The (Vagina) Chip on My Shoulder
I feel there is something unexplored about women that only a woman can explore. –Georgia O’Keefe.
A female MD recently posted that her male PhD engineer friend couldn’t understand how a woman could pee if she had a tampon in. Hers was a cautionary tale on why men, perhaps, should not be passing laws about women’s bodies. She certainly raises a good point.
I possess two early 20th century medical dictionaries. In both, a page and a half are devoted to vaccines and vaccinations. The vagina, however, is described only as a canal from the inner portion of the female body to the outer, with subsequent, paltry information on the various sexual and other diseases one could find in this passageway. Neither dictionary outlines why we have this wondrous route between cervix and vulva or highlights the fact that the vaginal walls can stretch to such a capacity, a bowling bowl could be passed.
Several studies highlight that this bias toward women in medical textbooks exists to this day. The pictures on the female reproductive anatomy prove to be simplistic, geared toward socially constructed norms, and lack diversity. As a result, female anatomy is unfavorably visualized as necessary for reproduction and childbearing only. Moreover, the pictures on anatomical differentiation aside, only about 30 percent of the 4,000 gendered images in the medical books reviewed were presented as female.
Sex and gender biases in anatomy can result in key misconceptions about clinically relevant issues. For example, the vagina’s elasticity and recoil are so immediate, that soon after childbirth (OK, I said passing a bowling ball), said tampon can be inserted and remain secure in the body until manually removed.
Besides childbirth, the vagina plays a key role in sexual pleasure, menstruation, and pregnancy. The vaginal walls are multilayered, which provides that structure and elasticity. Fluids are secreted, providing a moist and lubricated environment. The vagina can also absorb substances and is used as a gateway in medical treatment.
The vagina is host to a variety of bacteria and fungi that keep it healthy. In addition, it is subject to hormonal changes which changes the anatomy and blood supply to the structure, as well as potentially disrupts the delicate microbiome within the vagina. This disruption can lead to a variety of bacterial and fungal infections. In addition, as a corridor used during sexual stimulation, the vagina is vulnerable to developing sexually transmitted infections and cancer.
The reproductive health of women is strongly linked to the vagina’s delicate microbiome. However, researching this microbiome has historically proven problematic. First, women historically have been significantly underrepresented in research studies. This is particularly true for reproductive health research. Even without this bias, however, studying the vaginal microbiome is not easy. These human flora and fauna are not reproducible in animal subjects; hence, cannot be readily researched in laboratory settings.
Recently, however, researchers at Harvard University’s Wyss Institute for Biologically Inspired Engineering have developed the Vagina Chip, a pre-clinical model of the human vaginal mucosa. The chip is an inch-long, rectangular case containing live donor human vaginal tissue and a flow of estrogen-carrying material to simulate vaginal mucus.
Organs-on-a-chip like these mimic bodily functions and are already in use to study other hard to research areas, such as the gut biome and lung tissue. Using the chip, scientists can manipulate the environment and have already shown that certain bacterial growth favors a healthier vaginal microbiome. The researchers hope as well to evaluate the safety and efficacy of biotherapeutic products in a safer, more controlled environment.
The initial medical community response to the chip’s announcement has been positive, touting the breakthrough as bringing women’s reproductive health into modern times using cutting edge technology. Critics note, however, that like all organs-on-a-chip, not all biological and hormonal interactions can be replicated. And the chip is a stand-alone product, meaning other bodily functions that may contribute to vaginal health cannot be studied. That said, even if the vagina chip requires more development, its creators are confident its use will normalize reproductive research.
While the poor male PhD engineer may have been ignorant of the female anatomy, his plight is not relegated to his sex. Historically, a woman’s body was her best survival tool in patriarchal societies. A woman’s appearance and health are still heavily influenced by social and cultural values. In turn, these influences restrict notions of selfhood and women make decisions based on social and cultural demands.
Multiple studies reinforce this constant dissatisfaction with body image. Research has shown that around 50 percent of 13-year-old American girls reported being unhappy with their body, with the percentage increasing to nearly 80 percent by the time young women reached 17. Nearly 70 percent of adult women report withdrawing from activities due to their body image. A 2020 survey of 2,000 women found that 46 percent could not identify the cervix, one in four could not identify the vagina, and close to 60 percent thought the uterus was an organ outside the female reproductive apparatus. While 63 percent could correctly identify why females menstruate, over half expressed confusion on why females go through menopause.
For these perceptions to change, women must first become comfortable with the mortal coil within which they inhabit. To this day, I remember the scene in Fried Green Tomatoes where the group is asked to take charge of themselves by sitting down with a mirror and visually inspecting their vulva and anus. Perhaps as a less stark introduction, however, may I suggest walking through a Georgia O’Keeffe exhibit. You’ll get the picture. ▼
Sharon A. Morgan is a retired advanced practice nurse with over 30 years of clinical and healthcare policy background.