Despite the contrary claims of Realdo Colombo and some of his sixteenth century anatomical contestants the clitoris was well-known to ancient medicine1. The great physician and medical system builder of the Roman empire, Galen of Pergamum, was, it must be admitted, not very interested in the topic, briefly describing this part (‘nymph’ in Greek) as affording protection for the mouth of the womb, preventing it from becoming chilled, but other imperial medical writers devoted much more attention to this small but significant somatic item2. Rufus of Ephesus, for example, provided a particularly rich, clitorally-centred account of women’s genitals in his compact treatise On the Naming of the Parts of the Human Body, drawing on earlier treatments of the subject, both medical and etymological3. This clitoris was, moreover, an erotic locus in its own right rather than defending a more important bodily formation.

Female sexuality, however, always needed management in the ancient world. The pathological clitoris also featured in medical texts of the Roman empire, a pathology of excess which invited surgical reduction. These descriptions link into two discourses around women’s bodies and their regulation. The operation outlined overlapped with external and to some extent exoticising reports of Egyptian (and neighbouring) practices of routine female ‘circumcision’ or ‘excision’, alongside male circumcision, around the age of marriage4. The accounts of the diseased, outsized clitoris itself converge with the image of the phallicised woman who wrongly imitated male sexual behaviour in Roman satire and other condemnatory literary contexts, that is the tribas. This discursive figure emerged in the early principate, embodying a particular form of female gender transgression and taking her place among more traditional feminine misbehaviours. Masculine sexuality required the penetration of others, and for a woman such as Martial’s Philaenis – ‘tribade of tribades’ – to achieve that with substantial quantities of boys and girls, as the epigrams allege, the poet must, it is suggested, have imagined her either employing a dildo or an overlarge clitoris5. The early modern (re)discovery of the nymph was certainly connected with the contemporary re-emergence of the tribade, in a historically adapted form, but Sandra Boehringer has importantly challenged the retrojection of these associations and pre-suppositions6. The issue requires further investigation, therefore, starting from the medical texts themselves.

This essay provides a more global and focused survey of the evidence for the classical Greek and Roman clitoris. It starts with the surviving anatomical descriptions, with the clitoris κατὰ φύσιν, that is in its healthy, according to nature condition, and explores the different attitudes and understandings that were articulated in this context. Then it moves to the clitoris παρὰ φύσιν, contrary to nature, examining the pathologies delineated in the medical tradition and their cures in their wider cultural and political settings. Finally, it takes a material turn. Classical antiquity was full of representations of the human genitals, in votive and protective forms, in depictions of sexual acts across a variety of media. The phallus dominated, but there are plenty of images of female genitalia too, which occasionally include clitorises, though this seems to be rarely remarked upon. Since there is so much material it is necessary to split the discussion in two, starting with the texts before proceeding to the artefacts in Part II.

The Healthy Clitoris

The two earliest surviving descriptions of the clitoris come from around AD 100 and works authored by physicians from Ephesus. Rufus and Soranus both travelled from their home city to Alexandria, the centre of medical education in the Roman empire, though it seems that only the latter made the move onto Rome, the imperial capital itself7. Similarly, while they share much of the same knowledge and cite many of the same authorities in their extant writings, their specific positions in the world of learned medicine were distinct. Soranus was a proponent of the ‘method’ (μέθοδος), the approach to illness and cure formulated by Themison and Thessalus in polemical style8. Rufus stood in a loosely ‘rationalist’ tradition, in which to understand disease and prescribe appropriate treatment required a grasp of pathological causation and the broader workings of the body. Their accounts of the clitoris clearly drew on common resources, while featuring in treatises on different topics, with specific aims, and forming part of divergent overall literary and programmatic projects.

Soranus’ Gynaecology is a substantial work putting female health and generation into sustained dialogue in order to offer extensive advice on optimal childbearing. Rufus’ On the Naming of the Parts of the Human Body is a much shorter treatise, which claims to offer instruction in medical terminology, the first step towards a more general medical education9. Other surviving medical accounts of women’s genitals can also be divided between those featuring in discussions of procreation, whether focused on women or more encompassing, and those forming part of a dedicated anatomical catalogue. This distinction impacted on the presentation of the material to some degree, despite substantial overlaps. The clitoral description in the synoptic Greek medical handbook of the later second century AD entitled Introduction or The Physician, and mistakenly transmitted under the name of Galen, comes into the latter category with Rufus, and similar sequences occur in the Greek lexical tradition too. Whereas Caelius Aurelianus and Muscio’s late antique Latin adaptations of Soranus’ Gynaecology fall (unsurprisingly) into the former group, together with the sole mention of the clitoris buried in Galen’s extensive explication of the generative organs and their roles in On the Function of the Parts. Interestingly, shortened versions of the Galen, Soranus and Rufus passages were all incorporated into the anatomical books of Oribasius’ massive fourth century AD Greek medical compilation, the Medical Collections, illustrating both the proximity of their content and continuing interest in the clitoris. For the moment the differential emphasis engendered by the division between generative and anatomical framings will be explored, beginning with Rufus’ anatomy.

On the Naming of the Parts of the Human Body is a treatise which cites the great Hellenistic anatomist Herophilus of Chalcedon almost as often as Hippocrates and makes reference to dissection, past and present10. It starts with the outside of the body, apparently demonstrated on living subjects, and proceeds from head to toe, as traditional, reaching the ‘αἰδοῖα’ below the navel11. Deriving in some sense from αἰδέομαι, to be ashamed, the noun αἰδοῖον had long moved beyond any pejorative meaning to become an entirely neutral term, best rendered by the English term ‘genitals’, which have also lost all but the loosest connection to generation. Importantly, αἰδοῖα can be male or female, though somewhat asymmetrically as will become clear. In Rufus’ narrative the male version takes precedence, then:

τῆς δὲ γυναικὸς τὸ αἰδοῖον, κτεὶς μὲν τὸ τρίγωνον πέρας τοῦ ὑπογαστρίου· ἄλλοι δὲ ἐπίσειον καλοῦσιν. σχίσμα δὲ, ἡ τομὴ τοῦ αἰδοίου. τὸ δὲ μυῶδες ἐν μέσῳ σαρκίον, νύμφη, καὶ μύρτον· οἱ δὲ ὑποδερμίδα, οἱ δὲ κλειτορίδα ὀνομάζουσι, καὶ τὸ ἀκολάστως τούτου ἅπτεσθαι κλειτοριάζειν λέγουσιν. μυρτόχειλα δὲ τὰ ἑκατέρωθεν σαρκώδη· ταῦτα δὲ Εὐρυφῶν καὶ κρημνοὺς καλεῖ· οἱ δὲ νῦν τὰ μὲν μυρτόχειλα, πτερυγώματα, τὸ δὲ μύρτον, νύμφην.

As for the genitals of women, the triangular end of the lower abdomen is called the ‘comb’, others call it the ‘epision’. The ‘cleft’ is the division of the genitals. The muscly bit of flesh in the middle is the ‘nymph’ or ‘myrtle-berry’. Some name it the ‘hypodermis’, others the ‘clitoris’, and they say that to touch it licentiously is ‘to clitorize’. The ‘myrtle-lips’ are the fleshy parts on each side, and Euryphon calls them ‘crags’, while now the ‘myrtle-lips’ are called ‘wings’ and the ‘myrtle-berry’, ‘nymph’12.

Neither the openings of the vagina nor urethra merited a mention, the clitoris dominates13. It may be a small (muscly) item but it is central, has collected the most names, in some cases has determined other vocabulary, and can be touched lasciviously, for pleasure. The terminology itself is interesting, both in its range and its derivations. Fruit borrowings are rare in Rufus, for instance, but myrtle-berries – small dark-blue or purple berries of an elongated oval shape with a crown at the tip (see Figure 1) – had already appeared as part of the female genitalia rendered sexually off-limits in Aristophanes’ Lysistrata14.
 

Euryphron, the reputed author of the Hippocratic Cnidian Sentences also demonstrates the early interest in naming features of women’s genitals while the more contemporary terminology may continue previous themes15. According to a scholion on this passage, ‘nymph’ should be understood as referring to the resemblance between the clitoris and a rosebud, another of the Greek word’s significations16.

The imagery of nymphs or rosebuds (or both) endows the clitoris with a positive sexual charge, at least from a male point of view. The licentious (ἀκόλαστος) touching is a bit more problematic. The most obvious move is to identify the self as the haptic agent, to consider this to be self-pleasuring, though other possibilities – a male or female other, husband, lover or client, for example – are also left open. The act inherently exceeded the basic requirements of procreative marital intercourse in any case. Not that such intercourse was meant to be lacking in enjoyment, rather the reverse, the pleasure of both partners was at least helpful for, if not essential to conception17. This was a pleasure inherent in that act itself, however, rather than involving any additional activity18. So, Rufus was placing the woman in the realm of licentiousness, though the exact direction or character of the excess involved was not specified. There is, however, nothing phallic in any of this, more the opposite. Nor, indeed, has any comparison been drawn between the clitoris and the penis in any of these descriptions. Rufus kept the two adjacent accounts of the αἰδοῖα separate.

Much of this vocabulary – the various names for the labia and clitoris, and the verb ‘to clitorize’ (κλειτοριάζειν) itself – can also be found in the surviving Greek lexical traditions. The female genital sequence in Pollux’s late second century AD Onomasticon is very close to Rufus’, while later collections were organised by words not themes and broke up the narrative into its constituent parts19. Soranus himself composed an Etymology, now lost, demonstrating the ongoing exchange of material between medical and lexical genres which seems to have begun in Hellenistic Alexandria20. How independent any of these extant reports are is, therefore, questionable but multiple terms for the clitoris recurred in multiple contexts. The language had a certain currency and interest through the Roman imperial period. A point which is further emphasised by the later reworkings of Rufus’ treatise. A highly compressed rendition of his external sequence, including the αἰδοῖα opens Book 25 of Oribasius’ Medical Collections, for instance, and a different epitome circulated separately, as Alexander Sideras has shown21.

Rufus was not mentioned in the pseudo-Galenic Introduction but its tenth chapter is on ‘names’ of the external parts of the body, with Aristotle and followers of the other great anatomist of Hellenistic Alexandria, Erasistratus of Ceos, identified as key authorities in the field22. The narrative reaches the male and then female genitals (αἰδοῖα) at the bottom end of the thorax:

τοῦ δὲ γυναικείου αἰδοίου, οὕτω γὰρ αὐτὸ οἱ παλαιοὶ ὐνόμαζον, αὐτὸς μὲν ὁ κόλπος κτεὶς καλεῖται. τὰ δὲ περιέχοντα τὸν κόλπον πτερυγώματα. τὸ δὲ μέσον τούτων κατὰ τὴν διασχίδα ἐκπεφυκὸς σαρκίδιον, νύμφη, ὃ καὶ διὰ τὸ προκύπτειν ἐπὶ πολὺ ἐκτομὴς ἀξιοῦται παρὰ Αἰγυπτίοις ἐπὶ τῶν παρθένων.

In respect to the female genitals, for that is what they are traditionally named, while the vagina (or ‘cavity’) is called ‘comb’. Surrounding the vagina are the ‘wings’. The small piece of flesh growing from the division between them is the nymph, which, on account of protrusion to a great extent is deemed by the Egyptians to require excision among girls in such cases23.

Here the vagina is organisationally more central than the clitoris, and is the only structure with more than one name, though the account is very spare, with no reference to the function of any part24. Still, the nymph is rendered more peripheral by its possible removal. The formulation is not entirely clear but pathology seems to join anatomy despite the brevity of the passage. Excess is implicated, though the eliminative response is restricted to the Egyptians and practised on ‘girls’. This is one of several references to Egypt in the treatise, which some have argued supports an Alexandrian origin for the work but, as Caroline Petit has pointed out, fake Egyptian colour could be added to any composition, the relevant tropes were well-known in the medical community more broadly25. Certainly Rufus, whose Alexandrian associations are assured, offers a very different pattern of Egyptian engagements overall, and does not mention any in relation to the nymph26.

Soranus set up his discussion of women’s procreative processes in Book One of the Gynaecology with an account of the nature of the female ‘parts’ based on both observation and the findings of dissection27. The latter, he averred, makes no practical contribution to medicine. Knowledge gained this way is unnecessary for the pursuit of health but interesting for its own sake. For that reason and to avoid the accusation of ignorance, Soranus incorporated data acquired through dissection in his narrative. Where he took that sort of information from he did not explicitly say, but it is clear that Herophilus was again a key source in this respect (directly or indirectly). This reliance is most apparent in Soranus’ exposition of the uterus and all its attachments, which dominates the anatomical sequence given the generative focus of the treatise, but the possibility of Hellenistic antecedents for the whole configuration should be borne in mind.

Following his extensive discussion of the nature of the womb, Soranus turned to the female αἰδοῖον, also called the female ‘cavity’ or ‘sinus’ (κόλπος)28. So far, αἰδοῖον has been deployed in a more encompassing mode but here it clearly designates something like the vagina. This circular cavity, or tube, extends from the uterus to the somatic exterior and is where sexual intercourse (πλησιασμός) is accomplished29. Soranus considered the vagina to be a distinct structure in its own right. Its inner part grew around the ‘throat’ (τράχηλος) of the womb, ‘just like the foreskin in males around the glans’ (ὡς ἐπὶ τῶν ἀρρένων ἡ πόσθη τῇ βαλάνῳ), while its outer portion grew into the ‘wings’, that is the labia: to the anus at the rear, the thighs at the sides, and the neck of the bladder at the front30. The length of this cavity varied according to age and intercourse, when the neck of the womb stretches – just like the male αἰδοῖον – into the vagina, as well as according to individual constitution31. In most adult women the distance between the uterus and the external opening is about six finger-breadths.

Soranus did not give the anatomical features visible outside the female κόλπος a collective name. They start with the ‘wings’ formed as if they were the ‘lips’ of the cavity32. Thick and fleshy they originate from what is called the ‘nymph’ at the front, passing backwards towards the thighs. This, ‘in its nature is a small piece of flesh like a muscle, and it has been called “nymph” because this piece of flesh hides like a bride’ (τῇ φύσει δὲ σαρκὶδιόν ἐστιν ὡσανεὶ μυῶδες· νύμφη δὲ εἴρεται διᾶ τὸ ταῖς νυμφευομέναις ὁμοίως ὑποστέλλειν τὸ σαρκίον)33. Behind the clitoris another small lump of flesh covers the end of the neck of the bladder, called the ‘urethra’ (οὐρήθρα)34.

Soranus provided a complete account of the ‘female parts’, therefore, including the clitoris. The external genitals are centred around the vaginal opening, however, and the image of the shy, veiled, young bride, one of the meanings of νύμφη is the only hint at any erotic role for the clitoris, which otherwise lacks any particular function. It also lacks any male equivalence. Soranus’ twice likened the neck of the uterus, not the nymph, to the male anatomy. His notion that, just as the male αἰδοῖον, it expands into the vagina during sexual intercourse is a particularly striking one, a distinct vision of female phallicisation, both implicitly heteronormative and somehow symmetrical35. This is part of a broader sexual focus on the vagina, while all the other key activities Soranus was interested in – menstruation, conception, pregnancy and birth – belong to the womb36. Since he was sceptical about teleological arguments and providentialism, Soranus did not require all the parts of the body to serve a clear purpose, unlike Galen, still there is a certain hierarchy expressed in the order and contents of his anatomical narrative37.

Scholars have repeatedly emphasised that the late antique Latin gynaecologies of Caelius Aurelianus and Muscio should not be seen simply as translations of Soranus, they are more complex and active productions in various ways38. Soranus was a key resource for both authors but in the case of Muscio, whose Gynaecia was the most popular, judging by manuscript survivals at least, may have only been used indirectly and certainly alongside other sources39. The anatomical section in which the clitoris features can be used to illustrate the point, starting with its catechetic style40. Most, but by no means all of Muscio’s material is presented in question and answer form. The relevant enquiry here is: ‘where, then, does the mouth of the womb lie? (UBI ERGO IACET ORIFICIUM MATRICIS?)’41. The mouth having been the first part of this organ enumerated in the previous chapter on the overall form and configuration of the womb, accompanied by a helpful diagram42.

The response is:

in medio sinu mulieris, quia ipse sinus membranum nervosum maioris intestini similis est. intus autem est spatiosissimus, foris vero congustus, in quo coitus virorum et usus venerius efficitur. quem vulgus cunnum appellat. cuius foris labia greci pterigomata dicuntur, latini pinnacula dicta sunt, et a superiore parte descendens in medio landica dicta est.

In the middle of the woman’s cavity (sinus), because the cavity itself is a sinewy membrane similar to the large intestine. Inside it is very spacious but it is narrow at the outside, and in it the sexual activity and sexual pleasure of men are accomplished. Colloquially, it is called the ‘cunt’ (cunnum). Its outside lips are called pterigomata in the Greek, in Latin they are called the ‘little wings’, and that which descends from the upper part in the middle of them is called the ‘clitoris’ (landica)43.

The next question is about the distance between the mouth and the ‘little wings’, which, while recognised as varying according to age and nature, is generally about five or six fingerbreadths44. The clitoris does not appear again until the pathological chapters in the second half of the work.

The overlap with Soranus’ Gynaecology is obvious, but so is its active adaptation, and while Muscio does little more than acknowledge the existence of the clitoris there are a couple of points worth emphasising in this passage. It is, most likely, the latest text in this discussion since Muscio is usually placed in the fifth or sixth century AD and located in North Africa, home of much late antique medical writing in Latin45. Caelius was definitely African – from Sicca Veneria – and generally held to be slightly earlier, but his rendition of this section is missing from the sole surviving manuscript of his Gynaecia46. Late as Muscio is, his vocabulary reaches back half a millennium or so. Landica is a very rare word in Latin literature, coyly alluded to in one of Cicero’s letters and directly deployed in a single epigram of the self-consciously obscene Carmina Pripaea47. Interestingly, it is also epigraphically attested, once on a slingshot aimed at Fulvia, wife of Mark Antony, and once in a Pompeian graffito, neither being exactly complimentary48. The term does not feature in the, often sexually explicit, satires of Martial, however, though cunnus certainly does. While its poetic usage is flexible, and often generic, Muscio is specific, this is the colloquial word for the ‘female cavity’ or vagina49. Following on from Soranus, this was the location of men’s sexual activity and pleasure, the heteronormativity of the passage now made explicit, along with the male ownership of erotic action and enjoyment.

Questions of equivalence between male and female somatic structures, of teleology, and how to explain the complex processes of human generation dominate the discussion in which the clitoris makes its sole appearance in Galen’s massive surviving oeuvre. Books 14 and 15 of his physiological magnum opus, On the Function of the Parts, composed in Rome over the AD 160s, and in corrective conversation with Herophilus and Aristotle, focus on the organs of generation – that is the genitals, testicles (ὄρχεις, male and female), and womb – along with their operations50. He promised a complete account demonstrating the optimisation of each part for their particular purpose, down to the smallest detail. He further committed, in the course of Book 14, to at least exploring if not proving the idea that ‘all the parts then, that men have, women have too’ (πάντ’ οὖν, ὅσα τοῖς ἁνδράσιν ὑπάρχει μόρια, ταῦτα καὶ ταῖς γυναιξὶν), but inside rather than outside51. Thus, turned inward, the male scrotum would form the uterus, flanked by now interior testicles, and his penis (καυλός) would become the neck (αὐχήν) of the uterus thus created (something like the vagina or a combination of the cervix and vagina), while the skin at the end of the penis, the foreskin or prepuce (πόσθη), would transform into the female genitals (αἰδοῖον). In the reverse process, in moving to the exterior, ‘the neck’ of the womb turns into the penis and the skin-like growth at the end of the neck, that is the female αἰδοῖον, becomes the man’s prepuce. The problem is that, in this externalising sequence, the penis has been labelled as the male genitals (αἰδοῖον), as elsewhere in the work, whereas the vagina (or ‘neck’) is definitely not the female αἰδοῖον, which is instead interchangeable with the foreskin52.

This breakdown of equivalence becomes more apparent in Book 15 when, after about eight pages of printed text on the wonders of the penis, the narrative briefly touches on the sexually differentiated formation and positioning of the bladder in relation to these other parts and then proceeds to discuss ‘the outgrowths of skin at the ends of the two genitals’ (αἱ δὲ τοῦ δέρματος ἐπιφύσεις ἐπὶ τοῖς πέρασι τῶν αἰδοίων ἑκατέρων), that is of men and women, without any coverage of the female αἰδοῖον itself53. All the indications are that here it should be understood as the vagina, roughly speaking, or its invisible correlate, though it should be said that the neck of the womb had already received plenty of attention in the previous Book, along with the rest of that organ.

Regardless of these problems, the liminal skin still has work to do for Galen’s total teleology in Book 15. In women, its formation is for the sake of ‘good order’ or ‘comeliness’ (κόσμος) and to cover and protect the uterus from the cold – while in men there is some beneficial contribution to appearance, since the requirement of equivalence makes it ‘impossible’ for there to be no male version54. Galen offers no names for these outgrowths in this introductory outline, though it is presumably the foreskin which is being referred to as κόσμος in men. Margaret Tallmadge May, in her impressive translation of On the Function of the Parts into English, assumed that it is the labia – what Rufus and others called the ‘wings’ – which are being alluded to in women, with the final sentence in this brief account giving a similar safeguarding role to the νυμφή, ‘just as the uvula provides protection to the pharynx’ (οἷον δέ τι πρόβλημα τῆς φάρυγγος ὁ γαργαρεών ἐστι)55.

The phrasing is confusing overall, but what is clear is that Galen compared the nymph, not to any part of the male anatomy, but to the uvula. He suggested that the clitoris stands in the same relation, positionally and functionally, to the uterus as the uvula does to the pharynx. Both are set in front of, and provide covering and protection for, the relevant openings and what they lead to. The main point is, however, that Galen struggled to fit women’s external somatic configuration into his male model, and was not very interested in the female body in its own right.

A heavily abbreviated version of the opening section of Book 15 of On the Function of the Parts, including the analogy between the nymph and uvula, was incorporated in Book 24 of Oribasius’ Medical Compilations56. It was immediately followed by a fuller excerpt from Book One of Soranus’ Gynaecology, ending with his description of the ‘wings’, nymph, and urethra57. As mentioned, a very compressed rendition of the external sequence of Rufus’ Naming then opens what remains of Book 2558. The ‘comb’ and ‘cleft’ both make the cut, and ‘the muscly bit of flesh in the middle is the myrtle-berry or nymph, on either side are the myrtle-lips or wings’ (τὸ δ’ ἐν μέσῳ μυῶδες σαρκίον μύρτον ἢ νύμφη· μυρτόχειλα δὲ τὰ ἑκατέρωθεν πτεγυγώματα)59. This kind of anatomical and physiological material was increasingly limited in later Greek medical encyclopaedias, as Oribasius’ seventy books were reduced to sixteen by Aetius of Amida in the sixth century AD and seven by Paul of Aegina in the following century. As long as there was interest, however, descriptions of human anatomy included the clitoris in the Greek and Latin learned medical traditions.

Overall, then, the clitoris was an integral component of the ‘female parts’ in medical writing of the Roman imperial period, and likely before that too, in the Hellenistic era and perhaps even earlier60. Consistently described as a small piece of flesh, and located at the front, perhaps the origin, of the labia, it accumulated a rich set of names in Greek, though not in Latin. Rufus of Ephesus was the only medical author explicitly to endow the nymph with erotic capacity, but the language of sexual pleasure is reflected in the terminology more widely, and Galen offered the sole functional alternative. With sexual desire already taken care of by the female (and male) seed, the purposes of Galen’s clitoris were aesthetic and protective61. Galen is also alone in comparing the nymph to part of the male anatomy, that is the foreskin, though not with a great deal of conviction, and having been very clear that it is the neck of the womb, the vagina, which is equivalent to the penis in general, a perspective that Soranus hinted at too, at least for his more distinct ‘female cavity’. None of this, therefore, can be considered as, in any sense, phallicising the clitoris, though other issues are raised. Possibilities of erotic impropriety are indicated by Rufus, while pseudo-Galen reported specific Egyptian concerns about somatic proprieties in this area. Women’s bodies always tend to excess in ancient medicine, after all.

The Diseased Clitoris

The pathological clitoris was particular to gynaecological writing of the Roman imperial period. Not mentioned in any of the surviving generic works on acute and chronic disease but discussed in both Soranus’ and Philumenus’ Gynaecologies and may be in that of the Herophilean Alexander Philalethes too62. Soranus’ chapter ‘on the overlarge clitoris and clitoridectomy’ (Περὶ ὑπερμεγέθους νύμφης καὶ νυμφοτομίας) is lost, only the title remains in a listing of the contents of Book Four, along with some much reworked descendants63. Not only in the later Latin Gynaeciae of Caelius and Muscio but also in the section on clitoridectomy and κέρκωσις in Paul of Aegina’s seventh century Greek medical encyclopaedia64. κέρκωσις, that is a tail-like growth in the mouth of the womb, was the subject of the next chapter in Soranus too65. Extracts from Philumenus’ second-century AD work, located in a loosely ‘rationalist’ tradition like Rufus, were preserved in several late antique medical compilations, especially in the final and also gynaecological book of Aetius of Amida’s so-called Tetrabiblos66. It includes a section on clitoridectomy, from Philumenus67.

All these passages describe a condition characterised by an excessively large clitoris – landica or νύμφη – treated by the surgical removal of that excess. Muscio’s version can stand for the Soranian tradition:

de inmoderata landica quam greci las nymfin appellant
 
turpitudinis sintoma est grandis las nymfin. quidam vero adserant pulpam ipsam erigi similiter ut viris et quasi usum coitus quaerere. curabis autem eam sic. iactantes eam supinam pedibus clusis mizo quod foris est et amplius esse videtur tenere oportet et scalpello precidere, deinde conpetenti diligentia vulnus ipsum curare68.

On the excessive clitoris which the Greeks call ‘las nymfin’
 
A large nymph is a symptom of indecency. Indeed some maintain that the flesh itself is made erect in the same way as in men and that it seeks the enjoyment of intercourse, as it were. You will treat her thus, therefore. Placing her on her back with feet drawn up, one ought to grasp with the forceps what is outside and seems to be too large, and to cut it off with a scalpel, then treat the wound itself with the appropriate care.

There are variations in detail but the chapters in Caelius and Paul are very similar. An overlarge clitoris was understood to be intrinsically unseemly (horrida or ἀπρεπής respectively), a matter of shame and disgust (foeditas or αἰσχύνη). It was also associated with sexual impropriety, evoked in somewhat vague terms and with questions of cause and effect left unclear, but in a clearly phallicising mode. The vocabulary of erection recurred (tentigo and ὀρθιάζω), together with an urge to sexual intercourse. The similarity with men was recorded in respect to the physical response and the sexual desire. The treatment also has the same shape. The woman was placed on her back, the surplus held and then carefully removed with a scalpel. This was cast as a trim not the complete excision of the clitoris, done cautiously and followed by the right kind of after-care. Though, of course, the definition of excessive in these cases was left entirely open, determined it would seem without reference to the woman herself. No one asked her about her sensations and desires, everything was based on external observation and judgement.

Sandra Boehringer is certainly correct when, in contradiction to claims made by Bernadette Brooten, she asserts that ‘none of these works mention sexual behaviour between women’69. On the other hand, they all equate (or at least report the equation of) an enlarged clitoris with male sexuality, physically and in terms of urge and desire. Which would mean that these women sought sexual activity with males and females, taking the masculine role in both cases. There is some overlap with poetic representations of phallicised women, therefore, with the image of the ‘tribas’ which will be explored shortly. First it must be pointed out that the Philumenus passage, while sharing key aspects with the post-Soranian tradition, is also quite distinct in various respects, and worth citing in full:

ἡ λεγομένη νύμφη οἶον μυῶδες ἢ δερματῶδες ἐστὶ συγκριμάτιον κείμενον κατὰ τὴν ἄνωθεν τῶν πτερυγώματα συμβολήν, καθ’ ὃν τόπον ἡ οὐρήθρα τέτακται· μεγεθύνεται δὲ τισιν ἐπὶ πλέον τῶν γυναικῶν αὔξησιν λαμβάνων, καὶ εἰς ἀπρέπειαν καὶ αἰσχύνην γίνεται. ἀλλὰ καὶ παρατριβόμενον συνεχῶς ὑπὸ τῶν ἱματίων ἐρεθίζει, καὶ τὴν πρὸς συνουσίαν ὁρμὴν ἐπεγείρει, διόπερ πρὸ τῆς μεγεθοποιήσεως ἔδοξε τοῖς Αἰγυπτίοις ἀφαιρεῖν αὐτὸ τότε μάλιστα, ὁπότε πρὸς γάμον ἄγεσθαι μέλλοιεν αἱ παρθένοι.
 
ἐπιτελεῖται δὲ ἡ χειρουργία τὸν τρόπον τοῦτον. ἐδραζέτω μὲν ἡ παρθένος ἐπὶ δίθρου, παρεστὼς δὲ ὄπισθεν νεανίσκος εὔτονος ὑποβάλλων τοὺς ἰδίους πήχεις ταῖς ἐκεινης ἰγνύαις, διακρατείτω τὰ σκέλη καὶ τὸ ὅλον σῶμα· ἐστὼς δὲ ἐναντίον ὁ ἐνεργῶν καὶ μυδίῳ πλατυστόμῳ συλλαβὼν τὴν νύμφην διὰ τῆς εὐωνύμου χειρὸς ἀποτεινέτω, τῇ δὲ δεξιᾷ ἀποτεμνέτω παρὰ τοὺς ὀδόντας τοῦ μυδίου. μέτρον δὲ προσήκει κατέχειν ὡς ἑπὶ τῆς ἀποτεμνομένης κιονίδος, ἵνα τὸ περιττεῦον μόνον ἀφαιρεθῇ· παρὰ δὲ τοὺς ὀδόντας τοῦ μυδίου τὴν ἀφαίρεσιν εἶπον γενέσθαι, διὰ τὸ δερματώδη εἶναι νύμφην καὶ παρεκτείνεσθαι μέχρι πλεῖστου, ὥστε μὴ ἐκ τῆς περιττοτέρας ἀποκοπῆς ὠς ἐκ τῆς βαθυτέρας τῶν ἐγκανθίδων ἐκτομῆς ῥοιὰς ἐπακολουθεῖν70.

The part called ‘nymph’ is a small muscly or skin-like sort of structure, lying just behind the front joining of the wings, close to the place the urethra opens. In certain women it increases its size more, taking part in their growth, and it becomes unseemly and shameful. Furthermore it is aroused by being continually rubbed by the clothes and it excites the urge for sexual intercourse, on account of which the Egyptians decided to remove it before its enlargement, especially at the time when the girls are about to be given in marriage.
 
The surgery is performed in this way. The girl should be placed in a chair and a robust young man standing behind her and placing his arms over her thighs should hold her legs and her whole body still. Standing facing her and grasping her clitoris in wide-jawed forceps71, the surgeon should stretch it out with his left hand and cut it off with his right hand, along the teeth of the forceps. It is appropriate to retain a moderate amount, just as when cutting the uvula, the excess alone should be removed. I said to make the excision by the teeth of the forceps, where the clitoris is skin-like and can be stretched the most, so that no haemorrhaging results from the amputation of the excess, as from the deeper excisions for eye tumours.

Some post-surgery instructions follow. The wound is to be closed with wine or water, wiped with a sponge, sprinkled with powder and then covered with lint and a sponge both soaked in vinegar water. After a week a fine calamine powder, with or without rose flowers, or a dry genital application from ground tufa should be applied, and other treatments for wounds to the genitals are also appropriate.

The opening sequence, the integration of anatomical information, is interesting but the main points of distinction come later. Firstly, there is no explicit assimilation to the male here, though some of the language is suggestive72. The overlarge clitoris is unseemly and shameful but with a different arrangement of the clothing would generate no sexual impulses or improprieties. Secondly, having set up a contrast between a scenario in which excessive clitoral growth only occurs in some women, and the alleged Egyptian practice of removing the clitoris in all girls just before marriage, thus preventing the possibility of shameful excess and improperly generated sexual desires, the surgery is described as being performed on young women (παρθένοι) apparently aligning it with the latter, Egyptian situation. All the indications are that the ‘circumcision’ of girls in Egypt, as it is described in a Ptolemaic papyrus, was a religious or domestic ritual rather than a medical operation, however, and an insistence that only the clitoral surplus be excised would seem to fit better with the first set of circumstances, that is a specific case in which immoderate enlargement is already deemed to have occurred73. Maybe the two alternatives are not so contradictory, however, since this type of external control on female bodies fits most easily into a familial, and precisely pre-nuptial, context regardless. This is, moreover, an edited version of Philumenus’ text from which further details and explanations might well have been lost, so the passage should not be pressed too hard.

Despite the editing, the fuller description provided of the surgical operation is notable. The comparison with uvulectomy might link to Galen’s functional analogy between the two structures74. The further comparison with excising eye-growths serves to embed clitoridectomy within a broader procedural category, that of the delicate removal, with particular risks of bleeding. Cutting a girl’s clitoris was presented as a variation on a standard therapeutic theme.

As it survives, therefore, the medical tradition on the overlarge clitoris and clitoridectomy is internally similar but not uniform75. Its Soranian strand does seem to offer a possible physical correlate to the literary figure of the tribas, the woman who transgressively adopted the ‘active’, male role in sex76. This corporeal configuration is never made explicit. Tribades appear in literary genres which relish innuendo, uncertainty and surprise, are structured around paradox, impossibility and fantasy, not characterised by straightforward description and balanced analysis. This is, moreover, not accidental, rather the reverse. Still, the anatomical dimension of this discussion was foregrounded by the first-century AD fabulist Phaedrus’ origin myth for tribades and their male counterparts, ‘soft-’ or ‘effeminate-men’ (molles)77. The story is that, after a night out with the wine-god Liber, Prometheus drunkenly applied female genitals to male bodies and vice versa, ‘so that lust now enjoys a perverted pleasure’/ita nunc libido pravo fruitur gaudio78. The tale offered one possible conceptual approach to those who transgressed the gendered norms governing sexual activity in the Roman empire, through genitally embodying the mismatch. Tribades could be conceived of as women with penetrative genitals and molles as men with genitals to be penetrated, that was to capture something important about those categories as constructed in the Roman imaginary.

There were non-anatomical options also, as explored in one of second sophistic superstar Lucian’s Dialogues of the Courtesans79. What exactly it was that the wealthy Lesbian woman Megilla had, instead of what men had but which nonetheless made her a match for any man as a (paying) sexual partner for Laena, the conversational protagonist, is left tantalisingly unclear. A range of possibilities are canvassed, explicitly and implicitly, and it might indeed be a technique she possessed rather than anything physical. Laena refused to tell her friend Clonarium how her night in bed with both Megilla and her ‘wife’ the similarly wealthy and ‘similarly skilled’ (or ‘accomplished’, ὁμότεχνος) Corinthian woman Demonassa ultimately went down. Megilla had also both claimed and disclaimed various aspects of maleness when Laena interrogated her on the subject, turning the amorous threesome into something more like a Socratic dialogue, as Boehringer has shown80. The interrogation ends in epistemic aporia, though considerable erotic pleasure follows. Uncertainty is the crux of both conversations in the piece, which has nonetheless expanded the territory of female sexual agency in respect to other women. Even if Megilla is to be located somewhere on an essentially male, if not phallic, sexual spectrum, neither Demonassa nor Laena are, and the former’s desire for the latter is no less, and at the outset of the encounter no less active than Megilla’s.

Martial’s epigrammatic tribades come closest to the medical descriptions. They unequivocally, in some sense constitutively, engage in penetrative sexual activity, with suggestions that this is accomplished by means of a masculinised anatomy, though the details are kept vague. In Book Seven, the appropriately named Philaenis ‘buggers boys’/pedicat pueros, ‘drills 11 girls a day’/undenas dolat in die puellas, then is later addressed as ‘fucking’ (fututis) her ‘girlfriend’ (amicam)81. Pedico and futuo signified, reasonably precisely, phallic anal and vaginal penetration respectively, and though dolo was a less specific term, it is one of a group of verbal metaphors built around the notion of the penis as a sword or other sharp implement82. Most crucially Philaenis failed to understand that cunnilingus is no more manly than sucking cock, and so eagerly indulged in the former while rejecting the latter. It is her misconstrual of masculinity, her excessive and erroneous performance of its norms, that is the focus in this poem, with little attention paid to any mechanics. Still, it was ‘with a fiercer hard-on than a husband’s’/tentigine saevior mariti, that she ‘drilled’ so many girls, a possible allusion to an erect, overlarge clitoris83. Similarly, in Book One, Bassa, though surrounded only by women and apparently a model of female virtue, is revealed as a ‘fucker’ (fututor), an anti-Lucretia84. ‘You dare to join two cunts and your prodigiosa venus feigns masculinity’/inter se geminos audes committere cunnos mentiturque virum prodigiosa Venus, so that, paradoxically, where there is no man still there is ‘adultery’ (adulterium). As Deborah Kamen and Sarah Levin-Richardson argue, prodigiosa venus is a double entendre, signifying both ‘monstrous love’, the inversion of appropriate female sexuality, and ‘monstrous organ’, most likely an oversized clitoris85. This is again imitative and mistaken maleness, all the more morally reprehensible for its failures.

Finally, it should be noted that tribades make their sole appearance in any surviving classical medical text in another of Caelius Aurelianus’ Latin adaptations of Soranus. His treatises on acute and chronic diseases included a chapter on molles among the latter conditions86. They were compared to tribades, glossed as women who sexually desired both males and females, indeed have a preference for other women, pursuing them ‘with almost masculine jealousy’/invidentia paene virili87. Both molles and tribades were suffering from a mental not a physical illness. ‘For, as Soranus says, this affection comes from a corrupted and most depraved mind’/est enim, ut Soranus ait, malignae ac foedissimae mentis passio88. Therapies were to be directed at the mind rather than the body therefore, attempting to somehow bring it under control. There was no mention of clitorises, enlarged or otherwise, though there was some discussion of further aetiology for the molles, focused on their process of generation.

Neither νύμφαι nor landicae feature in the coverage of another, apparently contiguous disease in the medical texts, that is satyriasis. An acute affection defined by sustained and painful tension of the genitals, satyriasis was generally described in generic or implicitly male terms, as the name suggests89. Soranus, however, asserted that ‘it also occurs in women’ (γίνεται δὲ καὶ ἐπὶ γυναικῶν), and his later latinsers followed suit90. Meanwhile, Aretaeus the Cappadocian denied this possibility91. Women’s constitutional coldness formed the first barrier and their lack of ‘the parts for erection, like a satyr’ (μόρια ἐς ὀρθίησιν, ὅκωσπερ σάτυρος), was the second92. Similarly, men cannot suffer from uterine suffocation since they have no womb93. Soranus, who was committed, on principle, to an essentially shared human pathology – to the idea that specific manifestations of disease varied between the sexes but not their fundamental character – avoided these objections94. He recognised that most sufferers were men, so the fullest discussion was in the treatise on acute diseases, with a much shorter version in the gynaecology95. In women the itching that accompanied the pain was more intense, forcing them to keep bringing their hands to their genitals and, on this account, develop an irresistible desire for sexual intercourse and a form of mental derangement, through sympathy between the womb and the meninges of the brain, which removed all shame96. The involvement of the womb and the vagina in the narratives, as well as other formulations, indicates that the insatiable urge is for normative heterosexual sex, at least normative in shape though not in quantity or legality. Satyriasis was predominantly imagined as an ailment afflicting the physical conditions for performing penetrative sex, and so male, but a female version was possible, cast as the reverse, with the genital tension internalised and itchy. The treatment for women involved vaginal pessaries and borrowed heavily from the prescriptions for a constricted and inflamed uterus, as a local variation on a broader therapeutic theme97.

The ancient intersections between sex and disease were, therefore, many and varied. Only Caelius – following Soranus – made a transgressive sexual figure, the mollis (and the tribas), into a disease category, while also serving to emphasise diversity in other ways. Crucially for this discussion, Caelius demonstrates that it was perfectly possible to be a tribas without an excessive clitoris. It should also be noted that some (non-medical) ancient authors imagined sex between women involving a dildo, or indeed, entertained the notion that it might be more reciprocal, not based on the male model at all98. Within the set of sources and examples discussed here, Demonassa, Philaenis’ amica, and other unnamed women confirm that women’s sexual desire for other women was not always characterised as phallic. As extant, the physician Philumenus considered the overlarge nymph to be unseemly and shameful without leading to masculinised erotic activity at all. The sexual arousal and pleasure engendered through touch and rubbing has been a recurrent theme, in an open way. It is important to stress that a range of possibilities, different ideas and combinations, were always in play. Plurality and vagueness were fundamental, innuendo was the dominant epistemic mode.

Within this wider set of options, however, some convergence between the figure of the tribade and the medical accounts of clitoral excess with its removal has become apparent. Without the development of particular concerns about gender roles and female sexuality in the Roman empire, crystallised in the persona of the tribas, it seems unlikely that clitoridectomy would have moved from ethnographic to medical discourse. This ties in with some broader post-Hellenistic trends in learned medicine, as Ann Ellis Hanson has argued, including the general ways in which women’s physiology was brought closer to men’s, reflecting shifting and expanded female roles in Roman society in comparison to the world of Hippocratic physicians, and a greater Roman focus on female hypersexuality99. A complex combination of social circumstances and ideological thematics gave the notion of an overlarge clitoris medical traction, in conjunction with its cure.

A final point to make before bringing the healthy and diseased clitorises together in conclusion is about absence. Missing from the medical discussions of clitoridectomy was any comparison with male circumcision (περιτεμνόμενον), though the two were often joined in other accounts100. The gynaecological genre bears some responsibility for this state of affairs, though it did not banish male anatomy from its precincts, measurement against the male standard was always a possible discursive move. Book Six of Paul of Aegina’s encyclopaedia was, moreover, inclusive, dedicated to conditions requiring surgery as part of their cure. Organised roughly head to toe, treatments of the penis and male genital area more broadly appear before the sequence dealing with the equivalent parts of the female body. The operation for hypospadias in boys is closest to clitoridectomy in technique, while the short chapter on circumcision opens by stating that it is not about the religious version of the practice, only about removing a portion of the foreskin that has become blackened through some genital condition101. The contrast with the section on clitoridectomy is very clear, men’s and women’s bodies, especially their αἰδοῖα, were valued and approached very differently.

Conclusions

The mismatch between the medical accounts of the clitoris in health and in disease is striking. Not just that the world of the ‘nymph’, of rose-buds and young brides, seems to have become so sordid and corrupt but that the anatomy does not fit. In so far as the various descriptive or generative sequences analogised male and female genitalia, the vagina or the ‘neck of the womb’ were made equivalent to the penis not the clitoris. Galen toyed with a comparison between foreskin and clitoris but as something of an afterthought which does not actually work in his overall system. The erotic character of the nymph was also entirely unphallic, indeed generally underplayed. It was about response not initiating action, being touched or rubbed not anything even vaguely penetrative.

Roman imperial concerns about gender and sexuality, represented by the figure of the tribas, play a significant part in this story, therefore. Hellenistic antecedents for the anatomical descriptions and vocabulary seem likely. There is no evidence for the pathological clitoris before Soranus and Philumenus, though ethnographic reports of female ‘circumcision’ among the Egyptians are earlier. It should also be stressed that the healthy version of women’s genitalia, the terminological richness, persisted in a range of texts right through the Roman imperial period too. Moreover, the state of the sources generates further uncertainty. In the Soranian tradition, the view that women with an excessive clitoris experience erections and desire like men and were thus impelled towards sexual intercourse was reported as belonging to ‘many’ rather than being unanimous, for example. Did Soranus’ original set out the debate in more detail? Was Philumenus aligning himself with an established position in an ongoing dispute? Or did medicine simply accede to shifting social demands and incentives without worrying too much about internal consistency? If the Roman patriarchal imaginary found that, in some circumstances, the nymph usefully lent itself to being phallicised that was sufficient.

Overriding any anatomical qualms, moreover, was the fundamentally good fit of clitoridectomy into classical medicine’s regulatory approach to the female body102. In contrast to the medical address to men as active agents, key participants in their own health-care, girls and women were externally governed. There is no female agency in these therapeutic accounts, no subject enacting an appropriate relationship with their body and physical well-being. If her clitoris was judged excessive a woman or girl was placed on her back – or otherwise held still – and the surplus removed with a scalpel. The operation was understood to require considerable aftercare to stop the bleeding and heal the wound, but no thought was given to any possible damage to sensation that might be caused, or indeed any long-term problems that could be generated for the women concerned. Physicians may not have taken the initiative in establishing this procedure, incorporating it within the medical art, but it worked for them and their paymasters, medicine and patriarchy were neatly aligned and mutually reinforcing in this area as others.