The Sociology of the Vaginal Examination JAMES M. HENSLIN MAE A.

BIGGS All of us depend on others for the successful completion of the roles we play. In many ways, this makes cooperation the essence of social life (with due apologies to my conflict-theorist friends). Without teamwork, performances fall apart, people become disillusioned, jobs don t get done-and, ultimately, society is threatened. Accordingly, much of our sociali!ation centers on learning to be good team players. "he work setting lends itself well to e#amining cooperati$e interaction and to the socially acceptable handling of differences-of %working arrangements & that defuse threats to fragile social patterns. 'or e#ample, instructors often accept from students e#cuses that they know do not match reality. 'or their part, students often accept what instructors teach, e$en though they pri$ately disagree with those interpretations. (onfrontation not only is unpleasant, and there fore preferable to a$oid, but also is a threat to the continuity o interaction. "hus both instructors and students generally allow on another enough leeway to )get on with business) (which some might say is education, while others-more cynical-might say is the earning a li$ing and the other a degree). *ne can gain much insight into the nature of society by trying to identify the implicit understandings that guide our interactions. In this selection, +enslin and ,iggs draw hea$ily on -offman s dramaturgical framework as they focus on the $aginal e#amination. .ote how much teamwork is re/uired to make the definition stick that nothing se#ual is occurring.

-0.01A2 ,0+A3I*1 I4 51*,206A"I( in American society. Americans in our society are sociali!ed at a $ery early age into society s dictates concerning the situations, circumstances, and purposes of allowable and unallowable genital e#posure. After an American female has been sociali!ed into rigorous norms concerning society s e#pectations in the co$ering and pri$acy of specified areas of her body, especially her $agina, e#posure of her pubic area becomes something that is e#tremely problematic for her. 0$en for a woman who has o$ercome this particular problem when it comes to se#ual relations and is no longer bothered by genital e#posure in the presence of her se#ual partner, the problem fre/uently recurs when she is e#pected to e#pose her $agina in a nonse#ual manner to a male. 4uch is the case with the $aginal e#amination. "he $aginal e#amination can become so threatening, in fact, that for many women it not only represents a threat to their feelings of modesty but also threatens their person and their feelings of who they are. ,ecause emotions are associated with the genital area through the learning of taboos, the $aginal e#amination becomes an interesting process7 it represents a structured interaction situation in which the )pri$ates) no longer remain pri$ate. 'rom a sociological point of $iew, what happens during such interaction8 4ince a (if not the) primary concern of the persons in$ol$ed is that all the interaction be defined as nonse#ual, with e$en the hint of se#uality being a$oided, what structural restraints on beha$ior operate8 +ow does the patient cooperate in maintaining this definition of nonse#uality8 In what ways are the roles of doctor, nurse, and patient

performed such that they conjointly contribute to the maintenance of this definition8 "his analysis is based on a sample of 9:,;;; to 9<,;;; $aginal e#aminations. "he female author ser$ed as an obstetrical nurse in hospital settings and as an office nurse for general practitioners for fourteen years, gi$ing us access to this area of human beha$ior which is ordinarily not sociologically accessible. ,ased on these obser$ations, we ha$e di$ided the interaction of the $aginal e#amination into fi$e major scenes. We shall now e#amine each of these bounded interactions. "he setting for the $aginal e#amination may be di$ided into two areas (see 'igure 9=.9). Although there are no physical boundaries employed to demarcate the two areas, highly differentiated interaction occurs in each. Area 9, where 4cenes I and 3 are played, includes that portion of the %office-e#amination) room which is furnished with a desk and three chairs. 6ea :, where 4cenes Il, III, and I3 take place, is furnished with an e#amination table, a swi$el stool, a gooseneck lamp, a table for instruments, and a sink with a mirror abo$e it. Scene 1: The Personalized Stage: The Patient as Person "he interaction flow of 4cene I is as follows> (a) the doctor enters the )office-e#amination) room7 (b) greets the patient7 (c) sits down7 (d) asks the patient why she is there7 (e) /uestions her on specifics7 (f) decides on a course of action, specifically whether a pel$ic e#amination is needed or not7 (g) if he thinks a pel$ic is needed, he signals the nurse on the intercom and says, )I want a pel$ic in room (?))7 (h) he gets up, and (i) lea$es the room. @uring this scene the patient is treated as a full person, that is, courtesies of middle-class $erbal e#change are followed, and, in addition to gathering medical information, if the doctor knows the patient well he may intersperse his medical /uestions with /uestions about her personal life. "he following interaction that occurred during 4cene I demonstrates the doctorAs treatment of his patient as a full person> @octor (upon entering the room)> +ello, Boyce, I hear you re going to 4outhern Illinois Cni$ersity. 5atient> Des, I am. I $e been accepted, and I ha$e to ha$e my health record completed. "he doctor then seated himself at his desk and began filling out the health record that the patient ga$e him. +e interspersed his /uestions concerning the record form with /uestions about the patient s teaching, about the area of study she was pursuing, about her children, their health and their schooling. +e then said, )Well, we ha$e to do this right. We ll do a pel$ic on you.) +e then announced $ia the intercom, )I want to do a pel$ic on Boyce in room 9.) At that point he left the room. "his interaction se/uence is typical of the interaction that occurs in 4cene I between a doctor and a patient he knows well. When the doctor does not know the patient well, he does not include his patient s name, either her first or last name, in his announcement to the nurse that she should come into the room. In such a case, he simply says, )I want to do pel$ic in room 9,) or, )5el$ic in room 9.) "he doctor then lea$es the room, marking the end of the scene.

Scene II: The Depersonalized Stage: Transition from Person to Pelvic When at the close of 4cene I the doctor says, )5el$ic in room (?),) he is effect announcing the transition of the person to a pel$ic. It is a sort of ad$ance announcement, howe$er, of a coming e$ent, because the transition has not yet been effected. "he doctor s signal for the nurse to come in is, fact, a signal that the nurse should now help with the transition of the patient from a person to a pel$ic. Additionally, it also ser$es as an announcement to the patient that she is about to undergo this metamorphosis. "he interaction flow which accomplishes the transition from person to pel$ic is as follows> Cpon entering the room, the nurse, without preliminaries, tells the patient, )"he doctor wants to do a $aginal e#amination on you. Will you please remo$e your panties8) While the patient is undressing, the nurse prepares the props, positioning the stirrups of the e#amination table, arranging the glo$e, the lubricant, and the speculum (the instrument such, when inserted into the $agina, allows $isual e#amination of the $aginal tract). 4he then remo$es the drape sheet from a drawer and directs the patient onto the table, co$ers the patient with the drape sheet, assists her in placing her feet into the stirrups, and positions her hips, putting her into the lithotomy position (lying on her back with knees fle#ed and out). ME !I!" #$ T%E D#&T#'(S )SE!&E

"he doctor s e#iting from this scene means that the patient will be undressing in his absence. "his is not accidental. In many cases, it is true, the doctor lea$es because another patient is waiting, but e$en when there are no waiting patients, the doctors always e#ists at the end of 4cene I. +is lea$ing means that he will not witness the patient undressing, thereby successfully remo$ing any suggestion whatsoe$er that a striptease is being performed7 'rom the patient s point of $iew, the problem of undressing is lessened7 since a strange male is not present. "hus se#uality is remo$ed from the undressing room, and when the doctor returns, only a particulari!ed portion of her body will be e#posed for the ensuing interaction. As we shall see, the doctor is no longer dealing with a person, but he is, rather, confronted by a )pel$ic.) T%E P'#)*EM #$ +!DE'&*#T%I!" Cndressing and nudity are problematic for the patient since she has been sociali!ed into not undressing before strangers.9 Almost without e#ception, when the woman undresses in 4cene II, she turns away from the nurse and the door, e$en though the door is closed. 4he remo$es only her panties in the typical case, but a small number of patients also remo$e their shoes. After the patient has remo$ed her panties andEor girdle, the problem for her is what to do with them. 5anties and girdles do not ha$e the same meaning as other items of clothing, such as a sweater, that can be casually draped around the body or strewn on furniture. (lothing is considered to be an e#tension of the self (-ross and 4tone 9=F<), and in some cases the clothing comes to represent the particular part of the body that it co$ers. In this case, this means that panties represent to women their )pri$ate area.) (omments made by patients that illustrate the problematics of panty e#posure include> )"he doctor doesn t want to look at these,) )I want to get rid of these before he comes in,) and, )I don t want the doctor to see these old things.)

4ome patients seem to be at a loss in sol$ing this problem and turn to the nurse for guidance, asking her directly what they should do with their underclothing. 6ost patients, howe$er, do not ask for directions, but hide their panties in some way. "he fa$orite hiding or co$ering seems to be in or under the purse.: *ther women put their panties in the pocket of their coat or in the folds of a coat or sweater, some co$er them with a maga!ine, and some co$er them with their own body on the e#amination table. It is rare that a woman lea$es her panties e#posed somewhere in the room. T%E D' PE S%EET Another problematic area in the $aginal e#amination is what being undressed can signify. @isrobing for others fre/uently indicates preparation for se#ual relations. 4ince se#uality is the $ery thing that this scene is oriented toward remo$ing, a mechanism is put into effect to eliminate se#uality-the drape sheet. After the patient is seated on the table, the nurse places a drape sheet from just below her breasts (she still has her blouse on) to o$er her legs. Although the patient is draped by the sheet, when she is positioned on the table with her legs in the stirrups, her pubic region is e#posed. Csually it is not necessary for the doctor e$en to raise a fold in the sheet in order to e#amine her genitals. 4ince the drape sheet does not co$er the genital area, but, rather, lea$es it e#posed, what is its purpose8 "he drape sheet depersonali!es the patient. It sets the pubic area apart, letting the doctor $iew the pubic area in isolation, separating the pubic area from the person. "he pubic area or female genitalia becomes an object isolated from the rest of the body. With the drape sheet, the doctor, in his position on the low stool, does not e$en see the patient s head. +e no longer sees or need deal with person, just the e#posed genitalia marked off by the drape sheet. Det, from the patient s point of $iew in her supine position, her genitals are co$eredG When she looks down at her body, she does not see e#posed genitalia. "he drape sheet effecti$ely hides her pubic area from herself while e#posing it to the doctor. T%I"% )E% VI#' American girls are gi$en early and continued sociali!ation in )limb discipline,) being taught at a $ery early age to keep their legs close together while they are sitting or while they are retrie$ing articles from the ground. "hey recei$e such cautions from their mothers as, )Heep your dress down,) 5ut your legs together,) and ).ice girls don t let their panties show.I 0$idence of sociali!ation into )acceptable) thigh beha$ior shows up in the $aginal e#amination while the women are positioned on the e#amination table and waiting for the doctor to arri$e. "hey do not let their thighs fall outwards in a rela#ed position, but they try to hold their upper or midthighs together until the doctor arri$es. "hey do this e$en in cases where it is $ery difficult for them to do so, such as when the patient is in her late months of pregnancy. Although the scene has been played such that dese#uali!ation is taking place, and although the patient is being depersonali!ed such that when the doctor returns he primarily has a pel$ic to deal with and not a person, at the point in the interaction se/uence the patient is still holding onto her se#uality and )personality) as demonstrated by her )proper) thigh beha$ior. *nly later, when the doctor reenters the scene will she fully consent to the dese#uali!ed and depersonali!ed role and let her thighs fall outwards. After the props are ready and the patient is positioned, the nurse announces to the doctor $ia intercom that the stage is set for the third scene, saying )We re ready in room (?).)

Scene III: The Depersonalized Stage: The Person as Pelvic $ &E,T#,P+)I& I!TE' &TI#! "he interaction to this point, as well as the use of props, has been structured to project a singular definition of the situation- that of legitimate doctor-patient interaction and, specifically, the nonse#ual e#amination of a womanAs $aginal region by a male. In support of this definition, a team performance is gi$en in this scene (-offman 9=J=> 9;<). Although the pre$ious interaction has been part of an ongoing team performance, it has been se/uential, leading to the peak of the performance, the $aginal e#amination itself. At this time, the team goes into a tandem cooperati$e act, utili!ing its resources to maintain and continue the legitimation of the e#amination, and by its combined performance reinforcing the act of each team member. "he doctor, while standing, places a plastic glo$e on his right hand, again symboli!ing the depersonali!ed nature of the action- by using the glo$e he is saying that he will not himself be actually touching the %pri$ate areaI since the glo$e will ser$e as an insulator. It is at this point that he directs related /uestions to the patient regarding such things as her bowels or bladder. "hen, while he is still in this standing position, the nurse in synchroni!ation acti$ely joins the performance by s/uee!ing a lubricant onto his outstretched glo$ed fingers, and the patientAs $agina while e#ternally palpating (feeling) the uterus. +e then withdraws his fingers from the $agina, seats himself on the stool, inserts a speculum, and while the nurse positions the gooseneck lamp behind him, he $isually e#amines the cer$i#. 5rior to this third scene, the interaction has been dyadic only, consisting of nurse and patient in 4cene II and doctor and patient in 4cene I. In this scene, howe$er, the interaction becomes triadic in the sense that the doctor, nurse, and patient are simultaneously in$ol$ed on the performance. "he term triadic, howe$er, does not e$en come close to accurately describing the role-playing of this scene. 4ince the patient has essentially undergone a metamorphosis from a person to an object- ha$ing been objectified or depersonali!ed, the focus of the interaction is now on a specific part of her body. "he positioning of her legs and the use of the drape sheet ha$e effecti$ely made her pubic region as the focus of interaction but also blocking out the %talklinesI between the doctor and patient, physically obstructing their e#change of glances (-offman 9=FK> 9F9). Interaction between the doctor and the patient is no longer %face-toface,I being perhaps now more accurately described as %face-to-pubicI interaction. )'E STS S !#!SE-+ * #).E&TS

5rojecting and maintaining the definition of nonse#uality in the $aginal e#amination applies also to other parts of the body that are attributed to ha$e se#ual meaning in our culture, specifically the breasts. When the breasts are to be e#amined in conjunction with a $aginal e#amination, a rather interesting ritual is regularly employed on order to maintain the projected definition of nonse#uality. "his ritual tries to objectify the breasts by isolating them from the rest of the body, permitting the doctor to see the breasts apart from the person. In this ritual, after the patient has remo$ed her upper clothing, a towel is placed across her breasts, and the drape sheet is then placed on top of the towel. 4ince the towel in and of itself more than sufficiently co$ers the breasts, we can only conclude that the purpose of the drape sheet is to further the definition of nonse#ual

interaction. Additionally, the doctor first remo$es the sheet from the breasts and e#poses the towel. +e then lifts the towel from one breast, makes his e#amination, and replaces the towel o$er the breast. +e then e#amines the other breast in e#actly the same way, again replacing the towel after the e#amination. T%E !+'SE S &% PE'#!E

"hat interaction in 4cene III is triadic is not accidental, nor is it instrumentally necessary. It is, rather, purposely designed, being another means of dese#uali!ing the $aginal e#amination. Instrumentally, the nurse functions merely to lubricate the doctorAs fingers and to hand him the speculum. "hese acts ob$iously could be handled without the nurseAs presence. It becomes apparent, then, that the nurse plays an entirely different role in this scene, that of chaperone, the person assigned to be present in a malefemale role relationship to gi$e assurance to interested persons that no untoward se#ual acts take place. Although the patient has been depersonali!ed, or at least this is the definition that has been offered throughout the performance and is the definition that the team has been attempting to maintain, the possibility e#ists that the $aginal e#amination can erupt into a se#ual scene. ,ecause of this possibility (or the possible imputation or accusation of se#ual beha$ior ha$ing taken place), the nurse is always present.K "hus e$en the possibility of se#ual content in the $aginal e#amination is ordinarily denied by all the role-players. It would appear that such denial ser$es as a mechanism to a$oid apprehension and suspicion concerning the moti$ations and beha$iors of the role-players, allowing the performance to be initiated and continue smoothly to its logical conclusion.< T%E P TIE!T S !#!PE'S#! TE M MEM)E'

With this definition of objectification and dese#uali!ation, the patient represents a $agina disassociated from a person. 4he has been dramaturgically transformed for the duration of this scene into a nonperson (-offmaan 9=J=>9J:). "his means that while he is seated and performing the $aginal e#amination, the doctor need not interact with the patient as a person, being, for e#ample, constrained neither to carry on a con$ersation nor to maintain eye contact with her. 'urthermore, this means that he is now permitted to carry on a )side con$ersation) with the person with whom he does maintain eye contact, his nurse. 'or e#ample, during one e#amination the doctor looked up at the nurse and said> )+ank and I really caught some goodsi!ed fish while we were on $acation. +e really enjoyed himself.) +e then looked at his )work) and announced, )(er$i# looks good7 no inflammatione$erything appears fine down here.) 4uch ignoring of the presence of a third person would ordinarily constitute a breach of eti/uette for middleclass interactions, but in this case there really isn't a third person present. "he patient has been )depersonali!ed,) and, correspondingly, the rules of con$ersation change, and no breach of eti/uette has taken place.J "he patient, although defined as an object, is actually the third member of the team in the $aginal e#amination. +er role is to )play the role of being an object)7 that is, she contributes her part to the flow of the interaction by acting as an object and not as a person. 4he contributes to the definition of herself as an object through studied alienation from the interaction, demonstrating what is known as dramaturgical discipline (-offman 9=J=>:9F-9L). 4he studiously ga!es at the ceiling or wall, only occasionally allowing herself the lu#ury (or is it the danger8) of fleeting eye contact with the nurse. 0ye contact with the doctor is, of course, pre$ented by the position of her legs and the drape sheet.

After the doctor tells the patient to get dressed, he lea$es the room, and the fourth scene is ready to unfold. Scene IV: The 'epersonalizing Stage: The Transition from Pelvic to Person @uring this stage of the interaction the patient undergoes a demetamorphosis, dramaturgically changing from $aginal object to person. Immediately after the doctor lea$es, the nurse assists the patient into a sitting position, and she gets off the table. "he nurse then asks the patient if she would like to use a towel to cleanse her genital area, and about L; percent of the patients accepts the offer. In this scene, it is not uncommon for patients to make some statement concerning their relief that the e#amination is o$er. 4tatements such as )IAm glad that s o$er with) seem to indicate the patient s o$ert recognition of the changing scene, to acknowledge that she is now entering a different scene in the $aginal drama. @uring this repersonali!ing stage the patient is concerned with regrooming and recostuming. 5atients fre/uently ask if they look all right, and the common /uestion. )6y dress isn t too wrinkled, is it8) appears to indicate the patient s awareness of and desire to be ready for the resumption of roles other than $aginal object. +er dress isn t too wrinkled for what8 It must be that she is asking whether it is too wrinkled (9) for her resumption of the role of (patient as) person and (:) her resumption of nonpatient roles. 6odesty continues to operate during this scene, and it is interesting that patients who ha$e just had their genital area thoroughly e#amined both $isually and tactually by the doctor are concerned that this same man will see their underclothing. ()+e won t be in before I get my underwear on, will he8)) "hey are now desiring and preparing for the return to the feminine role. "hey apparently fear that the doctor will reenter the room as they literally ha$e one foot in and one foot out of their panties. "hey want to ha$e their personal front reestablished to their own satisfaction before the return of this male and the onset of the ne#t scene. 'or this, they stri$e for the poise and composure that they deem fitting the person role for which they are now preparing, fre/uently using either their own pocket-mirror or the mirror abo$e the sink to check their personal front. @uring this transitional role patients indicate by their comments to the nurse that they are to again be treated as persons. While they are dressing, they fre/uently speak about their medical problems, their aches and pains, their fight against gaining weight, or feelings about their pregnancy. In such ways they are reasserting the self and are indicating that they are again entering )personhood.) "he patient who best illustrates awareness that she had undergone a process of repersonali!ation is the woman who, after putting on her panties, aid, )"hereG Bust like new again.) 4he had indeed mo$ed out of her necessary but uncomfortable role as object, and her appearance or personal front once again matched her self-concept. After the patient has recostumed and regroomed, the nurse directs the patient to the chair alongside the doctor s desk, and she then announces $ia intercom to the doctor, )"he patient is dressed,) or, )"he patient is waiting.) It is significant that at this point the woman is referred to as %patient) in the announcement to the doctor and not as )pel$ic) as she was at the end of second scene. 4ometimes the patient is also referred to by name in this announcement. "he patient has completed her demetamorphosis at this point, and the nurse, by the way she refers to her, is officially acknowledging the transition. "he nurse then lea$es the room, and her interaction with the patient ceases.

Scene V: The 'epersonalized Stage: The Patient as Person #nce More When the doctor makes his third entrance, the patient has again resumed the role of person and is interacted with on this basis. 4he is both spoken to and recei$es replies from the doctor, with her whole personal front being $isible in the interaction. @uring this fifth scene the doctor informs the patient of the results of her e#amination, he prescribes necessary medications, and, where$er indicated, he suggests further care. +e also tells the patient whether or not she need see him again. "he significance of the interaction of 4cene 3 for us is that the patient is again allowed to interact as a person within the role of patient. "he doctor allows room for /uestions that the patient might ha$e about the results of the e#amination, and he also gi$es her the opportunity to ask about other medical problems that she might be e#periencing. Interaction between the doctor and patient terminates as the doctor gets up from his chair and mo$es toward the door. &oncl/sion: Desex/alization of the Sacred In concluding this analysis, we shall briefly indicate that conceptuali!ing the $agina as a sacred object yields a perspecti$e that appears to be of $alue in analy!ing the $aginal e#amination. 4acred objects are surrounded by rules protecting the object from being profaned, rules go$erning who may approach the )sacred,) under what circumstances it may be approached7 and what may and may not be done during such an approach (@urkheim 9=FJ>J9-J=). If these rules are followed, the )sacred) will lose none of its )sacredness,) but if they are $iolated, there is danger of the sacred being profaned. In conceptuali!ing the $agina in this way, we find, for e#ample, that who may and who may not approach the $agina is highly circumscribed, with the primary person so allowed being one who is ritually related to the possessor of the $agina, the husband. Apart from the husband (with contemporary changes duly noted),F e#cept in a medical setting and by the actors about whom we are speaking, no one else may approach the $agina other than the self and still ha$e it retain its sacred character.M ,ecause of this, the medical profession has taken great pains to establish a routine and ritual that will ensure the continued sacredness of the $aginas of its female patients, one that will a$oid e$en the imputation of taboo $iolation. Accordingly, as we ha$e herein analy!ed, this ritual of the $aginal e#amination allows the doctor to approach the sacred without profaning it or $iolating taboos by dramaturgically defining the $agina as just another organ of the body, dissociating the $agina from the person, while dese#uali!ing the person into a cooperati$e object.

Notes

With a society that is as clothing conscious and bodily conscious as is ours, undressing and nudity are probably problematic for almost e$eryone in our society from a $ery early age. It is, howe$er, probably more problematic for females than for males since males ordinarily e#perience structured situations in which they undress and are nude before others, such as showering after high school physical education classes, while females in the same situation are afforded a greater degree of pri$acy with, for e#ample, pri$ate shower stalls in place of the mass showers of the males. Bim +ayes has gi$en us a corroborating e#ample. In the high school of <,;;; students that he attended in ,rooklyn swimming classes were segregated by se#. 6ale students swam nude in their physical education classes but female students wore one-piece black bathing suits pro$ided by the school. *ne can also think of the fre/uently traumatic, but re/uired, en masse nudity e#periences of males in military induction centers7 such e#periences are not forced upon our female population. : 'rom a psychiatric orientation this association of the panties with the purse is fascinating, gi$en the 'reudian interpretation that the purse signifies the female genitalia. In some e#amination rooms, the problem of where to put the undergarments is sol$ed by the pro$ision of a special drawer for them located beneath the e#amination table. K It is interesting to note that e$en the corpse of a female is defined as being in need of such chaperonage. 0r$ing -offman, on reading this paper in manuscript form, commented that hospital eti/uette dictates that )when a male attendant mo$es a female stiff from the room to the morgue he be accompanied by a female nurse.) < (ompare what -offman (9=J=> 9;<) has to say about secrets shared by team members. 1emember that the patient in this interaction is not simply a member of the audience. 4he is a team member, being also $itally interested in projecting and maintaining the definition of nonse#uality. Another reader of this paper, who wishes to remain anonymous, reports that during one of her pregnancies she had a handsome, young, and unmarried +ungarian doctor and that during $aginal e#aminations with him she would )concentrate on the instruments being used and the uncomfortableness of the situation) so as not to become se#ually aroused. J In this situation a patient is )playing the role) of an object but she is still able to hear $erbal e#change, and she could enter the interaction if she so desired. As such, side comments between doctor and nurse must be limited. In certain other doctor-patient situations, howe$er, the patient completely lea$es the )person role,) such as when the patient is anestheti!ed, which allows much freer banter. In deli$ery rooms of hospitals, for e#ample, it is not uncommon for the obstetrician to comment while stitching the episiotomy, )4he s like a new bride now,I or when putting in the final stitches, to say, )"his is for the o9d man.) Additionally, while medical students are stitching their first episiotomy, instructing doctors ha$e been known to say, )It s not tight enough. 5ut one more in for the husband 6 (onsensual approaches by boyfriends certainly run less risk of $iolating the sacred than at earlier periods in our history, but this depends a good deal on religion, education, age, and social class membership. M It is perhaps for this reason that prostitutes ordinarily lack> "hey ha$e profaned the sacred. And in doing so, not only ha$e they failed to limit access to culturally prescribed indi$iduals, but they ha$e added further $iolation by allowing $aginal access on a pecuniary basis. "hey ha$e, in effect, sold the sacred.

'eferences @urkheim 0mile (9=FJ). The Ele entary !or of the "eli#io$s Life. .ew Dork> "he 'ree 5ress (9=9J copyright by -eorge Allen N Cnwin 2td.). -offman, 0r$ing (9=J=). The %resentation of Self in E&eryday Life. -arden (ity, .D> @oubleday, Anchor ,ooks. -offman, 0r$ing (9=FK). Beha&ior in %$'lic %laces( Notes on the Social )r#ani*ation of Gatherin#s. .ew Dork> "he 'ree 5ress. -ross, 0dward, and -regory 4tone (9=F<). )0mbarrassment and the Analysis of 1ole 1e/uirements,I A erican Jo$rnal of Sociolo#y +,>9-9J