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LHMP #271g Cadden 1993 Meanings of Sex Difference in the Middle Ages: Medicine, Science, and Culture Ch 6

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Cadden, Joan. 1993. Meanings of Sex Difference in the Middle Ages: Medicine, Science, and Culture. Cambridge: Cambridge University Press. ISBN 0-521-48378-6

Chapter 6: Abstinence & Conclusions

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Medieval opinions about abstinence--as expressed in medical, philosophical, theological, and social literature--are more complicated and ambivalent than those about procreation. Given that much of the discourse around procreative sex frames it as driven by medical and moral imperatives (e.g., theories about how sexual desire has the goal of achieving balance and promoting health), how can abstinence fit into the same framework without being considered unhealthy?

There were varieties of abstinence. Virginity was the one held in highest regard, especially in the early Christian period, and represented a complete avoidance of the experience of intercourse at any point in one’s life. Virginity was often contrasted with marriage (in contexts where marriage assumed sexual activity), with marriage being a “second-best” way of avoiding fornication (unauthorized sex). But one could also be a virgin within marriage, a condition that often features in saints lives.

Men could be virgins, just as women could, though the condition was more salient for women. In the later middle ages, the Church deemphasized virginity, either as an ongoing state, or as a requirement for various events such as marriage or taking monastic vows. This seems to have been largely a matter of practicality.

In a social context, only women’s virginity was emphasized and subject to family protection and control. This was driven by the desire for controlling the parentage of offspring. A number of medical tests purported to be able to determine whether or not a woman was a virgin, and of course the ultimate proof of non-virgin status was pregnancy and childbirth. There were no equivalent tests and proofs for male virginity or fidelity. Countering these tests, there were also manuals with instructions for how to counterfeit proofs of virginity, especially the bleeding after penetration that was associated with myths about the hymen.

Although religious principles regarding sexual continence were, in theory, gender-neutral, they were generally compatible with the secular interest specifically in female virginity. One exception was that the Church allowed for the possibility of “spiritual virginity” even after the experience of intercourse. Thus some held that those who only experienced approved sex within marriage (the usual understanding of the term “chastity”) could be considered virgin. Theology was also less interested in the sex-specific “proof” offered by an unbroken hymen.

The next “rank” of sexual abstinence after virginity was permanent celibacy, as for those who took religious vows. Monastic institutions regularly had problems with enforcing this and the sexual misconduct of monks and nuns was a regular trope in medieval popular culture. A sincere religious vocation was only one of the paths to monastic life. Monastic institutions were commonly used as a place to store “surplus” sons and daughters for whom no land or dowries were available--a purpose that would be undermined by procreation. But conversely, for people (especially women) who wished to abstain from sex, a religious life was a useful option.

Far more common than these lifelong commitments to celibacy were temporary periods of abstinence such as due to postponed marriage or abstinence during certain religious festivals. Certain regional marriage patterns involved postponement of marriage well into the 20s, and demographics indicate that this wasn’t accompanied by significant illegitimacy rates. Medical texts indicate that this could be considered a problematic condition, and might recommend nonreproductive sexual activity such as masturbation (in conflict with the theological position on the topic). Both theology and medical theory supported a woman being abstinent while menstruating. The two also agreed on the desirability of women being abstinent during pregnancy, though some medical theories recognized that women might experience sexual desire during pregnancy even though it served no biological purpose. The prohibition was largely on moral grounds regarding the justifications for enjoying sex, though there were also anecdotal theories that a pregnant woman who committed adultery could achieve a second pregnancy with her lover’s child.

The central theme in all of these is that even for those who have a context for licit sex, the desired state is “continence”, that is, sex only in approved circumstances for the purpose of procreation. This was the principle behind condemnations of contraception, abortion, sodomy, and masturbation, as well as sex during pregnancy. This theme of the desirability of control over sexual impulses belongs to theological literature, while medical texts address only specific types of nonprocreative sex that are considered harmful. In other contexts, medical manuals (such as the one attributed to a female author, Trotula) acknowledge the harmful effects of abstinence on women who have no licit outlet (such as widows), or the ill effects on some women of sexual activity (and its consequences) who are not in a position to abstain, and offer treatments for those situations. One approach was the use of anaphrodisiacs to decrease sexual desire. This was not an approved theological solution as it removed the moral benefit of actively resisting temptation.

In general, medical authorities considered sexual activity to be essential for good health. Abstaining would put the body out of balance, unless one’s personal constitutional balance was already out of balance in a way that sex would aggravate. For those whose constitutions required sex for good health, but whose personal circumstances did not offer the opportunity, remedies might include medicines, diets, or activities that addressed the imbalance in other ways. But some medical authorities recommended masturbation as a way of restoring health. This might be dressed in the guise of a professional treatment, as in some prescriptions for women to have a midwife massage their genitals until orgasm.


While the interests of medical, philosophical, and religious traditions often aligned in principle around issues of sex and gender, when dealing with specific medical problems and conditions, the secular authors often showed flexibility and practicality in applying the varied and contradictory theoretical traditions to the topic at hand. There was no unified over-arching system to their approach, but the general principles of polarities, balance, and a “whole life” approach carry through. Beliefs about inherent differences between male and female bodies result in different assumptions and approaches. Although medical theories were sometimes used in support of social or theological concerns, as a general rule, medical writers did not feel constrained by purely theological principles (though theology might be an unnoticed part of the underlying assumptions).

The enforcement of a philosophical system of binaries, and the acceptance that qualities could manifest in contradiction to their expected assignment as a form of “imbalance,” meant that medieval medical and philosophical theories had no framework for understanding homosexuality as a distinct phenomenon. Rather, individuals were viewed as manifesting properties at odds with their nature. So, for example, a female person who desired sex with another female person was not viewed as having “same-sex desire” but rather as being of a masculine nature, where part of the inherent properties of a masculine nature was to desire women. [Note: One should not lose sight of other behaviors that could indicate a “masculine nature” in a female person, such as being strong, brave, intellectual, and in control of one’s emotions.]

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