As of 2017, the leading causes of death for women are heart diseases, lung cancer, chronic lower respiratory diseases, and Alzheimer’s (Center for Disease Control and Prevention). However, public discourse surrounding women’s health and illness often focuses on other conditions, such as breast, ovarian, and cervical cancers, polycystic ovarian syndrome, premenstrual syndrome, and complications pertaining to childbirth, labor, and delivery (Ellingson and Buzzanell, Dean, McKinley, Hensley Owens). In the 1980s, cardiologist Nanette Wenger coined this phenomenon “bikini medicine,” or the “concentrat[ion] on the breasts and the reproductive organs, while essentially ignoring the rest of the woman” (qtd. in Gulati). Bikini medicine has, undoubtedly, helped to bring some of women’s bodies to the forefront of popular healthcare conversations and research. However, the focus on these limited body parts is still largely the norm, and this emphasis has continued to entrench disparities in healthcare by channeling a disproportionate share of resources, time, and attention into just a few select parts of women’s bodies.
One way that the logics of bikini medicine materialize is through pinkwashing. Pinkwashing is the leveraging of the nearly-ubiquitous pink ribbon to raise awareness about breast cancer, while undermining efforts to actually improve outcomes of this disease (Breast Cancer Action). The pink ribbon’s prevalence and visibility is nearly inescapable in the public sphere and medical industries, and as Bryna Siegel Finer notes, it has become “so rhetorically powerful that every woman [she] knows has been persuaded by it” (206). Further, Siegel Finer points out how the pink ribbon — and the fear of breast cancer that this icon perpetuates — is perhaps so rhetorically powerful that it obscures the attention to and conversations surrounding other illnesses that are, statistically, “much more likely to actually kill us” (206).
Now, however, pinkwashing is often used as a colloquial term to refer to the broader commodification and “beautification” of women’s health, packaging it to be something trendy, and popular. In this way, bikini medicine and pinkwashing go together: they direct scholarly and public attention only to certain body parts and illnesses, and then they capitalize on that visibility. In order for this cycle to continue, these two phenomena must share the same two central claims: first, and perhaps most obviously, that only some body parts matter. Secondly, that some bodily functions are more inherently “normal” than others, and that some places are therefore more “acceptable” for women to experience their illnesses.
To demonstrate how these logics materialize in women’s lived experiences with illness, I look “beyond the bikini” to two members of the “illness networking” site CrohnsForum, an open-access online community for people with intestinal bowel disease, or IBD. Women with IBD suffer a particular double-edged sword: providers are still likely to uphold gendered stereotypes of women as “weak,” “uninformed,” or “overly emotional” patients, and those outside institutional medical spheres often consider these conditions taboo. As many common symptoms of IBD — vomiting, diarrhea, bloating, and cramps — are often met with social stigmas surrounding “appropriateness,” “politeness,” and what it means to be “ladylike,” these patients often find themselves lacking both institutional and public space to process and respond to their illness and suffer decreased mental and physical health outcomes as a result. Here, I offer analyses of posts by two women, Abby and Sarah (pseudonyms), as they grapple with managing, treating, and responding to an illness that is simultaneously fraught with stigma and invisibility.
Abby: When Pinkwashing Doesn’t Include Your Symptoms
While bikini medicine and pinkwashing work together to put the highest premium on women’s breasts and reproductive systems, they simultaneously put relatively low value on other parts of women’s bodies, particularly if their functions threaten sexist expectations for cleanliness and beauty. At its core, pinkwashing still relies on gendered norms and stereotypes, and it is therefore understandable how conditions pertaining to the gastrointestinal (GI) system are noticeably absent from corporate efforts to make women’s illness more easily packaged for “cuteness” or “appropriateness.” Without publicly-oriented strategies geared toward decreasing stigma, women often find that social pressure to conceal their symptoms plays a major role in their perceived barriers to effective and patient-oriented care.
For example, Abby’s narrative indicates that she is primarily concerned not with what her symptoms indicate about her health, but how others may respond to her illness. She especially takes up concerns of her symptoms such as diarrhea and bloating becoming visible to others, where she anticipates that they will be met with stigma and judgement. However, she also ties these manifestations of illness to her own perceptions of her ability to perform her gender in acceptable ways. She writes, “One day I know I will crap my pants and I’m so young and a woman… this isn’t quite a feminine condition” (emphasis added). Narratives surrounding illness, gender, and permissibility have worked to rhetorically construct Abby’s conceptions of what counts as a “feminine condition,” and given that her symptoms are excluded from these conversations, she struggles with the idea that she can simultaneously be sick and acceptably feminine.
When detailing what symptoms are of primarily concern to her, she even feels the need to self-moderate in her post. For example, Abby writes, “insane BMs (very ‘loose’ to keep it clean),” though members of the CrohnsForum community actively discourage this type of censoring (emphasis added). This verbal self-monitoring highlights the pressure that Abby feels to sterilize both her physical performances and linguistic choices in order to minimize the risk of stigma and discrimination. The pressure to sanitize one’s experience with illness affects not just for a person’s mental and psychological health; rather, these external pressures and value systems also work as material and discursive barriers that women must navigate while deciding when and how to seek out and receive treatment.
Abby’s self-censorship in the name of femininity is not an isolated incident. Zipporah Arielle, a disability activist publishing under the username coffeespoonie, reflects on this pressure, too:
[Crohn’s disease] means I have symptoms that society considers gross, unfeminine, and irredeemably unattractive — I usually let people figure it out by having them google the name of my diagnosis, which tells them absolutely nothing about my particular situation, but at least usually does the trick and staves off any further questions.
While the pinkwashing of healthcare may have increased the probability that women are able to ask for a tampon or discuss performing a breast self-exam without judgment, this openness has clearly not extended to women discussing other activities pertaining to bodily functions and illness. If anything, pinkwashing has shored up the notions that Abby and Zipporah’s symptoms are, at their core, not part of women’s health, and therefore something deep, dark, and shameful — something to hide when possible, or distill and sanitize when there are no other options.
Sarah: When Bikini Medicine Fails To Meet Your Needs
As I’ve outlined, pinkwashing is no longer just about the pink ribbon icon, but the larger corporate movement that relies on gendered expectations to further a narrow medical agenda. This too emerges from the underlying logic of bikini medicine: that women are defined best by their sexual and reproductive organs, and that the most important interventions therefore must concern these parts of the bodies. As Sarah’s post demonstrates, the emphasis placed on these body parts often misdirects attention from more dire concerns, placing women in the uncomfortable position of needing to qualify why the rest of their body matters. She also demonstrates that the attention to these narrow body parts reinforce sexist expectations about the roles that women must take.
Sarah’s narrative focuses primarily on how she experiences these unequal value systems in the contexts of institutional medical spaces. Whereas Abby makes it clear that social expectations exert enormous force on her experiences of illness, Sarah also reflects on how healthcare providers rely on those same gendered assumptions that contribute to her feeling trapped in an inescapable loop of sickness and judgment. She writes, “I’m totally over Dr’s forgetting manners and asking if i’m really sick… Now, Dr’s look at me and ask.. are you sure you’re ok?..” (sic, emphases added). The pressure to perform one’s illness in a certain way clearly shapes this patient’s experiences with her providers: should she appear to be too level-headed, her illness would likely be negated, but had she responded too emotionally, her mental stability and clarity would be put up for debate. Since bikini medicine only grants some of women’s illnesses legitimacy, sexist — and as Sarah explains, inconsistent — expectations for how patients perform their illness reinforces unequal power dynamics between practitioners and patients.
In another op-ed piece that links pinkwashing to the ineffectiveness and inefficiency of institutional care for conditions that don’t affect our breasts (much like Sarah describes), Mary Elizabeth Williams summarizes this cycle by stating, “Perhaps it’s time to consider what this glut of pink says about our attitudes about the meritocracy of disease, and the ways in which we dispense compassion.” She notes that while it might be more “pleasant” to promote awareness for some already highly-visible and well-publicized conditions, we would be better healthcare activists if we provided “even a measure of the same generous, unconditional support we give to women with breast cancer for those living with less morally unambiguous conditions.” Linking moral failure to illness is a common rhetorical tactic, particularly for Black, Indigenous, and people of color, the working class, and LGBTQ+ folks, but Sarah’s narrative also draws complex links between morality, social norms, and her illness. In her post, she writes, “Divorced, and sick of being strong… Oops, forgot to have kids.. now it’s prob too late.” (emphases added). Here, Abby suggests that while her physical and emotional health is clearly of importance to her, her divorce and lack of children suggest some deeper layer of social — and perhaps moral — failure. Bikini medicine’s logic does not just stop at the disproportionate attention to sexual and reproductive organs, but to the functions that these body parts can perform. As Sarah’s example demonstrates, this exerts a powerful normalizing force on women to place social expectations for their romantic and familial relationships above the needs of their own medical care. For example, on the Crohn’s and Colitis Foundation’s FAQ page for women, seven of the eight questions pertain to “feminine body functions,” such as menstruation, intercourse, and pregnancy. The medical advice on this site channels women into performing limited sexist and heteronormative gender roles, as expectations to overcome painful sexual activity and become pregnant is often emphasized over patients’ desires and physical and emotional health. Taken with Sarah’s narrative, it is unsurprising that she ties up her illness with romance and motherhood, just as Abby does with beauty and cleanliness.
The arguments that I pose surrounding pinkwashing and bikini medicine are not to suggest that women with diseases that affect their breasts or reproductive systems do not face institutional or social discrimination. This is also not to suggest that health conditions need to subscribe to the gender binary, as transgender and non-binary individuals are particularly vulnerable to abuse and silencing within medical contexts. Future work may also take an explicitly intersectional lens to examine how pinkwashing and bikini medicine disproportionally affects BIPOC folks and the working class. However, I do want to expose how the covert logics that undergird bikini medicine and pinkwashing devalue women’s experiences with IBD, restrict their comfort in managing their illnesses in public spaces and the offices of medical professionals, and pass moral judgment on their choices surrounding their social roles and relationships.
I conclude by asking: What if we placed a higher premium on women’s autonomy and agency? What does it mean to challenge these gendered discourses? What does it look like to care for women fully? If Sarah and Abby’s narratives point to anything, it’s that bikini medicine only protects some parts of us. Pinkwashing doesn’t mean anti-cancer. It’s about time we look beyond the commodified, the sexual, and the “beautiful” to expand our efforts at healthcare activism.
Elena Kalodner-Martin is a PhD student at the University of Massachusetts Amherst, where she studies the rhetoric of health and medicine, technical communication, and digital technologies. Her current research focuses on the intersections of gender and healthcare, particularly for women with chronic illnesses. She is an instructor in the Professional Writing and Technical Communication certificate program and is also developing supplementary research materials for a course in narrative medicine.
Breast Cancer Action. “What is ‘Pinkwashing?’” Breast Cancer Action, https://bcaction.org/what-is-pinkwashing/. Accessed 11 June 2020.
Abby. “Serious anxiety due to your condition!?” CrohnsForum, https://crohnsforum.com/threads/serious-anxiet-due-to-your-condition.40518/. Accessed 2 June 2020.
Center for Disease Control and Prevention. “Leading Causes of Death in Females, United States.” CDC, https://www.cdc.gov/women/lcod/index.htm. Accessed 5 June 2020.
coffeespoonie. “Early Morning Thoughts on Desirability, Internalized Disablism, and Disease.” Medium, https://medium.com/@coffeespoonie/early-morning-thoughts-on-desirability-internalized-disablism-and-disease-a07864bc079d. Accessed 15 June 2020.
Crohn’s and Colitis Foundation. “Women with IBD.” Crohn’s and Colitis Foundation, https://site.crohnscolitisfoundation.org/resources/women-ibd-factsheet.html. Accessed 11 June 2020.
Ellingson, Laura L. and Patrice M. Buzzanell. “Listening to Women’s Narratives of Breast Cancer Treatment: A Feminist Approach to Patient Satisfaction with Physician-Patient Communication.” Health Communication, vol. 11, no. 2, 1999, pp. 153-183.
Dean, Marleah. “‘You have to be your own advocate’” Patient Self-Advocacy as a Coping Mechanism for Hereditary Breast and Ovarian Cancer Risk.” Women’s Health Advocacy: Rhetorical Ingenuity for the 21st Century, edited by Jamie White-Farnham, Bryna Siegel Finer, and Cathryn Molloy. Routledge, 2020, pp. 148-163.
Gulati, Martha. “Women and CV Disease: Beyond the Bikini.” American College of Cardiology, https://www.acc.org/latest-in-cardiology/articles/2017/05/15/15/women-and-cv-disease-beyond-the-bikini. Accessed 10 June 2020.
Hensley Owens, Kim “Writing My Body, Writing My Health: A Rhetorical Autoethnography.” Women’s Health Advocacy: Rhetorical Ingenuity for the 21st Century, edited by Jamie White-Farnham, Bryna Siegel Finer, and Cathryn Molloy. Routledge, 2020, pp. 14-25.
McKinley, Marissa. “Analyzing PCOS Discourses: Strategies for Unpacking Chronic Illness and Taking Action.” Women’s Health Advocacy: Rhetorical Ingenuity for the 21st Century, edited by Jamie White-Farnham, Bryna Siegel Finer, and Cathryn Molloy. Routledge, 2020, pp. 34-44.
Sarah. “Crohn’s and the daily struggle – my A-Z.” CrohnsForum, https://crohnsforum.com/threads/crohns-and-the-daily-struggle-my-a-z.78840/. Accessed 2 June 2020.
Siegel Finer, Bryna. “‘The Rhetorician [or Health and Medicine] as Agent of Social Change’: Activism for the Whole Woman’s Body.” Women’s Health Advocacy: Rhetorical Ingenuity for the 21st Century, edited by Jamie White-Farnham, Bryna Siegel Finer, and Cathryn Molloy. Routledge, 2020, pp. 204-213.
Williams, Mary Elizabeth. “The Smug Morality of Breast Cancer Month.” Salon, https://www.salon.com/2010/10/01/breast_cancer_month_overload/. Accessed 13 June 2020.
Image Source: Flickr