The Big Idea: Why we need to rewrite the history of women’s bodies

meIn the 17th century, the ovaries got their modern name, which basically means “place for eggs.” Prior to this, they were known only as female testes, and were believed to be relict versions of male gonads that may or may not produce “female sperm”. The young Dutch anatomist Regnier de Graaf was the first to show that they actually made eggs, by dissecting rabbits that had just mated. He wrote: “Nature was preoccupied with her work when giving birth to a female as well as when giving birth to a male.”

But in the 19th century, the trend of surgeons removing healthy ovaries to treat “diseases” such as hysteria, made it clear that they were doing much more than just making baskets for eggs. In fact, these humble members were supporting a woman’s well-being in a more fundamental way. Ultimately, the discovery of estrogen helped scientists piece together the fact that the ovaries were a force for female health, held in a complex feedback mechanism between the brain and the body. They orchestrated the production of hormones that support nearly every physical system, from bones to brain development.

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The concept of a “basket of eggs” is typical of the way scholars, for centuries, have viewed women primarily in one dimension: as a baby-maker. However, even when it comes to organs that are directly involved in reproduction, it can lead to poor science and missed opportunities.

For example, menopause is often described as the end of a woman’s “childbearing years” and the point at which the ovaries “fail” or “drain” themselves. In fact, we now know that the ovaries continue to produce important hormones even after this transition. Surprisingly, scientists have identified ovarian stem cells that have the ability to grow into new eggs, including in postmenopausal women. This raises the possibility of new treatments for infertility or hormonal disorders, and calls into question how much we actually know about the mechanisms behind menopause.

The roots of this reproductive bias go back thousands of years. In ancient Greece, women were believed to be under the control of their untamed wombs – with the state of disobedience often caused by untimely childbearing. If she remained unmarried long after puberty, it was thought that a woman’s uterus would trample around her body like a small child, causing all sorts of unpleasant symptoms. This idea would eventually develop into the concept of hysteria, with its roots in the Greek word meaning womb, hysterics.

This entrenched bias has again led to gaps in our knowledge, and a great deal of suffering. Consider endometriosis, a condition that appears when tissue similar to the lining of the uterus grows elsewhere around the body. Medical textbooks in the late 1990s considered it a “professional woman’s disease”, describing it as affecting women who had given up marriage and children to pursue their careers. Some doctors have even suggested pregnancy as a “cure” (and still do so today, despite the fact that the idea has long been disproved).

This kind of thinking has hampered our understanding of an incredibly painful and common disease — one that affects women who have already given birth, premenstrual girls as well as transgender and non-binary men. Today, researchers are finally beginning to see endometriosis for what it is: a chronic, body-wide inflammatory disease. This new understanding opens the door to potential treatments that do not rely on manipulating hormone levels or stopping menstruation altogether.

The centralization of reproduction has also marginalized parts of the body that, although nominally considered part of the “reproductive system”, are in fact about sex and pleasure. Specifically, the clitoris, famously rejected by the father of modern anatomy, Andreas Vesalius, as “that new and useless part”. In his eyes, the female body was a reflection of the male body: the uterus was an inverted penis, and the ovaries were internal testicles. According to this framework, women already had all the body parts they needed, and a clitoris was not required.

It is no coincidence that the loss and rediscovery of the clitoris by men of science has continued throughout anatomical history. In the 1990s, it was often omitted or minimized in medical textbooks, with charts referring to the clitoral glans – the equivalent of the head of the penis – as everything. Even today, this organ is hidden in medical training, as its role in healthy sexual function, and therefore human health in general, is underestimated. The resulting lack of understanding can lead to clitoral injury in women who undergo the knife for things like pelvic mesh removal, urethral procedures, vulvar biopsies, and even hip surgeries. Because gynecologists rarely examine the clitoris, problems such as clitoral adhesions or vulvar cancers may also be overlooked or diagnosed late.

In some ways, the consequences of all this skewed science over the ages are clear: We are now facing a huge knowledge gap when it comes to half of the bodies on Earth. The fact that science still doesn’t know exactly how these important organs function when they don’t contribute to having a baby is upsetting, to say the least.

But the implications are broader than that. Women’s health is not her own planet, it is separate from men’s health. We all share the same overall body plan, the same origins in the womb, and the same hormones and basic body processes. Therefore, almost all of these issues have similarities in male bodies. Researchers who study endometriosis, for example, have found that the patterns of inflammation that underlie the disease also affect male health. Research into the vaginal microbiome sheds light on the penile microbiome. The study of menstruation teaches us about comprehensive biological processes such as regeneration and scar-free wound healing.

For centuries, science has treated women as mobile wombs, baby machines, and incubators for a new life. This narrow perspective has kept us from asking questions and making progress that can help us all live longer, healthier lives. It’s time for a paradigm shift. We finally need to see the female body for what it is: a powerful constellation of interlocking elements, each inseparable from the whole, working together to support our health from cradle to grave. As we fill in the missing parts of this picture, we will undoubtedly expand our understanding of all objects.

Rachel E. Gross is the author of “The Mysterious Vagina: An Anatomical Journey.” (WW Norton).

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Body Sex by Anne Fausto Sterling (Basic, £18.99)

The Seeds of Life by Edward Dolnick (Essential, £18.99)

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2022-05-09 11:30:00

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