The history of the word "vagina" illuminates our persistent problem with biased reproductive health

Roughly half of people in the world have a vagina between their legs, but the first recorded medical word for this body part didn't arrive on the scene until 1680. Although circles of women all over likely came up with their own names for their anatomy before then, male physicians in Ancient Greece for the most part kept female anatomy under wraps.

Greek physicians typically didn't examine female bodies due to historical taboos and dismissed the vagina and its neighbors as contemptible parts. Hippocrates, the father of modern medicine, called female genitalia "the shame parts." In 1545, French anatomist Andreas Vesalius followed suit, calling the clitoris "membre honteux," which means "shameful member," according to Rachel Gross, author of the book "Vagina Obscura." Adaptations of the word pudendum, a Latin word that translates to the verb "to be ashamed," can still be found in medical vocabulary today.

"Vagina" stems from the Latin word for a "sheath," like that which holds a sword. Despite the vagina's role in reproduction, pleasure and vitality, its etymology boils it down to a holding place for what has historically more often been seen as the reproductive system superstar: the penis. 

Today, female anatomy is still misunderstood: Medical textbooks remain biased toward male anatomy, and studies examining conditions that affect primarily women receive a fraction of the funding that research into conditions affecting men does. It wasn't until 2005 that Australian urologist Dr. Helen O'Connell finally published the first full diagram of the clitoris, and it wasn't until 2012 that the National Institutes of Health established a branch specifically dedicated to gynecologic health.

Yet we cannot be expected to empower our bodies if we do not know them, and sidelining female anatomy in medicine continues to have lasting impacts in healthcare and beyond.

"The more we can get clear on language and normalize that 50% of the population has this anatomy and that lots of things can change and go wrong with their medical parts just like the heart and the lungs, then people can understand that they don't have to put up with being ignored or minimized when they have complaints or issues," Dr. Rachel Rubin, a urologist and the education chair of the International Society for the Study of Women's Sexual Health, told Salon in a phone interview. "They can actually advocate for themselves."

In Ancient Greek texts, the female body was usually referred to in relation to the male body. While males were seen as whole and pristine, the female body was historically thought of "in terms of incompleteness or inversion," according to an analysis of Greek texts, including Aristotle. The Greek physician Galen, for example, believed the uterus was basically the male scrotum tucked in on itself. In many cases, a woman was instructed by her physician to have sex with her husband to cure bodily ailments.

"The male body is seen as sort of a norm and as this kind of healthy, properly functioning [body]," said Kristina Gupta, Ph.D., an associate professor in the Department of Women's, Gender and Sexuality Studies, who studies the history of medicine at Wake Forest University. "Whereas the female body is seen as kind of dysfunctional, even if it is normal functioning."

Although major improvements have been made toward equity in medicine, some aspects of medical education are still centered around the default male today. Rubin said it wasn't until her urology fellowship that she learned how to properly examine the external genitalia of the female body. Although the vagina sometimes inaccurately serves as a stand-in for the entire genitalia, the vulva, the clitoris and the labia majora and minora each have their own set of functions and healthcare needs.

"It's not a priority," Rubin told Salon in a phone interview. "If anything, it gets kind of glossed over in many ways."

In the 1960s, information about reproductive and sexual health was dispersed as the Women's Liberation Movement picked up speed. The idea was to educate women so they could advocate for themselves, and there was a lot of progress made with the publication of books like "Our Bodies, Ourselves." The arrival of birth control pills on the market in 1950 and the legalization of abortion in 1973 gave women a new sense of control over their own fertility. Although great strides were made to improve reproductive health, there were many other pains, pleasures and problems associated with the vagina that didn't get the same attention at this time.

"In women's health, we often just focus on reproduction and cancer prevention," Rubin said. "Very rarely do we focus on pleasure and quality of life. The clitoris is completely ignored by medicine and science at every level, and we don't ask women about their clitoris and how their orgasms work."

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In medicine, it is becoming more clear that there are unmet needs in women's sexual healthcare, and treatments are beginning to reflect that, said Dr. Sharon Parish, a general internist focused on menopause and sexual health at Weill Cornell Medical College. At the same time, reproductive rights are once again being challenged.

"There was some revolution, so to speak, over the second half of the 20th century, and now it's swinging back again, which is concerning," Parish told Salon in a phone interview. "I think there's a lot of taboo in public and, although improving, there's been some gender bias in the availability of treatments for women. It's been an uphill battle."

Some common conditions affecting the vagina still lack effective treatments. Bacterial vaginosis — a condition caused by the imbalance of bacteria normally present in the vagina that causes itching, pain and changes in vaginal discharge — affects one in four women and is usually treated with antibiotics. But infection comes back for 60% of patients under the current treatment regimen, which basically hasn't changed since the 1980s, said Dr. Caroline Mitchell, the Director of the Vulvovaginal Disorders program at Massachusetts General Hospital. 

"The number of people who had a doctor say to them, 'Just have a drink of wine and relax,' [is ridiculous]," Mitchell told Salon in a phone call. "No one would say that to a man."

Other conditions go undertreated because of a lack of awareness. Genitourinary syndrome of menopause, which causes dryness, irritation and recurrent urinary tract infections, affects 50 to 80% of women. It can be treated with vaginal estrogen cream, but some studies estimate that around 50% of women go untreated.

"The solution is so easy," said Dr. Kelly Casperson, a urologist and author of a recent book on female sexual pleasure, "You Are Not Broken." "But we have sexless marriages because of lack of education and communication."

Studies show this lack of knowledge about sexual health extends beyond the doctor's office. One 2016 survey in Britain found 44% of women could not accurately label the vagina, with even fewer correctly identifying the vulva. 

"We have a catastrophic, poor understanding of our health and sexual education that actually harms us and it harms our relationships," Casperson told Salon in a phone interview. 

Words like "vagina," have been censored on the internet throughout the past few decades, and sexual education has been attacked in certain school districts, threatening to further enshroud the vagina and the rest of the female genitalia in taboo. Yet the need for equitable education and healthcare is just as important as ever. To bridge the gaps that remain, part of the onus is on healthcare providers to educate themselves about gynecologic health, Casperson said. But it's also on the individual to advocate for themselves, she added. 

"It's your job to know your body," Casperson said. "Let's not assume any male knows anything better than we do."