Dr. Elizabeth Comen Gets Real About the Myths Surrounding Women’s Health
Sandra Rose Salathe
For centuries, women have been bombarded with myths and misconceptions surrounding their physical strength and overall health. In her new book, All in Her Head: The Truth and Lies Early Medicine Taught Us About Women’s Bodies and Why It Matters Today, Dr. Elizabeth Comen, a breast cancer oncologist who has joined the Breast Cancer Center at NYU Langone Health’s Perlmutter Cancer Center and NYU’s faculty as an associate professor in the Department of Medicine in its Division of Hematology and Medical Oncology, dispels those myths and delves into how these outdated notions continue to impact women’s health today.
In an in-depth conversation with Flow Space’s Editor-In-Chief, Galina Espinoza, Dr. Comen discusses her groundbreaking new book, providing historical context on how gendered notions of the female body have been perpetuated in medicine. Watch (or read) their informative discussion to learn more.
Flow Space: Today I’m joined by Dr. Elizabeth Comen, an associate professor of medicine at NYU Langone in New York City. Earlier this year, Dr. Comen released her first book, All in Her Head: The Truth and Lies Early Medicine Taught Us About Women’s Bodies and Why It Matters Today. That’s the part that I’m excited to jump into with you Dr. Comen, because it turns out that we are still feeling the harmful ramifications of centuries’ worth of misinformation when it comes to women and physical strength. In fact, in your book, you have a chapter called “Muscle” in which you look at all the ways in which doctors have, for hundreds of years, encouraged women to be physically weak. Explain this to me.
Dr. Comen: Well, thank you so much for having me. I wrote the book really as a walk through women’s bodies in history going back thousands of years, and by organ system, the same organ systems that really mirror the specialties of medicine. Today, whether it’s our skeletal system, cardiovascular system, or our nervous system, we need to really understand the legacy that we inherit when we show up at the doctor’s office today and what limits us from really accessing our best health. So the muscular chapter, as you know, really focuses on what is the history of what we’ve been told about our bodies, both by society and culture, and how that influences what doctors are interested in and also promoted with our bodies. And there really has never been, at any point in medical history, in Western medical thought, a dominant theory that allowed for women to be strong, to be smart, to be capable. So how do you change that narrative moving forward?
Flow Space: And when they were studying women’s bodies, were they doing research? Was there science behind all of these ideas that they were quoting in which they were saying, ‘you know, there are dangers to women’s health if they participate in exercise,’ for example?
Dr. Comen: Medicine is complicated in the sense that it has been going on since we’ve been a species. However, it’s inextricably linked to the background of those who come to the table to deal with it for so long. Women were not allowed to even be part of medical schools. We were perceived as not being ignored. I mean, look at the history: Even Charles Darwin, who championed evolution, claimed women were more primal. We were less intelligent. We were closer to the ground. We look at pictures of bodies and in anatomical structures. They were almost egregious, grotesque versions of what they thought women were. Our heads were smaller and our hips were wider. Why? Because we were allegedly less intelligent. And we were meant to birth babies as vessels and not necessarily play sports, and the muscular chapter opens with the history of the bicycle and women’s ability or inability to ride them.
Flow Space: I found myself, quite frankly, screaming as I was reading this chapter because there are pages detailing the ‘evils’ of bicycle riding, including this made up idea that women would develop “bicycle face” if they were to ride a bicycle. Now, “bicycle face” is not a real thing. So tell us about this horror that we’re trying to avoid.
Dr. Comen: The interesting thing is, bicycles are fantastic. They give you this sense of freedom. You can leave your home and back at the turn of the century. You didn’t need a horse, you didn’t need a buggy, and you didn’t need a chaperone. So for women, it was a newfound sense of mobility. And throughout history, you see that the history of women riding bicycles was also associated with other things including the right to vote. So suffragists are often pictured with a bicycle with them. But along with this idea of freedom and mobility from home is also the concern, when maybe women shouldn’t be in these places.
So, it’s fascinating if you look through medical journals that there were doctors against women riding bicycles. Many of the concerns of women riding bicycles was that your muscles would get too bulky, you would exert yourself too much that it would affect your reproductive function, and your pelvis, and also that you would develop what they termed “bicycle face,” which was essentially that your face would be frozen in a grimace from the exertion. There many newspapers and publications that had [articles on] the do’s and don’ts of what women could do on a bicycle (not what men could do and cannot do on a bicycle).
The other fear was that women would be masturbating on these bikes, and so for all of us who love Peloton and SoulCycle, that was clearly why we love it. And so it’s fascinating what doctors felt women were capable of. Even in the reference to this idea of bulky muscle and what that means, you have to understand where is this legacy is coming from even in medicine, of women being told more cardio is better, that you have to be a certain size, or that there’s an ideal body weight or ideal size.
I was looking at a pilates class on the Upper East Side the other day, and one of the first questions was ‘Am I going to become too bulky? Are my muscles going to become too bulky?’ So where in the history of medicine, in the history of our culture, have we been afraid of women developing muscles, when we know strength training is key to our longevity?
Flow Space: There is so much to unpack in what you’ve just said. But I’m going to start with maybe the simplest question of all, which is what were some of the other activities that women were discouraged from participating in?
Dr. Comen: Lots of things, like running. You know, we have the Olympics coming up and participation in competitive sports. If you look at what was acceptable for women to participate in, a lot of it was things that look more feminine, more dainty, and did not alter the idea of what it means to be a feminine, physical body. One of the surprising things to me, was an Olympic figure skater. She won in the Olympics. She also became a surgeon, a Harvard medical surgeon. And I feature her in the book because she was this Olympic athlete and a physician, that really shows the context of what women understood what they could do with their bodies. She was against rowing, or strength training or things that might limit what she perceived as a beautiful feminine form. So for a physician, a Harvard-trained Olympian surgeon, who’s already overcome so much bias herself, to be talking about what women should and should not be doing from a physical standpoint, it was really fascinating for me.
Flow Space: Also, having those conversations through the lens of aesthetics, not through health, which is what you expect from doctors and healthcare providers. You know, other than saying this is the patriarchy at work, what else does that say here? You’ve mentioned several times this idea of our reproductive organs, and I do think that sometimes in medicine, there’s an outsized focus on that aspect of our health systems, but not every other aspect. Does that play a role?
Dr. Comen: I think it speaks to the more border term of women’s health, that it’s been reduced to this idea that we are our breasts and our reproductive function. We are head to toe different from men and we are not small men. But throughout our culture, our society and infiltrating our medical system, is the idea that what we are born to do and is most valuable is our reproductive function as vessels, and that is certainly not the case for many women. That doesn’t address our entire healthcare system and our bodies.
Flow Space: And we still see that in medicine today, as we move through perimenopause and menopause, we don’t have as much attention paid to our heart health or brain health and every other aspect of our health. It’s almost like the medical system stops at a certain point.
Dr. Comen: There’s so much focus on ‘Well, women are crazy or hormonal, and you’re damned if you do and damned if you don’t.’ When you’re going through puberty or when you’re pregnant or whatever it may be, you’re crazy then. If you have PMS, then menopause, ‘Well, you’re an aging female so what are you what are you good for?’ One of the things that I discussed is the journey about women, whether they can be president or not. We’re ‘too hormonal’ when we’re menstruating, and then we’re too ‘old and complicated.’
And also, just thinking about our medical school training, I had very little in what women should and should not do in terms of exercise. What’s safe during pregnancy? What’s safe during any age? What different types of exercise are key? Much of the messaging was about body mass index, and that women should be a certain weight, and a certain bracket of what’s an unhealthy body mass index. We know that the entire scale was not developed with a real sense of what it means to be healthy.
Flow Space: And that comes back to the subtitle of your book. You know why this matters today and why we’re having this conversation, is because we are still feeling the ramifications of this legacy. I mean, I’m of a generation that if I was encouraged to lift weights, which I really was not, I was handed a set of three-pound hand weights or ankle weights. Something that would still keep me very alive and slim, but not bulky because God forbid we should actually show muscle, right? So talk to me about what women actually need to know when it comes to strength training.
Dr. Comen: I’m learning this too. So I grew up as a dancer and playing sports. I tore my ACL ligament in my knee when I was 14 and was told ‘Well, let’s see how active you become.’ And of course, I was super active and then ended up almost needing my whole knee repaired when I hurt it four years later. I think there’s a lot that we need to know. I can say even from my own experience, as someone who’s been a lifelong athlete and dancer and into fitness, so much of my own journey was focused on cardio. And strength is so important at every stage, for mobility, for flexibility, for strength, for the ability to live in this world.
If you take a fall and not break a bone, as you get older, maintaining your bone density really comes in large part from strength training. We know through every metric that you age better when you are stronger, and yet, to teach a 40, 50, 60, 70-year old woman how to strength train is overwhelming. I saw a young woman in the clinic the other day, barely over 30, and she was just getting into these hip workouts and had no idea how to do a squat. That’s not her fault. This is not something that we teach. And yet her husband was like, ‘Oh, you know, I did a lot of strength training in college and this is the form.’ Yet we don’t teach women these basic mechanics, and often they’re getting hurt when they’re starting out. Even if they know that it’s important that they learn.
Flow Space: Do you think we’re reaching a tipping point or have reached a tipping point, in this information, this realization that women need to strength train? Is that message being accepted or do you think we still have work to do?
Dr. Comen: Well, we’re doing this today, and you have a huge reach, so thank you so much. And I think there are a lot of people out there that are trying to dismantle these obstacles and biases. But this idea of the skinny beautiful woman, or the ‘heroin chic,’ or the ‘dainty woman,’ whether it’s the tuberculosis fainting woman in the Victorian era, or the fragile, heroin chic woman who is so sick and so beautiful, I think that’s still insidiously weaved itself into our culture in lots of different ways. Yet there are loud voices, powerful women and men, really encouraging women to step into their power to understand their bodies better. That aging isn’t just about some 12-step skincare regimen and a bath, and making sure that we sleep but also taking the time to understand our bodies better and build them back even stronger.
Flow Space: You talked earlier about the debate that there has been about women’s bodies through many, many years. Yet, we don’t have the same kind of debate about men’s bodies. Why are men immune from this conversation and why have women been such a source of obsession?
Dr. Comen: Yes, I think we haven’t been allowed to be part of these circles of power. And when we think about who’s in the position of power, who’s in leadership positions, it’s incredible that I mentioned earlier that women were not allowed to be part of medical schools for so long. Of course, that history has changed and greater than 50% of women graduate medical school, which is fantastic. But yet, in many different specialties, we don’t have the same representation of women, and even more so in positions of leadership. So I think to really change the conversation around women’s health, we need to make sure that it’s not just the public that’s banging pots and drums, and doctors, but also doctors who are in positions of leadership, who can help represent the diversity of our population and really speak to the different narratives that we need to improve upon.
Flow Space: Well, thank you for being part of helping to drive this change. And if we could have one final question. Let’s say you’re writing an update to this book five years from now. What do you hope the muscle chapter reads like?
Dr. Comen: What a great question. I love to have vision. And I love to dream big with incredible people such as yourself. I think I would like to see the arc of medicine change. In order to change the narrative about what we understand about strength, we have to not just understand it in the gym, but much earlier than that. And to be an academic for a second, preclinical studies and the research that we do is so important. So if you look at the recent White House Initiative, which is aimed towards improving women’s health, it matters how we invest in women, not just when they come to the doctor’s office, but how we understand their needs very early on.
So we start to ask the questions of, what do we need to do to help women be stronger, to have better longevity? And to start that with the questions that we ask from a research perspective, what do we really need to be teaching them all the way through clinically meaningful treatments later on in life, and the doctor and patient conversations that we have? So I’d like to see an improvement, if I can dream big. It’s not just in the exam room, but the type of research that’s being conducted and the type of messaging that we give women beyond just the one-on-one doctor saying, ‘let’s have you strength training five days a week.’ The whole world needs to change in terms of that messaging.
