There’s a lot that scientists still don’t know about the female reproductive system. They don’t know enough about treating the most common vaginal infection, bacterial vaginosis. They don’t have good solutions for many people who suffer from endometriosis, a common and sometimes incredibly painful condition in which tissue similar to what grows in the uterus grows elsewhere in the body. They still have many questions about what menopause does to a body.
A few years ago, Rachel Gross, a scientific reporter who focuses on reproductive health, began writing a book on the mysteries of the female reproductive system. But as she delved into the research, she began to wonder what expression she was using: the phrase “female reproductive system.”
First, not everyone with the organs she examined was female. She spoke to non-binary people, intersex people, transgender people; all people for whom this anatomy was relevant and intimate.
Also, the idea that these organs—the clitoris, the vagina, even the ovaries—only played a role in reproduction began to become reductive. Of course these organs are involved in making babies, but, she says, “I found that they were doing so much different, not just sexual things, which is huge and often overlooked, but they participated in immunity and protection and regeneration.”
on inexplicable – Vox’ podcast that explores great mysteries, unanswered questions, and all the things we learn by diving into the unknown – Gross talks about one of these organs: the ovaries. She tells us a well-known story: that the ovaries are “biological clocks” that only lose eggs, without ever getting anything back. But then she walks us through new research that questions that idea, suggesting that the ovaries may be able to generate new eggs using stem cells.
And, as Gross explains, this new way of understanding and envisioning the ovaries could lead to new fertility treatments — but potentially new ways to treat some of the health effects of menopause, such as bone density loss.
In her book, Vagina Obscura: An Anatomical Journey, Gross finds many examples of metaphors such as the “ticking clock” of the ovaries, or even whole stories about various pelvic organs, which have hindered science and perhaps even prevented scientists from solving some of the big questions about these organs.
“When you study the human body, even though the human body doesn’t change, you really see what you expect to see… and you just blur the rest,” she says.
I asked Gross to go over some more examples from her book with me. What follows is our conversation, edited for clarity and length.
What is an example of an organ that we have misrepresented and misled science about?
A great example is the clitoris. It has been called a tiny phallus or an underdeveloped penis or a small lump for hundreds and hundreds of years. And science has minimized it in many ways, from literally leaving it out in anatomical textbooks to simply not studying 90 percent of it, which is below the surface.
It took a female urologist to say, “Wait, the research on the female side is a lot less rigorous than on the male side. We didn’t look at all the nerves, at the erectile bodies.”
She found that the clitoris has these roots and these bulbs that hug the vagina and swell with blood and become erectile, just like the penis. So you have the exact same erectile tissues, you have the head – or the glans clitoris – that’s the part you can see and touch. But then you also have a shaft that goes back into the body and you have spheres and a kind of arms that flow back into the pelvis. And these are all made with the same erectile tissues as the penis.
These things are super important for women undergoing surgery in this area who don’t want their nerves cut.
If you look at it [the clitoris] as a homologous organ [to the penis]you come to such a different conclusion than that it is a small phallus or a small nodule that is difficult to find.
This video takes a closer look at another misleading story that scientists have been telling for decades – this about the role the sperm and egg play in fertilization.
[At the beginning of her book, Rachel Gross describes a personal experience. She got a persistent vaginal infection, and her gynecologist recommended that she put boric acid in her vagina. The poison would kill a lot of the organisms in her vagina, including, hopefully, the one causing her problems.
Boric acid is also used as a rat poison, however, so the harshness of the treatment surprised Gross. And as she dived into the research, she realized that a new way of imagining the vagina might lead to more effective, less poisonous treatments.]
You talked about putting this boric acid pill in your vagina. Is that treatment based on an outdated story or a metaphor around the vagina that people are rethinking?
So I think there’s been a strong attitude towards the vagina of like… it has to be pure, it has to be clean, it has to be sterile. And from that you get all these vaginal cleansing products. What struck me was instead looking at the vaginal microbiome as this teeming ecosystem of protection.
What is the vaginal microbiome?
So you’ve heard of the gut microbiome, the specific bacteria that help keep digestion healthy.
Well, your vagina also has a microbiome, and it’s actually very unique to humans. It is a slightly acidic environment created mainly by bacteria called lactobacilli, but also by other bacteria, some viruses and fungi. And they all live in harmony and protect you from intruders and keep this liminal space between you and not-you healthy. It can withstand anything that comes up there, whether that’s tampons, semen, birth control, jade eggs, whatever else you put in it…like your vagina is responding, protecting you and rebalancing.
Interesting. So when you think of that space as a garden that wards off intruders, it feels like you’d rethink putting rat poison in the center of your yard.
Precisely. If you re-imagine it as a garden and it’s fine to have weeds and different species in a garden, it’s not about stripping it of life what the rat poison does. It’s about cultivating the right mix. And that has led to innovations in vaginal microbiome transplants or probiotics that could terraform the vagina. All these different ideas, it’s not clear if they will all work, but there are so many smarter and more fanciful ways to think of a healthy vagina.
So, do we know? something about our body? Or are they all stories we tell ourselves and determine the direction we take?
I think we know a lot about bodies and we use that knowledge very practically in medicine to heal them and improve things. But there is a lens of language that directs the questions we ask and what we find interesting and worthwhile. So could you swing that lens a little bit to the left, to the part that’s all blurry, and focus on that? And what would you see?
How do you swing the lens and reshape what we know about the reproductive system?
By introducing new people from new backgrounds to science and letting them ask their questions and be interested in what they are interested in. And we’ve had a similar lens for a long time.
You had people who centered the male body as something that represented something and looked at the female body as an afterthought or as something primarily involved in reproduction. That is especially the interesting difference between types of bodies. So yeah, my whole book is about how once you have new voices and people in science, the whole lens changes in really exciting ways.