JOURNALIST Rachel E. Gross was working as the science editor at when she developed an 鈥渙bnoxious鈥� vaginal infection that set her on a mission to better understand her own body. It may have started with her genitals, but in her new book, Vagina Obscura: An anatomical voyage, Gross not only unravels many misunderstandings about the female body, but also rewrites the history of the science of gynaecology with women and LGBTQ+ researchers front and centre. She spoke to 快猫短视频 about why this matters.
Catherine de Lange: What made you want to write this book?
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Rachel E. Gross: I was doing a lot of coverage of women in the history of science. These themes kept coming up of women in scientific fields that had been left out of the conversation or blocked from attaining certain levels. And at the same time, there were all these questions about women鈥檚 bodies and bodies [of people] with a uterus and ovaries that weren鈥檛 being asked. I made the connection: the deceptively simple reason why these questions weren鈥檛 being asked was because women weren鈥檛 at the table.
How did you find these incredible stories of women who were written out of the history books?
The darkest section of the book is about and the development of the speculum. It鈥檚 well known that he was a southern slaveholder who made his advancements on the bodies of enslaved Black women. But there is a lot more to that story. I relied a lot on historians who had excavated the stories of some of those women, namely Betsy, Lucy and Anarcha. Deirdre Cooper Owens is the historian who spearheaded the argument that these women, and others, became surgical assistants who ended up knowing as much about fistulas (openings between the walls of the bladder and the vagina that can occur after a long or obstructed childbirth) as any doctor. They gained all this medical knowledge and potentially went back and used it to help their own communities. That was just such a paradigm shift for me.
I was shocked to read about experiments in the 1950s that involved transplanting microbiomes of people with vaginal infections into pregnant women, and other examples in which the female body was seen as available for people to do what they want with. Do you feel optimistic that this is changing?
A lot of the history of gynaecology is a history of experimentation on vulnerable populations. But I think that this growing awareness about the importance of true medical consent, and about these vast gender disparities that have happened throughout history, is changing things. The experiment you refer to was performed by a well-known bacteriologist, Herman Gardner, in Texas, who did the first experiments on what we now call bacterial vaginosis. He transplanted fluid from women who had infections into women who didn鈥檛 鈥� many of whom were pregnant, many of whom ended up infecting their husbands. And there鈥檚 no documentation of any meaningful consent involved. But then I spoke to scientists who are now trying to do the first vaginal microbiome transplants in order to help people who have recurrent vaginal infections. They were aware of that history and reacting to it by being extra careful and transparent and taking a long time to find the right subjects and have them be completely informed. I think it has made a lot of researchers more careful.
Speaking of microbiomes, I was interested to learn that humans have a vaginal microbiome that seems to be completely different from those of other animals. Why is that?
Human beings are the only animals that have Lactobacillus-dominated microbiomes with certain traits that are really important for protection. I think of it as this semipermeable membrane protecting this space between you and not-you. People have called it an army, but I really love the metaphor of a garden, with a specific ecosystem of flowers and plants. There might be a few new plants or weeds in the mix, but, overall, you have the right balance to be healthy.
One theory of why we have this ecosystem is that when nomadic humans settled down and started fermenting food, that fermentation was created by lactobacilli. It seems that these bacteria got into the vagina and set up a home and it was a really good environment for them. Over time, they could have co-evolved with us to make this their primary niche. Now, there is a personal protective ecosystem down there. There are a lot of things that make us human, but one thing is our vaginal microbiomes.
Vaginal microbiome transplants are a hot area of research right now. Are they about to take off?
Unlike many of the lethal diseases we treat with faecal transplants, such as C. difficile infection, the imbalances in the vaginal microbiome are not deadly. They mostly affect quality of life, sexuality and relationships. Yet researchers in this field told me that鈥檚 not something that funding bodies care about as much. I kept getting this really sad answer: that women鈥檚 quality of life doesn鈥檛 matter enough to prioritise this type of work. So, the short answer is that I hope this will take off, but it may be a while before we get past these biases.
When thinking about some of the roles of the female sexual organs other than reproduction, animals can teach us a lot, can鈥檛 they?
Yes. The real chapter where I got into animals was the vagina chapter, which was surprising to me because it started out as a book on the science of vaginas, so I thought that this would be a central human chapter. But there was so little research on what is happening to the vagina and vulva during different stages of a person鈥檚 life. Really basic stuff wasn鈥檛 there, like the shape and size of most vaginas, or how the vagina and surrounding organs bounce back after a vaginal birth. So I resorted to animal research. I followed an incredible evolutionary biologist, Patty Brennan, who is illuminating vaginas throughout the animal kingdom, starting with ducks and moving on to dolphins and snakes. Her work sheds a lot of light on why we have these gaps in knowledge in the first place, and why scientists have shown this consistent lack of curiosity about what the female reproductive tract is doing in comparison to the male.
Right, because there are all these animals that have weird penises, but no one鈥檚 asking about the vagina.
It鈥檚 so simple that it just seems like it can鈥檛 be the reality that nobody thought to look at the other half, but that鈥檚 what Brennan found. For instance, she was dissecting dolphin vaginas and she realised they have a huge clitoris that looks similar to the human clitoris 鈥� it has a similar shape, erectile tissue, large nerves and appears to be functional and pleasurable for dolphins. There are so many fascinating, wacky types of female genitals in the animal kingdom. Everyone knows about the giant hyena clitoris, but there are also bright red, swollen baboon vulvas and there are clitorises in really unexpected animals. So, some of these features are clearly not being shaped by a reproductive need, by sperm needing to get to the egg. They are being shaped by other forces, like pleasure and bonding and same-sex sexual interactions. Thinking outside the box about animal genital evolution can spur us to ask new questions about ourselves.
I think, for a lot of people, research on the clitoris seems almost frivolous. Why does all this matter?
Understanding the anatomy, vasculature and location of the clitoris is important for procedures that are really important to women鈥檚 lives. One of them is gender affirmation surgery. That surgery has really evolved over time to be more about trans women鈥檚 experience with their own bodies, rather than just making a hole for penetrative intercourse. Our new understanding of the clitoris also shows us that there is this huge subterranean network of erectile tissues beneath the surface of the vulva, and that can be important for those who have experienced genital cutting 鈥� to think of their anatomy as being whole and interconnected and that they didn鈥檛 necessarily lose something that they felt they had lost. There is also the advent of surgical restoration that tries to lift up some of the buried clitoral tissue and place it back so it is exposed. This technique relies on knowing the true anatomy and extent of this organ.
More broadly, having this knowledge can change your relationship with your body, which, in turn, changes how you communicate about your health and body to medical providers, a sexual partner or friends.
I certainly learned a lot about my body, so thanks for that! Did you learn anything about yourself?
Oh my god, yes. I mentioned that I had a really obnoxious vaginal infection that was very uncomfortable. At the time, I had all these feelings that I would end up encountering in the book again and again, of shame, and this frustrating obscurity of my own body, where even my gynaecologist didn鈥檛 know what was going on. I had previously thought that I knew a good amount about vaginas and vulvas, but discovered I had no idea what was happening in my own body. So that really got me into the burgeoning world of vaginal microbiome science, and that totally changed the way that I think about my genitals. I love to think of it as this microscopic world happening down there, and that it鈥檚 working to keep me in balance and keep me healthy. And I want to protect it. So it gave me the sense of wonder about my own body, whereas previously the messages I was getting from society and medicine were of shame, disgust and stigma.
How do we change these messages, especially for young women?
I think the first step for me was becoming aware of those biases, because many of us have that internalised shame and feelings of dirtiness. But where does it come from? Perhaps it is the way that we frame sex education for girls, which is currently more about how to avoid getting pregnant or getting diseases, whereas for boys we talk about pleasure and sexuality. In the book, I go into the origins of thinking of the egg as a passive damsel in distress and sperm as the explorer, or how the vagina is considered this passive organ and the penis as the active component. So, once you know that those biases exist, I think you can work to combat them when introducing them.
There鈥檚 also always been a lot of mystery around menstruation. If someone had talked to me about the amazing science that was happening in my body and why, I think I would have felt a lot more empowered instead of afraid. It鈥檚 not just blood, it鈥檚 stem cells and immune cells and this amazing collection of regenerative cells of the uterus, that are like leaves on a tree that are supposed to fall every season and then come back.
I feel like I have to ask about the G spot because some of 快猫短视频鈥榮 most popular articles of all time are about it. Why are people so obsessed with it?
I鈥檇 been told about the G spot in all these women鈥檚 magazines, but it never felt true to what I knew about my body. So I spoke to some anatomists instead. The answer I got from Helen O鈥機onnell, the researcher who had specifically asked whether this was a unique anatomical structure, was that yes, there is a sensitive area in the zone that is sometimes referred to as the G spot. But it鈥檚 not a magic button, it鈥檚 the root of the clitoris, where the bulbs and the arms combine and wrap around the urethra and the front wall of the vagina. There鈥檚 a lot of sensitive erectile tissue there, and so for some people, it may be associated with a different or more intense sensation. Sorry if that takes away some of the mystery, but, surprise! It鈥檚 just the clitoris.
What is the most amazing thing that you have discovered through your research?
My biggest wow was that there was more than a decade of research finding that ovaries may have the ability to make new eggs throughout a lifetime. That completely went against everything I was ever taught in reproductive biology and just sounded so far-fetched.
I ended up spending a couple of years looking into that research, spending time in the lab where it was happening and looking at the wild controversy swirling over it all, and I came away understanding that there are stem cells and regeneration in almost every part of the body. That鈥檚 happening in the ovaries as well. We don鈥檛 yet know to what extent or exactly what these stem cells are doing, but it seems absurd to assume that human beings are one of the few animals in which females don鈥檛 make new germ cells, when we have found that it is almost certainly happening in mice and fruit flies and other species.
It might not have any immediate health effect on me, a 33-year-old woman, but it changed the way I relate to my body and made me think of my ovaries less as degenerating organs that 鈥渇ail鈥�, but as hotbeds of regeneration and resilience. And that makes me happy.
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