Article Text

Book review
Conceiving Masculinity: Male Infertility, Medicine, and Identity
  1. Laurie Essig
  1. Correspondence to Dr Laurie Essig, Department of Gender, Sexuality & Feminist Studies, Middlebury College, Middlebury, VT 05753, USA; lessig{at}

Statistics from

Liberty Walther Barnes. Published by Temple University Press, 2014. Paperback, 228 pages. ISBN 978-1439910429, $29.95.

In Conceiving Masculinity, Liberty Walther Barnes gives us an illustrative example of how bodies, technologies and gender get entangled in ways that make it difficult to figure out where one ends and the other begins. Take the ‘problem’ of infertility. It turns out that a certain segment of the American public not only believes it is their right to reproduce, but also sees the lack of reproduction as a real threat to their sense of being a man or being a woman. Because of new technologies, this problem can now be diagnosed and sometimes even resolved with pregnancy. This long and arduous process of resolution—from semen donation to IVF—must do the emotional labour of protecting heterosexual masculinity from any sense of failure.

As Barnes points out, protecting hetero-masculinity is why it is generally assumed that failure to get pregnant is the woman's fault. It is also why there are five times as many female infertility specialists as male infertility specialists and why infertile men are more or less invisible in our culture, the lack of pregnancy seen on the woman's (not pregnant) body. Yet according to the WHO and the American Society for Reproductive Medicine, infertility is just as likely to be male as female. Despite men's equal responsibility for infertility:(w)omen are more likely to bear the social stigma of childlessness and are more likely to bear the social stigma of childlessness and are more likely to undergo medical treatments, even in cases of male infertility. (p. 3)

It should come as no surprise, then, that when Barnes takes a closer look at the treatment of male infertility by spending hundreds of hours in US clinics that treat male infertility, she finds a variety of strategies employed by doctors, wives and the infertile men themselves to maintain hegemonic masculinity. Of course some of this commitment to upholding hegemonic masculinity is because her participants were all married, heterosexual, primarily white and upper middle class. Given that they are the most likely to benefit from this masculinity, it should be no surprise that they work hard to maintain it. I would argue, however, that it is precisely the specificity of her participants that allows Barnes to draw larger insights into just how ‘sticky’ and also ‘flexible’ hegemonic masculinity really is.

The hegemonic masculinity Barnes encounters in the clinics is sticky in that it is upheld in a variety of ways. The male infertility specialists, who are themselves all men, work hard to protect their patients’ sense of themselves as ‘real men’ by using a variety of masculinist metaphors for their inability to reproduce. In addition to the expected metaphors like guns firing blanks and blocked bridges, the male doctors in Barnes’ study use cars, planes and motorcycles to explain male infertility to their patients. These metaphors are ‘employed to stabilize masculine identity and build trust between doctors and patients’ (p. 63). The metaphors work alongside penis jokes as a kind of ‘social lubricant’ (p. 78) to uphold the masculinity of the patients.

The doctors also protect their patients by refusing to make room for the patients’ wives in their practices. According to Barnes, the doctors consistently told women to be quiet and let the men speak and complained of the wives’ ‘impatience’. One doctor in her studybelieved that women were less likely to understand the biological causes of infertility than were their husbands because… men have greater aptitude for understanding science. (p. 73)

The patients themselves use the language of ‘just a medical condition’ to disconnect their bodies and their masculinity from infertility. For many of Barnes’ respondents,conceptualizing infertility as just ‘some sort of medical condition’ is an important step toward believing that his poor infertility does not make him ‘less of a man.’ (p. 88)

Unlike more marginalised members of society who have been pathologised and thus disempowered by the medical gaze, the men in Barnes’ study seemed to find power in the discourse of disease and cure. These meninterpret(ed) their disciplined participation in medical treatments as their means for taking control of the situation… Medical technologies can potentially restore fertility, one facet of masculinity, but their use is also a demonstration of masculinity. (p. 127)

It is the ability of these men to redefine masculinity as submitting to the medical gaze that gives us some insight into just how persistent normative gender roles can be. Despite the fact that they fail to produce viable sperm, these men are able to reconfigure their failure as a test for proving that they are, in fact, real men by submitting to medical interventions.

All of this leads us to the ‘so what?’ question. Here Barnes has given us a case study in the medical gaze as producing disease (male infertility) that is then embodied in actual men. Naming something a disease may be a social decision, but it is always a social decision with deep personal consequences. Barnes shows us the embodied effects of medical discourse as well as medical technologies. She has also given us more philosophical issues to consider. What does it mean when the medical gaze takes up the most powerful among us as its object? Turning Foucault on his head, we see that although the medical gaze exerts itself onto bodies, some bodies can redistribute the gaze to maintain their power. In the case of the white, heterosexual, married and well-off men that Barnes studied, coming into the world of disease and cure did not disrupt their hegemonic masculinity as much as it forced them to reassert it through treatment. Turning to another male-dominated medical field, cosmetic surgery, which catches mostly women in its objectifying gaze, we see a different set of practices. In my own research, I saw almost exclusively male doctors upholding gender hierarchies by helping their patients see their bodies as failures, not machines. The failed female body required the expertise of men to reshape and resculpt it. Even when the women resisted this narrative, it was always already available in a larger culture that sees the female body as a problem. Because powerful and heterosexual men's bodies are not a problem, they negotiate the medical gaze without ever feeling as if they themselves are the problem. Instead of failed bodies, the men are taught to see opportunities to take control and protect their wives. Rather than a singular feminist critique of medical discourse as disempowering, we can use Barnes’ book to produce more subtle understandings of the medical gaze as producing a variety of effects on a variety of bodies and none of those effects can be universalised, but rather must be studied in the specificity of their expression. Barnes has given us just such a study.

View Abstract


  • Competing interests None declared.

  • Provenance and peer review Not commissioned; internally peer reviewed.

Request permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.