I'm Alexander Heffner, your host on the Open Mind and I'm delighted to welcome our guest today, Rachel Gross.

She's the author of Vagina Obscura: An Anatomical Voyage.

Rachel, a pleasure to meet you today.

GROSS: Alexander, thanks for having me.

The pleasure is all mine.

HEFFNER: When did you decide to write this book?

GROSS: I was an editor at Smithsonian Magazine covering science.

It was like 2018.

And I was covering a lot of reproductive science stuff, a lot of animal sexual behavior but also a lot about the history of women in science.

And I was starting to realize that the two were kind of intertwined, that we knew very little about the female reproductive system, especially in humans.

And part of the reason was that we had been pushing women and especially women of color and people out of medicine for centuries.

And I was kind of running this column where we chronicled all of these systemic barriers to women in science.

And you could see that as they started entering the field, they started asking all these new questions about like what's the composition of vaginal fluid or how does conception actually happen?

Or what is behind infertility problems?

And so we finally were kind of rewriting the science of the female body.

And that's what I really wanted to capture in the book.

HEFFNER: And I think you might want to capture something else too, which is how this subject is revealed to young people and probably older people too, over the course of their education.

You know, what was wrong, if anything, with this significant piece of the sex ed curriculum as you reported on it and embarked on this book project and hope that this book could fill in some of those gaps?

GROSS: Yeah, I think a lot about sex ed in America, how it's super patchwork and really there's so much missing.

Like I often think about pleasure and sexual health being missing.

There are so many sex ed programs that don't even talk about the clitoris or masturbation for girls that don't even talk about like gender identity.

But really, I think, I don't want to oversimplify it, but the way that I got sex ed was basically at some point you're going to get your period and you should be afraid and you're probably wearing white pants and you should be afraid of STDs, and you should be afraid of pregnancy.

That's your sex life.

And it's so lacking.

It's like teaching you how to cook a beautiful dinner by telling you how not to burn the house down with the stove.

So there's so much that I would still actually like to contribute to sex ed, but this book, I think a sense of wonder and curiosity about the female body instead of that shame and fear that is so unfortunately classic and mainstream is what I hope to get out there.

I hope that young people with every form of body parts can be more interested and curious about themselves and about exploring instead of coming from this sense that it's off-limits and inappropriate.

HEFFNER: Whether you believe in God or Intelligent Design or you are an atheist, the reality is the obscura, the central piece of what you describe is integral to perpetuating human life.

And you describe in chapters the traits, the characteristics of the vagina obscura, as you say, to illuminate it, from desire and resilience to the power of creation and, and regeneration and beauty.

Which of these is most important in telling the story?

Both the, the physiological story and the story in history of how we've come to know this sexual organ.

GROSS: The title is Vagina Obscura because the vagina has the name value recognition, but it's about everything we consider our reproductive parts.

So uterus, ovaries, vagina, clitoris, vulva, which is the outside parts, the part you can see in touch, the fun bits.

And of the ones you were talking about I tend to think a lot about regeneration.

So this was a chapter about how the uterus essentially regenerates a new organ, which is the uterine lining every month, whether or not you are pregnant or have an egg fertilized.

So through this intricate hormone cycle and through the release of an egg, your uterus is basically getting these signals to build up layers and layers of new cells, including new blood vessels that kind of pump it full so it becomes plush and could eventually be a bedding for a fertilized egg.

But if it doesn't get that signal, then it sheds all of that and it starts the whole process anew again every month.

And some people consider this to be like the uterus, learning how to make the best conditions.

And this was really significant to me because the uterus has been looked at as the organ of pregnancy.

Like that's all it does.

It kind of just sits around waiting for you to get pregnant.

And if you don't get pregnant, there's so much mythology, even in the science literature that you're kind of asking for reproductive diseases like endometriosis which was considered a disease of career women who put off childbearing too long.

So for me to look at the uterus as this dynamic and resilient and regenerating organ all the time, like really changed how I look at my body that it is designed intelligently, not in a religious way, but it knows what it's doing and it's constantly working to improve your overall health.

Just like your ovaries are pumping out hormones that are not sex hormones, they're growth hormones, they're body-wide hormones that are supporting your bones, your brain, your heart health, like your entire life.

So even calling them reproductive organs is kind of a misnomer to me.

And I want people to think of them as integrated into your overall health and part of you, not just part of your reproductive capacity.

HEFFNER: There's been a consensus in society about the beauty of the female sexual organ relative to the male sexual organ, at least the stereotypes in popular culture that have been I think established.

But I also think there probably is truth to that.

And...

GROSS: Wait, we think it's prettier, right?

HEFFNER: Prettier.

Right, right, right.

But also, is it objectively, so let's say it's objectively prettier, is it also objectively more complicated than the male sexual organ?

GROSS: I mean, I think all genitals are beautiful.

I definitely don't want to pick a side here, even if I'm slightly more interested in vulvas and vaginas.

That's a really good question.

I've never been asked that.

Because I tend to think that we have overcomplicated and overmystified female system because we've considered it mysterious and obscure because life is generated there.

And so, I tend to lean towards, it's actually more logical and simple than we thought.

But it is doing one thing that is pretty incredibly different, which is being able to create life.

And that does require a whole other organ.

You could say three organs because the uterine lining is its own thing.

And so is the placenta the only temporary organ in the body?

So the uterus is different.

But I also really emphasize the homology of the clitoris and the penis and the ovaries and the testes.

So like we have the same erectile structures that are exactly the same when we're all embryos floating around in the womb.

We have these, the gonads, the testicles and ovaries that produce sperm and eggs, but also again, produce those hormones that are important for our whole health.

So there's a lot of multitasking going on in both cases.

Maybe I'm trying to not do a direct comparison because I think that's been done too much.

HEFFNER: All I know is in sixth grade, if you were taking a health test at any point, probably in the last few decades, there were more items to identify, you know, specific physical components in the female exam or quiz than the male exam or quiz.

But to you, your book is an amazing historical journey of perceptions and interpretations of the female genitalia.

And, and I wanted to ask you who you thought historically had the most foresight because things had been simplified in the way you described from the outset for centuries.

But it's sometimes interesting to look at the figures in history who were unsung or unexplored and had a sense of the complete history that we observed today.

Or maybe everybody was lacking the foresight until we established some parameters of contemporary science.

GROSS: That is kind of more what I saw was everybody was trapped in the paradigm that they were working in and they had really remarkable insights and hunches, but found it really hard to get out of that paradigm.

So the first chapter starts with someone that I think very few people in science are aware of.

Her name's Marie Bonaparte, and she's the great grandniece of Napoleon.

And she ends up exploring the clitoris and what constitutes female orgasm and what is the physiology of orgasm.

But she also works under Freud, and she works at a time where feminine sexuality or whatever is being very separated from male sexuality and considered like deviant and problematic.

And the clitoris is considered masculine and that anybody who likes their clitoris is not accepting their womanly role.

So you have all these, she has these really weird hybrid ideas where she's like, well, I think the clitoris is integral to pleasure and I really like mine.

So, I guess I'm just really masculine and I'm also very creative and intellectual, so I must just be a very masculine woman.

So, it's like she couldn't break out of that dichotomy quite, but she was saying, hey, this is really important to sexual experience.

It's important to women's sexual experiences when all the research being done was centering the male experience and the phallus.

I think I also go into great scientists like Darwin, who was extremely biased about gender and always describes female animals and Victorian women as passive, delicate.

Not as creative and intellectual.

However, he was on the cusp of some major, major connections.

So I write about how he kind of foresaw modern genetics but didn't know what a gene was at the time because Mendel was working with peas somewhere else and probably they never encountered each other's work.

So there was just like this almost moment of realizing why offspring share all these traits and the fact that female and male contribute exactly as much genetic material.

So there's a lot of like reaching for stuff that didn't quite happen.

HEFFNER: What was the most surprising thing from your research for the book that you found that you wanted to impart to your readers, or perhaps the reaction of readers, too, to a particular section of the book?

GROSS: Honestly, people still react the most to the clitoris chapter.

Well, there's two chapters really, but the fact that it's like this iceberg organ, as scientists call it that is more than 90% beneath the surface that is incredibly extensive.

And we just counted actually the nerve fibers, it's more than 10,000 which negates the popular tweet that the clitoris has 8,000 nerve fibers and is still not as sensitive as a white man on the internet.

So people still really respond to that.

And I think there's something really empowering about being told that this is shameful and small and hard to find and all of that like terrible messaging and realizing that it's like really powerful and that your body has a huge sexual capacity.

HEFFNER: Is there any teachable moment in the book, in a climate where we live in now that Roe vs. Wade is overturned in that states have heavily restricted abortion access, reproductive health access where someone may read a passage of this book and be adamantly in the outdated nomenclature of pro-life or anti-abortion and recognize the, the autonomy, the creative autonomy, what I have called on this program, the First Amendment right, that ought to have been enshrined in our Constitution.

Not in any other section other than the First Amendment of reproductive access, the right to give birth, the right to pleasure oneself, the right to take care of your sexual organ.

But is there any segment of the book that you think could have that instructive impact in a climate that has severely reduced women's access to reproductive health?

GROSS: I hope so.

I'm not sure how it will land with people who have their own values, but the last chapter is actually about how medicine has treated trans women and intersex people.

So basically how medicine has helped uphold this binary idea of what men and women are supposed to be and that anyone who falls outside that box, according to them, needs to be hemmed into it.

Using sexual control, reproductive control, like invasive surgery.

And to me, learning this history was just so profound because it showed that it's so often that personal autonomy is not forefront of mind and full medical consent, consent has not been medicine strong suit historically.

And this harms all of us from fully expressing ourselves, from having full control over our bodies, from being able to author our own destinies with our bodies, with our reproductive and sexual rights.

So I think the treatment of trans women, intersex people and the fact that they had treatments either withhold from them or foisted upon them to make them fit the idea of what a woman should be really should be a warning to us going forward.

I also think that the book really emphasizes how intertwined pleasure and reproduction and overall health are that you cannot separate out the ability to reproduce from these organs that are doing so much for your health, for your sexuality, for your pleasure.

And so by writing laws that limit us from controlling our fertility, our reproduction, you are curtailing and limiting people's health in so many ways.

You are not giving them the option to take hormones that can help control chronic reproductive illnesses.

You are withholding the ability to get surgeries that will help you when you have a miscarriage or something else goes wrong in the fertility realm.

Like you can't just say that you can't have a baby and that we're going to prevent that without having massive consequences for the rest of your body.

HEFFNER: Now to this question of what surprised you; I've given you a little more time to consider that.

GROSS: That's a good call back.

No, thank you.

Because I did think of something.

Okay.

So I think a lot of us were taught in sex ed going back to that, that the journey of the sperm to the egg is this like heroic journey of a sperm.

I mean, yeah, there is a Woody Allen film where he is... HEFFNER: School house rock.

Yeah, simplistic.

GROSS: Right?

But it's always like he is the daring explorer going off into uncharted land.

The female's always the territory, like kind of the background, the field, that's always a language you get.

And so when I actually really dug into what the egg is doing this whole time, it was shockingly both [beep] and violent.

So like it's not just one egg like pops out delicately and like slowly makes its way passively to the uterus.

So there's like a cohort of eggs growing and they're extremely competitive.

They all get the same signal, only one of them can survive.

So they're actually competing way more than the sperm and which everyone grows the biggest, which is huge, like the full egg and follicle can be an inch off of your ovary.

And your ovary is like the size of a small kumquat.

So that's huge.

And so whichever one grows the biggest inhibits all the others.

So they shrivel away and die and then it explodes out of the ovary.

And you can actually sometimes feel this.

So when you feel like a pinch or a twang that's potentially you ovulating.

It's like a violent event and it just like sprays like all these hormones out into the pelvis and then the egg has to cross this divide.

Like it's not just going to the ovary, or excuse me, to the fallopian tube.

The fallopian tube is like a [inaudible] that has all these fingers and the eggs coming out the ovary, and it's like hovering in the middle and the fallopian tube has to find it, grab it, suck it in, and then it starts making its way down to the uterus.

And once it is there, and if sperm happened to make an appearance, it has all of these mechanisms for deciding whether or not to let it enter.

It has this like jelly coating that has receptors that see what chemicals fit into it and whether there are enough like keys that it wants to open.

So the egg is doing the most out here.

And so I always think of that journey and I think it's much more compelling than we give it credit for.

HEFFNER: And is what you describe an explanation for why for many women it's not a simple matter to be impregnated or to become pregnant because those are, that's a multi-step process you're describing.

Everything has to be churning just so.

GROSS: Yeah, I mean definitely it's a very complicated process, not just sperm meets egg.

We have short circuited, a lot of that with IVF because then it really is just sperm meets egg.

You can kind of get rid of that whole journey.

But one third of infertility cases are unexplained.

About a third is usually female side, if we're talking about female to male, and about a third is male side.

So one really big bias in medicine is that often it's assumed that it's the woman's fault, which is kind of a historic cultural assumption.

And so fertility for women has been really medicalized.

Just you can look at the rise of reproductive technology in IVF and like you're getting all your hormone levels tested, you're going through invasive processes.

Whereas, ironically, we actually don't know that much about sperm and its role.

Because, like again, if a third of cases are male-based, then we should be equally probing male infertility.

But we actually don't know enough about that.

Our tests for sperm are pretty old.

All we look at is how many do they move are they fertile?

And so it hasn't changed in like 30 years essentially.

So I talk about consequences for like us not knowing enough about female bodies and female diseases, but actually these biases harm everyone, I would say.

HEFFNER: So is that the sequel testes obscura?

GROSS: Ask that a lot and I don't think I have quite enough interest to spend three or four years, but there's a really good book called Phallacy, P H A L L A C Y, that is about the history of the animal penis and how scientists understood it.

So I'm going to defer to that one.

HEFFNER: In the climate that we described that has changed since Roe v. Wade was overturned, there have been reports of increased abortion since the decision came down.

What does the future hold in all likelihood, the Supreme Court is not going to be overhauled in the next decade.

This will really come down to state politics and the manifestation of reproductive health on the local and state level.

Because that's really what the Supreme Court changed.

Where do you see the future of reproductive health going in this country, understanding this new legal and political framework?

GROSS: Yeah, it can't be overstated on the whole field of gynecology obstetrics.

And you know, so many people not only who are or will be seeking abortions, but are trying to get pregnant using reproductive technology.

So one thing is like the rise of medical abortion.

So pill-based abortion has been really swift over the past few years, even before Roe was overturned.

And I do think we're going to see a lot more research into that.

We're finding out how safe it is.

People are finding new ways to get it to Americans, whether it's across the border or in vans.

So I think there's kind of going to be a whole black market and research into that.

I do know like people, OBGYNs who are finding kind of loopholes in the law for how to provide abortions in a way that's not considered an abortion that might be for another procedure.

So similar to before we had Roe when everything was clandestine and people were having to find ways around it.

I think we're entering that period again.

One really dire consequence is that people who are future gynecologists and doctors are leaving the field partially because they can't get training to do abortions, and they get lower quality like training in general because of that.

So there's all these ways people are trying to go across the country or leave the country just to get abortion training.

And people who entered this field in order to help women and because they believe in abortion, are now being trapped by these laws and don't want to practice.

So like there's going to be a huge crisis in women's healthcare or whatever you want to call it in the next few years.

And that's going to have to be addressed.

There's going be a shortage of people who deliver babies, do pap smears and do abortions.

So we need people to enter that field regardless.

And we need new ways to train them, whatever that might be.

So people are going to have to get creative.

I also think about this, you know, like abortion is often a very like crucial crisis level thing, but this side effect of centering all of our talk about abortion rights means we're talking less about sexual health.

And about kind of again, what these organs are doing beyond pregnancy.

Like, we're kind of going back to like everything is about reproduction and that worries me because there's been a really important movement to say sexual health is health.

Like, let's talk about are you fulfilled, satisfied in your sexual relationships?

Are you taking care of your sexual health, your STD health?

Like really important research into that.

And I think that also helps people see themselves as full human beings, not just walking uteruses.

And I just see the conversation going back again and again to this basic like, are you pregnant?

Do you want to get pregnant?

How do you not be pregnant?

HEFFNER: We're about out of time, Rachel, but last question.

Have you been aware of anyone blacklisting or attempting to ban your book in classrooms?

Because we just had a senate hearing where a senator was reading explicit language about reproductive organs or things of that nature.

There is a movement underway to ban things that are not even necessarily pro-trans or Queer literature, but just things that that speak in the explicit language.

And while your book has received much praise in the circles that I would expect it to, I wonder if you have become aware that it's being banned in any classrooms or places.

GROSS: No, I'm kind of waiting for that, honestly.

I would like those people to be reading it and if they're offended, fine.

The most negative criticism I got was out of the UK and that was from a lot of the what do they call themselves like trans critical feminists.

So people who did not see why I had an entire chapter on trans healthcare and said like, this is supposed to be a book about women and their organs, and didn't understand that it's about how science often sees women through a narrow lens and who that harms and what the consequences are and how we're kind of expanding our idea of the female body.

So they were politically not into that.

HEFFNER: Got it.

Well, I encourage all of our viewers and listeners today to check out Vagina Obscura: An Anatomical Voyage, an award-winning new book by our guest and Smithsonian vet and science writer, Rachel Gross.

Thank you for your time and your insight today, and congratulations on the book.

GROSS: Thank you so much.

Thanks for your great questions, Alexander.

Have a great day.

HEFFNER: Please visit The Open Mind website at thirteen.org/open Mind to view this program online or to access over 1500 other interviews.

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