In my book Edward VI in a Nutshell I postulate that Edward VI, Arthur Tudor, and Henry Fitzroy all died in their mid teens of nonclassic (atypical) cystic fibrosis. Non-classic CF could also be a clue in the long-standing historical whodunit (or who didn’t dun it) of whether or not Katherina of Aragon and Arthur Tudor consummated their marriage. More accurately, chronic obstructive pulmonary disease (COPD) as a result of the complications of non-classic cystic fibrosis resulting in erectile dysfunction could explain why a 15 year old boy was unable (as Katherina swore to her dying day) to have sex with his bride.
Cystic fibrosis, in and of itself, is associated with infertility but not erectile dysfunction. However, all types of cystic fibrosis are by their nature chronic obstructive pulmonary diseases (COPD) and advanced COPD can cause erectile dysfunction. One of the most common forms of COPD is chronic bronchitis, which involves a long-term cough with mucus eroding lung function and oxygen uptake. Both cystic fibrosis and COPD are associated with chronic airway inflammation that can also inhibit oxygenation of the body. If the inflammation is severe enough and continues long enough then the patient can become both hypoxemic and hypoxic. Hypoxemia occurs when there is insufficient oxygen available in the arterial blood supply, while hypoxia describes the lack of oxygen in the body’s tissues due to hypoxemia.
In one of the ironies of physiology, hypoxemia causes coughing but the coughing counterproductively worsens into hypoxia. Hypoxia engenders sweating, wheezing, cough, shortness of breath, and discoloration of the skin. Hypoxemia and hypoxia also make a patient incredibly weak, easily tired, and can cause erectile dysfunction. With current breathing treatments and medications, erectile dysfunction doesn’t become a problem until men are middle-aged. In the Tudor time period, the lack of antibiotics to combat chronic bronchitis means that COPD could have easily affected Arthur much sooner than that because the hypoxemia and hypoxia would have been more pronounced at a younger age.
Arthur may have been incapable of consummating his marriage and his claims to the contrary could have been merely bravado born from embarrassment.
The lack of wedding-night copulation is a subject of debate, largely because the one person who knew for sure was Katherina of Aragon and the cultural inability to take a woman’s word regarding sexual matters and assume she is telling the truth still exists, albeit subconsciously for the most part. Katherina herself was adamant the marriage was unconsummated. She swore, despite what she believed would be the endangerment of her immortal soul if she were lying, that she had become a widow while she was ‘intacta et incorrupta’, i.e untouched and pure. Those who believe that Katherina was lying base their arguments largely on the papal dispensation for her betrothal to Henry VIII, which said the marriage had ‘perhaps’ been consummated, and testimony against her given in a court, the Legatine Court at Blackfriars held over the summer of 1529, that Henry had summoned specifically to help him find reasons to dissolve his marriage.
Evidence against Katherina’s post-nuptial virginity presented at Blackfriars included the fact that Katherina’s young husband shared her bed several times and remembrances of what her groom had claimed after the wedding night. Arthur’s body servant, William Thomas, testified that after he had helped the prince get ready for bed, he then ‘conducted him clad in his night gown unto the Princess’s bedchamber door often and sundry times … and that at the morning he received him at the said door … and waited upon him to his own privy chamber’. Furthermore, it was recalled that Arthur had bragged that he had accomplished his marital duties, insisting that he had been ‘in the midst of Spain’.
Not all evidence at Blackfriars supported the argument of consummation, however. Nicholas West, the Bishop of Ely, testified the widowed Katherina had told him more than once that she was still a virgin. Furthermore, Katherina was able to wrest a de facto admission from Henry VIII that she had been a virgin when she had wed him. Kneeling at his feet like the most humble of wives, Katherina swore before all those assembled that she had been, ‘a true maid, without the touch of a man’ when she married the king, and told Henry ‘whether this be true or no, I put it to your conscience’. Henry’s response was ringing silence rather than any refutation. A final piece of evidence that indicates that Katherina was telling the truth is that Henry VIII’s annulment tactics began to focus on the idea that exchanging vows was enough for a couple to be married even without consummation, which suggests he knew Katherina had been a virgin on their wedding night.
As the English had done at Blackfriars, the Spanish held a tribunal in 1531 at Zaragoza to hear witnesses from the wedding night. Spanish witnesses testified that the nuptial sheets were spotless and Katherina herself told her ladies she was worried her frail husband would never be up to the task of lovemaking. Juan de Gamarra, who had been a serving boy for Katherina and had stayed in her antechamber on the night of her marriage to Arthur, said that “Francisca de Caceras, who was in charge of dressing and undressing the queen and who she liked and confided in a lot, was looking sad and telling the other ladies that nothing had passed between Prince Arthur and his wife, which surprised everyone and made them laugh at him”. Katherina’s doctor was also reported to have said that Arthur ‘had been denied the strength to know a woman’ because of ill health.
If Katherina’s first marriage went unconsummated, which seems to be the likeliest scenario given the testimony of the bride, then there was probably a physical reason behind Arthur’s inability to have sex with his bride. COPD as a result of chronic pulmonary disease is a plausible explanation for Arthur’s theoretical erectile dysfunction and one which more closely aligns with the evidence given by the Spanish attendants and the manner of the prince’s death a few months later.
 Fletcher, E. C., and R. J. Martin. 1982. “Sexual Dysfunction and Erectile Impotence in Chronic Obstructive Pulmonary Disease.” Chest 81 (4): 413–21.
 Eickmeier, Olaf, Marisa Huebner, Eva Herrmann, Ulrich Zissler, Martin Rosewich, Patrick C. Baer, Roland Buhl, Sabina Schmitt-Grohé, Stefan Zielen, and Ralf Schubert. 2010. “Sputum Biomarker Profiles in Cystic Fibrosis (CF) and Chronic Obstructive Pulmonary Disease (COPD) and Association between Pulmonary Function.” Cytokine 50 (2): 152–57.
 Verratti, V., C. Di Giulio, F. Berardinelli, M. Pellicciotta, S. Di Francesco, R. Iantorno, M. Nicolai, S. Gidaro, and R. Tenaglia. 2007. “The Role of Hypoxia in Erectile Dysfunction Mechanisms.” International Journal of Impotence Research 19 (5): 496–500.
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 Bernard, G. W. 2005. The King’s Reformation: Henry VIII and the Remaking of the English Church. Yale University Press.
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 Bernard, 2005:22
 Tremlett, Giles. 2010. Catherine of Aragon: Henry’s Spanish Queen. Faber & Faber.