“There comes a time in every woman’s life when she sees herself as medicine has seen her: a mystery. An enigma. A black box that, for some reason, no one has managed to get inside.”
—Rachel E. Gross
Ten years ago, I went to see my ob-gyn, complaining of pain with sex. A pelvic examination revealed nothing. “Everything looks okay down there,” she said from her three-legged stool, adding that she would order a pelvic ultrasound. She paused a moment, then uttered words that would haunt me.
“Pelvic pain is the black box of gynecology.”
A decade on, no one has completely cracked the black box of my pain. At least now I have a diagnosis: pudendal neuralgia (PN), or chronic pain of a pelvic nerve, brought on by long-distance cycling. It took months, and a trip to a knowledgeable physical therapist, to learn I had PN. My ob-gyn’s words were prophetic. She couldn’t figure out what was wrong with me, and while I finally found a doctor who helped relieve my symptoms, he retired at the end of 2018, and I’ve struggled with pain flares ever since.
Rachel E. Gross opens her debut book Vagina Obscura: An Anatomical Voyage with a vaginal complaint that, like mine, eluded gynecological knowledge. Back in 2018, she was diagnosed with an infection that persisted through one antifungal treatment and two rounds of antibiotics. Finally, her doctor prescribed a treatment that was “basically rat poison” (these were her doctor’s actual words). Gross dutifully inserted the medication vaginally until, in a middle-of-the-night stupor, she unthinkingly swallowed a suppository and ended up in the ER.
Like me, Gross had stumbled into what she calls a “black box” moment. “There comes a time in every woman’s life,” Gross writes, when “she sees herself as medicine has seen her: a mystery. An enigma. A black box that, for some reason, no one has managed to get inside.”
Luckily, as an online science editor for Smithsonian Magazine, Gross was poised to, if not crack every secret, certainly explore female anatomy’s many “mysteries.” Across eight chapters with titles like, “Desire (Glans Clitoris),” “Power (Ovaries)” and “Beauty (Neovagina),” Gross takes us on a journey around the female body, elaborating both on what science knows, and what it doesn’t: It wasn’t until 1993 that a federal mandate required researchers to include women and minorities in clinical research.
Gross recently spoke to me by phone from her home in Brooklyn. Thoughtful and erudite, she talked about the female and LGBT researchers who’ve made scientific inroads against the odds, the myth that the “clitoral” and “vaginal” orgasms are distinct from each other, a princess who relocated her clitoris, koala vaginas and much more.
Carli Cutchin: Let’s talk about why you wrote Vagina Obscura. What gaps in awareness and knowledge did you see, and how does the book address them?
Rachel Gross: The introduction maybe gave the impression my own vaginal infection was the impetus. It was more of a crystalizing moment. At that point, I’d been the online science editor at Smithsonian Magazine for two years. I’d expanded their coverage of women in science and, separately, reproductive biology. We would do stories like the history of the modern IUD and how medical schools are developing a “robotic” vagina for medical training. Then I helped launch this column on unsung women in science—how they transformed their fields and the systemic hurdles they faced.
I started realizing there was an intersection between these two types of coverage. For a long time, women and LGBT scientists had been marginalized. They hadn’t been the ones asking questions. This marginalization of women and other gender minorities from science, I began to see, was closely tied to the marginalization of women’s bodies from science. I wanted to spotlight the factors leading to why these particular areas of the human body were misunderstood and understudied. [Vagina Obscura] tries to chronicle the people who did ask these groundbreaking questions, and the challenges they faced.
For a long time, women and LGBT scientists had been marginalized. They hadn’t been the ones asking questions. This marginalization of women and other gender minorities from science, I began to see, was closely tied to the marginalization of women’s bodies from science.
Cutchin: The first chapter, “Desire (Glans Clitoris)” tells of Marie Bonaparte, who went to great lengths to achieve a “vaginal orgasm,” which Sigmund Freud had recently deemed the pinnacle of properly feminine pleasure—though, unlike Freud, Marie believed anatomy and not psychology was keeping her from vaginal climax. What drew you to Marie’s story?
Gross: Marie Bonaparte is a figure with such a particular lens. She’s a noblewoman, the great-grandniece of Napoleon. She grows up in interwar France and really wants to be a doctor but is thwarted in that ambition because she has to “marry rich” and do what’s expected of her station. She ends up becoming besties with Freud—becoming his pupil, challenging him on some of his core beliefs about female sexuality, then personally acting on [her] theories. She develops an experimental surgery to literally relocate her clitoris so she could experience what Freud had deemed the “vaginal orgasm.”
[Spoiler alert: The surgery didn’t produce the desired results.]
She’s such a complex woman who clearly had original ideas, is fearless about pursuing them in both her personal and professional life and surmounts a lot of obstacles to do medical research and get it published in peer-reviewed journals under a male surname. At the same time, she’s an incredibly privileged woman who has access to resources that few people could dream of: to Freud himself, to ob-gyn offices, and to women she ends up interviewing across the world.
She also has some very problematic ideas about race—[ideas] that she’s not alone in having in her time, but are limited and backward. She’s one of these complex figures from history. Her story is worth telling because it shows how Freud’s theories trickled down to women’s actual relationship with their bodies, but she was also someone I wanted to be careful not to heroize. And this is the case with most of these historical figures, including women scientists. They are going to be fascinating and flawed and often contradictory.
Cutchin: In fact, Marie Bonaparte and Freud were wrong about the female orgasm, as you relate in Chapter 2. There’s really no distinction between clitoral and vaginal orgasms, because, as Helen O’Connell, a groundbreaking Australian urologist, points out, the clitoris is not a single organ but a “cluster of erectile tissues” that hug the vagina and urethra. During vaginal penetration, sensation actually comes from the stimulation of the clitoris through vaginal walls.
I have to say I was stunned when I read this, and I’ve been telling anyone who will listen about it ever since. How might this information change the way people with vaginas approach sexuality and pleasure?
Gross: I hesitate to give advice; I’m not a sex therapist. I would in hope in some ways it doesn’t change what people are doing, which is hopefully exploring their bodies with curiosity, finding what works for them in terms of sexuality and pleasure and orgasm.
What I took away from that research was that our conception of our own bodies—those of us who identify as women—could look very different. I found that from the Greeks to Freud, there’s been this strong tendency to divide up female genitals into separate parts.
There’s this pattern where people are always trying to say, “Oh, these bulbs? They’re not part of the clitoris. We’ll just call them blubs of the vestibule.” “Oh, their purpose is to squeeze the penis.” And then of course Freud separated out the “vaginal orgasm” from the “clitoral orgasm” with zero scientific evidence. It all seems to be part of this pattern of splitting up our bodies into disparate parts.
After doing this research, and talking a lot to Dr. Helen O’Connell, I took away that we were a lot more interconnected and whole than we were made out to be. The body parts we’re talking about all work together so intimately. They’re interconnected in their blood supply and their nerves, and in the sensations that they give us.
I liked [O’Connell’s] use of the word “clitoral complex” because it shows that all these tissues are intimately tied together in their fates, and physically incredibly close and touching. So there’s no such thing as an either/or framework here. There’s no, “Either you have this type of orgasm or this type of orgasm.” You can frame it that way: You can frame, like, a G-spot orgasm or a clitoral orgasm, but I think it does us a disservice. I personally appreciate having a more whole and interconnected view of my body. It feels less alienating to me than cordoning off different body parts and sexual experiences in the way that a lot of these male thinkers have done.
From the Greeks to Freud, there’s been this strong tendency to divide up female genitals into separate parts. The body parts we’re talking about all work together so intimately. They’re interconnected in their blood supply and their nerves, and in the sensations that they give us.
Cutchin: Biologists like Dr. Patty Brennan are mapping non-human genitalia and finding that animal vaginas are more “complex and variable” that anyone believed. Some details from Vagina Obscura made me laugh out loud. For example: that female dolphins masturbate by rubbing their clitorises against sand, other dolphins, and eels. Do you have a favorite animal genitalia?
Gross: I love koala vaginas! I was so blown away when I learned they have three vaginas. They have two on the outside and one that goes down the middle. The ones on the outside are where conception and insemination happen. And when they eject the joey into the pouch, that’s through the middle tube. Koalas can be pregnant always—pretty much forever. They often have a joey in the pouch, and then there’s another one gestating that will pop into the pouch as soon as the other one climbs onto their back. So koala mothers are often very fatigued. It takes quite a lot out of them.
The koala vagina illustrates what a beautiful multi-tasker the human vagina is. We’re doing it all—sex, reproduction, childbirth, protection against disease. Get you a tube that does it all.
Cutchin: Tell me about the “Father of Modern Gynecology,” James Marion Sims, a Southern slaveholder and doctor. When you say that the history of gynecology is intertwined with that of slavery, what do you mean?
Gross: You can’t separate the origins of modern gynecology from the history of slavery. Sims is credited with developing the vaginal speculum. He helped put American gynecology on the map globally. He also did his research on enslaved women, who we cannot say gave any form of true consent. They went through incredible pain and suffering at his hands.
Thanks to dogged historians, we now know the names of three of them: Lucy, Betsy and Anarcha. There’s been a really important effort to write them back into a history they were integrally a part of. In her book ‘Medical Bondage: Race, Gender, and the Origins of American Gynecology,’ Deirdre Cooper Owens showed that Lucy, Betsy and Anarcha were active participants in gynecology; they were serving as Sims’s surgical assistants. They were trained and working medically, and probably knew more about fistula [an abnormal opening between the vagina and bladder or rectum, which Sims was trying to treat] than any doctor at the time.
This history is important because so many advances in gynecology since then have come at the expense of vulnerable populations: the Tuskegee syphilis experiments [in which life-saving treatment was deliberately withheld from Black male subjects] and the contraception pill trials in Puerto Rico [in which women, who tended to be poor and lacking in education, were not adequately informed of potential side effects] are some of the most well-known, but there are so many more involving gray areas. Being aware that gynecology suffers from this history of ethical breeches should make scientists more cautious and thoughtful when they design experiments today.
Lucy, Betsy and Anarcha were active participants in gynecology; they were serving as Sims’s surgical assistants. They were trained and working medically, and probably knew more about fistula [an abnormal opening between the vagina and bladder or rectum, which Sims was trying to treat] than any doctor at the time.
Cutchin: If the medical establishment could take one or two lessons from Vagina Obscura, what do you hope they would be?
Gross: I don’t know that I wrote it for the medical establishment. I can make observations and see limitations as an outsider, but I didn’t write it as if I was going to give them a lesson. The takeaway for me was that patients are quite often experts in their own experience and their own reality. There’s a strong history of doctors not listening to them, or of trusting an outdated authority more than the people sitting in front of them.
But I do think there’s a broader lesson here for any researcher. There are so many fascinating avenues to explore and basic questions to answer, and we can only see these if we have different types of people asking questions. The book always comes back to this. It’s not only that more diversity equals better science, although that is also true. It’s that by shutting out whole groups of people from the enterprise of science—women and LBGT researchers, and patients, for example—we’ve missed fundamental questions and entire parts of the human body. That is such a huge loss, which is now finally being rectified. That’s really hopeful. But let’s try to do this more actively in the future.
Up next:
