性別、科技與身體：子宮內膜異位症的興起與擴展，1950-2005

本文旨在探討1950年代至今，子宮內膜異位症的興起與演變。此一歷程的面向包括了科技與診療的結合，子宮內膜異位症的診斷與治療方式的改變，女性主體的醫療經驗，及其中的性別意涵。本研究以質性研究的方法進行，訪談婦產科醫師、子宮內膜異位症的患者，並對相關的子宮內膜異位症醫療論述加以分析。從歷史脈絡來看，子宮內膜異位症是台灣1950年代新興起的疾病，1970年代後迄今，透過腹腔鏡科技、媒體、團體網絡及醫療論述等多重管道逐漸擴展。子宮內膜異位症診斷與治療隨腹腔鏡發展而改變，1950年代，醫師透過徒手感知作為評估病患的工具，此時若無法判斷問題時，僅能以藥物緩解症狀。70年代後，轉變以儀器導向的評估方式，醫師的工作模式也由原先注重女性的身體經驗，轉為著重腹腔鏡科技操作，且經由腹腔鏡取得疾病的證據後，進而以藥物治療，此時腹腔鏡侷限於診斷的功能。直到1990年代，手術腹腔鏡的出現，診斷與治療得以同時進行，不僅能當下清除病灶，讓不孕的患者及時把握懷孕的機會。然而，比傳統剖腹手術方便的腹腔鏡手術，也讓某些女性不斷追求以治療不孕，因而承受重複的醫療處置。此外，科技「標準化」的分類結果，並未將重要症狀之一的疼痛列入評估標準，而僅以生殖器官評估疾病的嚴重度，及判斷不孕的治療效果，預設不孕是此病的最重要問題，強化了疾病與生殖間的關係。在醫療科技發展後，雖然提供患者不同的治療選擇，改善部分女性不孕與經痛的問題，但對女性也未必全然是有利的，某些女性可能為了治療不孕，忍受藥物與手術治療的煎熬，卻仍然無法解決問題。然而，不孕的原因不全然是女性的問題，但不孕檢查往往以女體優先，或許女性僅有輕微的病灶，便被視為不孕的主角，而許多有不孕問題的男性，卻可能逃之夭夭，讓女性承擔不孕的污名。不論醫療是否有利於婦女，若醫師認為子宮內膜異位症的治療是有必要的，本研究期望醫界在不孕的檢查上不能預設女性為問題之唯一所在而忽略了男性，或一味強調懷孕治療的必要性，視女性為生育的工具。而作為醫療使用者的女性，可以從許多子宮內膜異位病人的經驗中學習，重新思考有關身體健康生育等議題，而不將醫療視為唯一的出路。

關鍵字

子宮內膜異位症；腹腔鏡；性別

並列摘要

This thesis examines the history of the making of endometriosis as a disease for women from the 1950s to the present. Several aspects are important to this history, including the role of changing technology in diagnosis and treatment, the lived experiences of women who suffered from endometriosis, and gendered medical practices. This research is based on qualitative research, and it includes several interviews with gynecologist-obstetricians and women with endometriosis. In addition, written sources regarding endometriosis are also analyzed. Endometriosis first emerged in Taiwan in the 1950s, and beginning in the 1970s it gradually expanded as a result of various factors, including the advance of laparoscopy technology, popularized essays in the mass media, networks of patients’ self-help groups. The diagnosis and treatment of endometriosis changed profoundly with the development of laparoscopes. In the 1950’s, doctors diagnosed patients’ conditions by manual palpitation. If doctors could not make a diagnosis, they could only relieved patients’ symptoms by prescribing drugs. After the 1970s, diagnoses began to oriented toward instruments (i.e. laparoscopes), and the use of laparoscopy technology also became an important feature in gynecologist-obstetricians’ practice. As a result, women’s body experience increasingly lost its importance in diagnosing the disease, if not entirely ignored. In the period between 1970s and 1980s, medication was often prescribed following a diagnosis of the disease via laparoscopy. After operation laparoscopy was invented in the 1990s, diagnosis and treatment could be done at the same time. Not only does laparoscopy enable physicians to see the disease, but it also can be used to eliminate lesion. Many women who were unable to conceive could then hope for a chance of becoming pregnant. However, in order to treat sterility, many women undergo repeated medical procedures using the more convenient laparoscopic operation, which might be unnecessary. The advance of technology also resulted in “standardization” of the disease classification, which does not include pains. The seriousness of the disease is evaluated based on the extent to which it covers the reproductive organs, and whether or not one is cured is based on the elimination of sterility, which indicates that sterility is seen as the most important problem of this disease. In this way, women’s body is tied to reproduction. After the development of medical technology, although patients have more treatment options, and some women’s menstrual discomfort could be improved and infertility might be overcome, it is not completely favorable for women. In order to treat sterility, some women may put up with drugs and operations but their problems remain unsolved. Despite the fact that it takes two to be infertile, women are those who seek out for medical help first. It is not impossible that women with slight lesion might become the culprit of sterility, while their male partners could remain unsuspected. This study suggests that the medical community should not see women as the only source of the problem when it comes to sterility. Learning from the experiences of many endometriosis patients, we can rethink many issues concerning reproduction. It is clear that for many women, medicine is not the only solution.