Tuesday, December 13, 2022

The Vagina Bible by Dr. Jen Gunter, MD

Source of book: I own this


So, to begin with, I do not have a vagina, so this book may seem like a peculiar choice. However, people dear to me do in fact have vaginas, and a bit of better knowledge about them seemed like it might be useful. This book is all about medical matters, from STIs to menopause and a lot of other stuff. It also has the advantage of being science based, not woo based, which, well, I’ll talk about that a bit in this post, including in the postscript about my birth family and “alternative medicine.” 


First of all, why is it so important to have science-based information? Besides the obvious that better information is, well, better, there is also a lot of misinformation out there. 


I think it is fascinating the sources of this misinformation. Dating back to possibly the dawn of humanity, there have been a lot of really toxic beliefs about the female reproductive system. One can pretty much chalk this up to the fact that males have written the books on medicine for a long time. In other words, patriarchy. There are two facets to this. First of all, humans tend to fear what they do not understand, and for males, the female reproductive system is a mystery, hidden inside the body, and bleeding periodically. The sexual act leads to a fully formed infant in about nine months, but the process is carried out mysteriously. 


So, understandable that males might find females a bit fearsome, perhaps. But there is also the fact that females are necessary in a way that males are not for reproduction. (Technically, reproductive rate is limited by female biology - and one male could in theory be all that is necessary.) So, males have always sought to control females, and, being larger, could do so physically, then justify said control with a variety of religious, philosophical, and taboo rules. Oh, and also by the association of female stuff with dirt, disease, filth, and grossness. Hey, sound familiar. 


So, while we call them “old wives’ tales,” it seems likely that old men were every bit as responsible for them. 


What this leads to is such a plethora of harmful misinformation floating around that tends to drown out the important science-based information that women need. 


Dr. Jen Gunter is a gynecologist who wrote this book in order to put the important science-based medical information women need in one place, with citations to the research, and with tips for how to find and evaluate medical information. 


Because the book is science-based, one thing you will not hear much of is “100% success rate.” In fact, if you ever see this claim in advertising, that is a good chance the product is a total scam. Humans are complicated and diverse, and a 60% success rate is often as good as it gets for a truly successful treatment. Would it be nice if it were better? Of course. But pretending that full success exists is in itself harmful. 


Gunter addresses the various topics by giving useful information, debunking misinformation from old wives’ tales to the claims of Big Natural™ as she calls the “alternative medicine” movement, and encouraging women to understand their own bodies better. 


Obviously, trying to summarize this book would be both impossible and silly. But there were some bits that I want to highlight. 


While sex is a fairly small part of the book, Gunter does dive in there after some basic anatomical and physiological information, perhaps to try to hook the reader. (Sex sells!) What I love most about this section - which wasn’t really new information for me: I did my research using reputable sources before marriage - is this line, which would be my number one bit of advice for any couple: 


A good sexual encounter is not about optics that make a man (it’s usually a man in this scenario) feel as if he has achieved something. A good sexual encounter is about pleasure. As long as you are having an orgasm or two, who cares about anything else? 


This runs contrary to a number of advice books commonly given to young couples, particularly within the Evangelical subculture. I myself was given The Act of Marriage by Tim and Beverly LaHaye, and, while it wasn’t the absolute worst advice I received, it wasn’t particularly useful. The worst part was the insistence that the goal of sexual technique was a simultaneous orgasm through intercourse alone. Which is, simply put, not possible for most couples. Considering over 80% of women do not orgasm through intercourse alone, let alone simultaneously with a partner, this is setting couples up for disappointment and frustration. 


Gunter’s advice is far better. It doesn’t really matter how you get to an orgasm, as long as you are getting there. It is about pleasure, not optics or checking a box. Just have fun, and make sure you learn how your partner gets to orgasm, so that he or she is fulfilled. It’s so much less pressure that way. 


With those chapters out of the way, most of the book is all about health for the vagina and vulva. How to stay healthy, how to fix problems, and so on. There is a recurring theme, which I alluded to before: there are a lot of charlatans promising cures out there. Don’t believe them. Find quality peer reviewed research. Here is an example of Gunter’s approach, as applied in this case to yeast infections. 


If diet could reduce yeast infections, we would already know. A doctor selling a special diet and supplements who has never published research in the area does not have the secret answer to the question of how to reduce yeast colonization.


And don’t give me the crap of “research is expensive.” There are trillions of dollars in the supplement industry - they can afford research. They just choose not to, because research would prove their supplements were worthless. 


Gunter is plenty snarky about cleanliness. The idea that vulvas and vaginas are dirty is wrong, and also misogynistic. But our society sure pushes the idea that normal vulvas are dirty and need expensive products constantly to keep them “fresh.” 


The only parts of your body that medically need regular cleaning are your teeth and your hands. When we open doors or shake hands or prepare food, we are at risk of transferring virus or bacteria from our hands to our nose, mouth, or eyes. We don’t shake hands, eat, or cut raw chicken with our vulvas. Also, the vulva evolved to cope with semen, blood, feces, and urine long before the Romans mixed a paste of fat and ash to create the first soap. 


And that leads to another personal story. So, my late paternal grandfather was kind of the MLM equivalent of a jack-of-all-trades back in the day. From Amway to Herbalife, he tried it all. He never made much, but, hey, he was retired and it kept him out of trouble. It also gave family a way of keeping him out of poverty without direct charity. Not very efficient, but it worked in its own way. 


One that comes up in this book is Tea Tree Oil. Ah yes, I can still smell it. This stuff was supposedly a cure-all, better than an antibiotic when used topically, and a great addition to literally every home care product. Gunter mentions it because it is a serious irritant, and tends to dry skin out. Oh, heck yes it does. Don’t use it anywhere, but particularly never on mucous membranes. 


Gunter’s biggest target, though, is douches. No, not the kind that drive giant brodozers with Trump flags and Truck Nutz. The kind to wash out one’s girl parts. Don’t use them. The vagina isn’t dirty, doesn’t need cleaning, and can be seriously harmed by this interference. 


One random thing I did not know before this book: lice are dependent on the spacing and texture of hair, which is why pubic lice cannot live on the head, and vice versa. Talk about a very specialized evolution. If humans go extinct, we may take two species of lice down with us…


While douches are actively harmful, a number of other products are neutral. They don’t harm, at least, but they have no medical benefit. That doesn’t mean they are useless.


When using any product, it is important to be mindful of your reason. There are medical benefits, and then there is joy. It is not wrong for pleasure to be a motivator; I just don’t kid myself that my fancy shoes are good for my feet. 


And, on a related note to the question of cleanliness and joy:


I’m currently a bath bomb aficionado, as one of my sons is an addict. I’m amazed that society focuses on the nonexistent smells of the female genital tract while largely ignoring the greasiness of the male adolescent, many of whom seem as averse to water as the Wicked Witch of the West. If bath bombs are what get my teenage son to rinse the testosterone-fueled sebum-fest off his skin, then bath bombs it is!


Cannabis gets a chapter, not because it has any positive effect (very limited data, no firm conclusions), but because there is a lot of misinformation out there. I once again loved her insistence on good evidence. 


The lack of information doesn’t stop wild claims. One company claims their product is “proven effective at delivering longer, stronger orgasms in 8 out of 10 women.” If your data has not been published in a peer-reviewed medical journal for everyone to read, it has not been proven effective. 


Peer review isn’t perfect, and some studies are junk. But if you don’t have peer reviewed data, then your claim is shit. Period. 


The chapter on probiotics was pretty eye opening. As with pretty much everything in the supplement and woo industry, you have literally no idea what you are putting in your body. 


Finally, you simply don’t know what you are taking. A recent study found that 33 percent of probiotics contain fewer colonies than indicated on the label, and 42 percent were incorrectly labeled, with either mislabeled species, missing species, or species not included on the label. Mislabeling and unknown ingredients are unfortunately common in the supplement industry. The New York Attorney General commissioned an investigation in 2015 that revealed only 21 percent of the dietary supplements tested (not probiotics, but regulated the same way) contained the ingredients that were on the label. Unlisted contaminants were often the only ingredients. Another 2013 study also found contamination and substitution were common with herbal supplements. As the ingredients, purity, and doses for supplements - including probiotics - in the United States are on the honor system, it is very much buyer beware. 


This is why we need full regulation and inspection of supplements, in my opinion. Right now, they are no different from snake oil of 150 years ago. 


Gunter also gets pretty huffy at cosmetic procedures for the vulva or vagina. Here is a great passage. 


I have read about plastic surgeons who do labiaplasty so women can look “sleeker in so-called athleisure wear.” I know some people who call this look “camel toe” but I prefer “labial cleavage,” and the answer is not surgery - it is better-fitting athletic wear. I’ve stared at more male butt cracks (gluteal clefts) than I care to remember, whether it was just some guy bending over or gravity-defying pants that appear to hover like magic just above the anus without a belt. What I never hear is that men should seek out plastic surgeons to get their gluteal clefts sewn shut. I also can’t imagine a similar industry for men that products from surgically trimming penises so they look better in tight jeans. 


Mic drop.


I’d like to finish up the main review with two bits of complementary advice that Gunter gives for evaluating potential treatments. 


The first is this: you often hear “well, it can’t hurt.” Which is sort of true. But there is a cost to low-risk interventions. 


Every time we make a woman jump through a useless hoop to get better, we add a burden, be it financial, or emotional, or the exasperation of doing so many things and yet realizing that you are running very hard but not getting anywhere. 


This is so true. The waste in time, money, and frustration is real. As I note in the postscript to this post, the endless chasing after the “well it can’t hurt” ideas in diets and supplements did have lasting negative consequences for my birth family. 


The other one is a pushback against a toxic characteristic of marketing. 


Does the site use words like “detox” and “cleanse”? If they do not know those are dubious concepts, what else escapes them? Do they use words like “pure,” “clean,” and “natural”? Women are constantly fed lies about toxins in their periods or that the vagina is dirty. “Pure,” “clean,” and “natural” are just modern riffs on that destructive messaging. They also do not mean anything medically. You want sound hypotheses and clinical evidence, not patriarchy’s dog whistle. 


Those words of advice are worth heeding, not just when it comes to vulvas and vaginas, not just when it comes to medicine, but in every facet of life. The words “pure,” “clean,” “natural,” “detox,” and “cleanse” are not neutral. They have no medical meaning, but they appeal to an emotion in a way that has negative consequences for everyone. It isn’t that far from seeing the vagina as dirty to seeing racial minorities or immigrants as dirty. It isn’t that far from seeing certain [expensive] foods as “clean” and others as “toxins” to refusing to eat with the impoverished, and eventually considering low-income people themselves to be unclean and toxic. I have seen this happen many times. 


The Vagina Bible has such a wealth of information, I definitely recommend it to anyone who wants a better understanding of the female body. 




Note on transgender issues:


Major points to this book for addressing transgender health head-on, and in a logical, scientific, and compassionate way. Gunter devotes a chapter to transgender health, with specifics for both trans men and trans women. For example, when do trans men need a pap smear? What are the specific health concerns after a vaginoplasty? Gender and sex are complex, but the specifics of medical needs can be addressed clinically and compassionately - it isn’t that hard, and Gunter demonstrates that. 




My own story: 


I have talked about this here and there, but perhaps not in great detail. My mom was always into woo, in various ways, some more benign than others. As the book notes, women have been abused and neglected by male-dominated medicine, and by the 1960s and 1970s, women were pushing back on a number of fronts. 


One key area was that of obstetrics. On the one hand, modern medicine has greatly reduced infant and maternal mortality, but on the other, it has tended to dehumanize women, and treat pregnancy less as a potentially dangerous natural event, and more as a pathology in itself, needing constant treatment and correction rather than just monitoring for problems. Particularly in the past, it was a male-dominated field - a huge change from the original midwifery profession, which was all female. It is beyond the scope of this post to discuss how the change occurred, and the connection between the change and the rise of anti-contraception and anti-abortion movements. 


In my own case, me and my siblings were born at home, with the assistance of a midwife. Since we were uncomplicated pregnancies, nothing went wrong either for us or for our mother, which is probably somewhat lucky. My mom’s choice of homebirth in turn led to her buying in to the idea that modern medicine was (mostly) a scam, and a conspiracy to suppress the treatments that actually worked in order to make money. 


Now, was there a point to be made about obstetrics? Yes. Did that mean it was a scam? No. Should we be encouraging the return of midwives as a norm for uncomplicated pregnancies? Maybe, maybe not. Certainly, other first world countries have moved in that direction, and, for other reasons, their maternal and infant mortality rates have continued to decrease, while the United States is going backwards. This is primarily due to poverty and inequality (which in turn is strongly driven by racism.) 


Because of this embrace of “alternative medicine,” I had some strange things about my childhood that people who grew up in mainstream families will never quite understand. 


I tell people about the fact that I was a sickly kid. This led to my being homeschooled - I missed a lot of school, and the principal suggested we just do it at home since I was taking all my work home anyway. It also led to my parents feeding me ground up cow adrenal glands and a bunch of other “glandular therapy” stuff, mixed in applesauce. We also took vitamins and other supplements most of my childhood, and used garlic capsules as our primary “defense” against getting colds and other contagious bugs. 


This is not to say that my parents rejected all modern medicine. I certainly did enough antibiotics over the years, which undoubtedly kept me alive. We saw the doctor, got our vaccinations, and got interventions as needed when we were sick or injured. It was more of a soft-alternative sort of thing. 


The other thing we did was try to control (or at least have the illusion of control) over our health through our diet. As a kid, that meant that for years we avoided sugar, put honey on stuff for sweetening, and ate hippie food. In retrospect, most of this was probably not any healthier - carob is not better for you than chocolate, for example - but it probably didn’t hurt us either. 


The things that were really good about our diet were the large quantities of vegetables, food cooked from scratch and thus without all the processed crap and extra sugar and salt, and the emphasis on regular exercise. 


But those things are actually recommended by mainstream medicine too. Because they are science-based recommendations. 


So, really, from my childhood, I mostly remember things with a bit of amusement, and gratitude that I learned how to eat and cook vegetables. 


Things took a bit of a less pleasant turn in my teens. I really am not sure what all triggered my parents to have an existential crisis of sorts, but let’s just call it “middle age” as the pop culture term. 


This manifested in several ways, and made my teen years far harder than it should have been. 


The first was the spiritual crisis - we left both John MacArthur’s megachurch, and later a small church led by a Master’s Seminary graduate, so basically the same thing on a smaller scale. We explored a few different alternatives, spending some time in a Charismatic church, even visiting a Catholic small group, and a few other departures from where we had been. Unfortunately, this also included (like I swear it did for every white Boomer Evangelical in the early 1990s) a phase of obsession with end-times theology, which in turn led to conspiracy theory thinking - trilateral commission, masons, Jewish bankers, and other forms of “the antichrist.” So we bounced around a bit, but I noticed that what was not included was any form of progressive Christianity or social justice minded work. 


Finally, we ended up with the “dead woodchuck” scenario: Bill Gothard. (That’s a reference to Dilbert, by the way…) 


Yeah, the thing that lingered was the cult group. 


Along with this, though, came a bunch of other upheavals. The throwing away of any secular music (unless you count classical), the burning of our Lord of the Rings books, the decision that none of us children would be allowed to date, and so many other things that I tried to believe in at the time, but have later realized were toxic. 


But there was one more: the death of one of my dad’s cousins from cancer seems to have triggered a renewed obsession with diet and “alternative medicine” fads. It wasn’t helped by my mom making friends with a bunch of women who were really into it, and, in those pre-internet times, passed around books and articles. 


This then led to our going through a set of fad diets during my teens. We were vegans for a while (but with no idea how to cook or eat a balanced diet, let alone a flavorful one.) We went high protein (before “keto” became a thing.) We cut out this, we cut out that, we ate mostly this, we ate mostly that. Things were constantly changing depending on whatever new article my mom read. Again, most stuff was harmless, but particularly for the vegan fad, I was hungry all the time, and frustrated at being jerked around with little say in my own life. 


If it had just been this one thing, it would have been frustrating enough, but combined with the other fads we were following, and particularly my being enrolled in a cult over my own objection, well, my teen years were tough. I’m sure I was moody and difficult and all that, but instead of taking a look at all the upheavals I was experiencing, and the lack of a clear future (regular college was off the table for Gothard followers), my parents bought Gothard’s lie that my normal teenage response to my life and normal human development were “rebellion” - literally opening up my heart to Satan every time I pushed back. So of course I tried my best to believe it all, to be the good kid - I’m a natural authority pleaser - but I just couldn’t.


The thing that broke me when it came to “alternative medicine” was at age 16, when I took chemistry in high school. And then, I read one article my mom was all enthused about, and saw that it was claiming that “sodium bicarbonate is different from sodium carbonate because it has a second carbon atom” - which is horseshit on a stick, something any person who passed high school chemistry would know. At that moment, I realized that all of this stuff was just snake oil. They weren’t even trying to be scientific. Rather, because they could sell anything without regulation, just by saying it worked, even if it harmed, nobody even bothered to try to prove it. Just say a bunch of lies, and watch the money roll in from gullible people. 


I wish I could say that things got better, that my parents wised up. But they didn’t. Last I heard (they cut me out of their lives a few years back), they had gone deeply down the Covid conspiracy rabbit hole, apparently believing that the mRNA vaccines me and my family got will kill us all of autoimmune diseases in a few years, and that ivermectin is a miracle drug suppressed by Big Pharma. (Um, who sells ivermectin anyway? It isn’t being mixed up in a bathtub along with the gin…) It is really sad to see, but once you start listening to charlatans, you become an ever greater mark for all the others, from “alternative medicine” to cult leaders, to Donald Trump. 


This is particularly saddening because they could literally have asked my wife - ICU nurse on the front lines of Covid for the last nearly three years - about all of this. Did she give ivermectin or hydroxychloroquine to patients? (Answer: yes. And a bunch of other experimental stuff they tried in the early days of the pandemic based on limited data.) Did either of those work? (Answer: No. They did not have any positive effect, and sometimes negative side effects.) Did she see adverse vaccine reactions? (Answer: Yes. A small number of myocarditis reactions, which were treated, with full recoveries.) Did the vaccines make a difference in hospitalizations and deaths? (Answer: Yes. A HUGE difference. In particular, the overwhelming majority of deaths of younger patients were unvaccinated. Vaccination was the single biggest step a person could take to improve their odds.) 


But rather than believe my wife, they would rather believe the claims of a charlatan and traitor who tried to overthrow democracy in America. 


I do not want to give the impression that my childhood or teen years were horrible. They weren’t. As with most dysfunctional relationships, there were a lot of good times, and my parents did a lot of things well for a long time. But you can see the seeds of the eventual destruction of the relationship in the embrace of false information. Do that long enough, and you will lack a common way of understanding reality that enables relationships with others outside the misinformation bubble. 


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