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The outbreaks of sexually transmitted infections in World War II brought interest in sex education to the public and the government. During the late 1930s and early 1940s, military maneuvers increased worldwide and sexual hygiene and conduct became major problems for the troops. Soldiers and sailors on assignment overseas were often lonely, had time to spare, got homesick, or were just looking for female companionship. This resulted in many men having multiple sex partners, and as a result, became a major health concern. During the Great War, venereal diseases (V.D.) had caused the United States Army to lose 18,000 servicemen per day. Although by 1944, this number had been reduced 30-fold, there were still around 606 servicemen incapacitated daily. This drop in numbers was partly because of the Army's effort to raise awareness about the dangers faced by servicemen through poor sexual hygiene, and also because of the important developments in medicine. In late 1943, a case of gonorrhea required a hospital treatment of 30 days, and curing syphilis remained a 6-month ordeal. By mid-1944, the average case of gonorrhea was reduced to 5 days, and in many cases the patient remained on duty while being treated. [1]
Soldiers and sailors were taught to either abstain from sex or commit to a long-term mutually monogamous relationship with a partner who had tested negative for venereal disease. However, latex condoms were encouraged for every sexual encounter. [1]
To raise awareness about practicing safe sex amongst its recruits, the U.S. Government produced a series of posters which were displayed in Army barracks, hospitals, and railway stations. Many of the posters were straightforward like the awareness posters of today. [1] The Selective Service discovered that almost fifteen percent of those who were eligible for the draft were already infected with a venereal disease, sparking an intense anti-venereal disease campaign across America. Red-light districts were shut down, and American cities sought new laws which would criminalize prostitution to protect young men from contracting a venereal infection. [1]
The U.S. Government produced a number of pamphlets which were issued to troops educating them about the importance of good sexual health. One of these pamphlets was "Sex Hygiene and Venereal Disease", printed August 1, 1940 by the U.S. Government Printing Office. There were also 1942 and 1943 editions. The pamphlet was to be furnished to each recruit upon enlistment. The booklet not only offered information to soldiers about avoiding V.D., but also what to do if they became infected. The pamphlet provided sufficient information about various diseases to allow troops to diagnose diseases and infections without visiting the Pro-Station. [2] The following is the summary which is offered by the pamphlet:
Many commanding officers told their men "just because you have the desire is no reason why you must give in to it. Sex relations in the military should be kept for marriage." The Army and Navy wanted to make a dramatic statement to scare lower ranking personnel by saying: "Between people who aren't married they often lead to shame, sorrow and diseases. The public knows this so well that laws forbid sex relations between persons not married to each other. Good morals limit these sex relations to marriage".
By 1941, many of the sex education materials had been created by the Public Health Service. Hollywood produced motion picture films that showed men exactly how to play safe and what to do if they caught syphilis or gonorrhea. [3] Later on these films were made available for wider distribution by the nation's various state and local health departments. [4]
In the 1940s, personnel were taught that a wet dream is when the sex gland fills up with sperm and overflows while a man is asleep. This may happen several times a month or only once or twice in several months. Many medical officers taught their personnel that a wet dream is normal for men and that they needed to take extra precautions against doctors that may try to mislead them into buying their fake cures.[ citation needed ]
During World War II, masturbation was defined as having the same effect on the body as a wet dream. "Although a childish habit, it does no real harm and does not lead to insanity. If you have this unfortunate habit, try to control it as a matter of pride." [2]
In World War II, venereal disease was a serious problem for the US Army and Navy. In some hospitals one out of eight men had contracted some form of venereal disease. Two of the worst venereal diseases known to the Medical Department during the Second World War were gonorrhea and syphilis. Consequently the majority of treatment and awareness programs had great emphasis on these two infections in particular. [1]
Syphilis is a sexually transmitted infection (STI) that can cause long-term complications and/or death if not treated correctly. Symptoms in adults are divided into stages. These stages are primary, secondary, latent, and late syphilis. Syphilis has been called "the great imitator" because it has so many possible symptoms, many of which look like symptoms from other diseases. The painless syphilis sore that the soldier or sailor would get after they were first infected can be confused for an ingrown hair, zipper cut, or other seemingly harmless bump. The non-itchy body rash that develops during the second stage of syphilis can show up on the palms of the hands and soles of the feet, all over the body, or in just a few places. Men can be infected with syphilis and have very mild symptoms or none at all. [5]
Also called the "clap" or "drip", gonorrhea is a contagious infection transmitted most often through sexual contact with an infected person. It can also be spread by contact with infected bodily fluids, so both men and women are susceptible. The infection spreads most often among people who have many sex partners. [6]
During the war, medics were generally supplied with prophylactic kits in bulk, designed to allow a man to perform treatment on himself if he feared he had sex with an infected woman. The individual packet contained a tube containing 5 grams of ointment (30% calomel + 15% sulfathiazole), a direction sheet explaining how to apply the ointment, a soap impregnated cloth and cleansing tissue. Sometimes the men were issued condoms (usually three to a pack) and sometimes they were given Sulfonamide (sulfa drugs) or other pills to carry "just in case". [2]
The U.S. Military highly encouraged the men to use condoms during sexual intercourse, concerned that servicemen would bring home diseases and infect their wives. Government training films urged soldiers, "Don't forget - put it on before you put it in."[ citation needed ]
The military struggled greatly with determining the true rates of venereal disease among the troops. According to the U.S. Army Medical Department's Office of Medical History, many soldiers already had V.D. before enlisting, but were counted as a new infection when they were treated by medical personnel, increasing the officially recorded rate of V.D. Additionally, some soldiers were transferred between hospitals during treatment, but were counted as a new infection when they arrived at the new hospital, further increasing the V.D. rate. The V.D. rate was artificially lowered by medical staff who treated patients without recording it. This was done mostly at the request of the troops, who feared punishment for contracting V.D. Throughout the war, officers had a noticeably lower recorded rate of V.D. The Army believes that this was because officers were able to get medical treatment from Army medical personnel, and then pressure them into not recording the incident.
Despite these issues, the Army concluded that the lowest rates of V.D. occurred in 1943, then rose throughout 1944 and 1945, and again increased markedly after the cessation of hostilities. Despite the raise in V.D. throughout the war, personnel noneffectiveness due to V.D. decreased, likely due to better treatment.
World War II also saw the creation of women's military corps. For the first time, women were able to serve their country, though not in a combat capacity, without serving as a nurse or laundress. In the Women's Army Corps, women were enlisted and commissioned as soldiers and officers in much the same way that the Army enlisted and commissioned men. Women serving in the Armed Forces, however, were absent from venereal disease poster artwork during the World War II era. [7]
The first American Forces stationed in Northern Ireland (USANIF) and in the British Isles (USAFBI) received special attention from the Medical Department. The units were directed, in cooperation with local authorities, to establish the first off-base Prophylactic Stations and trace the contacts of servicemen who became infected. American units were warned to keep everything as tactful as possible, and to use general terms such as U.S. Army Aid Station, instead of Prophylactic Station. Despite the measures taken, V.D. spread among the troops, and even with rapid and effective treatment, including the use of sulfa drugs and penicillin, the cost to the Army was heavy due to lost time from duty, diversion of medical resources, and political and social tensions between American Forces and their British hosts.[ citation needed ]
This also occurred in France, after the liberation of Paris, and to some extent in Germany, although this country was by then militarily defeated and occupied. V.D. control officers were appointed and special recreation programs were introduced in close cooperation with the Red Cross and Special Services. Sexual education was emphasized and line officers, surgeons, and chaplains gave lectures.[ citation needed ]
In 1940, the military, the Public Health Service, and the American Social Hygiene Association, a private organization, agreed to cooperate in creating a plan "to defend the armed and industrial forces from venereal disease". [4] The May Act, which was passed in 1941, enables the Justice department to override local authorities and directly police areas that presented a threat to the safety of either military or industrial workers. [8] The Lanham Act, which was also passed in 1941, specifically provided the funds for hospitals where carriers of venereal disease could be quarantined until they had been cured. [4] The Comstock laws effectively made any form of contraception illegal in the United States, punishable as a misdemeanor with a six-month minimum prison sentence. [9] Titled the Eight – Point Agreement, this plan called for an expansion of the service's existing campaign to control venereal diseases. This gave the Army, Navy, Public Health Service, and ASHA developed and implemented aggressive measures to track the spread of venereal disease, to encourage the infected to seek medical care, to provide treatment to those who were infected, to repress prostitution, and finally, to promote sex education to arrest the further spread of disease. [10]
During World War II, as a product of psychiatry's increasing authority, the military chose to exclude homosexuals because of them being regarded as having a mental illness and because they believed homosexuals would hurt the productivity of the armed forces. The military used a screening process through military psychiatrists in determining if an individual was homosexual or not. Some psychiatrists did not enforce their screening and many soldiers lied to psychiatrists about their homosexuality so many were thus able to enroll into the armed forces regardless. Homosexuality was a crime according to the military and was punishable by prison. Because military prisons already held more than capacity, a new discharge system was used instead.
The formation of the Women's Army Corps provided a place for lesbian women within an otherwise wholly male institution. Rumors of difficult enrollment screenings for gay men deterred very few lesbians. Because of women's marginal status in the military before World War II, neither the Army nor the Navy had developed policies or procedures concerning lesbian enrollment in the armed services [11] (p. 28). Even on the home front, criminal law generally ignored lesbians and women were rarely prosecuted in court for engaging in sex acts with other women. At the onset of the war, psychiatrists and military officers reflected this history of invisibility and issued no policies or procedures for screening out lesbians [11] (p. 28). The pressure to meet unfilled personnel quotas was also a significant force in keeping recruiting officers and examiners from prying into the sexual lives of women volunteers [11] (p. 29). During entrance exams, female masculinity, unlike male effeminacy, was not considered to be a disqualifying defect, reflecting the military's need for women who could perform traditional male jobs. [11]
The Women's Army Corps represented a pivotal turn in cultural understandings around gender and sexuality. As the culture of the 1940s grew increasingly anxious about women's sexuality as a result of the shift in public or private spheres, and homosexuality in particular, the formation of the WAC sparked a storm of public speculation and concern of the potential breakdown of heterosexual norms and sexual morality. [12] : 68 Historically, women had been most visibly associated with the military as prostitutes. The general public expressed fear that, in forming the WAC, the military was trying to create an organized coalition of prostitutes to service male GIs. [12] : 66 Print media of the World War II era supported a dual effort to maintain a sense of "normalcy" through prescriptions of control and containment of women's sexuality, within and outside of the military, while simultaneously "normalizing" the drafting of women into the armed services. [13] The media both responded to and reinforced emergent cultural and political perceptions of a threat to the existing social structure. The response of Women's Army Corps Director Colonel Oveta Culp Hobby was to challenge this by characterizing female soldiers as chaste and asexual [12] (p. 66). Like advertising and other media elements, military propaganda emphasized traditional female qualities and roles. For example, a magazine article featuring the WAC declared, "You'll like this girl. She does a man's work...servicing airplanes, but she hasn't lost any of her feminine sweetness or charm" [3] (p. 17).
In segregated America, African Americans disproportionately lived in poverty. Compared with whites, the majority of African American military personnel had limited to no access to education opportunities, good wages, or health care, all factors that were crucial in protecting Americans from venereal disease and ensuring treatment for the infected. By the 1940s these problems had created a situation in which "sexually transmitted diseases were nationally known as special problems of the black people". [14] As America continued to be segregated even though African, Asian, and Native American soldiers fought for democracy abroad, federal funds were desperately needed simply to ensure that sex education programs could reach those who needed them. Both immediately before and during the war, these federal funds transformed the battle against sexual ignorance and the problems caused by this ignorance throughout the United States, but especially in the South by ensuring that all races and classes received some form of sex education. [14]
In the United States, World War II-era venereal disease posters depicting women were created for an overwhelmingly male, military audience. These posters warned men in the Armed Forces away from civilian women, depicting women as the primary carriers and spreaders of venereal diseases. These sentiments were mirrored in the civilian populations as young civilian women were criminalized for engaging in sexual activities. [7] Worse yet this view did little to protect women who engaged in extramarital intercourse. But because many of these women worked in essential military industries, this approach also threatened the morale of the war effort. [4]
Syphilis is a sexually transmitted infection caused by the bacterium Treponema pallidum subspecies pallidum. The signs and symptoms of syphilis vary depending in which of the four stages it presents. The primary stage classically presents with a single chancre though there may be multiple sores. In secondary syphilis, a diffuse rash occurs, which frequently involves the palms of the hands and soles of the feet. There may also be sores in the mouth or vagina. In latent syphilis, which can last for years, there are few or no symptoms. In tertiary syphilis, there are gummas, neurological problems, or heart symptoms. Syphilis has been known as "the great imitator" as it may cause symptoms similar to many other diseases.
Cervicitis is inflammation of the uterine cervix. Cervicitis in women has many features in common with urethritis in men and many cases are caused by sexually transmitted infections. Non-infectious causes of cervicitis can include intrauterine devices, contraceptive diaphragms, and allergic reactions to spermicides or latex condoms. Cervicitis affects over half of all women during their adult life.
Men who have sex with men (MSM) refers to all men who engage in sexual activity with other men, regardless of their sexual orientation or sexual identity. The term was created by epidemiologists in the 1990s, to better study and communicate the spread of sexually transmitted infections such as HIV/AIDS between all sexually active males, not strictly those identifying as gay, bisexual, pansexual or various other sexualities, but also for example male prostitutes. The term is often used in medical literature and social research to describe such men as a group. It does not describe any specific kind of sexual activity, and which activities are covered by the term depends on context. An alternative term, males who have sex with males is sometimes considered more accurate in cases where those described may not be legal adults.
The Contagious Diseases Acts were originally passed by the Parliament of the United Kingdom in 1864, with alterations and additions made in 1866 and 1869. In 1862, a committee had been established to inquire into venereal disease in the armed forces. On the committee's recommendation the first Contagious Diseases Act was passed. The legislation allowed police officers to arrest women suspected of being prostitutes in certain ports and army towns. Since there was no set definition of prostitution within the Act, the question was left to the police officer’s discretion, and women could be arrested even if there was no actual evidence of prostitution. The women were then subjected to compulsory physical examinations for venereal disease. If a woman was declared to be infected, she would be confined in what was known as a lock hospital until she recovered or her sentence was completed. Men suspected of frequenting prostitutes were not subjected to the same treatment of compulsory checks and confinement. The law was initially aimed at working-class women in towns near military bases, due to the concern that sexually transmitted infections were hampering Britain’s forces. The original act only applied to a few selected naval ports and army towns, but by 1869 the acts had been extended to cover eighteen "subjected districts".
Sexual health clinics specialize in the prevention and treatment of sexually transmitted infections.
Sexual Ecology: AIDS and the Destiny of Gay Men is a 1997 book by gay activist Gabriel Rotello, who discusses why HIV has continued to infect large numbers of gay men despite the widespread use of condoms and why a number of experts believe that new HIV infections will disproportionately affect gay men in the future. Rotello examines the origins and timeline of the AIDS epidemic, drawing on epidemiology, sociology, gay history, and ecology. His conclusion is that gay men need to reduce their number of partners and increase condom use to bring the infection rate down. Rotello's central argument derives from the epidemiological concept that sexually-transmitted epidemics are the result of three factors, sometimes called the Triad of Risk: the "infectivity" of a sexually transmitted disease (STD), or how easily it spreads; the "prevalence" of that STD in a particular group, and 3. the ‘contact rate,’ or the average number of sexual partners that people have within a particular group.
Venereology is a branch of medicine that is concerned with the study and treatment of sexually transmitted diseases (STDs). The name derives from Roman goddess Venus, associated with love, beauty and fertility. A physician specializing in venereology is called a venereologist. In many areas of the world, the specialty is usually combined with dermatology.
Women who have sex with women (WSW) are women who engage in sexual activities with women, whether they identify as straight, lesbian, bisexual, pansexual, have other sexualities, or dispense with sexual identification altogether. The term WSW is often used in medical literature to describe such women as a group for clinical study, without needing to consider sexual self-identity.
Prostitution in Myanmar is illegal, but widespread. Prostitution is a major social issue that particularly affects women and children. UNAIDS estimate there to be 66,000 prostitutes in the country.
The American Sexual Health Association (ASHA), formally known as the American Social Hygiene Association and the American Social Health Association, is an American nonprofit organization established in 1914, that cites a mission to improve the health of individuals, families, and communities, with an emphasis on sexual health, as well as a focus on preventing sexually transmitted infections and their harmful consequences. ASHA uses tools such as education, communication, advocacy and policy analysis activities with the intent to heighten public, patient, provider, policymaker and media awareness of STI prevention, screening, diagnosis and treatment strategies.
Gonorrhoea or gonorrhea, colloquially known as the clap, is a sexually transmitted infection (STI) caused by the bacterium Neisseria gonorrhoeae. Infection may involve the genitals, mouth, or rectum. Infected men may experience pain or burning with urination, discharge from the penis, or testicular pain. Infected women may experience burning with urination, vaginal discharge, vaginal bleeding between periods, or pelvic pain. Complications in women include pelvic inflammatory disease and in men include inflammation of the epididymis. Many of those infected, however, have no symptoms. If untreated, gonorrhea can spread to joints or heart valves.
The history of condoms goes back at least several centuries, and perhaps beyond. For most of their history, condoms have been used both as a method of birth control, and as a protective measure against sexually transmitted infections such as syphilis, gonorrhea, chlamydia, hepatitis B and more recently HIV/AIDS. Condoms have been made from a variety of materials; prior to the 19th century, chemically treated linen and animal tissue are the best documented varieties. Rubber condoms gained popularity in the mid-19th century, and in the early 20th century major advances were made in manufacturing techniques. Prior to the introduction of the combined oral contraceptive pill, condoms were the most popular birth control method in the Western world. In the second half of the 20th century, the low cost of condoms contributed to their importance in family planning programs throughout the developing world. Condoms have also become increasingly important in efforts to fight the AIDS pandemic.
A sexually transmitted infection (STI), also referred to as a sexually transmitted disease (STD) and the older term venereal disease (VD), is an infection that is spread by sexual activity, especially vaginal intercourse, anal sex, oral sex, or sometimes manual sex. STIs often do not initially cause symptoms, which results in a risk of passing the infection on to others. Symptoms and signs of STIs may include vaginal discharge, penile discharge, ulcers on or around the genitals, and pelvic pain. Some STIs can cause infertility.
The Public Health Advisor, or "PHA" is a type of public health worker which was established in 1948 by the United States Public Health Service in the Venereal Disease Control Division. Today they are hired primarily by the U.S. Centers for Disease Control and Prevention (CDC) and serve in many public health programs. This type of worker is unique in public health, because they begin their service at the entry level of public health doing what is known as "field work" or "contact epidemiology" which refers to the interviewing and locating of people who have been exposed to an infectious disease so as to offer them treatment and to reduce the epidemic. Following their initial work experiences, PHAs are exposed to a variety of public health programs across the United States, learning to function at all levels of the public health system. During their time of service, PHAs are called upon to respond to public health or humanitarian crisis. This article will briefly describe the history of the Public Health Advisor and will mention a few notable contributions made over the course of their history with the Public Health Service and later with the Centers for Disease Control and Prevention.
The Guatemala syphilis experiments were United States-led human experiments conducted in Guatemala from 1946 to 1948. The experiments were led by physician John Charles Cutler, who also participated in the late stages of the Tuskegee syphilis experiment. Doctors infected 1,300 people, including at least 600 soldiers and people from various impoverished groups with syphilis, gonorrhea, and chancroid, without the informed consent of the subjects. Only 700 of them received treatment. In total, 5,500 people were involved in all research experiments, of whom 83 died by the end of 1953, though it is unknown whether or not the injections were responsible for all these deaths. Serology studies continued through 1953 involving the same vulnerable populations in addition to children from state-run schools, an orphanage, and rural towns. However, the intentional infection of patients ended with the original study.
John Charles Cutler was a senior surgeon, and the acting chief of the venereal disease program in the United States Public Health Service. He is known for leading several controversial and unethical human experiments of syphilis, done under the auspices of the Public Health Service. He willfully spread syphilis and gonorrhea to unwitting patients including soldiers, prisoners, adults with leprosy, mental patients and orphan children as young as nine in the Guatemala syphilis experiments. He also conducted the Tuskegee syphilis experiments, in which African American men, not informed of the nature of the experiment, were deliberately infected with syphilis.
John Friend Mahoney was an American physician best known as a pioneer in the treatment of syphilis with penicillin. He won the 1946 Lasker Award.
The Terre Haute prison experiments were conducted by Dr. John C. Cutler in 1943 and 1944 under Dr. John F. Mahoney, the head of the Venereal Disease Research Laboratory of the US Public Health Service, to determine the effectiveness of treatments for sexually transmitted diseases. The experiment focused on creating prophylaxis treatments for gonorrhea. The test subjects were prisoners at the U.S. Penitentiary in Terre Haute, Indiana. They were given disclosures and consented to the experiments. A total of 241 prisoners participated in the study and received $100, a certificate of merit, and a letter of commendation to the parole board at the end of the study. The researchers deposited various strains and concentrations of gonorrhea into the penises of the test subjects. After several months, Mahoney noted that the method of inducing gonorrhea in humans was unreliable and could not provide meaningful tests of prophylactic agents.
The Chamberlain–Kahn Act of 1918 is a U.S. federal law passed on July 9, 1918, by the 65th United States Congress. The law implemented a public health program that came to be known as the American Plan, whose stated goal was to combat the spread of venereal disease.
Fit to Fight is a silent sex hygiene film about the dangers of venereal disease written and directed by Edward H. Griffith. It was produced by the Commission on Training Camp Activities and initially shown to American World War I soldiers. After the war, a slightly edited version was commercially released to the public in 1919, under the title Fit to Win. The film proved controversial due to its graphic imagery and its limited support for prophylaxis. It was subject to censorship attempts, and contributed to the emergence of the exploitation film as a distinct niche.