Dr. Jen Gunter, author of The Vagina Bible: The Vulva and the Vagina: Separating the Myth from the Medicine (Photo credit: Jason LeCras)
Taking care of your gynecological health often requires wading through misinformation and stigma to find answers: What’s causing my pain? What are the side effects of this medicine? Will this treatment work? What happens if it doesn’t? Jennifer Gunter is a doctor with answers. Gunter, the Gray Lady’s ob-gyn-in-residence, is known for her bluntness in taking on the wellness-industrial complex—reminding you not to steam your vagina or put a jade egg up there. She comes at issues often complicated by junk science with precision and candor. Her new book is no exception.
The Vagina Bible: The Vulva and the Vagina: Separating the Myth from the Medicine tackles every old wives’ tale and bit of women’s-mag fearmongering you heard as a teen—like whether cotton underwear is really best, how Toxic shock syndrome really works, and the lowdown on Kegel exercises. Gunter’s book is a critical tool for any patient who wants to advocate for their own health: Whether you’re having your first period, going through menopause, navigating an STD diagnosis, or wondering what kind of lube is best for you, The Vagina Bible has an answer. I recently talked to Gunter about medical misogyny, why communication is the key to both better medical care and better sex, and the need for a new guard in medicine.
Why do you think reproductive healthcare is so fraught with misinformation?
It’s both an incredibly long answer and a one-word answer: patriarchy. Women’s bodies have been weaponized since the beginning of time. You had to be virginal until you needed to reproduce as quietly and efficiently as possible. Then, you were an “old maid” with no value. That’s a lot of centuries of oppression to undo.
I went to medical school in the ’80s, and though between 30 and 40 percent of my class were women, almost all my instructors were men. It was really rare for me to have a woman [mentor] until I was done with [school]. We’ve had such a lack of diversity in healthcare that we obviously hear about how’s that affected everybody, whether that’s when you’re having a heart attack or something else is happening to you. But there’s an extra layer because women [in general] haven’t even been able to use the words for their body parts. If you can’t name your body parts, how can you even start the conversation? What does that say to young women if you have to say “vajayjay” [instead of vagina]?
What it is like to be a female ob-gyn who’s tackling this misinformation?
I don’t think you have to have a medical condition to be an expert in [tackling misinformation]. I don’t think I’ve ever had any of the conditions that I’m an expert in, and I’m still good at treating them. But when you’re talking about the systematic oppression of everybody who’s not a white man, I think it’s helpful to have a voice that’s understood those pressures. I don’t think a man would walk through a museum like I did and [ask], why can I see penises on every statue but all the vulvas are hidden? The other thing that I did in the book, which I don’t think a well-intentioned male physician would be able to do or do as well, is every single thing I wrote about, I also thought, how does this benefit the patriarchy? Why do we tell women these things? Why do we tell them medically? How does that benefit the status quo? Misinformation benefits the status quo. Misinformation can oppress you.
There’s an ego in it too that’s characteristically patriarchal.
I see a couple of huge issues in the way the old guard has approached medicine, but I’m a subspecialist [in women’s health and pain medicine]. I see everybody who thinks they’re at the end of their road and there’s nowhere else for them to go. They have a yeast infection or pain that never goes away and they’ve come to me because either a doctor feels medically they’re at the end of the road, they disagree with their doctor, or they hate their doctor. I tell everybody that we need to start from scratch because I don’t really know what’s been done and what will happen [outside of having] objective evidence. Give me your pathology report, your surgical report, and your lab results, and then let’s start from the beginning. Let’s make sure we’re talking about the same symptoms.
It’s very easy, in a patriarchal system, to say, “I know what’s wrong with you.” That’s why I have a chapter about how to communicate with your doctor, and I hope to introduce more of that into the field of medicine. Sometimes what’s bothering the patient isn’t what I think should be bothering them or what they’re worried about. You need a plan and I don’t know if giving people a plan is taught or if the idea that, “I know how to get through this. I’ve heard about it before. So you’re going to all follow these,” is just patriarchal. I’ve always been plan-focused, but there’s a lack of planning [that comes from not] listening to patients.
I am really obsessed with this concept of informed choice, because it should be how you govern medicine. You tell people the risks and benefits, and then they decide what works best for them. Some people want to take the fastest journey and do all the tests at once, but that [route] might cost them the most. Costs could be pain, money, or taking days off work to go to the doctor. People are generally okay with that as long as they know that’s what they signed up for.
The Vagina Bible: The Vulva and the Vagina: Separating the Myth from the Medicine by Jen Gunter (Photo credit: Citadel)
It’s a cliché, but knowledge is power, and books like yours are critical for patients’ ability to self-advocate. Can you speak to that?
Just knowing you can say those words out loud is really empowering because misinformation or disinformation are the root of so many problems. Being able to listen to a doctor and say, “Let me go and see what Jen Gunter says about that. Wait a minute, she’s saying something different.” Even [getting] information that helps you pick the right doctor for you is a form of advocacy.
I hope doctors read my book. So much about the way women live their lives—the underwear they choose, the way they clean their skin, the way they have sex, the lubes they use, the way they choose to remove their pubic hair—[comes from not being] taught about these things. There aren’t a lot of studies on things like these, and they’re considered quasi-cosmetic. But they also have health ramifications if they’re done incorrectly or if the wrong stuff is used. Sometimes there are health ramifications that we don’t even know about. We really have very little idea about how removing pubic hair could change the ecosystem of your skin. Could it? Yes? No? Don’t know. Many doctors don’t think about those things.
You are very vocal about your feelings about GOOP and other nonmedical sources that advocate for alternative modes of wellness and methods of treatment. How do you balance trusting that your patients know what’s best for them and protecting them from pseudoscience?
I want people to have facts, and then they can make decisions [about what’s best for] them. The facts are we don’t know if there are cannabinoid receptors in the vagina. No one’s studied that, so I would say no to anyone who’s claiming that alternative methods [will change levels of sexual arousal] are effective. If you want to try alternative methods for yourself, sure. It’s your body and your choice. And you should make that decision knowing that it’s unstudied and that there’s some data suggesting that this could potentially have a role in increasing yeast colonization, but we don’t know what we don’t know. But anybody making claims of efficacy hasn’t proven that.
But we see that with pharmaceuticals as well. There are risks, bad science, and unstudied or poorly studied impacts on both ends.
I would push back on that. Alternative medicine has zero data to it. If it has data, it becomes medicine, and it is more predatory to offer a claim with a zero data. I’m not a fan of Big Pharma at all, but having some data is more ethical than having no data. It’s important that I view every single person who sells “alternative medicine” in the same way I look at pharma—and if you judge them by the same standards, [alternative medicines are] worse because they don’t have to prove what’s in their product. If a drug is FDA-approved, the FDA can walk into that factory, stop the line, test the drug, and use the sample as security. They go in and check all the time. It’s super important to judge both [pharma and alternative products] by the same standards because they’re both offering medical care.
Can you understand, though, why patients who are frustrated by poor care might turn to alternative methods, like medical marijuana?
There’s very little data. I’m not saying it works or it doesn’t. I’m just saying physicians want to have data before we recommend something, so the physician’s standpoint is always going to be different than the patient’s. There should be some science behind recommending medical care. There should be some data, and then you can recommend something based on both expert opinion and anecdotes. It’s really important to know when you’re trying something that it might be based on anecdote. Is it wrong to try [medical marijuana]? No, as long as you have a basic understanding of how it may or may not help you. It really just comes down to making sure we’re clear about the source and the quality of the information.
I can totally see why people turn to other things. Medicine has not done a good job of explaining what therapies [exist], what some options are, and going through the whole standard medical care, expert opinion, and anecdote. A lot of times, physicians feel it’s a personal offense if you turn their therapy down. I’m like, No, you’ve got the information, and I’ve presented it to you in a way that you totally understand. If you don’t want that, that’s totally fine.
Your book puts reproductive health and sex on a level playing field. It’s very matter-of-fact about the connection between the two, which doesn’t happen often in conversations about reproductive health or about sex.
I don’t think judgmental people have any place anywhere in society. Maybe it’s because I grew up in a puritanical home where the idea that I was sexually active was “a thing” to my parents, even when I got pregnant at 35. I grew up in a household where you couldn’t mention sex. My mother hates that I’m a gynecologist. That was the worst thing in the world for her, so she never tells people I’m a doctor. From a really early age, that just struck me as too stupid. Maybe that was my way of dealing with it.
It’s such a universal experience that so many women have. I had horribly painful periods in school, like missing a day or two [every month], and my mom just said, “Well, that’s what it’s like.” I didn’t even know [painful periods were abnormal] until I was an undergrad and someone said to me, “You should go to urgent care. You’re in agony.” I was like, Oh, it’s just my period. She was like, “No, you should go.” I walked into urgent care and told them what was going on. They [gave me] a prescription for Naproxen. Three hours later, I was like, Holy fuck! It’s the best fucking thing in the world.
Painful periods are normalized. I started showing symptoms of endometriosis when I was 14, but I wasn’t diagnosed until almost a decade later. I passed out in college from cramps. In the emergency room, they said, “She probably has a urinary tract infection.” I didn’t. The bloodwork all came back normal. They were like, “She’s small. We see this all the time. She probably just didn’t have enough to drink today.” I was 22 the first time I heard the word “endometriosis.”
I want young women to have all that information so they’re armed with their checklists about what works for them. Hopefully, doctors will get on board too. I know medicine has horrible, terrible gaps, and I’ve experienced them. I had sepsis after my kids were born, and people thought I was being hysterical. I’m a white woman ob-gyn on my own postpartum floor; if I can’t be listened to, who else has a chance?
Alternative medicine has zero data to it. If it has data, it becomes medicine, and it is more predatory to offer a claim with a zero data.
Sex and our reproductive health are intertwined. If we can’t talk about the basic functions of our body, then we’re screwed, no pun intended.
Absolutely. I tell everybody that good sex requires communication. If you can’t communicate, then you can’t tell someone what you like. And that might mean different things to different people. It might be, “Touch me here.” Or it might be that you appreciate how I felt today. It could mean a lot of different things to different people. If you can’t talk about it [and are] not empowered to talk about it, then it’s pretty hard to have the sex you want to have. When women in heterosexual relationships don’t communicate, men make assumptions because men think they know everything. And a lot of women get their sexual information from the least knowledgeable partners: heterosexual men.
Books like yours really level doctor-patient power dynamics in a way that I hope will create a systemic change in medicine.
I love when people come in and are well-informed. The problem is what they’ve read is sometimes misinformation and disinformation. You get people who say, “I want to do a cleanse. I want to do X. I want to do Y. Why aren’t you treating the systemic yeast in my body?” My idea has always been people are just doing the best they can with what they have. It’s not their fault they’ve turned to the internet. In fact, I think it’s great: The internet is like a library and I would never fault someone for going to the library to look up information. But doctors never actually show them where to look. So it’s not their fault they got that information. Instead, it’s the fault of the person putting the misinformation out there. That’s who my anger should be directed toward.
This interview has been edited and condensed for length and clarity.
