Vaginas and Friends

Quinn:

We have ignored vaginas for a very long time. Hear me out. On the one hand, history and popular culture from God Kings to love songs to movies to fan fiction are littered with stories of men with a single pursuit, intercourse with a vagina. But along the way, these same men have pigeonholed women and their vaginas into simple vehicles for heterosexual sex or reproduction. They have ignored almost everything else in that area and shamed women for even considering pleasuring themselves or pleasure at all, for getting sick, for failing to carry a child and more.

Quinn:

This ignorance touches everything from the law to culture and music videos, to racism, to medicine and psychotherapy. We've studied penises six ways from Sunday while completely ignoring their heterosexual reproductive counterpart. Now on the one hand, we've come a long way from women being outlawed from having an orgasm with anyone but their husband in the missionary position. And it better be a vaginal orgasm because what else is there? But on the other hand, maybe not. Sex ed is under attack. Birth control is under attack. Reproductive rights are under attack. Trans rights are under attack.

Quinn:

There's simply never been a better or more consequential time to understand how and why the vagina works every day, not just on sex day, or during menstruation or menopause, to understand what lies is beneath and how incredible the whole thing can be. And how different one person's setup can be from another. My guest today is Rachel E. Gross. Rachel is an award-winning science journalist based in Brooklyn whose writing has appeared in the New York Times, the Atlantic, National Geographic, WIRED, New Scientist, Slate, Undark, and NPR among others. Rachel covers the debates and personalities that shape scientific knowledge. Most recently, as digital science editor for Smithsonian Magazine. She's a skilled and experienced speaker and moderator, and she's won the award for excellence in religion reporting, a Wilbur Award for best online story, and was a finalist for the online journalism award in digital storytelling.

Quinn:

In 2016, which feels like 1,000 years ago, Rachel launched a series at Smithsonian to uncover the stories of women scientists who were written out of history. And she now tells these stories as a columnist for the BBC Future series Missed Genius. In 2016, she also traveled to Germany and Poland as a journalism fellow at the FASPE program for the study of professional ethics at Auschwitz. In 2018 and 2019, she was a night science journalism fellow at MIT where she studied reproductive biology, gender, and history of science. And in 2019, Rachel received a MacDowell Fellowship to complete research and reporting for her new book, Vagina Obscura: An Anatomical Voyage. Ed Yong said of her new book, "Through her seamless storytelling and meticulous research, Rachel Gross shows how long we have misunderstood the bodies of half the people who have ever lived, how much we still have to learn, and how wondrous and rewarding that quest can be. Vagina Obscura is science writing at its finest, revelatory, wry, consequential, necessary, and incredibly hard to put down."

Quinn:

I couldn't agree more, and that is why we're here today to talk with Rachel about vaginas. To be more inclusive, we're here to talk about, as Rachel puts it, vaginas and their friends because there's so much more to the vagina and her friends than you could possibly know. And that's just the thing. From the microbiome to the clitoris, we're learning new things every day about a hugely meaningful and ignored part of 50% of our species. Improving women's health, sex lives, reproductive health, and more is among our most necessary tasks. And so I'm thankful Rachel wrote this book and took the time to have a conversation with me about it. Rachel, welcome to the show.

Rachel E Gross:

Thank you so much for having me, Quinn.

Quinn:

You're very welcome. I am so excited to have this convo today and have you with us. Your book is tremendously informative and entertaining and provocative, and such a wonderful path forward. We're on the cusp of just discovering so much incredible stuff that we should have done a long time ago, but there's no time like the present.

Rachel E Gross:

Exactly.

Quinn:

So excited. Rachel, we like to start with one important question to set the tone for this. Which is, instead of, hey Rachel, what's your entire life story, I like to ask why are you vital to the survival of the species? And I encourage you to be bold and honest. You're here for a reason.

Rachel E Gross:

Okay. I found in writing this book, Vagina Obscura, that I was asking a lot of questions that nobody wanted to ask and nobody wanted to answer. Just very frank questions about genitals and reproductive organs, and why we don't know anything about them, and whether sexist and racist forces have something to do with that. And I do think that I brought some sort of audacity or just ability to ask uncomfortable questions to this topic. Which kind of made it very clear that prudishness and social forces and shame and stigma were really playing a strong role in the science and why we are where we are. Call that what you want, shamelessness, something to do with my last name being Gross, having written about animal sex for 10 years, but I really enjoy, not putting people on the spot, but asking those kind of questions that nobody wants to talk about.

Quinn:

I love that. I'm so glad you did it. And I'm so glad you have the self-awareness after a decade of writing about animal sex to know that this is among, I imagine, your many superpowers.

Rachel E Gross:

Yeah, you have to embrace what you got.

Quinn:

I love it. I love it. So I want to get into the racism and the sexism and the history and the doctors and the scientists, and all of that. But first I want to talk about duck vaginas. Because I got to tell you, I mean, you lead with the duck penis as a mystery show. Who can know? But duck vaginas. I mean, holy shit. We've got this lake behind our house, right? So I have heard and I kind of grew up in the forest, like that duck sex is maybe not the most casual, relaxing sex of the list.

Rachel E Gross:

No, it's not great.

Quinn:

I mean, I think we can all say sex for any animal in a pool or a hot tub or a lake, also overrated. But this is all what makes so fascinating to me. Your prose describing the duck vagina is incredible. This labyrinth of booby traps and clearly evolution at work was just the most incredible. I imagine you found this research and was like, oh my God. I have to do this. Can you tell me a little bit about first, if you can describe to people how a duck vagina works, and then further why you decided to really focus on this?

Rachel E Gross:

Yes, I would love to. I mean, there were a lot of memes a few years ago about duck penises, and how there were these horrifying corkscrew like unfurling things. And there's a lot of attention on this. And like, as I said, because I do animal sex stuff, this was in my face. And so I did always wonder what's going on with co-evolution with both halves of this equation, if you will. And so yeah, in researching this book, I found this incredible biologist, Patty Brennan, who her claim to fame was the duck penis and the duck vagina. She was the only one in her field to say, "Nobody's looked at the female side of things. If everyone's so impressed by this member on the male side, then there has to be an equally complicated thing going on on the female side."

Rachel E Gross:

And so she was the first person to fully dissect out the duck vagina, which is a very difficult task. She described it as like unwrapping a present, just like pulling little tiny micro layers of skin away until you reveal the shape, like David in the block of marble. And yeah, a labyrinth is a good way to put it. It basically is a twisting, turning, spiraling structure that's very strategically made. It has dead ends and pockets where sperm go to die. And it appears that somehow the female duck can in some way control which semen gets to her ovaries and fertilizes her. Or rather gets to the egg. She's able to pocket away sperm. And if it was a mating that she didn't want, or a male that she didn't want to sire her kids, she can prevent that, minus all the anthropomorphizing.

Quinn:

Of course.

Rachel E Gross:

So that's the duck vagina. And the reason actually that I ended up doing a whole chapter on that was because I couldn't find enough about human vaginas. So this book is not that animal heavy. And I really thought that this would be an easy chapter to do because the book was called Vagina Obscura, and vaginas were quite central to what we were talking about. But every time I had a very basic question about human vaginas, there was no data on it. So how does the vagina change through puberty and childbirth and after childbirth, and what is the range of vaginal sizes and shapes, which could be very important for medical devices and IUDs. And no one had really done that work. I did find a retired anatomy teacher who tried to do molds using dental latex of women's vaginas, willing participants. And she was kind of laughed off her campus. And her work didn't get funding, and she was never able to complete that. So I really sort of resorted to looking at animals to get at the questions I was asking.

Quinn:

Well, I love that. And you spend an enormous amount of time, not just talking about human vaginas, but also how we have come to understand them or purposefully ignored them, or just use them as a vehicle for children. But I did think that chapter was so emblematic when you talk briefly about whale and dolphin vaginas, and the dolphin clitoris. And dolphins, who are probably smarter than us, mate for fun. And we have examples in the masturbating in the bonobos with this huge front facing clitoris that may be for same sex intercourse. It's such a great overall example of maybe we don't know what the fuck we're talking about here. And maybe it's way more complicated than we think, because look at all of this shit, and this is what we barely know.

Rachel E Gross:

I'm so glad that you noticed that. That was one of my favorite passages to think about. There are so many theories for why the human clitoris evolved and why it is where it is. I actually find some of them kind of uninteresting because people always try to directly say, "There must be a role in reproduction. There must be a role, like sperm uptake and stuff." When there's not really any data for that. But basically it just made it really clear. If you center pleasure or bonds between the same sexes, and just anything except reproduction, you get all these different hypotheses and different answers and different forces at play. There's so many more interesting questions out there if we just stop asking the same old tired ones.

Quinn:

Yeah. I love it. And again, thought it was so indicative of the bigger questions that most folks don't answer. Either again, because white male doctors forever, or because we're Puritan, or whatever it might be. It's wild to me. So on that note. So before we get started for real, you actually, not surprisingly considering your journalism, went to great lengths in the book to clarify who we're talking about when we talk about people who have this collection of organs and pieces, or people that some of them work and some of them don't. But who we're talking about. And I feel like your methodology, and please correct me, hang up the phone, whatever you want, if I'm wrong here, but you sort of said when we say essentially women or female in this book, we're talking about people with this anatomy. How should we define that, let's say for this conversation? How do we want to sort of set the baseline for that? Because you clearly spent a lot of time and effort trying to write this and phrase things and refer to people and body parts and processes with so much intention.

Rachel E Gross:

And accurately. Thank you for noticing that. In the book, I did say that we often use woman historically to mean people that were referred to women in Freud's time.

Quinn:

Right. That guy.

Rachel E Gross:

That guy who plays an astonishingly-

Quinn:

Didn't see that coming.

Rachel E Gross:

... large role... Yeah, me neither, honestly.

Quinn:

Holy shit.

Rachel E Gross:

I was like how did Freud get into my book? I didn't invite him here.

Quinn:

And not just in your book, throughout your book.

Rachel E Gross:

Right, right. And he shows up in every chapter. He just made himself a character and settled in. And Darwin. The anatomy stuff, I do try to be inclusive. And when it's useful and accurate to say people with vaginas, people with clitorises, because I do talk to a wide range of people, including trans women, intersex people, and non-binary people, I think it's historically where I use women as a sort of shorthand, which is not perfect, but clarity and accessibility is important. So I'll try to make it clear. I'll just add on when necessary to make it more inclusive and expansive.

Quinn:

And it's not just that it's the right thing to do, it's not just that it's far more intentionally inclusive, but I really thought about and took throughout the intentionality with which you addressed everything, not just gender and sex. But also, like we were saying offline before we started, talking about these body parts, just historically referring, thinking, studying, operating with it as a reproductive system, right? Again, going back to dolphins masturbating on rocks, right? Let's take the other 50% of the world, right? Saying a penis is just a reproductive system is wildly ignorant of like, I got to pee three times a night. It's not a reproductive system. And there's no reproducing going on in any part of that. I can promise you. There's nothing going on. But language, it matters so much. And you were so revealing about the fact that what are we doing here? Why would you just silo this?

Rachel E Gross:

Yeah. And really what I focus on is how these kind of invisible biases and assumptions end up shaping the science that gets done. And calling this the reproductive system, I'm still working on a better name, but I like to say the vagina, et al, or the vagina and friends.

Quinn:

Great.

Rachel E Gross:

Reproductive and sexual system's a little better, but it's a mouthful. But calling it the reproductive system really means that most of the funding and research and scientific questions is about reproduction, about making a baby. And it leaves out so much. It's not just that this constellation of organs is really important for sexuality. And yeah, there's some urinary stuff going on in there, but also the ovaries produce hormones that support your entire body, every system. Blood, brain ,all day, but all throughout your life, whether or not you're ever pregnant. And the uterus is regenerating every month for a lot of women. It's one of the most regenerative organs in the body. Participates with the whole immune system. The vaginal microbiome is an extension of your immune system. So these are full body fully embedded organs. And again, that shifts the frame when you start thinking about it.

Quinn:

I love that you mentioned the uterus here. Because again, it's about shifting perspective. Whether that's these invisible biases or whether it's just like, I mean, again, like the things we cover, from climate change to COVID, whatever it might be, the history of white guy doctors, professionals, lawyers, legislators, making decisions. And it's like here we are. The receipts are in. It's not super great.

Quinn:

But I thought about in early puberty and health class, and everybody okay, we're going to put on the video. Here's how menstruation works. And which is immediately after we kind of stop telling kids that babies come out of a mommy's tummy. Also not totally true, right? The point is kids kind of find out about periods. They can generally be grossed out. And it's ridiculous because you said shifting perspective, the uterus is fucking incredible. It regenerates itself. It's like the most sci-fi thing we do. But we're just like, that's gross. And we should think less of 50% of people. And you're like, well, you think it's awesome when lizards can cut off their tails and grow them back. Why would you not think that this thing that's giving you these hormones all the time and just protecting itself. And like you said, what we're starting to understand about the microbiome stuff is like, and how that's different from the stomach, why aren't we just celebrating and going holy shit.

Rachel E Gross:

Yes. I mean, I am. I'm saying holy shit. But got to get the funders and venture capitalists and the NIH on board.

Quinn:

So the history of men ignoring the clitoris is long and pretty comprehensive, which is kind of hilariously self-defeating. But I would love to know how you think about and understand why you decided to start the book, the clitoris, and sort of our history of misunderstanding it, and the incredible stories with Marie Bonaparte. And like we said, Freud, and all that. Why start there?

Rachel E Gross:

I think very early on, I did think of the structure of this book as sort of a journey to the center of the earth, journey to the center of the female body, as it were. And female is not a perfect word either. But you know what I mean in this case. So you want to start with the outside, which in my opinion is where all the fun happens, and that's the good stuff. And the clitoris, which gets two chapters actually, was an obvious place to start.

Rachel E Gross:

And once I learned this story from history about Marie Bonaparte, a noble woman and a princess of Greece and Denmark who came up with an experimental surgery to move her own clitoris in order to feel the type of vaginal pleasure that Freud instructed her to, was just so wild. It was both an example of a woman and a scientist. She published in medical journals under her male pseudonym. She interviewed hundreds of women at their gynecology exams. She did measurements of the outer genital stuff that actually a white male researcher probably could never have done.

Rachel E Gross:

So it was both the story of this really trail blazing researcher who was trying to figure out her own anatomy and realizing there was a real lack of understanding about her body, and the story of someone who was deeply affected by the psychological theories of her day and made to feel deeply inadequate. And she needed to change her basic sexual response and anatomy to fit this mold, what the culture was telling her, which was you need to orgasm during heterosexual sex with your husband, probably missionary style. So there was a lot going on there and it really allowed me to dive into the history of how those attitudes got started, and why she kind of found herself in this pressure pot of forces.

Quinn:

And I thought the historical context was so helpful and the societal context. Because like you said, there wasn't just this fully outspoken expectation that you are supposed to have a vaginal orgasm during missionary style sex only with your husband, but conversely, masturbating, no, no.

Rachel E Gross:

Infantile.

Quinn:

No sex for fun. There was no disconnection from reproduction. The entire context for understanding it is wild. And yet, like you said, she went to such great lengths to understand it and still chose to do this to herself. It's incredible.

Rachel E Gross:

She really did find this great variations in where the clitoris is, and the measurements of the vulva. And modern researchers that followed up on that and found that there were some correlations she found that were useful. So she did forge ahead within the system she was in. The other thing that struck me was I came to this with this understanding of the clitoris as this kind of deep underground empire. And I'd seen and I've made 3D models of the full clitoris shape.

Quinn:

I've seen pictures. It's incredible.

Rachel E Gross:

It's really cool. It's kind of unlike anything else. I call it a spaceship penguin.

Quinn:

It's so cool. It looks like the alien from Arrival where you're just like, oh my God.

Rachel E Gross:

Oh my God. Yes.

Quinn:

It's like it's so much bigger than you think it is. And you're like, yeah, that's the whole thing.

Rachel E Gross:

Yeah. And honestly it makes a lot of sense to those of us that have one. I kind of knew that whole shape. And so as I'm reading Marie Bonaparte's journals and her book called Female Sexuality, I'm so frustrated with her because she keeps being like, "Oh the minuscule penis, the not developed..." She thinks it is this nub that's not important. And she wants to get at the vaginal orgasm. I'm like, it's the same thing. And it's not just a nub. And you're trying to move the glands, like the top part. It's not going to get you any result that you want. Just surgery in the 1920s, not great.

Quinn:

Yeah. Any surgery. Right.

Rachel E Gross:

So her story also was just a way into how there was so much more to be uncovered. And that's what the next chapter gets into, which is this whole subterranean kingdom. And how finally as different people are entering urology and gynecology, we are learning the extent of the clitoris, and it's finally making its way into textbooks and models.

Quinn:

And again, I think that's where the context is helpful. Where you were saying with the time, and with the morality and all that, I often tell folks, one of the biggest differences between World War I and World War II is penicillin, right? For so long, the best, and it was a very effective, way of stopping an infection was to cut off your leg because it actually worked. Barbaric. And now we look back and go, oh my God, but it worked. And you have to always put yourself in that context. At the same time, not that long ago, and for a fundamental part of 50% of the species to have only understood so much, and to have misjudged and often purposefully minimized such an important part of 50% of the species up till that point, up till Helen O'Connell, who I loved learning about. It's wild. And I know we can talk about it all day. Like this is criminal. I can't believe we did this. But it's profound.

Rachel E Gross:

Well, I think that gets at the other reason why I started with this because it's just anatomy doesn't change over hundreds of years. We don't evolve that fast. Our bodies are pretty much the same. And yet the understanding of the female body changed wildly with regard to the clitoris. And it's such a great example of how culture shapes science and medicine and what we choose to emphasize or ignore or omit at any given time.

Quinn:

So the clitoris. Often described as the little hill. Turns out, not so much. Large, like you said, penguin, alien. It's incredible. Tell the folks a little bit about Helen's work, and sort of how that's been received.

Rachel E Gross:

Helen is the first female urologist in Australia. And she noticed in med school that she was getting pages upon pages of the penis and all of its nerves, and its roles in reproduction and pleasure and urination. And when it came to the clitoris, it was either not in certain diagrams, or it was described as there was one phrase that was like a failure of development or formation, and just a very small version of the penis. And there were not descriptions of things like the nerves, which turned out to be quite important when she started doing surgeries on women as a urologist, and realizing how am I going to protect their sexual function and make sure not to hurt anything if we don't know where these nerves are? Which we do know for the penis, and we ask men about their erections for prostate surgeries.

Rachel E Gross:

So she's seeing all these biases. And I think an interesting part is she ended up working at a women's health clinic later, and encountering the feminist self-help movement. And there are books like Our Bodies, Ourselves, for instance, that came out of not necessarily doctors, but feminists who examined their own bodies with speculums, and did all of this very hands on research. And they showed the clitoris as this large winged body that was full of a erectile tissue. And that underwent arousal and erection very similar to the penis, and that caught her eye. And I think she realized that between what a male anatomist had found, what was in her textbooks, and what the feminists had found, there was some sort of truth that she could uncover.

Rachel E Gross:

So she did. She did a lot of micro dissection. She used MRI imaging. Some of this had been done in the past occasionally, but she had new tools. And she went mainstream, I think, for the first time. And she showed that the clitoris was 90% at least beneath the surface. It had these bulbs that kind of hugged the vagina and these arms that flare out into the pelvis. And those are all composed of different types of erectile tissue that are pretty much the same as the columns in the penis. It's like a burrito, taco. Similar ingredients, different formation. And that is what really stunned people in 2005 with one of her very big papers. And people said like, "Oh my God, she's reimagined the shape of female pleasure." And she was called a clitoris guru and stuff.

Rachel E Gross:

It's funny because her work was huge because she really put together a lot of pieces that had been disparate. A lot of books showed that these bulbs were part of the vagina, connected to the vestibule, not part of the clitoris. Where she was like, "It's all part of the same thing. This is a unified structure. Our bodies are not just pieces floating around in space. They are a whole." And so that was a really big deal. But there are very good, very full images of the clitoris from the 1800s that show the erectile tissue. They just did not catch on.

Quinn:

It's amazing. And like you said, I mean, I hope people heard that. That was 2005. I mean, not to date myself, that's when I barely graduated college. That is not that long ago. And in annotating your wonderful book, I noticed another pinpoint, which is in 2014, the National Institute of Health finally set up a vagina and uterus study, but they put it in the childhood development group.

Rachel E Gross:

Yeah, basically. It was a whole department.

Quinn:

So close.

Rachel E Gross:

no, no. That was the idea. But I guess fortunately it's not just a study. They had department for infertility and fertility. And that was also incredible to me that the way that they categorized it was about reproduction and childbirth, but there was nothing devoted to these pelvic organs. And now they have a gynecology branch that also deals with things not to do with reproduction. But again, it's in the childhood development section. Baby steps, literally.

Quinn:

It's interesting, right? Because, so a lot of what we operate in here is not just how we got to where we are today, why we got to where we are today, but also where we are and where we might be going soon considering sort of the facts on the ground. Whether from the macro forces, but also some of the research coming out of labs and things like that, whether that's COVID, we're learning about we're doing it live, or other things. And yes, research and understanding and taboos and cultural and moral acceptance, much less embracing vagina and friends, which I think we're just going to have to make t-shirts of. Yes, it is criminally behind.

Quinn:

But at the same time, it's also this fundamentally exciting time because we're starting to really understand it for the first time, right? And to try to understand it for the first time. And I had a great conversation with Representative Lauren Underwood last year about maternal health in the US, which is a nightmare, and Black maternal health specifically and all her work there. And a conversation with Dr. Elizabeth Ruzzo, who's this geneticist who's trying to build basically a test so that women can find, people who need it, can find a birth control that doesn't immediately send them into a depressive spiral, right? Because also wildly ignored.

Quinn:

So what is interesting in, and again, those conversations coming from a place of ignorance, and again, my own family history dealing with IVF and things like that, every vagina is so different. And while there are some basic parameters that apply in most cases, it seems almost like the microbiome in the stomach. We need to really start setting the baseline that we can't just study white women's vaginas, right? We can't just pigeonhole these things. They're wildly complex once you get past the surface. Is that anywhere near accurate?

Rachel E Gross:

Yeah, absolutely. So the vaginal microbiome was one of those wildly cool things to me, like you were saying. Wow, the science is just starting, and we're learning so much about this really diverse ecosystem that we all have that's protecting us and keeping us in balance, and really operating on its own, and kind of adapting to the environment.

Rachel E Gross:

But yes, when you dig into that research, you find that a lot of the foundational work on the baseline of what a "healthy or normal vagina" is is what a often white Western woman's vagina is. And there was sort of this tacit assumption that if Black women, for instance, had a different combination of microbes, then it was a racial thing always. This is a problem in the field where there's an assumption that it's the cause is going to be sex or race. And really, I think we're very much understanding now that there's so many sociocultural factors. And that growing up with poverty, racism, not having access to the same medical care, that also shapes your body and your health.

Rachel E Gross:

So you have to be sensitive to those things, and not just say Black women, Asian women have these type of vaginas. And that can get problematic because of what is coded as healthy or normal. So essentially the answer's not easy. But definitely it's about expanding out these studies. And when we look at different populations, not automatically assuming that it's something racial or genetic, which really hearkens back to eugenics. But looking at the other factors at play and what's really different going on here. And just what those women are actually grappling with, and what's considered a problem.

Rachel E Gross:

So many women and people with vaginas are having recurrent infections that affect their sex life and their intimacy, and yes, their fertility as well. And they are bringing their complaints to doctors. And doctors are just saying, "We don't have many cures for this." I talk in the introduction about being prescribed, "rat poison" by my gynecologist for the most common vaginal infection that one in three women before menopause have had. So if we start from a place of listening to patients and people about their concerns, I think that leads us to be interested in very different things about the vaginal microbiome. It's not just about a sizing up what a X woman's vagina looks like and a healthy white woman's vagina looks like, it's about how do we get everyone to a place of not having pain and infertility concerns and recurrent infections. And it requires something different than coming up with a solution that just affects majority culture or white women.

Rachel E Gross:

I do think that what we are learning is super cool. We are learning that, for a lot of people, there's kind of these keystone species in the vagina that are different types of lactobacillus, which is similar to the bacteria in yogurt that ferments milk into yogurt. And it basically spews out a weak acid that keeps the vagina at around the pH of a glass of red wine, which I love. But it sculpts the ecosystem down there. And you have lots of other stuff too. Any vagina will have yeast, some viruses actually. And that's all totally fine. There used to be a battleground metaphor of keep out the invaders, keep it pure and sterile, which again, cultural. But no it's about a balance of species. And any garden can have some weeds and some new species. And that's fine as long as you have a general balance. These new metaphors are helping us, I think, understand what's going on there.

Quinn:

Well, it's also this idea of, I found this more applicable both in this work and also sort of, I guess, in my life and having kids and things like that, which is this the idea of if this, than what else? When I was talking with Representative Underwood, it was six, eight months ago, something like that. So a year after Beyonce shared her story of almost bleeding out with the maternal health issue, couple years after Serena Williams did the same thing lying on the bathroom floor in her room with her mom, and doctor's just not listening to her. So you've got essentially, forget their race, two of the richest, most powerful outspoken people on the planet, and it doesn't matter.

Rachel E Gross:

But you can't forget their race.

Quinn:

Right. No, no. But my point is, no, then we include it, and you go, you would think, oh, only rich people get health. They're super rich. That that didn't matter, right? They're very big names. You would think that would help. That matters. All these things contribute. And then you go, oh, well only 5% of doctors in the US are Black. And you start to go, oh, so we're not studying Black vagina and friends. We're not studying Black maternal stuff, or Black hearts or livers, or whatever it is. And it just goes. These things are so systemic.

Rachel E Gross:

Yes, absolutely. But I do think it's a bit more than the horrible statistic that 5% of doctors are Black. Like awful, but that doesn't mean that other people can't be doing this work and asking these questions. And I think a fundamental problem that I kept running into is that the white male body is considered the standard. And there's that one statistic people like to pick up on, which is in fact in 1992, the NIH finally said, "We need women and minorities to be in clinical trials." And it's like, wait, what was happening before? Why was it only white men? And there are all sorts of excuses about hormones and stuff. But the fact is if we continue to have this bias that white men can serve as an accurate representation of the whole population, then we will always consider women, Black women, to be at the periphery, to be fringe, and to be not like the main concern and not focus on them. So it's about who do you center in this work?

Quinn:

Yeah. White guys have a long history of making excuses for not doing the work. And we can do a fundamentally better job not just highlighting these things, but doing them. Either literally doing the research or medicinal or whatever, it might be clinical work themselves, or just hiring more Black doctors. If that's your job, if you're a hospital administrator, you can do that work. The point is, I think what I was trying to say is, because these things are so systemic, the kitchen sink method is the way forward, which is we can all do so much more to make these things better. So that we're actually at least studying these things more.

Rachel E Gross:

Yeah. I mean, I definitely argue that the more different perspectives and backgrounds you start getting at the medicine, the more you are covering all these kind of blind spots. But I think also just making those types of biases visible. Like, oh, the fact that we've considered a white male to be standard and ideal for most of history, it's going to be hard and take a long time to change the composition of medicine. And that needs to happen, but we can still root out these biases before then. We can say we should be on the lookout for this in future studies. And we should be more careful about designing studies. And that itself can change how we do science.

Rachel E Gross:

For instance, it was only maybe 20 years ago some epidemiologists told me that fertility studies generally did not include male partners. So female partners dealing with infertility were filling out journals every day of what they ate and how they felt. And they were trying to get to the root of the infertility problem. And doctors literally were like, "Well, men aren't going to fill out the journals. And they're not that important." So they wouldn't include them in grants. Now that looks ridiculous. And I think something similar happens with this centering one type of person for any type of reproductive health.

Quinn:

Yeah. I mean, first and foremost, it is on us to center these people so that we can help people who are having issues. Like you said, whether it's BV, which affects, correct me if I'm wrong, a third of women, right?

Rachel E Gross:

Yeah.

Quinn:

Which is just a huge number of people, clearly not just white women. But also, like you said, it's so in the science itself to have such a small group. You have to know at some point you're not getting the fullest picture of how these things operate. It's crazy.

Rachel E Gross:

Exactly. Just like we've been leaving out 50% of the population by understudying these reproductive organs we're talking about. And that doesn't just stunt research and treatment for those people. It really gives you half the picture of the science of genitals and anatomy.

Quinn:

So on that note, and I thought about this when I was riding my bike in this morning, these aren't just these systemic we're not going to study them this and this, the cultural insensitivities are so deep that the list of foreign translations for the vagina and the clitoris, and the Latin names for these things throughout, are so wild. And just a comedy writer couldn't come up with how demeaning some of these things are. So I would like to give you like 20 or 30 seconds. And if you could tell us as many, it's like a game show, but it's just revealing centuries of flagrant sexism. Like you said, Freud called woman a little creature without a penis. I'm trying to remember the German word.

Rachel E Gross:

Schamlippen. Shame lips.

Quinn:

Shame lips. I mean, it's like, what, what? Can you give us some other examples? Because again, I think it just helps to set the tone of, oh, this is how this has been considered throughout history for the West.

Rachel E Gross:

Yeah. And I think you really touched on the main theme there, which is shame. So Vesalius, who is considered the father of modern anatomy, he really did not believe the clitoris existed in healthy women. And he called it, "This new and useless part," to make fun of it, and say it was just made up. Although his colleague, his I guess rival, Colombo, called it amor veneris, the love or sweetness of Venus. So that was a nice one.

Rachel E Gross:

And I think one that I ended up writing a lot about is the word pudendum, which goes back very far, like many millennia. And it originally just meant genitals for male, female, animals. And it came to mean the vulva, and it is used in gynecology textbooks everywhere. And it means the part for which you should be ashamed. And it's not the only word like this. There was a French anatomist who dissected a human clitoris in the 1500s, that he named it, I can't speak French, but membre honteux, so the shame member. So you may be seeing a pattern. It's not just demeaning and dismissive, though it is. There's often a kind of a minimizing. It is this is a part that is inappropriate and not okay to talk about. And you can imagine how that affects everyone who has that part.

Quinn:

It's interesting. Because on the one hand, like you said, we've got the little creature without a penis, right?

Rachel E Gross:

Charming.

Quinn:

So lovely that guy. Which would seem to imply this part, it implies you are without the important parts, right?

Rachel E Gross:

Yeah. A lack.

Quinn:

Right. A lack. And then some of these descriptions, like you said, the part that's kind of a mistake, right> it's useless. It implies it's useless. But then there's this other side, the shame version, which is the worst seemingly because we do shame so well in this society. It implies that they almost knew what it's for considering the contextual, hey, you can't have an orgasm without your white husband and only missionary. It's like the big red button, like do not touch.

Rachel E Gross:

Yeah. Oh my gosh. That's so good.

Quinn:

It's interesting that there's just these three sort of different versions. You can't call it the shame lips without knowing what it does, I guess.

Rachel E Gross:

Yeah, absolutely. Right. It's like women are women because they have these specific organs that men don't, that include the uterus and the vulva. And then also these organs are bound up with shame because it's shameful and dirty to be a woman and have pleasure. Therefore it makes it like it's something ingrained or baked in, that to be a woman is to be lesser and inadequate and ashamed. And I think that's what gets a lot of people fired up, which understandably. And just the assigning any sort of moralizing terminology to a body part. I think there's a lot of work today about being like the vagina is just another body part. Kids shouldn't get in trouble for saying it. We should know how to name our anatomy. It's just basic. But the fact of the matter is historically it's not just another body part. There's so many of these attitudes that are very deeply attached to it. And I think we have to show them and make the visible, again, to strip them away.

Quinn:

It matters the language we use and what we call things. Because you still find yourself with someone like Marie Bonaparte apart who is so intelligent and thoughtful about trying to understand this, has Freud sitting on her shoulder and clearly understands what a clitoris can do so much that she's willing to have this surgery herself, right?

Rachel E Gross:

Right. Right. And in that case, in one way, she was referring to just the outer part as her clitoris. And that was a way that language was sort of obscuring the anatomical reality. But yeah, I think everyone's pretty much know what the clitoris can do, and that nobody needs a white man and missionary position to enjoy themselves and have an orgasm.

Quinn:

And nobody needs that period. We can stop there.

Rachel E Gross:

Yeah. Nobody. I really do think that language is important for both people's relationship with their own body, their relationship with their doctor. I've just heard so many stories from women about the shame and stigma that prevented them from being able to express what was going on with them, and just the active kind of dismissal or gaslighting by doctors about these issues. Like, oh, it's just vagina problems. Oh, everyone feels pain with sex.

Quinn:

Here's some antibiotics.

Rachel E Gross:

No. Have a glass of wine when you have sex. I guess maybe it's not always exactly what you meant about language, but there's a minimizing and there's a way in which this language is reflective of the larger cultural shame and stigma that hurts everyone, and including medicine and science, and people dealing with these issues, and people that want to have an empowered and accurate view of their own body.

Quinn:

We have so many listeners who are already doing incredible work and God knows what, as we like to say, on the front lines of the future, right? Founder, scientists, farmers, whatever it might be. Policy makers, journalists, artists. Everyone has a reason for why they end up doing the work they do, right? You were into it in seventh grade earth science, or a personal story, whatever it might be, a family thing.

Quinn:

And at the same time, we have a lot of folks who are younger or they've been working some corporate job, and they're trying to find some way to have an impact, whatever might be, whatever their field might be, who listen to these as a reason to try to find their way into their thing. To understand why people get in to do what they do. And to keep it, again, we've done 139 of these, but to the women we spoke about before Lauren Underwood, her best friend died from a maternal health situation. Dr. Elizabeth Ruzzo, she heavily considered suicide. You can listen to the episode, let her tell her story.

Quinn:

Again, I've seen the dark side of this. One of my best friends died from cancer, and it's made me do a lot of these things, ask big questions about what we can all do, right? I'm not happy that that happened. Just like I'm sure Elizabeth wouldn't have liked to have gone through that situation, and Lauren and everyone else. But it does matter to show that we can ask questions and go what can I do here? How can I affect things? And why do I need to keep pulling at this thread? We've skipped over a little bit, but you hinted at it. Could you tell a little bit about your story with BV and how you got here? Because you can laugh about it, but it's outrageous and probably pretty common considering the drug.

Rachel E Gross:

Yeah. I think it is really a common story, and that was the thing about it that made me want to pull at that thread, which I love that phrase. Rather than it was that kind of defining moment. I don't want to claim the kind of suffering that a lot of people have gone through, including people I talk too in the book. But I had a recurrent infection. I was the science editor at Smithsonian Magazine at the time. And I just had a burning bush. It's like had to keep itching it. It was awful. And I got prescribed I think, at first they thought it was a yeast infection, or like, all right, we know how this works. And they thought it was a UTI. And I got antibiotics. And it wasn't. It turned out to be this incredibly common thing called BV, which is really an ecosystem shift in the vagina, which I would learn. That just means it gets less acidic and has more of different types of bacteria rather than the lacto we talked about.

Rachel E Gross:

And I couldn't get rid of it. And it was lasting for a month and I was feeling dirty and ashamed and having to constantly run out of my office and go to the bathroom. And eventually my doctor said, "I don't know what to tell you. Most women, they get this, and it keeps coming back again and again. We already tried antibiotics. But there is another thing that you could try as a last resort. And it's called rat poison online. So I'm going to just tell you that now. It's actually boric acid." And it was a suppository that you put up your vagina every night and lay back and think about what you've done.

Rachel E Gross:

So I was taking that and it kind of is supposed to level out. People don't really know how it works, to be honest, but it's supposed to level out the vaginal ecosystem. Kind of kill everything in its path, and you hope that a better ecosystem grows back. Really fuzzy science there. And this is the part that is a me thing maybe that I don't know if anyone else has done this. But I woke up in the middle of the night one night and realized I hadn't done the suppository thing. And I took out this pill container. And important detail is they look exactly like antibiotics. They're these plastic capsules that have little grains in them.

Rachel E Gross:

So I wasn't thinking clearly. And it was like 3:00 AM. And I just looked at it and I swallowed it. I don't know what I was thinking. Anyways, then I freaked out, and I like sat on the toilet very hard. And I was like, oh my God, I just swallowed poison. Because literally the container said poison.

Quinn:

Rat poison.

Rachel E Gross:

Yeah. It says poison. It has a skull and cross bones on the container. And when I looked it up, which I did immediately, there was a lot of death by boric acid studies, and it said call poison control hotline. So I truly thought that I was going to, at the very least, have my stomach pumped. And I ended up in the ER still not knowing what was going to happen. The doctor an hour later told me that he actually had to call poison control as well. And then found out that you needed to take two cups in order to have a severe reaction. So I was going to be totally fine. He gave me some crackers and apple juice, and charged me like $400 I'm sure. American healthcare.

Quinn:

Different convo, but yes.

Rachel E Gross:

But yeah, exactly another conversation. But it was in that hospital I think with all those emotions raging. And going from am I going to die to everyone's laughing at me, I guess this is fine, that I had this kind of, I don't know, disassociation from self and this realization that I knew so little about my own body. I didn't know what I had been putting up there and why it would be okay to have it in my vagina, but not in my mouth.

Quinn:

Yeah. Why is that okay?

Rachel E Gross:

Yeah, actually there's a lot of similarities. A lot of mucus membranes. I mean it is okay it turned out to take one pill. I think if you stuffed two cups in your vagina, that would also be quite bad actually. Yeah. So that was just this realization of how little I knew. And I was like, and if I am someone who had a college education at Berkeley, and my mother is a doctor, and I'm working at the Smithsonian Science Section, this can't be just me. And I began to hear so many stories of women that often it was more like chronic pain, endometriosis, told to have a hysterectomy, or didn't know why they had infertility. So it was just mystery surrounding the female body. And this acting as if it was something we couldn't figure out. And each person with this anatomy kind of felt alone in their problem. That was the aha moment for me.

Quinn:

Well, I appreciate you sharing that. I don't know if that ever becomes a comfortable story to tell, but I think it does matter. Because like you said, I mean, this is something that affects a third of people. I mean people fuck up medication all the time, often with much more tragic consequences. This is why children's bottles, literally you discover as a parent, is it Tylenol, the bottle's only big enough that it can't poison a kid or something like... I can't remember what it is. Things you discover when you're just like you walk down the hall, ships pass in the night, and your wife is like, "I gave him medicine." And you're like, "Fuck, I gave him medicine too." Now poison hotline, got to check it out. And you discover like, oh, shit. But they only do that because something has happened because it happens all the time.

Quinn:

And if BV affects a third of women, you do the math. We have to share these stories. And again, that's easy for me to say, but it does matter because I think it makes people who are listening to this go again, like how can someone be so qualified and not know? And that's because we don't know because we haven't tried. And we haven't tried for a huge variety of reasons. But we have to support the people that are trying, and then the rest of us have to do a lot better.

Rachel E Gross:

Yeah. Yeah. And what kind of things are we taking seriously. If it's always going to be reproduction, infertility and fertility, which are incredibly important to so many people, then we're always going to be leaving out everything else that these organs are involved in, like pleasure, and for some chronic pain and immune function. And those things are important, and that needs to be asserted. And sometimes it feels like silly or not okay to say that because society's made us feel like this is not important or central, but it is.

Quinn:

You can keep pulling the string to cancer, to ovarian cysts, to people considering sex reassignment surgery. Of course we need to understand-

Rachel E Gross:

Gender affirmation surgery.

Quinn:

Yes. Thank you. The point is, if we don't understand, for example, the full extent of the clitoris, how can we possibly understand cancer that affects people here? Or like you said, the full extent of a hysterectomy, or any of these things. It's not just the basic surface level stuff.

Rachel E Gross:

Right. Yeah. Not just the surface level, just like the clitoris, which is not just at the surface level. The interconnectedness of our anatomy. It's not this new and useless part. It's part of your body that is related to, for many people, your identity, your pleasure, your sense of self. That's just a reality for many people, and connected to every other organ in your body.

Quinn:

Correct. I would like to talk briefly about action steps, how we can help people support you and your mission and your work. Besides buy the book from an independent bookstore, or book shop, or Libro, or your public library, Libby, everybody loves Libby. We'll put it all in the show notes. Any other, and again, you can email me later, whatever specific organizations or educational materials or things like that you think folks across the spectrum would find helpful.

Rachel E Gross:

A few come to mind. There's a really cool group that I came across. They're called Tight Lipped, and they have a podcast and a zine.

Quinn:

Fuck, that's a great name.

Rachel E Gross:

I know. Right.

Quinn:

Damn it.

Rachel E Gross:

It's so good.

Quinn:

I always, when you find something like that, I feel like you have to stop and appreciate these things and just go, oh my God. That's so good. Okay, continue. Tight Lipped.

Rachel E Gross:

It's so good. They're group of women and non-binary folks who tell stories of these issues with vulval pain, pelvic pain, and conditions and reproductive stuff that kind of is not considered appropriate to be told in general society. And they do have great educational materials and suggestions for how to talk to your doctor. They have a great website and podcast.

Rachel E Gross:

I also was thinking of interACT, which is one of the larger intersex rights groups in the country. And they are really great at educating on why it can be so harmful to enforce the gender binary literally on people's bodies. And they're working to have intersex kids, so kids that have atypical or slightly different genitals, grow up without having "normalizing" surgery, which is incredibly harmful, devastating. I think that they really help a lot of us better understand sex and gender, and how these things are not always intertwined. There's a great book called Fixing Sex by Lizzie Reis that is the history of intersex in America. And it is kind of the history of making men and women, and how society has approached that. So they're good. Definitely support your Planned Parenthood now more than ever. There are a lot of books I'd go into, but I'll stick them in the show notes.

Quinn:

Okay. Awesome. I love that. I love the idea of Tight Lipped because, again, just such a great name, one of the things we talk about, and one of my fears here is, at least in the US, is how much we have normalized things we really shouldn't. Whether it's gun violence, or climate change, or COVID deaths or long COVID, whatever it might be. But there's also such a power to normalize things in a proactive way. Like those conversations, like the personal stories that those people I assume are sharing. Because the more we say these things out loud, and one of the great climate scientists, Katherine Hayhoe. Dr. Katherine Hayhoe says, "The single best thing you can do for climate change is just talk about it." And that's how we elevate them to a place where they become more acceptable, not just to have discourse on, but to study and research and help people.

Rachel E Gross:

I love that. Yeah. And that's why I tell my vagina poison story so often. The night I swallowed my vagina poison. There is one more person doing what you just described. Sophia Wallace, she's kind of known as the Cliteracy artist. And she might be the reason you've seen the full shape of the clitoris because she started making these sculptures and kind of creating this iconography of the female genitals basically. And yeah, her point was that this is kind of this beautiful aesthetic thing in its own right. It's not weird to talk about it and say it. We should all have better cliteracy. And we should center pleasure in our lives. And I think she started a conversation and got this wave going.

Quinn:

That's awesome. I hope people, maybe you can find them an Etsy, I don't know. We'll put her in the show notes as well. This is awesome.

Rachel E Gross:

On Instagram.

Quinn:

Yeah. Yeah. Last couple questions we ask everybody, and I'm going to get you out of here, out of your cat room. Rachel, the first time in your life that you realized you or your posse, whatever it might have been, had the power of change, or the power to do something meaningful. The, oh shit, I moved people, or changed something, or won a student election, or whatever it might have been.

Rachel E Gross:

Definitely would be in journalism for me. I could go back to my college days, working at the Daily Cal, represent, at Berkeley, I was the science writer there. And then I was the education editor. But anyways, when people would come up to you and ask you about your article, and say that it got them really interested in X type of research, or it made them aware of an issue they weren't aware of. And the people in the stories, since I interviewed lots of scientists and professors, they would tell me like, "Wow, this really explained what we were trying to do really well." Or sometimes like, "You really missed this." It made it clear that people were reading all this ink on a page that you were printing every day. And that you were doing something by telling stories. That you were creating conversation, no matter how small, that made me believe in the power of journalism, which I still do honestly.

Quinn:

Hold on to that flame as long as you can. We need it.

Rachel E Gross:

I am pretty sincere about that.

Quinn:

That's awesome. I love it. Rachel, who's someone in your life that has positively impacted your work in the past six months?

Rachel E Gross:

There's so many.

Quinn:

I know. It's tragic. You can pick two.

Rachel E Gross:

No, no, I'll do the job and I'll pick one. I'm so lucky to have so many people. It was so hard to write the acknowledgements because there's too many.

Quinn:

But that's the best. How lucky are we?

Rachel E Gross:

Yeah, we are so lucky. Okay. I'm sorry to be cliche. My mom was really instrumental in this book. Not only being my mom and supportive, she's the one who's a doctor. But she was just a sounding board for every chapter. And she read the earliest work. At one point, I was really having trouble sitting down with a chapter, and she locked me in a room and took my phone. So this was during the pandemic. So I was at home for a bit. And she went on a walk with my phone. I don't know where she went. And I was able to structure the chapter.

Rachel E Gross:

But she just really sat with the frustration and the part she didn't understand of writing, that I was still learning, in a way that was incredible. And like I was very frustrating to be with. I was very annoying and just complaining about my writer's block and sitting around all day. And she wanted to be in that with me and experience it, and get inside my brain in a way that is really rare and special. And I think editors also have this relationship with their writers sometimes. Certainly my editor is a godsend, very kind and encouraging. So thank God for the people that can be inside our heads when it's honestly very hard for us to be in them.

Quinn:

Sure. Moms are the best. I mean-

Rachel E Gross:

Yeah. Also that. Yeah, I'm very lucky.

Quinn:

I had three siblings, and two of which were brothers, and then my sister at the end. As my dad likes to say, they got it right at the end. All I do now, when I see my kids causing destruction, is I just give her blanket apologies for my childhood. And she's like, "It was fine." I'm like, "Clearly not. So just like, I'm sorry. I'm sorry."

Rachel E Gross:

Every mother's day I'm like, "Thanks for popping me out of your vagina, Mom. And also shaping me into the woman I am today." She loves that.

Quinn:

Yeah. It's a lot of work. It's a lot of work.

Rachel E Gross:

In every way.

Quinn:

Last one, fun one. What's a book you've read this year that has opened your mind to a topic you hadn't considered before, or it's changed your thinking in some way? And we get a whole list up on bookshop of stuff.

Rachel E Gross:

I am halfway through Ed Yong's An Immense World.

Quinn:

I'm dying to do it.

Rachel E Gross:

Really destroyed headlines everywhere this week. I was lucky enough to have an early version of it. And so I would like sit down and read a chapter with coffee every weekend. And I expected something full of wonder and curiosity, and kind of defamiliarization which he does so well before he became the premier COVID reporter. But I was astonished at just the reframing, which I'm so interested in. Basically saying let's decenter humans and center all the variety of life on earth and how they perceive the world and their different powers of perception in ways that are honestly so difficult to even describe because we're so locked into our own viewpoint and perspective. And he really accomplishes that. He really transports you into the minds and bodies of a tree hopper. And it's just this beautiful getting you out of yourself in the most fundamental way, which is so valuable right now.

Quinn:

He is of the journalists I have spent the last two years leaning on, I have to imagine he's pretty far up there for both direct citations and also just having learned so much from him about how to interpret data and a huge swath of anecdotes and opinions and cultural stuff, and then how to translate it for people. At the same time, for his Pulitzer Prize for explanatory reporting, if you haven't read I Contain Multitudes, and if you're interested in the animal world at all, and Immense World, it's like what his powers that he applies to these books are just incredible. And it's just such a pleasure to read them. So thank you for sharing it. I'm jealous. I'm dying to do it.

Rachel E Gross:

Yeah. He's definitely been an inspiration and a big support.

Quinn:

Rachel, where can our listeners find you online? What's the place to go when your mom's not taking away your phone?

Rachel E Gross:

Please follow me on Twitter. I'm @rachelegross, R-A-C-H-E-L-E-G-R-O-S-S. And on Instagram, I'm gross_out. There's a lot of videos of me roller skating and playing with my cats there.

Quinn:

At the same time?

Rachel E Gross:

Actually there is one video of me dancing on rollers skate while holding a cat.

Quinn:

That's what we're talking.

Rachel E Gross:

I don't know if I recommend that. But yes. And you can always contact me through my website, Rachelegross.com.

Quinn:

Awesome. I am so thankful for you that you exist, and we didn't even touch on some of the other journalism of yours that I've loved around climate and faith and things like that. This is such a wonderful, instrumental book, and I hope everyone reads it and take some time to get something from it and do something about it because we can all do something about it. So thank you and thank you for your time. I really appreciate it.

Rachel E Gross:

Thank you, Quinn. Thank you so much for having me. This has been delightful and so thoughtful, which I appreciate.

Quinn:

Oh God, I hope you don't regret it. Awesome. Well thank you so much. I really appreciate it. Thanks for listening to the show. A reminder, you can send feedback or questions about this episode or some guest recommendations to me at questions@importantnotimportant.com. Links to anything we talked about today are in your show notes in your podcast player. If you want to rep any, or your shit giver status, you can find sustainable t-shirts hoodies and a variety of coffee delivery vessels in our store at importantnotimportant.com/store. You can subscribe to our critically acclaimed weekly newsletter for free at newsletter.importantnotimportant.com. Our theme music was composed by Tim Blane, the show was edited by Anthony Luciani, and the whole episode was produced by Willow Beck. We'll see you next time.