Melissa Harris-Perry: You're listening to The Takeaway. I'm Melissa Harris-Perry. Just a quick note here, we're going to be talking about reproductive and sexual anatomy in this segment using frank and anatomically correct language. Now, there's no doubt about it. Many of us are more than a little uncomfortable talking about female anatomy.

Speaker 2: The word itself makes some men uncomfortable.

Melissa Harris-Perry: In polite company, we resort to obscuring euphemisms rather than simply saying vagina, clitoris, uterus, ovaries, but our collective squeamishness has consequences. Negatively affecting sexual reproductive health for centuries. Luckily, it's a problem with a solution.

Rachel E. Gross: My name is Rachel E. Gross. I'm a science journalist and the author of Vagina Obscura: An Anatomical Voyage.

Melissa Harris-Perry: Rachel's new book looks at the historical dis, miss, and lack of information about the bodies of people with vaginas, which includes women, trans men, intersex people, and non-binary people. In the introduction to her book, Rachel describes conversations she had with multiple scientists who tried to explain why we understand so much less about female anatomy and vaginas compared to male anatomy and penises.

Rachel E. Gross: When pressed, he and others acknowledged that this discrepancy at its heart is due to sexism within science and who is actually doing the investigating. For most of history, women, especially women of color, trans women, and women who are sexual minorities have been excluded from the supposedly universal endeavor. As I reported this book, it became clear to me that the two problems were inseparable. The marginalization of women's bodies from science is largely due to the marginalization of women from science.

I'd already been thinking about a lot of these issues. I've been thinking a lot about what women and minority scientists are up against because I was running a column on unsung women in science at Smithsonian Magazine, and because I had written a lot about reproductive science and animal sex, but as I mention in the book, I also got a vaginal infection while I was working as an editor that was really annoying and it kept coming back and it turned out it was not a UTI or a yeast infection as my gynecologist originally thought, it was something called bacterial vaginosis and literally one in three women before menopause have it.

I was like, this is really common, this sucks, but there must obviously be an easy treatment for it. No, there was not. My gynecologist told me that if the antibiotics didn't work, then it basically could keep coming back and it often did. The only last resort was something called boric acid, which she described as rat poison, and you put that up your vagina. I did that and the container that it came in actually had a skull and crossbones, I still have it and it says ''Poison. Do not ingest by mouth. Keep away from pets and children.''

Somehow I was able to put this substance in my vagina, but not my mouth. I was just following directions and I trusted medicine and science, but I honestly didn't know how it was working or why I had to do this, or what the substance really was. That all became very apparent to me one night when I was very tired, it was like 3:00 AM and I realized I'd forgotten to do this insertion thing where you insert a capsule into your vagina and lie on your back and think about what you've done. [laughs] I basically was in the bathroom and I was holding this capsule, it looks just like an antibiotic and I put it in my mouth and I swallowed it without thinking.

That's when I had this really visceral realization. I was like, ''Oh my God, what even is this? Why did I agree to this?'' It's something called acid, and I look it up online and it says like, call the poison control if you ever ingest this. People have died from swallowing it. I was like, ''Oh my God.'' I ended up in the emergency room and I ended up being fine, but like that whole time, I thought I was going to have my stomach pumped. I honestly thought I might die because one of the first Google responses was about somebody dying from ingesting.

It turns out a lot of boric acid and it just got me thinking about how much trust I really had put in medicine and about how little medicine clearly knew about body parts like mine, and about how little I knew about my own vagina as a science reporter and person ostensibly who loved vaginas.

Melissa Harris-Perry: One should never judge a book by its cover, but let's start with your cover. Tell me about the beautiful artwork there.

Rachel E. Gross: I actually hope people will judge this book by its cover. Well, the cover gives a sci-fi fantasy journey feel. It was designed and created by Armando Veve, who's an incredible artist who does a lot of science fiction and it is kind of this world on the edge of the water that is rife with vaginal and female body symbolism, but sort of turned upside down. There's a picture plant eating a sperm dragonfly. There's a coy duck because we get into duck genitals later in the book.

There's actually an Easter egg, there's a clitoris flying that we call the clitoadapto in the background that's for Eagle-eyed readers. It really is supposed to give this impression of a journey into a really wondrous and new and sometimes alien land. There are little signs that there already have been explorers here before. There's like a little ship and a crumbling pillar that are these vestiges of really the colonialism of the female body.

Melissa Harris-Perry: Just one more beat on this because art matters a lot, the rendering of the vagina, even in medical renderings, the notion that it's a place where we should look. Both look with scientific inquiry, but actually also look like sometimes with a mirror in your restroom, in your own house. Talk to me about the importance of even being able to make an accurate rendering of women's anatomy.

Rachel E. Gross: Yes, that's right. A huge theme in this book is that you only see what you expect to see and you can't see what you aren't looking for. That mostly comes up when we're talking about these older, usually male anatomists who are looking at female bodies and expecting to see something. They expected the female body to be reproductive, to be mostly about the uterus. To not really have that big a capacity for pleasure or for active dynamic processes going on.

What they illustrated was very passive, a hole or a cave. The word vagina actually means a sheath, which suggests that its main role is to house a penis, which it is not. There definitely is a reimagining going on by a lot of new scientists and you can see that in the art throughout the book. Every chapter opens with an illustration that really looks at these organs in a new way. Usually, one that is active, dynamic, and resilient.

Melissa Harris-Perry: Looking part of why we're not looking. Again, not looking scientifically or not even looking interpersonally has to do with the issue of shame. Can you talk a bit about the deep historical roots of shame around women's bodies and particularly women's vaginas?

Rachel E. Gross: Absolutely. Unfortunately, the idea of shame has really impacted the way that science, medicine, and people with this anatomy have viewed the "female body." There's a really strong pattern going back to Hippocrates of anatomists really insisting on naming these body parts after shame, especially the clitoris and the vulva. Hippocrates called all the genitals the shame parts, essentially, but that continued. Every time a French anatomist would, ''discover" the clitoris, he would name it the shame part.

Even today you have words like Scham Lippin in German, which means the shame lips and refers to the labia. You have pudendum, which is an anatomical term that's hopefully being phased out, but it means the parts for which you should be ashamed. Again, it refers to only the vulva. Shame has really attached itself to the female genitals in particular, and that has affected the way science is done. There is a hesitancy of looking directly at this part of the body. There is a tendency to associate it with danger, sexuality in a negative light, the threat of pregnancy and STDs and disease.

It's really blocked us from looking at the incredibly unexpected and expansive things that this system is doing. The ovaries are producing hormones that support body-wide health from bone health to heart health, to brain health. The uterus is one of the most regenerative organs in the body, and when it's not pregnant, just going through monthly menstruation, it's ushering stem cells and immune cells to heal this wound painlessly, it's creating new blood vessels and it's doing this every month on cue, and it probably has a lot to teach us about regenerative medicine in general but having looked at these organs with themes like shame and only reproduction in mind has really narrowed the view.

Melissa Harris-Perry: One of the things that's extraordinary about the book is the interweaving of scientific discovery, history, but also narrative that we're able to take this journey into the vagina in, around, and through the clitoris, understanding the uterus, the ovaries, but often with a pal. Following on this path. Tell me a little bit about making the choice to bring us these stories in that way.

Rachel E. Gross: The first thing I want to mention is, yes, these are many, many stories about women, girls, and people who identify as female but there are also trans women and intersex women and intersex people in this book who are also explorers and also figuring out their own bodies and who also have these body parts. I really did make an effort to be as expansive as possible and to break down some of those binaries we often attach to the "reproductive system." Making this story narrative, which has grounded in the lived experiences and the hunger for knowledge that many of these scientists and patients had was really critical to me.

This is important because these diseases, these organs, and this biology matters intimately to people. It matters to their lives. It matters to their relationships, to their bodies. These are some of the people for whom it was the most critical to understand, people who struggled with diseases like endometriosis, people for whom menopause had an extremely important role in their family, people who were transitioning and seeing how scientists surround them, and the rest of society viewed their gender identity and how it was actually blocking them from doing better science.

Melissa Harris-Perry: These are not exclusively stories about health or anatomy or science. You are really going straight on here on the question of pleasure. Talk to me about how neglected pleasure has been in conversations, and particularly scientific conversations and psychological ones about these body parts.

Rachel E. Gross: What I was alluding to when I was saying that the female body has been looked at as reproductive, is that really medicine has focused on the female body as a walking womb, as a baby-making machine. That's where a lot of resources and money has gone and that's where the scientific interest has been. What's left out, as you say, is the fact that the genitals and especially the clitoris and vulva are really involved in sexual pleasure and sexuality and this embodied experience of yourself. That's something that a lot of prudish cultures like America and Europe have not wanted to face head-on.

When you see sexuality being addressed especially in my book, it's often a really dark history. Clitoral amputation was actually used as an anti-masturbation technique starting in Europe but then in America until the 1940s. People have known for a very long time that this body part is intrinsically involved in pleasure, but usually, their goal was not to better understand that and enhance it, it was to prevent it and to cut that relationship in the bud. As a result, we haven't looked as deeply into that.

We are just now completing our understanding of the human clitoris, a body part that half of the population has, and that is incredibly important to their health, well-being, and lives in many, many cases. Yes, pleasure has been deeply neglected. Even the idea that genitals evolve, not just for like the transfer of egg and sperm, but for pleasure and bonding and interaction and not just male/female interaction, but homosexual interaction, those concepts have been totally dismissed or laughed at until very recently.

Melissa Harris-Perry: I just want to walk through a few moments because I'm really like gobsmacked during reading, but you caught me on a few of these. Let's walk through just a few things here. Let's start in terms of things that I learned while reading this book about regeneration of eggs and ovaries. Excuse me, what?

Rachel E. Gross: Oh, I had the same reaction. I'd never heard of this before. At some point in researching this book, I found out that there had been at least 10 years of research on the idea that human ovaries make new eggs throughout your lifetime. Probably like you, I'd always been told that women are born with all the eggs they'll ever have and they just die off throughout your life until they run out and that's menopause, most likely not true at all. There actually is a growing canon of work showing that there are stem cells in the ovaries that are capable of producing new eggs.

The sticking point is whether they're doing that in their natural environment because all the experiments have been in the lab. We know that they can do this. We don't know exactly what they're doing in the female body but it increasingly looks like eggs don't just sit around and get stale, that there are dynamic processes going on inside the ovary and that there is regeneration as well as degeneration. These two things exist side by side.

One big reason that we didn't know this earlier is that it was long thought that the testes and the ovaries were fundamentally different and that one thing that made male genitals male genitals was that they produced millions of sperm every time a man breeds, and female genitals were thought to degenerate and fail. You can see there's like a ton of bias, often sexist bias baked into just the language we use to talk about these organs. My argument is that this language helps shape the direction of scientific inquiry. This is one great example where now that we're realizing that maybe that framework wasn't true, we can begin to ask new questions and possibly do interventions that could improve millions of lives.

Melissa Harris-Perry: Let me tell you, as someone who has been through, thank goodness, very successful IVF, this was a moment where I was like, "Wait a minute. What?" I just really spent a lot of time in this chapter. I appreciate that. Here's the second one for you. I have a passion for backyard farming. I have many, many chickens. I have about 30 chickens in my backyard, 28 of whom are hens, and I've got a couple of roosters and I've had lots and lots of ducks and I just love ducks, but I have never had a drake because I heard that drakes had these terrible duck penises and that it would be a terrible thing to bring a drake onto my little farm.

Again, in reading your book, I learned so much about duck genitalia, which again, countered my understanding and probably is going to change some of my backyard farming practices. Can you talk to me about duck genitalia?

Rachel E. Gross: This is an effect that I have never expected, so thank you.

[laughter]

Rachel E. Gross: Yes, yes. I would say hashtag, not all drakes, there are.

[laughter]

Melissa Harris-Perry: [laughs] Sorry. I really was like -- Because seriously, people go to the YouTubes, they say terrible things about the boy ducks. Yes.

Rachel E. Gross: Oh, yes. That was where I was starting from. I was around, we got the duck penis beams and the horrifying YouTube videos about these spiral quirks screw penises that explode out into the female and that male ducks are not very nice and tend to assault without permission. That is true in some cases, there are definitely different mating strategies among ducks but I think what was left out of that meme was what's happening on the female duck side and what's happening with duck vaginas.

I talked to a brilliant biologist Patty Brennan who really illuminated the duck vagina basically for the first time. She was also reading these papers about male ducks and saying, "Has anybody looked at the other half?" It turned out nobody had. She did these intricate dissections of duck vaginas that she described as peeling off these layers like opening a present, and found out that they were also a twisted spiral-like maze. They also had little offshoots and dead ends where sperm went to die. The crazy thing is that it's not a spiral that's meant to fit the duck penis.

It actually spirals the opposite direction. It's like an anti-lock anti-key situation. Basically, the idea is that the female duck has these built-in reproductive defenses against male ducks that get really aggressive and that she doesn't want to mate with. Even though she can't control what's happening to her, it is thought has some control over the paternity so she can, I use these words lightly but choose as in biologically choose the father of her offspring. It's a very complex and again, really active system down there that no one had looked at. I even called up some of those male duck researchers and asked them if they had looked at the female and if not, why? They said, honestly, it was probably just male bias, I guess we needed a woman to do it.

Melissa Harris-Perry: A lot of the work that you're doing towards the end of the book. I'm so appreciative of this because it's complicated because you're dealing with anatomy and these physical body parts. I think even in our conversation, it's easy for me to slip into a simple but also inaccurate binary of seeing these body parts associated with particular sex and gender identities. You really work hard to show us not just the social construction, but the science behind an understanding that these are body parts and not necessarily gendered in this way. Can you walk through just a bit of that?

Rachel E. Gross: That's right. I was just as guilty coming into this book. I described it as being about the female reproductive system, and that's a term I would never use today. The more I used it in the book, the more I realized it was problematic on every level. There are people with uteruses, clitorises, ovaries, vulvas, or any combination of these who are not biologically female or don't identify as female. There are intersex people, non-binary people, trans women, and trans men. Scientists are also coming to this realization that sex and gender are far more expansive than we have taken them.

There's, I think, two examples that I think are very helpful for looking at this. First, if you look at how the clitoris and the penis develop in the womb, it's basically the exact same material, the exact same tissues. You start out looking identical, no matter what your chromosomes are at six weeks. You have just this nub between your legs called the genital tubercle. You also have two sets of plumbing. You have the Mullerian or Wolffian ducts, which are known as the male or female. Depending on this combination of hormones, genetics, and other developmental factors, you will go down the clitoral route or the penal route.

Again, even no matter which you go down, you have the exact same erectile tissues. It's all homologous. The tip of the clitoris or the gland is exactly equivalent to the head of the penis. The clitoris too has a shaft and it has erectile pillars that again are the same ones as are in the penis. I like to say it's like tacos and burritos, like same materials, different configuration. Those similarities exist into adulthood and that plumbing I mentioned, this was a really fun fact that blew my mind. It's said that it withers away, so if you are female, the male part withers away.

Actually, there are remnants that exist in adults. There's something called the prostatic utricle, that's like a tiny uterus that's in the penile urethra. It's just these reminders that our bodies are all more similar than they are different. Some people like to say, we all start out female, but I really think of it as we have a shared body plan. You can embroider on that, but really it's all the same foundation. It stands to reason that some people will have different combinations and there is a beautiful variety of types of bodies. Variety is literally the material that evolution works with.

The other example is hormones. There's a really deep history of estrogen being considered the female sex hormone and testosterone being called the male sex hormone. Estrogen the name actually comes from oestrus, which is when animals are in heat. It means a frenzy as if stung by a gadfly which says a lot about what people thought being female was. Actually, they're not at all male or female, they're really-- Anne Fausto-Sterling, this amazing feminist scientist has called them growth hormones as they're necessary in almost every process.

Testosterone is necessary for ovulation as well as brain development. Estrogen is incredibly necessary in men. If they don't have it, then actually their bones will not end up closing and they'll keep growing. There's a condition where you end up taller and taller, and it's basically like these are just human hormones with really important, powerful uses that can't be confined as male or female or as sex hormones. This miscategorization again has shaped the science and has made us think that estrogen does something it doesn't and made us miss all the things it's doing that we don't even know yet.

Those are ones that apply to, I think, anyone who falls into one of these typical categories of male or female, but I did think it was really important to include a chapter on the history of gender affirmation surgery for trans women. That at first, I think, might have confused some readers or editors, but we are talking here about how science and medicine has viewed women historically, and how that is evolving and expanding.

You really can't do that without including this really important history of what trans women have dealt with from the medical system and how a procedure that they have asked for really went from being about heterosexual, penetrative sex and about someone disappearing into their role as a feminine woman and as a wife to now being a procedure that's about your embodied experience as a woman and what you are looking for out of it and directly about values like pleasure and beauty, and having the felt identity that you're looking for, and that's a huge transition that needs to be accounted for and that says so much about these social changes that we're going through.

This procedure also is teaching us quite a lot about other types of vaginas. In order to improve this surgery, you really need to understand that the vagina is self-lubricating, which is a really complex process, that it has an intricate microbiome that's an extension of your immune system, and you have to understand anatomy, especially the anatomy of pleasure and arousal so that you can give someone the experience that they want. By pushing this science forward, we are also understanding all sorts of other bodies that have clitoris and vaginas.

Filling in these gaps is important for science as a whole. It's not just like a niche like, ''Oh, this is women's health, or this is transgender health.'' That's a big argument I like to make is that we're talking about expanding the lens for everyone.

Melissa Harris-Perry: What mysteries still exist when it comes to the vagina?

Rachel E. Gross: Oh my gosh. So many. In a way, this book was not about chronicling the new science of the vagina and all its companions. It was really chronicling this little peak of a growing movement to reimagine them and the start of a lot of interesting science being done. The ovarian stem cells that we mentioned, that's still in its infancy, I would say. We're not able to make use of these insights yet. We're not able to see inside the female body to look at ovaries across the lifespan yet.

I'm really excited to see what in 10 years we do learn about how regenerative and resilient ovaries truly are and about whether terms like ovarian failure and ovarian exhaustion need to be phased out and replaced. For the vagina, I was super fascinated by the vaginal microbiome, partly because it was intimately involved in my own medical scare. The point of boric acid is actually to be a nuclear bomb in your vagina and level the whole ecosystem. The ecosystem is a really important mixture of microbes that protect you from the outside world and invaders and things like tampons and bacteria and sperm and stuff that could throw off your balance.

We are basically at the point where we've characterized a lot of healthy vaginal microbiomes and we're trying not to disrupt for people who have recurrent infections, we're trying to optimize the microbiomes, like terraforming a planet. That takes a really a lot of baseline knowledge about what that environment is. We're just starting that work and just like the gut microbiome, I think this is going to have huge health consequences for millions of people and I really want to hear more about that. The last thing is, so the clitoris, it has an incredibly long and storied history and many men have claimed to discover it and give it anatomical names.

Most recently, there was a urologist who is credited with fully mapping the clitoris which I get into in the book. There is some nuance, but there's still a ton to be discovered. We actually have an even fully counted up the nerves in the clitoris contrary to popular belief. There are now doctors; doctors who are often working in the realm of like trans surgeries and queer care who are finally getting some of this baseline knowledge about how the clitoris works, what its nerve structure is like, and how it does its beautiful, amazing things that it does. I also am eating popcorn over here waiting to hear back the results.

Melissa Harris-Perry: Rachel E. Gross is a science journalist and author of the book, Vagina Obscura: An Anatomical Voyage. Rachel, thanks so much for being here.

Rachel E. Gross: Thank you so much for this conversation, Melissa. It's been great.

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