Gynecology: The Missing Science of Men’s Reproductive Health. Rene Almeling, Oakland: The University of California Press, 2020, 304 pp.
The University of Iowa
In Guynecology, medical sociologist Rene Almeling excavates the development and impact of “non-knowledge” about men’s reproductive health. She asks and answers a question important to medical anthropologists and others who care about denaturalizing binary sex/gender: Why, since (White) men have served as the standard model of the human in biomedicine, has that field neglected to study their reproductive health? Almeling demonstrates how ignorance about men’s reproductive health is as actively produced as knowledge about women’s, and that this relational knowing/not-knowing reflects, reinforces, and naturalizes a binary understanding of women as reproductive and men as not. To accomplish this, Almeling examines this production of non-knowledge at intersecting levels of scale, from looking historically at failed efforts to create a medical specialty in men’s reproductive health to assessing the ideas that U.S. men today have—or rather, lack—about the role their health plays in reproduction. By convincingly documenting the active construction of this non-knowledge, this book makes a key contribution to our understanding of the ways that Western gender ideologies have become naturalized in biomedicine and reified in public imaginations of sexed bodies.
Almeling’s analysis ably applies social scientific theorizations of gender. She seeks to “rethorize the relationship between gender and medical knowledge making” (p. 5) by focusing not on the category of men, but on a relational field of knowledge production in which binary ideologies of sex/gender have fostered dualistic understandings of reproductivity in which women’s bodies are reproductive and men’s are not. To explain this effort, she uses the metaphor of a photographer taking a picture of two figures at different distances from the camera, choosing which to bring into focus and which to blur. In her own picture of binarily sexed bodied in the field of reproductive health, Almeling seeks to document the blurring of men’s bodies in relation to the focusing on women’s.
She does this by bringing disparate aspects of medical history and experience into the “same analytical frame” (p. 52). Almeling’s stated goal is to achieve a breadth rather than depth of knowledge about the production of ignorance regarding men’s reproductive health, which makes sense when mapping an absence long in the making. To achieve this, she combines historical and interview methods to trace past, largely failed, efforts to create a science of men’s reproductive health and to assess the cumulative outcomes of this history in American men’s current ideas about reproduction, gender, and health.
In Part 1, Almeling describes Western efforts to establish a medical specialty in men’s reproductive health. Chapter 1 describes such attempts in the late 1800s and argues they failed in relationship to the success of specialization in women’s reproductive health and the association of men’s sexual and reproductive ailments with stigma and quackery. Chapter 2 examines the slightly more successful establishment of andrology in the 1960s and argues that cultural changes made it more possible while the legacy of earlier failures limited its impact.
Part 2 focuses on medical knowledge about “paternal effects”—the influence of men’s overall health on their sperm and subsequently, their children—to assess its limited generation and circulation in comparison to knowledge on women’s preconception health. Almeling does this by reviewing the scientific literature on paternal effects in Chapter 3, and analyzing news stories and health organization materials to describe the circulation of this biomedical knowledge in Chapter 4. She finds that a small group of researchers have produced compelling evidence that factors like men’s age and exposure to environmental toxins affect sperm and child health, but that this research is marginalized. Further, presentation of these findings to lay audiences emphasize sperm cells and individual health rather than children and relational or contextual understandings of reproductive processes and risks.
Part 3 uses interview data to focus on individual Americans’ understandings of men’s reproductive health and the role of paternal effects in reproduction. Chapter 5 discusses interviewees’ characterizations of men’s role in reproduction. Almeling finds that men lacked concepts of paternal effects, and narrated biological reproduction in gender-stereotyped ways although they sometimes introduced secondary, more egalitarian narratives. (This chapter will be particularly useful for those who teach Emily Martin’s classic article about the gendering of egg and sperm, to show students contemporary examples of this discourse.) In Chapter 6, Almeling presents findings from a fascinating intervention done mid-interview, in which she had men read a flyer explaining the existing scientific knowledge about paternal effects. Their responses revealed their unfamiliarity with this information, highlighting the effect of the longstanding production of ignorance about men’s reproductive health. She further found that men’s vows to make lifestyle changes even as they identified structural and cultural barriers to doing so raise the possibility unpacked in the book’s conclusion that “new stories can be told about men’s reproductive health” (p. 167).
In that final chapter, Almeling calls for the development of such stories—via institutional support for and production of scientific knowledge about issues like paternal effects, and the circulation of findings to the public—in ways that would avoid reifying the sex/gender binary that framed women as reproductive and men as non-reproductive in the first place. With a caveat regarding the dangers of compulsory reproductivity or undermining the reproductive rights of gestating people, she calls for understanding all bodies as potentially reproductive and for understanding reproduction as relational, in terms of relationships among bodies as well as with their structural and environmental contexts. Finally, a detailed Appendix on methods is helpful for understanding the content and boundaries of the research this book presents. This appendix will also be a good resource for graduate students devising their own research methods, or other scholars investigating the production of ignorance.
Overall, this large-scale look across place and time feels accessible because of the book’s clear writing and structure. Throughout, Almeling provides well-chosen examples that illustrate and support her claims about broad historical trajectories, while providing lively detail. For example, readers will leave Chapter 2 knowing not only the history of medical specialization, but also which Victorian physician wrote the definitive book on testicles. While Almeling’s focus on breadth makes it impossible to exhaustively cover any one example she raises, the reader feels that they are seeing enough pieces of the puzzle for a compelling picture to emerge. Further, the book is occasionally dryly funny, from the opening vignette imagining a world where men’s preconception health is discussed, policed, and capitalized on as much as women’s, to Almeling’s aside regarding her kind demurral to reproduce genital rash photos.
Guynecology will be of interest to a range of audiences. It would be useful for teaching in undergraduate or graduate classes on medical anthropology or sociology, science and technology studies, gender studies, and medical history. It will also be an important read for clinicians and bioscientists working in fields related to reproduction, or simply treating men. Given its large scope and compelling claims, this book is likely to inspire scholars in all these fields to pursue depth-oriented research on the wide array of examples Almeling presents. Given both its content and generativity, this work is likely to have a major impact on the array of fields that do or could work to denaturalize gender in medicine.