Like many of the tales Hawthorne wrote during his time living in The Old Manse, "The Birth-Mark" discusses the psychological impact in sexual relations. The birthmark does not become an issue to Aylmer until after the marriage, which he suddenly sees as sexual: "now vaguely portrayed, now lost, now stealing forth again, and glimmering to-and-fro with every pulse of emotion". Written shortly after Hawthorne married Sophia Peabody, the story emphasizes the husband's sexual guilt disguised as superficial cosmetology. Some critics contend that the theme of the story is that human perfection can only be achieved in death and therefore not reachable at all, in that the trademark foreshadowing occurred during Aylmer's dream of cutting out the mark, in which he discovers the birthmark is connected to Georgiana's heart (which he elects to cut out as well in his attempt to remove the birthmark). Other critics, like Stephen Youra suggest that, to Aylmer, the birthmark represents the flaws within the human race which includes "original sin" which "woman has cast men into" and because of this, elects it as the symbol of his wife's "liability to sin, sorrow, decay, and death". While others suggest we view the story "as a story of failure rather than as the success story it really is — the demonstration of how to murder your wife and get away with it."
Hawthorne may have been criticizing the epoch of reform in which he was living and specifically calling attempts at reform ineffective and the reformers as dangerous. Other critics read the story as a critique of 19th century positivist science (positivism) situating the woman as nature and representing science as attempting to penetrate her/its secrets while ultimately destroying the object of its research. Still others see it as a defense of vitalism as against materialism – that one cannot find the essence or soul in mute bodily matter.
The story is often compared to Edgar Allan Poe's "The Oval Portrait".
Aylmer is a scientist and husband to Georgiana. Robert B. Heilman suggests that Aylmer has taken science as his religion and that Aylmer’s views on "the best that the Earth could offer" (Hawthorne, 130) is "inadequate". Heilman goes on to suggest that “the mistake Aylmer makes” is the “critical problem” with the story in that he has "apotheosized science".
Georgiana is the wife of Aylmer and, as Sarah Bird Wright puts it, “doomed heroine” of the story. Georgiana agrees to allow Aylmer perform experiments on her to attempt to remove her birthmark which turns out to be a fatal decision. Wright quotes Millicent Bell’s thoughts on Georgiana’s final words by saying they are "indicative of Hawthorne’s struggle with romanticism….he yearns to depict life as found".
Aminadab, Aylmer’s laboratory assistant, is described as being short and bulky with a shaggy appearance. Wright refers to Nancy Bunge's observation that "because Aminadab possesses vast physical strength and 'earthiness' he undertakes to perform unpleasant tasks in order to free Aylmer to 'cultivate delusions of transcendence'". Judith Fetterley Suggests that "Aminadab symbolizes the earthly, physical, erotic self that has been split apart from Aylmer".
The birth mark represents various things throughout the story. Two of the main representations are imperfection and mortality. Georgiana is human and mortal because of the one imperfection on her left cheek. The birth mark can also symbolize death. No one is perfect, and no one can escape death. It is a normal part of life. The birth mark portrays Nathaniel Hawthorne's belief in that human imperfection cannot be separated out of our humanity. In the text it reads, "The crimson hand expressed the ineludible gripe in which mortality clutches the highest and purest of earthly mould, degrading them into kindred with the lowest, and even with the very brutes, like whom their visible frames return to dust. In this manner, selecting it as the symbol of his wife's liability to sin, sorrow, decay, and death, Aylmer's sombre imagination was not long in rendering the birth-mark a frightful object..." It is in human nature to be imperfect. The shape of the birth mark is representative of the hand of God. The color of the birth mark is red, representing passion and sexuality. The control that Aylmer desires to have over the birth mark on his wife's face also represents the power of her sexuality and his lack of control around her. Aylmer is seen as foolish because he tries to compete with nature to fix an imperfection that ultimately causes death. Perfection is not attainable except through the spirit in death which makes it physically impossible to achieve. Although humans know they are imperfect and mortal, there continues to be a part that strives for immortality and perfection.
Aylmer's pursuit of perfection is both tragic and allegorical. He refuses "the best that nature has to offer," instead obsessing over his wife's singular physical "flaw." This pursuit is Aylmer's destruction. His discontent with his wife's mark ruins the most perfect thing in his life. The irony of Aylmer's obsession and pursuit is that he was a man whose "most splendid successes were almost invariably failures." Rather than obsessing over correcting his failures, he quickly forgets them. Similarly, instead of obsessing over Georgiana's splendid beauty, he quickly forgets it. That a man of so many failures would be trying to perfect someone else is both ironic and allegorical. This type of story has biblical symmetry to Jesus' "Sermon on the Mount" in Matthew 7. In verse 3 Christ is quoted as saying, "Why do you see the speck that is in your brother's eye, but do not notice the log that is in your own eye?" This similarity cannot be overlooked and can be analyzed as an indictment of the remnants of Puritan culture in New England at the time. Rather than focusing on their own failures, they instead made a life of pointing out the mistakes and flaws of others, regardless of whether they truly existed. The "Birth-Mark" is a morality tale and indictment of Puritan culture. Aylmer's unyielding pursuit to remove the one "flaw" from Georgiana shows his own blindness of conscience. Similarly, Puritans believed they had to separate from everything and everyone that believed things contrary to their beliefs.