in which it is presented within the clinic, is that these understandings of the topic are in direct conflict with the sexual freedoms enjoyed by contemporary patients, and endorsed by their liberationary politics. It is extremely difficult to map a traditional and essentially prescriptive conception of ethics onto this political field. The dilemma—conspicuously represented in the two issues of the journal Medicine and Philosophy devoted to Sexuality and Medicine¹⁹ —is compounded when bioethics is defined as a narrow band of possible choices and options and sexuality is understood largely as functional and instrumental.

Psychoanalysis might well seem the domain of inquiry which could break through this impasse. Psychoanalysis has thought through the notion of perversion, for example, in an altogether different mode from moral philosophy. Besides phenomenology and feminist theory, several papers in this book indeed draw upon psychoanalytic theory for illumination of the play of sexuality within the clinical encounter and elsewhere. But it is in fact remarkable how reluctant mainstream Western medicine has been to avail itself of this order of thought. Psychoanalysis is a complex body of knowledge, with many internal conflicts and contradictions: one of the problems of it being accessed by medicine has certainly been that the psychoanalytic scene in the United States, until the last decades, has been dominated by orthodox and doctrinaire Freudians. A result of this has been a remarkable narrowness in its conceptualization of sexual identities. Instinct or ‘drive’ theory, derived from Freud’s earlier thought, predicated sexuality upon a biological urge to which the sexual ‘object’ of desire is secondary. His theory of sexuality, as articulated in the Three Essays and elsewhere, was concerned with the development, out of earlier and more primitive modes of sexual satisfaction, of adult heterosexuality. ‘Only at the end of a long and hazardous evolution is [the sexual instinct] successfully organised under the primacy of genitality.’²⁰ Sexuality is like a mountain torrent which, meeting blocks or resistances (the chief of which, of course, is the recognition that the mother is a barred sexual object) is diverted into different channels or is dissipated into cultural and artistic creation.

Whatever value this concept has for understanding the sexual or psychological evolution of an individual patient, it focuses attention solely upon one person, just as the clinical gaze focuses attention upon one body. With the surprising discovery of the transference, or ‘transference-love’ in the first decade of the twentieth century, this changed. Psychoanalysis has shifted from what Jessica Benjamin calls a one-person, to a two-person field.²¹ Transference, and its inevitable accompaniment and auxiliary, the countertransference of the analyst, now becomes the very stuff of the analytic relation, the raw material, so to speak, with which it works. In contemporary psychoanalysis it is widely accepted that the practitioner will have fantasies (including sexual fantasies) about the patient, just as the patient has fantasies about the analyst. Unlike the patient, the analyst is able to put his or her fantasies to deliberate use, to employ them as means for understanding and coming into communication with the other person in the consulting room. It is through his or her capacity at once to respond to the patient’s emotional demands, and to contemplate them with some measure of detachment that restorative work can be done. Potentially then, and at a discursive or theoretical level, the analyst is capable of being thought of as a full human subject, and can model some aspects of the physician’s encounter with the patient.

Whilst psychoanalysis is still considered in some circles to place sex inadmissibly at the center of its epistemological understanding of the subject, in effect, contemporary psychoanalytic thought has broadened the concept of eros to include all the desires and needs of human beings, and it is this conception of psychoanalysis that is worked with by the contributors to this book. With the shift from the Oedipus complex to transference as the central psychoanalytic concept, sexuality becomes greatly enlarged in its meaning and reference. Hence, post-Freudian, Lacanian, and still more post-Kleinian psychoanalysis has much to contribute to a broader understanding, both of sexuality and of the clinical relation, as the papers in both sections 3 and 4 of this collection demonstrate. Psychoanalytic thought has the capacity to rescue a conception of the doctor’s participation in the clinical encounter that includes his or her sexuality.

The contribution of post-Kleinian psychoanalysis has been to suggest that the patient’s transference, or even merely the patient’s emotions, are to be understood not merely as symptoms, pertaining to one selfhood, one body, but as communications. In medical discourse, patients are said to ‘present’ symptoms, or just to ‘present’ themselves for medical attention. As this is usually read in medicine, this means that features are displayed, as an object displays features to an informed observer. But ‘present’ is a transitive verb in normal speech, not an intransitive one. Understood within this normal register, the patient presents something to the doctor, who would normally be, in D.W. Winnicott’s phrase, ‘there to receive the communication.’ Presenting to, that is, involves the notion of the doctor being responsive to the patient’s state of mind and condition of body through his or her own analogous corporeality. If the model of clinical consultation as the communication of states of being, bodily as well as emotional states is accepted, then the clinical consultation involves the doctor listening with his or her whole body, so to speak, not just with ears and mind.

It appears then that the discussion of sexuality and medicine has been placed under an embargo, or at least operates under severe constraints, under whatever umbrella of discourse the subject is contemplated. The coupling together of sexuality and medicine arouses deep cultural anxiety. Sexuality has been studied or made visible by the institutions of medicine, but always as the sexuality of the object. And because this sexuality has generally been configured or thought of as genital sexuality, tied consciously or unconsciously to the aim of satisfaction or fulfilment, the understanding of sexuality has been severely curtailed. Such a mode of thought has also been overlaid and reinforced by ways of thinking of sexuality under the aegis of the natural, the normal, the healthy. It remains, in the discourses of medicine and medicine’s metadiscourse—bioethics—restricted in effect to matters of sexual ‘dysfunction,’ abnormality or aberration, the criteria for assessment and treatment remaining always, if sometimes less than explicitly, the capacity of the subject (that is to say in this context, the patient, the object) for sexual pleasure or gratification. That the doctor is an embodied being, and that his or her body is a crucial modality for communicating with and understanding the body of the patient remains a thought that still today has difficulty finding admission, let alone acceptance, both outside and within healthcare circles.

Yet, this is all the more remarkable when we consider the contemporary explosion of thought about the body. Within the academy, of recent years, no subject has been more generally addressed across a range of disciplines within the social sciences, philosophy, literary and cultural studies, and history, generating along the way, its new fields—women’s, gay and gender studies, masculinities, psychoanalytic studies, queer theory. In concert, these new fields of thought have put the universality of the human body into question, and have stressed instead the cultural and historical shapings and makings that have produced, and produce, what we have taken for granted as our bodies and our sexualities. The practice of medicine, within the hospital and the clinic, the pharmacy—so long premised upon one universal, trans-cultural anatomy and body—cannot remain untouched by these developments towards a more fluid and complex conception of the body and its relation to identity. Even if medicine as an institution and education cannot initially find room for such notions, they will force their way into medical practice because they will be brought into the consulting room by patients. It is important that medicine take notice of these developments and respond to the challenges they represent.

It is a consequence of contemporary insights into bodies and sexualities that the desire to know all there is to know about sexuality cannot be satisfied. What would it be to attempt to unite the multiplicity and heterogeneity of work on sexuality under the umbrella of any single field? Rather, medicine, in its own diversity of aims and practices, can but listen to the differences and respond differentially. Thus, this collection casts its net wide. How shall medicine begin to re-conceptualize the body and its sexuality (its ‘sexualities’ would be a more accurate term)? This book seeks to open the issues by addressing both the broadest disciplinary and discursive matters, and by exploring the micro-ethical intimacies of the clinical encounter. Its project then is two-fold. On a range of fronts it questions current conceptions and representations of sexuality, including the term itself, and at the same time examines medicine, and especially the clinical relationship itself, to demonstrate how intersubjectivity and intercorporeality operate, potentially for the benefit of the patient.

The opening section of the book contains essays that address broad issues in the conception of sexuality. Mary Poovey offers a searching critique of the way sexuality is configured and constituted by the