What You Might Not Have Known About The Vagina

SOPHIE BUSHWICK: This is Science Friday, and I’m Sophie Bushwick.

There’s an important part of human anatomy that tends to be excluded from even the most candid discussions– the vagina. If this is something you feel uncomfortable talking about or hearing on the radio, I get it. Female anatomy has been treated in popular culture as mysterious and shameful, which is the perfect recipe for harmful misinformation.

Science Friday’s Christie Taylor talked to an author of a book that delves into the science of the vagina and its vital companion organs– the ovaries, the uterus, and the clitoris.

Christie, welcome back.

CHRISTIE TAYLOR: Hey there, Sophie.

SOPHIE BUSHWICK: So tell us all about this book.

CHRISTIE TAYLOR: Yeah, the book is Vagina Obscura: An Anatomical Voyage. And it’s by Rachel E. Gross. And it has all sorts of amazing facts from this very neglected field of research– like how uteruses are the only human organ that can heal wounds without a single scar. And that’s every single time someone menstruates.

And this isn’t even a book just about human anatomy. For instance, did you know that for many animals, such as ducks, the vagina has actually evolved to allow the female to choose which sperm, and therefore which duck, fertilizes her eggs?

SOPHIE BUSHWICK: That is super cool. What got Rachel investigating this topic in the first place?

CHRISTIE TAYLOR: Yeah, Rachel is a science journalist and an editor. She has spent a lot of time with the stories of scientists who are asking big questions. But she also noticed some things about whose questions and about what actually got explored thoroughly.

RACHEL GROSS: Whenever we would profile a female scientist who had a unique question– sometimes about female bodies and how the body works– we would see the ways in which she faced these systematic challenges, and often didn’t get to make those questions part of the canon. So I began to realize that the mystery surrounding the female body, and really the lack of research on the female body, was very intimately connected to a lack of women in science asking the questions.

CHRISTIE TAYLOR: Let’s actually pause a moment and talk about terminology, then. Because while this is definitely a book about vaginas and ovaries and uteruses, it would be inaccurate to say that this is the female reproductive system necessarily, right? So how do we talk about these things without leaving out trans men, non-binary people, and anyone else who’s invested in this biology?

RACHEL GROSS: So it’s really about how science and medicine have imagined those organs– the uterus, ovaries, vagina, clitoris. And in the past, it was very common for scientists to make this connection that anyone with those organs, particularly those with the uterus, were women. And today, obviously we know that we are also talking about intersex people and trans men and non-binary folks.

And so I wanted to both be able to say, this is how historically medicine decided to define women, and here are the effects of everyone it left out. And it often turns out that, say, trans men with endometriosis are really overlooked and get a lot worse treatment, and doctors don’t know how to handle them or ask the right questions to figure out what they’re going through. Because they just haven’t considered these bodies being associated with what they think of as a reproductive fetus.

CHRISTIE TAYLOR: When you say research has neglected these organs, you really mean neglected. There was even a long period where we didn’t think women had eggs or contributed any material to babies, even after the invention of the microscope. Tell me more about that.

RACHEL GROSS: Yeah, that was wild for me to learn. So until the 1600s, we called ovaries female testicles. Because we didn’t really know what they did. And we got microscopes in the 1600s. We had this Dutch microscopist, named Anthony van Leeuwenhoek. And the last thing he looked at was ejaculate.

He eventually said that he actually saw in each sperm an entire folded up human being. And so he surmised that this human being merely unfolded in the female body. And so the male contributed the seed and the female was the soil. And this was sort of an extension from an idea that had existed for centuries. But now it had the backing of someone who had a microscope and was a scientist.

CHRISTIE TAYLOR: And one of the recurring themes of this book is this assumption of female passivity. And in this case, I’m talking about the organs themselves. The egg is perceived as passively waiting for sperm. The vagina is perceived as this passive tunnel for copulation. But neither of these things is actually like that.

And I want to start with something that seems to be every biology nerd’s favorite story, which is duck vaginas. Can you unpack that for me?

RACHEL GROSS: I think, really, this started with a fascination with duck penises. I remember, like on YouTube, all these horrifying videos– corkscrew penises that kind of explode into the female.

In the book, I ended up talking to Patty Brennan, who is a biologist. And she basically asked, if this is happening on the male side, then what’s happening on the female side? There was an assumption that there was just nothing interesting happening in the female.

She ended up doing a really intricate– like, hours-long– dissection. And she realized that the female duck was really its own biological miracle. So it was this twisted, turning, kind of labyrinth, and there were pockets and dead ends where sperm go to die. And it looked like she might be able to exert some sort of physical autonomy over what sperm ended up fertilizing her eggs or not.

In this case, you had, again, this assumption that there was this passive female organ that’s real purpose was to interact with the male. And once you looked closer, you saw this super dynamic, complex, and totally unexpected labyrinth that was really doing a lot for the female duck, and doing things that we couldn’t even have imagined.

And similarly, when we start to look at bodies and genitals as, why did they exist in their own right, not just, why did they exist for male bodies, we start to realize that there’s so much more going on.

CHRISTIE TAYLOR: Yeah. Similarly, we found out that eggs are not just passively waiting for sperm to arrive– like their knights in shining armor is the textbook metaphor that we see. But actually the process of fertilization is a much more active chemical dialogue between the sperm and the egg.

RACHEL GROSS: The traditional story in many textbooks says that sperm are like nuclear warheads, and they know exactly where they’re going and they’re very purposeful. And they seek out the egg and they penetrate it. And really, there’s a lot more going on.

For one, the fluids in the female body– so in the vagina and the tubes– they allow the sperm to capacitate. Which makes it able to follow the chemical signals that the egg is releasing. And that’s the other thing. So the egg– we don’t fully understand it yet– but it’s putting out a call, telling the sperm where it is. And without that call, the sperm would have no idea, would just keep bumbling about, and would probably never get there.

And the egg has parts in this– like, it has kind of these little tiny tentacles on its surface that help grab the sperm and pull it in. This is a dialogue with two halves.

CHRISTIE TAYLOR: I want to move on to talking about pleasure. You mentioned the clitoris, which it has all these nicknames throughout history, about how small it is. You know, it’s like a nub. It’s a button, et cetera. Now we know it has this vast internal structure, with comparable erectile capacity to the penis. But how did researchers finally figure this out?

RACHEL GROSS: People like to say that the clitoris was fully discovered in, like, 2005. And that’s not quite true. It was discovered and rediscovered many times over the past millennium. So you can find drawings from the 1800s by German anatomists that show with pretty incredible detail these erectile bodies. So there’s two kind of like tulip bulbs that hug the vagina, and then there’s two flaring arms that go back into the pelvis. And they’re each made of different types of erectile tissue.

But what happened was that understanding of the clitoris is not what went mainstream and what caught on. So there was an Australian urologist, Helen O’Connell– she’s actually the first female urologist in all of Australia. And when she was going through medical school, she was seeing these kind of textbooks that didn’t have anything about the clitoris. Or if they did, they would use this derogatory language– like this failure to develop or the poor homologue of the penis– stuff like that.

So she wanted to figure out what was the truth that lay between these feminist interpretations and her textbooks. And the way she did that was by dissecting a lot of clitorises, and using the newer tools that were available to her. So like MRI imaging, microdissection. And when she pieced it together, she did find that there was this kind of underground kingdom, these roots of the clitoris, that made it 10 times bigger than what most people tended to think.

And one really important innovation that she had was those bulbs that I mentioned that can hug the vagina and can fill with blood, they’d been called all sorts of things. They’d been called bulbs of the vagina, bulbs of the vegetable. And a lot of male anatomists were like, oh, yeah, because they’re supposed to hug the penis and it’s supposed to give pleasure to the man.

Looking at their anatomy, they were clearly part of the clitoris. So by looking at this as one unified whole and not a bunch of disparate parts, it made it clear that this was a much larger organ that had a very important purpose– to give pleasure to the person who it was in, and that it just looked very unlike what everyone was thinking.

CHRISTIE TAYLOR: You write about researchers who want to prevent early menopause in cancer patients, surgeons who are working to restore pleasure for women who were subjected to genital cutting, or intersex people whose genitalia were altered at birth– Dr. Marci Bowers, the first transgender woman to perform gender affirmation surgeries. And you write that she’s someone who’s really working hard to change the conversation for what trans women might want from their new vaginas. Can you say more about that?

RACHEL GROSS: So trans women are really central to this book for a variety of reasons. Like, one, they are women who’ve been especially misunderstood by medicine and science. Two, those misunderstandings reveal a lot about what science thinks about women and what women are for. And three, some of this work that people like Dr. Bowers are doing to create vaginas and vulvas are really showing how remarkable these organs are and also how similar they are to what we think of as like opposite-sex genitalia.

But Dr. Bowers likes to talk about the beginnings of gender affirmation surgery. Just the entire approach in these early days was incredibly male-centric. It assumed that any trans woman was heterosexual, wanted to be in relationship with a man– usually married. And a common boast by surgeons at the time was that your husband won’t even know the difference.

So you can see who’s being centered and like who this vagina was for. And I was really struck, talking to Dr. Bowers, and when she describes the surgery that she performs, she says, first, the clitoris is central. It’s not an afterthought like it used to be. By the time you’re done, you should have sensitivity, experience pleasure, and experience orgasm.

She basically has taken this from being an afterthought to really centering the patient themselves and how they feel in their embodied self. And the whole reason that she’s able to create sensitive and functional clitoris– like this capacity– is how similar male and female bodies are. So just going back to all of those identical erectile tissues and identical structures that surgeons can utilize to turn vaginas and clitorises into penises and testicles, and vice versa.

CHRISTIE TAYLOR: Just in case you just joined us, I’m Christie Taylor. And this is Science Friday, from WNYC Studios. I’m talking to Rachel E gross, author of the book Vagina Obscura: An Anatomical Voyage.

It feels like we’re in a moment where bodily autonomy around anything perceived to be sexual or gender related is really under attack. Trans kids and teens are seeing their options for affirming health care shrink. Dozens of states no longer allow abortion. And there’s this cascade of possible other health care that is also harder to access now too. Where should this in-depth research inform the lawmakers who are outlawing some very basic freedoms at this point?

RACHEL GROSS: Yeah, it’s a dark time. What I’ve been thinking about a lot watching these kind of headlines is that this fundamental oversimplification, that bodies with uteruses are meant to reproduce and that reproduction is the sole focus of this constellation of organs, is really blinding a lot of people to the full capacity of our bodies.

So the kind of researchers that I was following around for this book are saying, what else are these organs doing for your health as a whole? How are they really deeply involved in immunity and regeneration and resilience? And how are they all interconnected in supporting your health?

If you think about what happens when you take out, say, the ovaries, you lose this powerful system of hormone production that supports your brain, your bones, your heart. Those organs aren’t just there to create a baby and to work for nine months and then just sit around. And preventing people from accessing the health care they need for these organs will ultimately affect their entire bodies and their entire lifelong health.

So I think we need to take a much broader lens as to the importance of what we think of as reproductive organs, and really value people’s sexuality and experience of their own sexuality, as well as all the ways these organs are interconnected and contribute to overall health.

CHRISTIE TAYLOR: What mysteries still remain for us to understand about the vagina and its companions?

RACHEL GROSS: Oh, my gosh, so many. The uterus is– no pun intended– really fertile ground for research that has nothing to do with reproduction. So I have a whole chapter looking at how researchers have misunderstood endometriosis, which is a super common painful disease when cells that are similar to those of the uterine lining escape into other parts of the pelvis, or even as far as like the brain, and they recapitulate this really dynamic cycle of growth and shedding that usually happens within the uterus. And it really has a lot to teach us about just universal processes of regeneration and scarless wound healing.

Because when the uterus heals itself after every period of menstruation, it’s this really neat process that we haven’t looked at as closely as we could. Similarly, we are still learning a lot about the vaginal microbiome. And we’re also learning that it has a big import and a lot to say about the penile microbiome, and that that’s actually important, too, for protection and disease transmission.

It’s not just that we have this huge gap in female health, and our understanding about bodies of those we call women. There’s this larger dialogue– what we understand about all bodies– and we’re missing a huge chunk. And therefore, our whole understanding is skewed.

So it’s like we’ve only heard one side of a telephone conversation. How can we think that the science of the human body is complete that way?

CHRISTIE TAYLOR: Rachel, I look forward to reading your next book about all of these mysteries. Thank you so much for joining us today.

RACHEL GROSS: Thank you so much for having me, Christie.

CHRISTIE TAYLOR: Rachel E. Gross is a science journalist and author of the book Vagina Obscura: An Anatomical Voyage. She joined me from New York.

And one more thing before we go. Maybe you’re ready to pick up Rachel’s book right now, but you can’t think of someone in your life who you can talk about vaginas with. Maybe you just don’t have a place to share your questions or mull over your thoughts as you’re reading.

We have covered, readers. The Sci-Fri Book Club will be reading Vagina Obscura together this September. You can find out how to join our online community, read an excerpt, and even enter to win a free book– yes, on our website– sciencefriday.com/vagina. That is sciencefriday.com/vagina. I’m Christie Taylor.

Copyright © 2022 Science Friday Initiative. All rights reserved. Science Friday transcripts are produced on a tight deadline by 3Play Media. Fidelity to the original aired/published audio or video file might vary, and text might be updated or amended in the future. For the authoritative record of Science Friday’s programming, please visit the original aired/published recording. For terms of use and more information, visit our policies pages at http://www.sciencefriday.com/about/policies/