I want to talk about how people talk about vaginas… Or, more specifically, how people have been talking about four particular vaginas over the course of the past month or so. For those of you who know me, or are familiar with my research, this will not be a surprise; after all, I write about technological advances in gynecology, so when the news broke in April that a research team at Wake Forest Baptist Medical Center's Institute for Regenerative Medicine had successfully implanted four vaginas grown in their lab from patients’ own cells, you can bet that I took notice.
Of course, so did the scientific community, the stem cell community, the blogosphere…well, you get the picture. This is not to suggest that such attention is not warranted: The implications of growing an organ—from a patient’s own cells—which can then be successfully implanted, continue to grow and develop, and pass function tests, are profound, and contain great promise for future advances in multiple fields. Indeed, there is already growing talk of what steps would be necessary in order to utilize this technology to manufacture what one article termed more “intricate” organs, like hearts and brains.
So, all in all, it’s been exciting for folks in numerous fields to watch this story unfold, and to contemplate the implications and possible future of this evolving technology. I eagerly scoured the dozen or so top stories about these vaginas online, all of which were based upon information contained in the “official” journal report of the study’s findings in the Lancet (published under the much less sexy title of “Tissue-engineered autologous vaginal organs in patients: a pilot cohort study”). Scientific sites, pop culture sites, blogs, chat rooms—my search led meeverywhere, and nothing was off-limits. I became fascinated not only with what the stories were telling me, but also with how they were relating that information. After all, vaginas had (apparently) just been made in a laboratory, successfully implanted in women, and passed function tests over an eight year period.
References in a variety of stories of “normal functioning” and anatomically correct vaginas left me with questions, and I decided to read the “official” account of these vaginas presented in the Lancet article. I was searching for an answer to a question that every single article, blog, press release, and chat room conversation that I read left me wondering: What exactly is a “normal functioning vagina”? What is the test that confirms which vaginas are normal, anatomically correct, and function as (some of these articles infer) nature intended? Who decides what is normal, and based upon what criteria, has implications that exceed the laboratory walls- especially once these criteria are written into stories that assume the authority of the scientific fields from whence they are assumed to have come.
Well, after much searching, I reached two main conclusions: 1) The self-administered Female Sexual Function Index questionnaire that was administered to the patients after implantation seemed to be the main tool being utilized to categorize normal function, and 2) This Index, and the subsequent language used to report its results, appears to privilege heterosexual, penetrative sexual intercourse as the measure of a “normal functioning” vagina. Now, make no mistake- the Lancet article also details the cellular match in the implanted organs as one of the “anatomically correct” aspects of these four vaginas, and the lubricating abilities discussed in the initial research report could be interpreted as extending beyond the self-reporting of the women’s sexual experiences (the references are a bit vague). However, the portion of the Lancet article that was repeated in every other piece written about these vaginas that I read was the ability of these four women to successfully engage in penetrative intercourse. This, apparently, is the measure of a “normal” and “anatomically correct” vagina. It is also, depending on which article you read, what makes these women “whole”, more able to live a “normal life”, and—it is implied—what makes them “normal” women.
In addition to an obsession with the ability of these vaginas to accommodate penetrative intercourse, there is intense interest in the possibility of pregnancy for the two women who have functioning uteri and ovaries. The theory is that it should be possible, but I only found one researcher who raised the question of whether or not these vaginas would be able to sustain the stretching necessary for a vaginal delivery. The overall rhetoric, however, was one of heteronormative possibility- these women were all now involved in (penetrative) sexual relationships, and many articles contain ample references to the possibility of marriage and childbirth (which I guess is not considered an option for women whose vaginas cannot accommodate penetrative sex).
Now, don’t get me wrong here—these women were suffering from a rare disorder that caused them real physical and emotional distress, and all indications from the self-reporting contained in the Lancet point to overwhelming satisfaction with the results of this procedure—and this is a very encouraging development for all women born with this rare disorder. Prior to the advent of this procedure, researchers estimated failure rates for previously available treatments for this condition as high as 73%, so even with such a small sample, the success of these vaginas is of immense importance. It is just this importance, however, that is lost in the media noise of technological breakthroughs that have the power to make women more “normal”, and more “appropriately functioning” sexual partners. I wondered, as I reviewed the questionnaire given to the women, why it was not administered before and after the procedures. While painful penetrative intercourse is generally an expected effect of an undeveloped vaginal canal, these women all had “normal” labia and clitorises, which begs the question: Since it is widely accepted knowledge that many women are able to obtain orgasm through clitoral stimulation alone, could these women achieve orgasm before they received their new vaginas? Were they satisfied with their sexual encounters without penetrative sex? And what would happen if a lesbian or an asexual patient required the procedure—what would be the measure of a “normal functioning” vagina for these women? What about for teens and/or children who undergo the procedures, and who are not sexually active? What standards are being created by the use of this questionnaire as the measure of appropriate and/or successful vaginal function? Who will be able to meet these standards- and who will fall short?
These are the questions that I would encourage all of us to consider when wading through the media blitz that attends not only this particular procedure, but scientific breakthroughs of all sorts. More importantly, these are the types of questions that I would encourage scientists and/or the authors of research studies to consider, both when formulating their studies, and when reporting on their results. The importance of this cannot be overstated, as these studies produce knowledge on multiple levels and in myriad venues. With careful—and early—consideration of what knowledge we are producing, we can make for a world with a lot more breathing room than is currently contained in ideals of “anatomically normal” and “normally functioning” that are based upon only one aspect of lived experience. At the end of the day, words matter, and we can find better ones—more inclusive ones—words that will more adequately encompass both the wide range of human experiences and the amazing possibilities of a world of more just—and precise—scientific endeavours.
Sources
http://www.sciencedaily.com/releases/2014/04/140410194326.htm;http://www.bbc.com/news/health-26885335
http://download.thelancet.com/pdfs/journals/lancet/PIIS0140673614605420.pdf?id=aaahJYbgqPxVl8eOHNgzu
