An Indelicate History of Sex and Sexually Transmitted Infections, Part 2

The Egyptians

The Egyptians closely followed the Sumerians in recording aspects of daily life including sexuality, contraception, and sexually transmitted infections (STIs). Depictions of sex are found in hieroglyphics but are discreet and scenes of oral sex and homosexuality are rare – or nonexistent in the case of lesbianism. Prostitution was acceptable “for soldiers, travelling businessmen, and others living away from home for long periods,” – just not in the temples, please. References to erotica, necrophilia and zoophilia, aphrodisiacs, birth control, and drugs for erectile dysfunction have been identified.

As in India, though details of genitourinary symptoms and treatments in men and women appear in various texts, there is no clear evidence of STIs. Rates of STIs in Ancient Egypt are thought to have been low by scholars of the writings.

Some clues to STIs have been found in Egyptian mummies. At least one genital wart was confirmed to be from the human papilloma virus (HPV). Pelvic adhesions have been found in female mummies suggesting they had either appendicitis or pelvic inflammatory disease which occur with untreated chlamydia or gonorrhea infections. And nits (lice eggs) have been found near the base of hairs on mummies, though I’m not sure if they were from pelvic or body lice.

Mud baths, certain herbs in home-brewed beer, desert date tree oil mixed with honey, flakes of copper and antimony, a metallic element also used as kohl, were suggested to treat vaginal discharge. Menstrual problems were treated with poultices of crushed onion and mustard in a base of pine sawdust.^[1]

Ancient Egyptians called genital infections “secret diseases,” illustrating that even then there was stigma attached to STIs. This and the lack of erotic scenes in their art suggests that the Egyptians were more modest about sex than some other cultures. Perhaps this is why STIs are not mentioned in their medical writings, or alternatively, as suggested by some scholars, the rates of infection were low. Others suggest that the absence of social upheaval, long periods of peace, early marriage, devotion to family life, and a relatively small and stable population had likely prevented the spread of venereal infections.^[1]

The Greeks

The Greeks were prolific in their writings, paintings, and sculptures about sexuality. Hesiod wrote that the first woman, Pandora, “caused all the problems on the Earth by opening her box”[3] (perhaps one of the earliest play-on-words). Greeks approved, or at least accepted, lesbians and homosexuals, brothels and prostitution. Hippocrates, the father of medicine who famously instructed physician students to “first, do no harm,” also admonished them to avoid seducing the women and men, whether free or slave, when visiting someone’s home – which remains a good idea today. He used an early form of a speculum and labeled vaginal discharge “leukorrhea” which it is still called today. He is thought to have described genital ulcers (likely herpes), genital warts, and ‘strangury’ – scarring in the penis from urinary tract infections.^[2]

The Romans

And then there was Rome. Prostitutes in ancient Rome were called “venere volgivaga” (I love how this rolls off the tongue), meaning ‘wandering venus.’^[2] They were admonished to wear deep red colored men’s clothing to identify themselves in public.

Like in Greece, Roman literature and art are filled with erotica including fellatio and cunnilingus. A lost book from Pompeii is said to have portrayed numerous coital positions. Homosexual depictions were common. Various Roman physicians described STIs in their books, including symptoms of urethritis, genital lesions, and anogenital warts (called ‘figs’) on the ‘partes obscenes.’

The Romans were aware that genital warts were transmitted via sexual contact and occurred more frequently in homosexuals.^[2] A Latin satirical poet of the time wrote:

In order to buy some slave boys

Labienus sold his garden;

But now he has only

An orchard of figs.^[3]

One leading physician, the ironically named Soranus of Ephesus, a noted expert in obstetrics, gynecology, and pediatrics, recommended treating the eyes of newborns to prevent newborn ophthalmia caused by gonorrhea, a practice that continues to this day. On the other hand, he prescribed sleeping on a hard bed to treat gonorrhea. His manuscript “Gynaecology” was very influential and widely consulted for several centuries. It strongly counseled that virginity in all sexes was the healthiest state and the least susceptible to disease. This ideal of virginity and celibacy became the most important virtue propagated by the western Christian Church (but it was not adopted by Eastern Christianity).^[2]

Another famous physician in antiquity was Galen of ancient Rome. Educated in Alexandria, Egypt, he brought to Rome the theory that four humors (blood, yellow bile, black bile, and phlegm) within the body caused all disease. Believers in this theory were called “humorists” but they weren’t – they were serious. Through dissection of animals (dissection of humans was against Roman law), Galen described many of the anatomical systems of the body including the circulatory, respiratory, and nervous systems.

When describing the reproductive systems in the human body, Galen was on the “one sex” team, believing there was only one set of reproductive organs shared by males and females, not a different set for each sex. In males, because of their more intense “heat,” the genital organs were on the outside of the body, while the same organs were on the inside of the “cooler” female sex. In this inside-out theory, labia are foreskin, the vagina and uterus comprise the inverted penis, and the ovaries are the testes. This theory also persisted for generations; specific words for female sexual organs did not emerge until the 18^th century.^[4]

The first use of the term ‘gonorrhea’ (gognos = semen; rhoia = to flow) is found in the writings of Galen. He described the disease in men as an involuntary overabundance of semen in the absence of an erection; similar to the description of profusio seminis made by previous physicians (sounds like a Harry Potter spell).

An overabundance of semen in women, however, was described in this way: “Their semen is discharged with titillation of the parts, and with pleasure and an immodest desire for connection with men.”^[3] Clearly, an abundance of genital lubrication in any sex does not equate to gonorrhea. Galen made some mistakes, but he kept sexual health moving forward.

Conclusion

In summary, we know that in ancient history, in Egypt, Greece, Rome, Iran, and India, sexual activity was prevalent, prostitution was tolerated, physicians studied anatomy and treated the sick, genital ailments were embarrassing, and genital sores, tumors, warts, and urinary tract infections were well-recognized and treated in various ways.

Though it seems so obvious now, historians think that the connection between sex and sexually transmitted infections was tenuous at best. Because of the oft-times long incubation period between sexual activity and the development of symptoms, and the dominant theory of the four humors that persisted over a thousand years,[2] sexually transmitted infections were simply diseases just like all the others. In fact, STIs were for centuries identified as predominantly skin diseases and they were treated by dermatologists. An accurate description of neither gonorrhea nor syphilis has been confirmed by historical scholars and most believe that these two STIs developed later, during the Middle Ages – which is where we will pick up our Indelicate History of STIs, Part 3, in the near future.

1. ^{Morton RS. Sexual attitudes, preferences and infections in Ancient Egypt. Genitourin Med 1995;71:180-186.}
2. ^{Gruber F, Lipozenčić J, Kehler T. History of Venereal Diseases from Antiquity to the Renaissance. Acta Dermatovenerol Croat 2015;23(1):1-11.}
3. ^{Oriel JD. The Scars of Venus: A History of Venereology. London: Springer-Verlag 1994.}
4. ^{Isis. Sexuality and Modernity: The Pre-Modern European Concepts of Sexual Difference http://www.isis.aust.com/stephan/writings/sexuality/euro.htm.}

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