It is based on ethnographic fieldwork in Brazilian cities, carried out in the context of two distinct research projects: on the uses of plastic surgery in Rio de Janeiro Edmonds and sex hormone therapies in Salvador da Bahia Sanabria , primarily by women. During fieldwork we each interviewed healthcare practitioners mostly surgeons, psychologists, endocrinologists, GPs, ObGyns, and nurses , observed clinical practices, and conducted ethnographic work with patient-consumers that took us into social contexts not directly tied to medical care.
Cosmetic surgery and sex hormones are very different kinds of therapies that target different aspects of the body, health and well-being. But in Brazil they have important areas of clinical overlap as a means of intervening in, or optimizing, women's reproductive and sexual health and well-being.
Hormonal contraceptives are among the most widely prescribed drugs in pharmaceutical history. In Brazil, they are widely available in a range of combinations and modes of delivery. They also have controversial rationales not limited to contraception or treatment of menopausal symptoms, such as regulating menstruation, body shape, or sexual and social performance. Such off label uses are often blurred with more acceptable indications such as birth control.
Globally, the availability of cosmetic surgery is more limited and is generally considered a form of enhancement. We bring these two cases together to explore how they have become normalized within a two-tier healthcare system and used experimentally to manage women's reproductive and sexual lives. Moreover, both therapies have an important experimental dimension, which we link to Brazil's regulatory context and societal expectations placed on medicine as a means for managing women's health. We argue these therapies are sometimes used with the intent of engineering the sexual and reproductive body from the inside out.
We further argue that these therapies are becoming morally authorized as routine ways of managing women's health.
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They are often merged with cosmetic and hygienic regimes of cuidar-se self-care seen as essential for modern femininity. Pharmacies, beauty parlors, gyms, health food shops, private medical practices, and pseudo-medical cosmetic services abound in Brazilian cities. The distinctions between cosmetic, hygienic, erotic and health practices are thus often blurred — as are the lines between necessary medical interventions and those with more diffuse rationales of boosting auto-estima self-esteem or managing life's exigencies.
The very ordinariness of contraceptives can mask their more experimental uses in boosting mood, controlling weight or regulating sexual or social life. Brazilian folk and medical ontologies see the body as considerably plastic — amenable to change and improvement Rohden , Sanabria We suggest a different critical approach, one that focuses on both the experimental medical uses of these therapies as well as what can be called their experimental social uses.
We explore how these technologies are adopted to respond to pressures, anxieties and aspirations arising out of work and intimate life.
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These uses often diverge from official medical discourse or public health agendas, although they can receive the tacit support and encouragement of doctors. Aesthetic goals are morally authorized as health goals while experimental re-tooling is rendered as necessary, routine or even pleasurable self-care. How do medical technologies reflect aspirations for social inclusion or mobility?
How do experimental, aesthetic or lifestyle uses of medicine become legitimated and integrated with more established forms of healthcare?
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Historically, however, there has been considerable medical and social uncertainty as to the appropriate use of both of these therapies. We briefly trace their origins as experimental technologies and contextualize their shifting medical indications.
Since their invention, the rationale for the use of sex hormones has been open to negotiation and subject to controversy. Contraceptives in Brazil come in a multitude of delivery systems, dosages and modes of administration Sanabria, forthcoming. In addition to variations in oral forms brand-name, national copies or generics, combined or minipills, second, third or fourth generation, etc.
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This multiplicity reflects the search for long-acting contraceptive methods for the developing world, in which Brazilian medical institutions have played a significant role. Doctors also have considerable leeway to experiment with new regimens. This is particularly true for hormonal implants developed in Brazil where standardized, brand-name implants such as Implanon are rare.
Although these implants are presented as state-of-the art treatments, their production is remarkably low-tech and labor-intensive. These treatments are not all clinically trialed, unlike those produced by transnational pharmaceutical corporations. The only published data come from observational studies of women, many of them conducted in Brazil, with loose ethical oversight.
One woman Sanabria interviewed in explained that her gynecologist had asked her to perform clinical exams at her own expense , including cardiovascular and cholesterol analyses. Marketing and health care practitioners present T as a kind of aphrodisiac, although women's descriptions of their experiences are more ambivalent.
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Although the doctors whom Sanabria observed prescribing implants usually referred to testosterone as dar fogo to give fire, an explicitly sexual metaphor , patients tended to emphasize wider dispositional changes. Cleonice is in her mids and married to an architect from the South of Brazil. Sanabria met her in a clinic where she was having her implants renewed, which she had been using for over a decade. It improves your performance in English , you have more disposition. In a series of press articles described the increasing use of testosterone implants by Brazilian women in academias gyms.
Referred to as mulheres chipadas women with a microchip , these women said that they build more muscle mass, lose subdermal fat more rapidly, and optimize their workout with T. While they are not endorsed by all users, drug effects are conditioned by patient expectations Moerman and Jonas In contrast to the banality of the pill, cosmetic surgery is often considered an exceptional — sometimes even a dangerous — treatment. We argue that cosmetic surgery in Brazil is moving towards routinization and becoming an integral part of managing passage through the female lifecycle. While doctors had previously experimented with cosmetic procedures, it was only the consolidation of technical skills through the repairing of the shattered faces of First World War veterans that raised the possibility of effective cosmetic surgery.
Yet social and medical attitudes at the time viewed the use of surgery for exclusively aesthetic aims as frivolous Gilman Euro-American society caught up to the therapeutic possibilities of cosmetic surgery in part due to the popularization of psychoanalytic research pointing to the emotional significance of appearance Haiken Surgical residents from many countries travel to train in Brazil's plastic surgery wards, drawn by opportunities for hands-on practice in cosmetic techniques Edmonds Another European resident, surprised to observe two major aesthetic surgeries being performed simultaneously in the same room, remarked that Brazilian surgeons are highly skilled and that complication rates are low.
In fact patients may be more at risk in some private clinics, which unlike public hospitals do not have life support systems. Surgeons explained that patients with African ancestry have a higher risk of forming thick keloid scars, but that due to extensive racial mixing ancestry is not always visible in phenotype.
Patients are often willing to try experimental techniques, combine surgeries, or have repeated retoques touch-ups. The injection of industrial-grade liquid silicone considered unacceptably risky and now banned is usually associated with the transformation of transvestites in Brazil and other countries. However, Brazilian women have also had liquid silicone injected by doctors or have experimented with this practice themselves, some coming to public hospitals for corrections. Other patients opt for surgery at the prompting of doctors to correct flaws they had not perceived themselves.
Raquel went to a public hospital for cosmetic breast surgery, but given the long waiting time, chose a nose job instead, her second preference. Brazilian plastic surgery and gynecological wards, we observed, are highly social places where information about procedures, hospitals, and sympathetic doctors are traded boca a boca word of mouth. We now explore further how these therapies are situated within women's healthcare by discussing the class dynamics in Brazilian medical institutions.
Post-dictatorship Brazil — has witnessed rapid, often contradictory changes in healthcare Biehl Some private clinics are shabby but free of the long public sector queues, while top-end institutions have the hallmarks of luxury and glamour. The equally heterogeneous public sector is often perceived as offering lower quality care. Although they are often represented as separate, doctors, patients and protocols travel between the public and private sectors Sanabria Oral contraceptives have been widely available in Brazil since the s when the state reversed its pro-natalist position.
But there continue to be important class differences in prescription patterns for hormonal contraceptives.
Rose and Rose and Rabinow have distinguished between an older, disciplinary biopolitics and a newer, emergent biopolitics. Class dynamics also shape the management of pre-menstrual tension, one of the key indications for menstrual suppressive contraceptives in Brazil. The addition of testosterone to implants is presented as enabling desire for busy middle- and upper-class Brazilian women. Among low-income patients who use methods such as Depo-Provera also a menstrual suppressive , rationales have focused more on the possibilities this affords for work, where menstruation is seen as depleting strength.
Across classes, women explained that they adopted menstrual suppressive treatments to manage their emotional oscillations, be these cyclical feelings of depression, irritation or anger, which impede domestic and work relations. Volume 2 , Issue 4. The full text of this article hosted at iucr. If you do not receive an email within 10 minutes, your email address may not be registered, and you may need to create a new Wiley Online Library account.
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