“The stream of the menstrual period in women is her generative greenness and floridity, which sprouts forth offspring; for just as a tree flowers in its floridity and sends forth branches and produces fruit, so the female extrudes flowers from the viridity of the stream of menstrual blood and produce branches in the fruit of her womb.  But just as a tree which lacks viridity is said to be unfruitful, so, too, the woman who does not have the viridity of her flowering at the proper age is called infertile.”

-Hildegard of Bingen (1098-1179)

This section discusses women’s health outside the scope of pregnancy and childbirth.  For more on that topic, please see my page on midwiferie.

Greek Foundations

Of the handful of Greeks who wrote about women’s health, the most influential on medieval medicine were likely Galen and Hippocrates.  The Hippocratic writing were composed between the fifth and fourth centuries BCE, and contained contradictory information at best.  About 20% of these writing were on the topic of gynecology.

Galen of Pergamon (ca. 130 – 215 BCE), a second Greek physician, would likewise influence medieval medicine.  Galen’s influences are more noticeable to the modern researcher in Arabic medicine than European medicine.  Unlike the devoted gynecological writings of Hippocrates, Galen’s gynecology is less of a focus and found intermittently throughout his other writings.  Galen’s profound influence on medieval medicine can be seen in the principles of the humors (blood, phlegm, yellow/red bile, and black bile) and the elements (hot, cold, wet, dry).


A third Greek writer worth mentioning here is Soranus of Ephesus, who practiced medicine in Rome in later centuries.  Soranus created and applied a unique methodology, literally called “The Method,” in which there were three states of the human body: the lax, the constricted, and both together.  Diagnosis was then simply determining which state the body was in, and applying the opposite.  Regarding women’s health, Soranus believed that menstruation, sexual activity, and pregnancy were unhealthy states for women.

Galen and Hippocrates had fundamental gynecological principles in common that would significantly influence medieval gynecology in the future: primarily, the role of menstruation.  Menstruation was a requisite purging of the blood (humor) that kept uterus-owners in good health.  Women were cold and men were hot.  Men being hotter, they metabolized their nutrients and expelled their waste more efficiently than women.  Women, therefore, must experience their monthly purging in order to maintain balance in the humors, unless, of course, they were pregnant or lactating in which the “excess” would be put to good use producing a fetus or milk.  If menstruation – purging of blood through the vagina- was not available, the body may create another venue for this purge (say, a nose bleed) in order to bring the body back into balance.  If menstruation was not taking place, the blood was accumulating in the body and the resulting imbalance becoming more and more impactful to the body.  This underlying medical theory, and the importance placed on healthy menstruation, may inform why so many medieval medical manuscripts seem obsessed with provoking the menses.

Another holdover from Galenic and Hippocratic gynecology that influenced women’s medicine in the middle ages is the concept of uterine suffocation.  Within this medical theory, the uterus may roam about the body, which of course was caused by retention of the menses, among other causes including a lack of heteronormative sexual activity, fatigue, dryness of the womb, etc.  In plain speak, the uterus would most often move upward towards the liver (because the liver is wet and the uterus is dry), hitting against this organ and together shifting, taking up the breathing space within the upper abdomen.  Suffocation in this way could be deadly.  The uterus could continue to move about the body, and each location where it may reside would create unique symptoms, facilitating diagnosis (Hippocrates, Diseases of Women I).  It was determined that virgins and elder women were most at risk for this particular affliction.  The underlying cause was that the uterus had become dry, and the prescribed method of wetting the uterus (heternormative intercourse, namely, semen) was believed to be unavailable to them.

If access to semen and sexual activity were limited or unattainable, the next best treatment was fumigation with herbal medicines.  This treatment was based on the theory that the uterus had a sense of smell.  An example of how uterine suffocation might be treated is fetid odors placed in in the nose while sweet odors were fumigated into the vagina so that the uterus may run away from the fetid odors near the head and be drawn down to the sweet odors of the lower abdomen.

The School of Salerno and Arabic Influences

The community of mentors and apprentices in the Italian city, commonly referred to as the School of Salerno, took a more integral approach to women’s medicine that built off of the texts surviving from Galen and Hippocrates, throwing away the methodologies of Soranus, and adding the Arab influences of Islamic medicine.  This occurred during the “twelfth century renaissance” occurring in Italy.

Islamic medicine gave Salerno the concept of Prophetic Medicine, “al-tibba alnabawi,” or “the medicine of the Prophet.”  This doctrine provides the justification that men may treat women, and women may treat men, even if in doing so they expose the patients’ genitals within the necessary practice of medical treatment. Even so, female practitioners were sought out in the areas of gynecology and obstetrics, for the sake of decency and modesty (Pormann, 2009). Medicine for women and by women continues to evolve and expand.   Of note, two female physicians from the ibn Zuhr family are documented to have served the Almohad 12 century ruler Abu Yusuf Ya’qub al’Mansur (NIH-NLM, 1998).  The first documented female surgeon appears in illustrations in the 1465 text, Cerrahiyyetu’l-Haniyya, or, “Imperial Surgery” by Turkish Physician Serafeddin Sabuncuoglu (Shatzmiller, 1994).

For my purposes here, the most notable of the Salerno medical texts on women’s health is the compendium commonly called The Trotula, comprised of Condition of Women, Treatments for Women, and Women’s Cosmetics.  Not at all surprising, gynecology was predominantly being written about by men, who were diagnosing and prescribing for female patients despite likely never interacting with patients’ vaginas.  This created the opportunity for women practitioners and professional midwives.  While discussing the social climate of Salerno during the twelfth century, it is also noteworthy that local women (possibly for the first time) impacted the content of the compendium.  Lived experiences of uterus- and vagina-owners in Salerno likely had an impact on the content of The Trotula.

Roman Influences, Pliny, and the paradigm shift of the thirteenth century

Following such texts as The Trotula from the School of Salerno, a shift takes place (see also Isidore of Seville) in which menstruation is seen as detrimental to health, and the healthy reproductive cycles of uterus-owners gains a negative context (more on this to come).

The Medieval Manuscripts

Folio 33: Illustrations of a case of uterine suffocation from a late thirteenth century English manuscript.

Oxford, Bodleian Library, MS Ashmole 399, f. 33r-v.

Image 1  A woman experiencing a seizure.  The dog may indicate her noble status (according to Green).

Folio 33 Image 1

folio 33 image 1

Image 2 depicts her believed to be deceased on her bier while servants are in mourning. The bowl on her chest likely depicts Platearius’s technique for diagnosis (Viaticum*) by which a flock of wool placed on the nose or a glass bowl of water placed on the chest would determine if she were breathing, as the wool would rustle or the water in the bowl would ripple.

Folio 33 Image 2

folio 33 image 2

Image 3 depicts the treatment in which foul smelling substances were applied to her nose while sweet smelling substances were used to smoke the genitals.

Folio 33 Image 3

folio 33 image 3

Image 4 indicates the classes of women considered most susceptible to uterine suffocation: widows (indicated by the prayer book falling from the hand of the veiled woman), and virgins of marriage age.  Also depicting an alternate treatment in which the servant is holding a bone to the older woman’s nose.

Folio 33 Image 4

folio 33 image 4

Depictions of Fumigation pots and pessaries from a fifteenth century Dutch translation; Copenhagen, Det Kongelige Bibliotek, MS GKS ff. 29r and 32r

fumigation pots and pessaries dutch fifteenth century no 2fumigation pots and pessaries dutch fifteenth century no 1

The Trotula | 12th Century, Salerno

Treatments for Women, the second of the three texts that comprise The Trotula, the most attributed to Trola herself, is the leading medieval source that I have found thus far on medieval gynecology.   This text also includes treatments in the areas of obstetric, andrological, pediatric, and cosmetic medicine.  This text poses some challenges for the the researcher.  There is an underlying anatomical and physiological basis, but that is assumed on the part of the author, and we are woefully left taken for granted and struggling in our modern interpretations.

One guiding principal that we do have provided in the prologue of the compendium is that men are hot and dry, and women are cold and wet (Green, p.35).  It is deviation from these ideal states that we experience medical conditions, and the return to which will restore our health.  It is here that we will begin to look at medieval gynecological diagnosis and treatment methods from Treatments for Women (Trotula).  The following is taken from Monica H. Green’s English translation.

First things first… is your patient hot or cold?

So that we might make a succinct exposition on the treatment of women, it ought to be determined which women are hot and which are cold, for which purpose we perform this test… We anoint a linen cloth with pennyroyal oil or with musk oil, or with laurel oil or any other hot oil, and we place the cloth thus anointed into the vagina in the amount of the little finger when the goes to sleep at night, tying it with a strong thread to her thighs so that if, when she wakes up, it has been drawn inside, this is proof for us that she labors from frigidity.  But if it is expelled, this is proof that she labors from heat.

If she labors from a hot cause, there should be set up a fumigation of cold herbs in this manner.  Because contraries are cured by contraries, let us place marsh mallows, violets, and roses in water, and we fumigate her with a decoction of these things.  

If, however, she labors from frigidity, which is better, we should make for the woman a fumigation and pessary of pennyroyal and laurel leaves and willow-weed, and thus when the excessive abundance of humors has been cleaned out, she will be ready for conceiving.  Afterward we make a fumigation for females which in a marvelous manner is effective and strengthens.  Take clove, spikenard, calamite storax, and nutmeg, and let them be placed in an eggshell upon a few hot coals.  And let there be prepared a perforated chair so that all the fumes go toward the inside.”

On Provoking the Menses: 

[135] “Take root of the red willow with which large wine jars are tied and clean them well of the exterior bark, and, having pulverized them, mix them with wine or water and cook them, and in the morning give them in a potion when it has become lukewarm.  If she labors greatly, we give her things to eat such as these.  We grind madder and marsh mallow, and we mix them with barley flour and white of eggs, and then we make from them little wafers.  Also good for provoking the menses is a fumigation made from these same herbs.”

[213] For provoking the menses, take vervain and rue, and pound them heavily, and cook them with bacon, and give them to the patient to eat. Afterward, grind root of delicate willow and root of madder, and give the juice to the patient with wine.

On Excessive Menstruation: 

[136] Take old soles of shoes and pennyroyal and laurel leaves and set them to cook.  Once cooked, make a fumigation.  Let hot ashes be mixed with hot, red wine and let them be mixed in the manner of a dough, and soften it, and then let some be taken in the form of a small cone and, wrapped in a new linen cloth, let it be inserted lukewarm.

[137] Take buck’s horn, plantain, powdered with ashes of white dead nettle, and let it be diluted with rainwater. WE give it to drink, but we do not omit the above mentioned fumigation, which strengthens cold wombs.

[138] They are also strengthened by this. Take some spikenard, clove, nutmeg, and the rest of the purgatives which we said were good for conception.

[216] For restraining the menses, take sage and camphor, pound them thoroughly, and make little wafers with wine and cook them upon a tile, and give them to the patient. Afterward, take nettle seed and buck’s-horn plantain, and give a powder made of this to drink with wine. 

For Pain of the Womb

[214] For pain of the womb when it rises due to its hardness, take saxifrage, sea holly, old cabbages, mugwort, marsh mallow, and root of dove’s-foot cranesbill. Cook all these herbs in water  thoroughly, and make the patient sit in it up to her breasts.  And when she exits from the bath, pound marsh mallow, mugwort, and camphor, and warm these pounded things in a pot, and make lozenges with laurel oil or a little pennyroyal oil and insert them as a suppository. 

[225] Pain of the womb happens from miscarriage, sometimes before that time from retention of the menses. This happens often from frigidity but only rarely from heat.  If from frigidity, the sign is ache and a stabbing pain on the left side.  Treatment. Take pennyroyal, oregano, catmint, fronds of laurel or its grains, and marsh mallows, make them boil in water and then foment the patient. Afterward, take clove, spikenard, nutmeg, and galangal, and let a fumigation be made, and let her receive the smoke through a funnel.  Then apply trifera magna or the potion of Saint Paul in the amount of a hazelnut with cotton.  

[226] If, however, [the pain] comes from heat, the womb is dried ouit and made hot from the use of Venus^.  The sign is that there is excessive warmth around these parts. Treatment. Take marsh mallow, herb of violets, roses, and root of rush, and cook them thoroughly in water, and foment the patient, and put on trifera saracenica the whole day. 

^Venus: intercourse

For Swelling of the Feet (due to pain of the womb)

[215] Sometimes it happens that the feet are swollen due to pain of the womb.  Then take sea brambles and cook them in sea or salt water, and fumigate the feet often. And after the fumigation, when the mixture has become lukewarm, you will wash the feet. 

On the Exit of the Womb and Its Treatment  (mka. a prolapsed uterus)

[149] For there are some women in whom the vagina and the anus become one opening and the same pathway. Whence in these women the womb comes out and hardens. We give aid to such women by repositioning [the womb]. We put on the womb warm wine in which butter has been boiled, and diligently we foment it until the womb has been rendered soft, and then we gently replace it. Afterward we sew the rupture between the anus and the vagina in three or four places with a silk thread. Then we place a linen cloth into the vagina to fill the vagina completely. Then let us smear it with liquid pitch.  This makes the womb withdraw because of its stench.  And we heal the rupture with a powder made of comfrey, that is, of bruisewort, and daisy and cumin. The powder ought to be sprinkled [on the wound], and the woman should be placed in the bed so that her feet are higher and there let her do all her business for eight or nine days.  And as much as necessary let her eat; there let her relieve herself and do all customary things.  It is necessary that she abstain from baths until she seems to be able to tolerate them.  Also, it is fitting that she abstain from all things that cause coughing and from all things that are hard to digest, and this especially ought to be done. In [subsequent] birth we should aid them thus.  Let a cloth be prepared in the shape of an oblong ball and place it in the anus, so that in each effort of pushing out the child, it is to be pressed into the anus firmly so that there not be another solution of continuity of this kind.

[150] There are also some women to whom it happens that the womb comes out from another cause, such as those who are not able to tolerate the virile member because of its magnitude or length; having been forced all the time, they endure it.  But when [the womb] comes out, it hardens. For such women we offer aid in the above mentioned manner.  And if we do not have pitch, we take a cloth and anoint it with warm pennyroyal oil or musk oil, and then we squeeze it and we smear it on or put it in the vagina, and we tie it on until the womb recedes by itself and becomes warm.  For this condition, we suggest that whatever causes coughing not be eaten.

On Flesh Growing in the Womb  (Vaginal Prolapse?)

[170] There are some women in whom pieces of flesh hang from the womb. And note that this happens to them from semen retained inside and congealed, because they do not clean themselves after intercourse. These women we always foment with a decoction of hot herbs.

On [Vaginal] Flux  (mka. Vaginal Discharge)

[160] There are some women who suffer, or who seem to suffer, from flux (discharge) of a lesion or flux of semen in the womb, just as there are some old women who emit a sanious flux (mixture of serum and pus with a slightly bloody tinge).  To these, in order to provoke the menses, aid ought to be given thus because they are sterile. 

[161] And there are other sterile women who in a similar manner emit a sanies (a thin blood-tinged discharge of serum and pus from ulcers or infected wounds).  And this happens at the time when the menses are accustomed to come to them.  For when their menses are denied to them, instead of the menses they emit sanies because of their frigidity, as if a hot flux were descending from the liver.  To such women aid ought to be offered thus.  

We should make for them a fumigation from wine or water in which the above-mentioned hot herbs are cooked.  Afterward we mix trifera magna in pennyroyal oil or musk oil, and in a linen or woolen or cotton cloth we wrap it up and place it in the vagina.

[162] There are also other young women who labor in the same manner on account of failure of the menses, but these women are freed when the menses are provoked. And it ought to be noted that some hot women are rendered sterile, yet they do not labor from this kind of flux but remain dry as though they were men.

[163] There are some women who have a sanious flux together with the menses.  Such women we make to sit upon a mass of wild rocket cooked in wine, a linen cloth having been interposed while it is still warm. 

[164] Likewise for the same: take powdered pennyroyal and let it be placed in a small sack which is made as long as it is wide, so that both sides of the private parts can be tied, which sack the patient ought to wear upon her vagina in order to prevent the flux. But before it is tied on, it ought to be warmed by the fire so that the anus as well as the vagina might be strengthened.

On Itching and Excoration of the Pudenda:  (Itching and Lesions of the Vulva)

[166] In these same women these parts itch, which they excoriate (rupture the skin) in trying to scratch them. Sometimes there arise pustules which turn into a very large lesion. Hence, we should anoint these parts with an unguent which is good against burns caused by fire or hot water, and for excoriations of this kind.  Take one apple, [Armenian] bole, mastic, frankincense, oil, warm wine, wax, and tallow, and prepare them thus.  WE should place the apple, cleaned of both the exterior and interior rind and ground, on the fire in a pot with the oil, wax, and tallow; and when they have boiled, we put in the mastic and the frankincense, both of which have been powdered.  Afterward, it should be strained through a cloth. Note that if anyone because of any burn has been anointed with this ointment, on the anointed place there ought to be put a leaf of ivy cooked in wine or vinegar, or a leaf of gladden.  This remedy is decent.

On the Treatment of Lice  (Pubic Lice, or, “crabs”)

[171] For lice which arise in the pubic area and armpits, we mix ashes with oil and anoint.

On Those Who Wet Their Beds  (Incontinence)

[168] There are some women who urinate in their beds at night, whether they want to or not, because their urinary passages suffer paralysis.  These women we foment with hot herbs.

For Conception: 

Women were believed to be unable to conceive due to the following: being “fat,” being “thin,” dropsy.

[142] If she is phlegmatic and fat^7, we should make her a bath of seawater, moderately salty, with rainwater ^8.  We put in [herbs], that is, juniper, catmint, pennyroyal, spurge laurel, wormwood, mugwort, hyssop, and hot herbs of this kind.  In this bath she should stay until she sweats sufficiently; afterwards let her be received in bed carefully and let her be well covered.  And if she desires some food, let her at first be given rosata novella ^9. Also, let her be given good and wholesome and warm food, and wine of the best quality taken moderately.  Thus let there be made for her a bath three or four times that day, and likewise the following day.  On the third day, let there be a very good, strong smelling fumigation, as we described above.  We also do this treatment for cold men, and instead of fumigation we give them warm strengthening medicines.

[143] If, however, the woman is fat and seemingly dropsical, let us mix cow dung with very good wine and with such a mixture we afterward anoint her.  Then let her enter a steambath up to the neck, which steambath should be very hot from a fire made of elder, and in it, while she is covered, let her emit a lot of sweat, and as though in a sweat bath let her remain there until she has purged herself a little through the inferior members, and that which comes out will be rather greenish.  After she has thoroughly sweated, let her wash herself with the water of the previous bath, and thus let her cautiously enter her bed.  And let this be done twice or three times or four times a week, and she will be found to be sufficiently thin.  You will feed her well, and let her drink good and sweet smelling wine.  We also render fat men then with this treatment.

A Good Constrictive

[190] A constrictive for the vagina so that they may appear as if they were virgins. Take the whites of eggs and mix them with water in which pennyroyal and hot herbs of this kind have been cooked, and with a new linen cloth dipped in it, place it in the vagina two or three times a day. And if she urinates in the night, put it in again. And note that prior to this the vagina ought to be washed well with the same warm water with which those things were mixed.

[191] Take a newly grown bark of a holm oak. Having ground it, dissolve it with rainwater, and with a linen or cotton cloth place it in the vagina in the above mentioned manner.  And remove all these things before the hour of the commencement of intercourse.  

[192] Likewise, take powder of natron or blackberry and put it in; it contricts marvelously.  

[193] Likewise, there are some dirty and corrupt prostitutes who desire to seem to be more than virgins and they make a constrictive for this purpose, but they are ill counseled, for they render themselves bloody and they wound the penis of the man.  They take powdered natron and place it in the vagina.  

[194] In another fashion, take oak apples, roses, sumac, great plantain, confrey, ARmenian bole, alum, and fuller’s earth, of each one ounce.  Let them be cooked in rainwater and with this water let the genitals be fomented.  

[195] What is better is if the following is done one night before she is married: let her place leeches in the vagina (but take care that they do not go in too far) so that blood comes out and is converted into a little clot.  And thus the man will be deceived by the effusion of blood.

On Foul-Smelling Sweat

[204] There are some women who have sweat that stinks beyond measure. For these we prepare a cloth dipped in wine in which there have been boiled leaves of bilberry, or the herb itself or the bilberries themselves. 

On Swelling of the Vagina

[196] The vagina of women sometimes swells in coitus. Let the woman sit in water where there have been cooked marsh mallows and pennyroyal, and she will be freed.

[206] For swelling of the vagina. Take pennyroyal, fleabane, and four fronds of laurel, and boil them in water, and you should make her sit in this water, and afterward make a fumigation from all these [herbs].

For Lesions on the Breasts

[201] There are some women who have lesions in the breasts. For this we make a maturative from marsh mallow and mayweed, wormwood, mugwort, and animal grease, and when the head [of the legion] appears, grind together nuts and apply them.  And if it does not rupture let it be opened with a lancet, and press out a little in the beginning lest by a sudden evacuation it becomes bad, and each day apply a lint twice or three times smeared with egg yolk.  

[202] But if this place has become fistulous, with a probe you will be able to determine this.  Put in root of black hellebore cleaned and dipped in oil or honey.  Place a powder of burnt burdock upon [the fistula] and sprinkle it on, too. For this cleans every fistula and makes it become necrotic, as long as it is not between any bones.  And this ought to be applied there until it has dried and become necrotic.  Afterward it will be treated like any other wound. 

[203] Note that the pain which occurs in the breasts of young women passes easily, for this distress is healed with the eruption of the menses, because in certain girls laboring from the falling sickness it happens from suffocation of the womb compressing the organs of respiration. *see also: the above illustrations of uterine suffocation

On Preserving the Celibate Women and Widows: 

Because (heteronormative) intercourse was a concept closely linked to health during the middle ages: “These women, when they have desire to copulate and do not do so, incur grave illness”

[141] For these women, let there be this remedy. Take some cotton and musk or pennyroyal oil and anoint it and put it in the vagina.  And if you do not have such an oil, take trifera magna ^6 and dissolve it in a little warm wine, and with cotton or damp wool place it in the vagina.  This both dissipates the desire and dulls the pain.  Note that a pessary ought not be made lest the womb be damaged, for the mouth {cervix?} of the womb is joined to the vagina, like the lips to the mouth, unless, of course, conception occurs, for them the womb withdraws.


Green, Monica H., editor. The Trotula: An English Translation of the Medieval Compendium of Women’s Medicine. University of Pennsylvania Press, 2002.

The Writings of Hippocrates and Galen, available online at:

Folio 33: Illustrations of a case of uterine suffocation from a late thirteenth century English manuscript. Reproduced with permission from Oxford, Bodleian Library, MS Ashmole 399, f. 33r-v.

Depictions of Fumigation pots and pessaries from a fifteenth century Dutch translation; Copenhagen, Det Kongelige Bibliotek, MS GKS ff. 29r and 32r

Pormann, Peter (2009). “The Art of Medicine: Female Patients and Practitioners in Medieval Islam” (PDF). Perspectives. 373: 1598–1599. Retrieved 22 Aug 2016.

US National Library of Medicine (1998) “Islamic Culture and the Medical Arts: The Art as a Profession”. (web article)  United States National Library of Medicine. 15 April 1998

Shatzmiller, Mya (1994). Labour in the Medieval Islamic World.