By JEN GUNTER
Saturday, August 17, 2019
Obstetrician and gynecologist. She is host of the documentary series Jensplaining, writes two columns for The New York Times and is the author of the new book The Vagina Bible: The Vulva and the Vagina - Separating the Myth From the Medicine, from which this essay is adapted.
I have been in medicine for 33 years, and I've been a gynecologist for 24 of them. It was early experiences with the health-care system that drew me to medicine (I had a kidney removed when I was 11 years old) and a love of science that made me commit to it. It was activism that led me to OB/GYN.
I've been pro-choice for as long as I can remember. In high school (I graduated in 1984), I was very clear - to myself and to anyone who asked - that restricting access to abortion had nothing to do with "life" and everything to do with the patriarchy. No man could tell me what to do with my body.
In medical school, OB/GYN fascinated me. Here was clear, factual information about the reproductive tract. Even though I had studied science before medical school, much of what was presented seemed new, given the amount of detail. How was I just now, in my early 20s, learning how my body worked? I also distinctly remember being annoyed that all my lectures were from men. This was the late eighties and the absence of women at higher levels in medicine was common. So common that one tended not to notice that most of one's professors were men.
But I did. And here, in the field of women's health, the absence of female doctors and researchers was a powerful reminder of that glass ceiling.
I needed to help change that system.
Over the years, I've listened to a lot of women, and I know the questions they ask as well as the ones they want to ask but don't quite know how. Almost all of these queries are born of inaccurate knowledge about their bodies, gleaned from what they learned (or didn't learn) in school or at home, from men or in magazines or online. The problem? You cannot be an empowered patient with inaccurate information.
One of the core tenets of medicine is informed consent. We doctors provide information about risks and benefits and then our patients, armed with that information, make choices. This system only works when the information is accurate and unbiased. Finding these kind of data can be challenging, as we have, apparently, quickly passed through the age of information and are now stalled in the age of misinformation.
False, fantastical medical claims are nothing new. However, sorting myth from medicine is getting harder and harder. In addition to social-media feeds that constantly display medical messaging of variable quality, there is a headline-driven news cycle that constantly requires new content - even when it doesn't exist. And with women's bodies, there are even more forces of misdirection at work. Those who peddle in pseudoscience are invested in misinformation, but so is the patriarchy.
Obsessions with reproductive-tract purity and cleansing date back to a time when a woman's worth was measured by her virginity and how many children she might bear. A vagina and uterus were currency. Playing on these fears awakens something visceral. It's no wonder the words "pure," "natural" and "clean" are used so often to market products to women.
Members of the media and celebrity influencers tap into these fears with articles about vaginal mayhem and products intended to prevent it, as if the vagina (which evolved to stretch and tear to deliver a baby long before suture material was invented) is somehow constantly in a state of near catastrophe.
That's why I have a vagenda: for every woman to be empowered with accurate information about the vagina and vulva. And that's why I've written a book on the subject. The Vagina Bible is everything I want women to know about their vulvas and vaginas. It is my answer to every woman who has seen me pass on information in the office or online and then wondered, "How did I not know this?" Misinforming women about their bodies serves no one interested in health or equality.
Widespread misinformation is the inevitable consequence of a long history of medical neglect of women's anatomy.
Going way back, medically speaking - as in Hippocrates (although there is a belief among many academics that Hippocrates wasn't even a real person) - male physicians rarely performed pelvic exams on women or even dissected female cadavers, as it was considered inappropriate or insensitive for a man to touch a woman outside of a marital relationship. As there were no female physicians, everything first written about women's bodies in ancient medical textbooks and taught to the first physicians was passed along, from women and midwives, to men, who in turn interpreted the information as they saw fit. So medicine has been steeped in mansplaining from the start.
Most ancient physicians, probably like many other males of the time, were unsure of the role of the clitoris and likely thought it unimportant. This stands in sharp contrast to the anatomic glory of the penis. In medicine, all body surfaces are assigned a front or back, which we call ventral (front) or dorsal (back). If you look at a person standing in a neutral position (arms at the side and palms facing forward), the face, chest and palms of the hands are on the ventral side, and the back and the back of the hands are dorsal. This convention is applied differently to the penis, because of course it is. The neutral stance for a man, according to the anatomists of old, was a massive, skyward-pointing erection. Except, of course, men don't walk around with constant erections, and so when you look at a man in what most people would consider the resting state - meaning a flaccid penis - the part that faces you is not the "front" of the penis but actually the "dorsal," or back surface, and the undersurface is the "ventral."
It's not really a small point; it is a wonderful (in a tragicomic kind of way) encapsulation of how society, including medicine, is obsessed with erections, while the clitoris barely registers as a footnote. The clitoris, when it was considered by ancient physicians at all, was believed to be the female version of the penis - but lesser. (I'm sorry, but the organ, capable of multiple orgasms, that only exists for pleasure is not lesser. It is the gold standard.)
Clitoral neglect wasn't confined to medicine. Think about all those ancient Greek statues with defined scrotums and penises (the penises are on the small side because sexuality was apparently at odds with intellectual pursuits and so a big brain, not a big penis, was the ideal). The vulvas of the time were but mysterious mounds concealed by crossed legs.
Around 1000 AD, Persian and Arab physicians began to take more interest in the clitoris, but given the constraints imposed on male physicians touching a naked woman or even a female cadaver, work was slow. By the end of the 17th century, descriptions of female anatomy, including the clitoris, were quite accurate, anatomically speaking.
Some anatomists who made these advancements are memorialized in the names of the structures they accurately described - Gabriele Fallopio (fallopian tubes; also invented the first condom and studied it in a clinical trial!) and Caspar Bartholin (Bartholin's glands).
By 1844, the anatomist Georg Ludwig Kobelt published such detailed work that his anatomic descriptions of the clitoris rival those we have today. However, his work was essentially ignored (as was almost everything that had led up to it), likely owing to a combination of the expansion of Victorian beliefs (essentially the dangers of female sexuality) and Sigmund Freud popularizing the false belief that the clitoris produced an "immature" orgasm.
Physicians in the twenties and thirties truly believed the vagina was filled with dangerous bacteria. Of course, that idea is absurd, and you don't need a medical degree to reach that conclusion. If the vagina were perpetually in such a state of infectious near-catastrophe, women would never have survived, evolutionarily speaking. The narrative of a dirty vagina did, however, fit the societal goal of female oppression.
For many years, discussing female sexuality in the doctor's office was taboo. Much of women's health, especially sexual health, was deemed unimportant or irrelevant because that is how women were viewed.
A male-dominated profession, a male-dominated society with little interest in women's experiences and opinions about their own bodies, a penis-centric view of female sexuality and the belief propagated by Freud's work that the clitoris was unimportant - those are a lot of obstacles to overcome.
In addition, the clitoris, being largely internal, is also harder to study than the penis, practically speaking. Eventually, anatomic studies using female cadavers to dissect the clitoris were allowed, but it is important to note the limitations of the work. Cadavers are expensive and not readily available.
Many cadavers are also older subjects, and clitoral volume reduces after menopause; in one cadaveric study, all subjects were between 70 and 80 years old. The preservation process also distorts the clitoris.
Before the advent of MRI (magnetic resonance imaging), it wasn't really possible to know exactly how the clitoris in a living woman was positioned or how it engorges with blood in response to sexual stimulation.
Anatomic knowledge has come a long way. While I don't remember each anatomy lecture from medical school and residency, I still have my textbooks. The two that are specific for OB/GYN are anatomically correct, clitoris-wise, but the general anatomy book (published in 1984) devoted three pages of illustrations (two in colour) to the penis, with the clitoris relegated to an inset image in an upper corner - and the entire structure is the worst shade of puce. It's also called a "miniature penis."
Before we had microscopes and testing, before we had X-rays or other imaging, we struggled to make real medical diagnoses. And of course, without knowing what is actually wrong, it is hard to prescribe the right therapy.
As women were denied an education and, because of social mores, could not get an exam from a male physician, they often had to make do with female healers, who likely did the best with what they had.
I often wonder what these women would think of this modern trend of eschewing science for so-called "natural" and "ancient" remedies. I truly believe they would favour modern diagnostics and therapies such as vaccines and antibiotics as opposed to crystals and poultices. I believe they would look at anti-fungal medication for yeast and call it magic.
Undoing medical mythology is hard.
In some cases, we see or hear the misconceptions repeated so often that we believe there must be some truth to them - the "illusory truth effect" (repetition being mistaken for accuracy) is real.
Additionally, women, who have historically been dismissed by the medical establishment, have an extra incentive to distrust it and turn elsewhere for help - especially if the person they turn to is welcoming and actually listens.
So here's a list of "old wives' tales" - although some are not so old.
Apple cider vinegar to balance your vaginal pH: Vaginal pH is controlled by healthy vaginal bacteria, not food or the environment. This basic misunderstanding of the vaginal ecosystem drives a lot of misinformation, such as this apple cider vinegar scam.
Vinegar has approximately the same pH as stomach acid, so how a shot of vinegar could balance your pH, but the acid floating around in your stomach doesn't, is never explained. I mean, come on. You can't change your blood pH with food because your kidneys and lungs control blood pH, and when they don't you get very ill and die. So the idea that vinegar could impact vaginal pH is, biologically, simply absurd. What drinking apple cider vinegar will do is damage the enamel of your teeth.
Birth-control pills cause weight gain: This has been well studied, and the answer is no. This is not disbelieving women; this is the exact opposite.
This is taking what women report about weight gain and studying it.
These data really reflects doctors listening to women. Several studies have shown no link between birth-control pills and weight gain. One study even compared women who took birth-control pills with women who had a copper IUD inserted - so no exposure to hormones. Both groups gained the same amount of weight. The life situation associated with starting new contraception may be associated with weight gain, but the pill is not.
Coffee enemas (rectal!) for anything: Dear God, no. People, even some doctors, promote this to treat depression! I. Just. Can't. Even. First of all, this is a waste of good coffee. But, medically speaking, to believe coffee in your rectum could treat anything is ludicrous. I mean, why is that different from drinking it? Chasing the origin of this myth led me down a rabbit hole of epic proportions (think clandestine Facebook groups, e-mails to medical historians, museum curators digging through archives). This myth started relatively recently. The only medical reference is in the 1944 Royal Army Medical Corps training manual during the Second World War, and it was used to keep men awake. I'll say! Just don't. And run from anyone who tells you this will help.
Hormonal contraception causes "infertility": Nope, but the patriarchy trying to scare you away from controlling your reproductive health is invested in this myth. Sadly, many "natural" health proponents also capitalize on this fear as well. Whether the infertility myth is from ignorance or misinformation (many bloggers writing about reproductive health don't fact-check or have little to no science background) or intent (disinformation: Think religious reasons or someone trying to scare you away from prescription contraceptives to sell you a menstrual-cycle tracking app), you will have to ask them. With the injection, fertility can be delayed several months, but by one year, all women are back to baseline. With all other methods of contraception, once stopped or removed, you are good to go, pregnancy-wise, the next month.
Lifting your arms over your head while pregnant will cause the cord to wrap around your baby's neck: Nope.
This isn't a vagina myth, but OB/GYNs hear it all the time, so I thought I would include it. This is just not biologically possible, and if pregnancies were that fragile, we would have died out years ago. I wonder if this myth serves the patriarchal ideal of the "delicate woman" or if it is simply born out of pregnancy fears.
Parsley in the vagina: The sprig.
Stuffed up the vagina each night for three to four nights to induce a period.
Look, I don't make this stuff up, I just report on it. Apparently some people - people who are wrong - think it could stimulate uterine contractions. There is no evidence vaginal application of parsley can do that to the uterus, but even if it could, that would not make you have a period. Progesterone withdrawal causes a period, not uterine contractions. Please don't put parsley in your vagina.
Steaming the vagina: This is promoted to "cleanse" the uterus. This ties into the destructive myth that the uterus is unclean because of menstrual blood that has been used by many cultures to exclude women from society - it's a defining characteristic of the patriarchy. So this idea is promoting a patriarchal idea. Some "health" bloggers promote losing weight to the point that periods stop to prevent the accumulation of these so-called "menstrual toxins." This is harmful on so many levels.
If you are dieting to the point your periods have stopped, you may be underweight, and if that continues, you could suffer real health consequences, such as osteoporosis (thinning of the bones).
Vaginal tightening sticks: These are promoted as Japanese in origin; whether they are or not I don't know. However, Western cultures are often guilty of exoticizing other cultures, so I would be wary when a specific culture or country is used as part of a marketing strategy.
Anything offered to tighten your vagina is an astringent that will likely damage the tissue that lines the vagina, as well as the protective vaginal discharge. It is also part of the patriarchal idea that a "used" vagina stretches and is undesirable. This mythology harms women medically and emotionally, and people who promote it should be ashamed of themselves.
Yogurt for yeast infections: It doesn't contain the strains of lactobacilli that are important for vaginal health. When a woman puts yogurt in her vagina, she is putting other bacteria there, as yogurt has live cultures, and the consequences are unknown. It may feel soothing because it is cream-like, but the risks are unknown and it will be ineffective.
Zinc to increase your libido: Zinc is apparently appearing in nutraceuticals intended to increase libido. In one study, zinc supplementation made male rats thrust more during sex (sexxxy!) and generally increased their "sexual competence." However, injecting zinc directly into dog testicles contributed to subfertility. I am going to have to go with a big no on this one, as there are no studies in women - although Sexual Competence of Rats could be the name of a punk band that never made it out of their parents' basement because their first single, Thrusting, failed to chart.
Power and health are inseparably linked. You can't be an empowered patient and get the health outcomes you want with inaccurate information and halftruths. Even if the information is correct, you also can't be empowered when the person or source informing you is making you feel bad or is not listening to your concerns.
When, in the past, I have come out against the misinformation presented to women, I have been attacked for diminishing the choices available to them.
But to me, the idea that women can take away what serves them from the morass of half-truths and lies about their bodies is the greatest perversion of choice. True choice - the ability to analyze information and make personal risk-benefit assessments based on it - requires facts.
And it is this quest to supply women with the facts that keeps me up at night. It is why I keep fighting.
I want every woman to have the power that comes with knowing how her body works and knowing how to look for help when her body may not be working as she hoped it would. I want all women to know when there is bias and medical subterfuge, when there are lies and when the patriarchy is just invested in keeping them frightened about their own normal (and, I might add, glorious) bodily functions.
The patriarchy and snake oil have had a good run, but I'm done with how they negatively affect women's health.
So I am not going to stop swinging my bat until everyone has the tools to be an empowered patient and until those who seek to subjugate women through enforced ignorance have shut up and taken a seat in the back of the class.
That's my vagenda.
Obsessions with reproductive-tract purity and cleansing date back to a time when a woman's worth was measured by her virginity.
Today, physicians and sex educators can print out accurate 3-D models of the clitoris, but for much of medical history no one had a clear idea what it looked like.
Zinc: Great for your rock collection, not so much for your libido.
You can't change your vaginal pH with vinegar, or any other food product.
Parsley will not help you induce a period.
PAUL J. RICHARDS/GETTY IMAGES