I. S. C. Jones / Open Journal of Obstetrics and Gynecology 2 (2012) 223-226
224
Also the literature which considers the health beliefs of
Australian Aborigines from more recent times must
distinguish between those who still live in rural and
remote regions and those who live in metropolitan areas
[12].
Until the arrival of Europeans Australian Aborigines
did not develop writing skills but relied on various art
forms e.g. rock and bark drawings, songs, dance, rituals,
other performances and story telling to pass on their cul-
tural heritage and knowledge. In Australian Aboriginal
culture there is a clear cut division between men’s and
women’s business and this is important when considering
gender specific health problems [13]. However this divi-
sion between the sexes does not seem to be an issue
within the realm of Australian Aboriginal art. Informa-
tion promoting The Indigenous Collection within The Ian
Potter Centre of the National Gallery of Victoria claims
that Aboriginal art is the oldest continuing tradition of art
in the world. Hence the art form and specifically the rep-
resentations of human anatomy have not changed sig-
nificantly over time unlike that reported in the English
literature which we are about to consider.
3. DESCRIPTIONS OF THE FEMALE
GENITALIA BY OTHER CULTURES
In the English literature and prior to 1800 the history of
Obstetrics and Gynaecology showed that obstetrics, more
correctly midwifery, was documented in greater detail
than the prac ti s e of wh a t we now refer to as gynaecology.
In comparison with midwifery the sparse records on gy-
naecology favoured writings about menstruation, the
uterus, ovaries and fallopian tubes with little recorded
attention paid to the female external genitalia. The re-
cords on the female external genitalia that are available
extend back over several thousand years. Although the
earliest representations of the human body in the form of
cave drawings and stone figures date back to the Middle
Aurignacian period (40,000-16,000 BC), it is not until
the ancient Egyptians (2000 BC) that specific references
to the vulva were recorded in the Kahun Papyrus [12].
In India the ancient documents of the Hindus, known
as the Vedas, were written 1500 years before the Chris-
tian era [14]. Charaka (a Hindu writer on medical issues,
born 300 BC) described tumours occurring on the vulva
and pruritus vulvae in the 30th chapter of his 120 chapters
in the “Ayur Veda” [14].
In Western countries social attitudes to the body as a
whole and to the genital organs in particular, influenced
the subsequent rate of progress in the study of the vulva.
For instance, the Greeks in the time of Hippocrates (460-
370 BC) referred to the external genitalia as “the sha-
meful parts”. Although they inspected the external geni-
talia their initial descriptions of vulvar pathology were
only recorded in vague terms such as ulcerations, aph-
thae and vegetations [14]. As time went by their descrip-
tions became more explicit. During the first century AD,
Celsus (27 BC-50 AD, it is unknown if he was a prac-
tising physician or where he was born) described the
imperforate hymen and Rufus (Ephesian, who resided in
Rome 98-117 AD, physician and anatomist) wrote a de-
tailed text of the hu man body in wh ich he named var ious
structures including parts of the vulva [14]. An extract of
this writing follows using terminology not in current
practice.
The privates of women, the triangu lar extremity of the
hypogastric region is called the comb, while others speak
of it as the episeion. The ap erture of the genitals is called
the skisma. The nymphe or the murton are the names
applied to that pendulous fleshy body in the midline;
others call it the hypodermis; while some prefer to call it
the clitoris. Titillation of this structure for lascivious
purposes is design a ted as clitorising.
Soranus (An Ephesian physician who worked in Rome
during the period 98-138 AD) described the vagina and
the external genitalia. He wrote of the hymen and the
difference between that of the virgin and that of the
non-virgin. Galen’s (130-199 AD, physician and anato-
mist) fame in gynaecology was based on his anatomical
dissections and descriptions of the female genitalia.
Galen mentions the use of a “scalpellus” in incising an
imperforate hymen [14].
During the Byzantine period (fourth to seventh century
AD) Vindicianus, an African born Latin physician [14]
wrote a “Gynaecia” dealing with anatomy, embryology
and physiology of the female genitalia. Aetius of Amida
(700 AD, Mesopotamian physician) was the first eminent
Christian physician and writer of texts. In his writings
“Diseases of the External Genitalia” he described a Bar-
tholin’s cyst recognising its location and the possibility
of it being bilateral. He also described hypertrophic
changes of the clitoris and “various ulcerations of the
pudenda and labia which may assume a malignant nature
and bleed freely, especially after coitus, exercise or fol-
lowing a speculum examination.” [14] (p. 185). Paulus
Aegineta (625-690 AD, Greek the last of the Byzantine
medical writers and surgeon) wrote on pudendal ulcers,
condylomata, haemorrhoids about the female genitalia
and hermaphrodites recommending excision of the su-
perfluous parts and treating the raw surfaces like an or-
dinary wound [14].
Ricci summarises the gynaecological data in the Ara-
bian medical manuscripts (800-1200) as being “scanty
and reflective of the views of the Greeks with gynaeco-
logy being neglected even more than obstetrics with the
practice of both specialties being left to midwives.” [14]
(p. 221). He suggested that this occurred because their
physicians and the population as a whole had a “profound
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