By Debbie Koenig
In the feminine hygiene aisle of the drugstore, on wellness websites, in spas, and even in doctors’ offices, a dizzying array of vaginal treatments are marketed to American women. Most of them are unnecessary, argues Jen Gunter, MD, a gynecologist whose straight talk has made her one of the leading voices on women’s health care. The problem, as she sees it: Too many women don’t understand how their own bodies work, which makes them vulnerable to misinformation and scams. She’s trying to rectify the situation, on Twitter—where she has more than a quarter-million followers—and now in her new book, The Vagina Bible: The Vulva and the Vagina—Separating the Myth from the Medicine.
WebMD spoke with Dr. Gunter about how a lack of knowledge can be dangerous for women.
Our interview has been edited for clarity and length.
WebMD: The first line of the book is, “I have a vagenda: for every woman to be empowered with accurate information about the vagina and the vulva.” When and how did you realize that vagenda was necessary?
Dr. Gunter: I’ve been talking to women about their vaginas and vulvas for 25 years. More and more, I was thinking, Why am I still debunking these myths? How does almost every woman have a smartphone, literally the library of all things, in her pocket, but she can’t get the right information? I started thinking about the barriers, the gaps in knowledge, the fact that many medical providers don’t have the right conversations with their patients. About the way women live their lives, things like menstrual products, pubic hair, things that aren’t really medical but medical-adjacent. If you use them incorrectly you have a problem, but we don’t really study many of these things.
I started paying attention to how pseudoscience online was exploiting the gaps created by medicine, using the language of the patriarchy, words like pure, clean, natural. I started to put it all together. I have a clinic—literally five women in one day came in with misinformation. It was something they found online, or a man said something to them, or a celebrity mentioned it. I spent my time undoing it and explaining how that body part worked. Each woman said, “How did I not know that?” Later I wondered how did they not know that? I realized women need a book and I’m going to write it.
WebMD: It seems as if a lot of women—and even more men—are unaware that women have both a vulva and a vagina. How does this lack of knowledge hurt women?
Dr. Gunter: Women’s body parts have been considered shameful. We speak in euphemisms; we’re told we’re dirty. There was a time when newspapers wouldn’t print those words, they’d call it “down there” or “ladyparts.”
When we became able to talk about parts publicly, we only said the word “vagina”—that’s the part that matters to penises. I look at everything we tell women about their body, even the way we talk about it publicly, and the first thing I think is, How does that benefit men versus women? And if you want people to think that the vagina’s only role in life is for a penis, you would only talk about the vagina.
But if you can’t describe your parts, you can’t communicate with your partner, your doctor, you can’t buy the right products at the store. You become vulnerable to predators; you can’t tell someone how you were touched. In many ways not being able to say the word is oppressive for women. Think about how women are made to feel damaged if they’ve been sexually assaulted—not the predator. Disclosing sexual assault makes you damaged, but it means somebody else is a criminal. In my practice I see women with unusual vulvar conditions, and they don’t even talk to other women about their own body parts. That’s how oppressive it is.
WebMD: For a book about women’s anatomy, the word “shame” comes up surprisingly often. What drives people to shame others about their vaginas, and why do so many women accept that shame?
Dr. Gunter: There’s a power dynamic. When you hold the least power it’s hard to stand up and say, “That’s wrong.” It’s hard to say, “Wait a minute, how is my normal body shameful?” I mean, if a gynecologist can’t say the words publicly without people laughing and giggling, who can? Everybody needs to be able to say body parts without shame.
WebMD: When I was trying to get pregnant, I learned about my cycle by reading a book. There were so many things nobody had ever mentioned to me before. Why aren’t girls and young women taught how their own bodies work?
Dr. Gunter: We have a science literacy problem in general. And we don’t teach this stuff well in school, or teach it in a way that sticks with people. You can have the best education but if it’s only taught that one time, five years later you’ve forgotten it, especially if it’s not taught in a relatable way. My editor said I should explain the menstrual cycle even though it’s a book about the vagina and the vulva, because people won’t understand what you’re talking about without a bit of background information.
As doctors we can’t understand how much we know versus a patient, like when a car mechanic talks to me about my car. They’ll say the most basic thing and I’m like, “Really?” Medicine is well served by simply giving the public more education. Part of my success is proof of that. People are hungry for relatable knowledge, presented in a way they can remember.
WebMD: It feels safe to say that if you’ve got a question about pretty much anything related to vaginas, vulvas, and their care, you’ll find answers in the book. How did you decide what to cover?
Dr. Gunter: This is what I do every day. Over the course of a month I talk to people about every single thing in there. When I started writing I thought, this is a textbook. How would I lay it out for doctors? Then I said, “Ok, now I’ll write it for everybody.”
This is 101, what you need to know to make your parts work. If you’re having trouble making the parts work, the next step would be to see a sex therapist. I tried to walk step by step: These are your parts, this is how they work, here’s basic info about sex, what happens when you get pregnant. It’s a different book than I would have written 15 years ago—there’s so much misinformation online now. Back then, people weren’t selling vaginal steamers.
WebMD: The book has more than one chapter about cleaning your vagina and vulva. If most women don’t actually need much more than water, how did we end up with a multimillion-dollar feminine cleaning product industry?
Dr. Gunter: Because people can’t talk about it. They have symptoms, but they feel shame about their body parts. When you walk into a drugstore and see shelves full of products, what else would you do? The whole system is set up to make women think their vaginas stink. People are invested in this.
Some women will need to use more than water on their vulva—for instance if you’ve got your period, water might not be cutting it for you. That’s when I recommend using an unscented, gentle facial cleanser. They’re much cheaper than feminine hygiene products. Talk about a pink tax! Feminine cleanser is a useless product that costs more.
Up until very recently it was uncommon for a doctor to say what I just said. I use a facial cleanser on my vulva. But it’s not a shocker that I have a vulva. I’m just telling you how I care for it, why is that dirty? I’d want to hear from an eye doctor how they clean their contacts. It’s only weird to talk about if it’s shameful. And there’s nothing shameful about it.
WebMD: Why has vulvar or vaginal rejuvenation become a thing? Are plastic surgery or laser treatments ever necessary?
Dr. Gunter: Cosmetic treatments are different than treating symptoms. I think you have to separate them. The problem with the rejuvenation industry is, they blur things: You must have symptoms if you look a certain way. I find it predatory.
I ask women, “What’s your bother factor?” If you have irritation or pain with sex, you don’t need rejuvenation. You need a diagnosis and approved therapy. A lot of these rejuvenation therapies prey on the idea that people have unsatisfactory sexual encounters. The industry weaponizes that. It makes women feel like they’re responsible for any issue that’s going on. Body parts do change with age; my skin isn’t the same at 53 as it was at 21. But the skin on your vulva isn’t the reason for your unsatisfactory sexual encounter.
There’s this idea that a vagina needs to be tighter. Why is that even a thing? It’s such a predatory, patriarchal concept. Usually the biggest predictor of success in a long-term relationship is a caring partner that’s attentive to your needs. The small amount of vaginal laxity you might have with aging, that’s unlikely to be responsible for a problematic sexual relationship.
It’s always your body, your choice. If looking a certain way cosmetically matters, you can make that choice. But you should know about the risks and complications first. Think about getting a drug to market. They start with animal data, they go through phase one, two, three, and there’s post-marketing surveillance. They don’t have to do any of that with vaginal lasers, for instance. People can use things off-label, so the laser might be FDA approved for something else. These treatments should have to be FDA approved. Who knows, maybe they’re really good? If it’s untested or poorly tested, we can’t know.
WebMD: I laughed when I read the term “yeast-industrial complex,” but you make a convincing case for it. Tell me about that.
Dr. Gunter: I’ve heard it for as long as I’ve been looking after vaginal conditions: This concern that women have Candida throughout their bodies. If you did, you’d be very sick. You’d be in the hospital.
Fifty to 70% of women who self-diagnose actually have something else. And many doctors inaccurately diagnose them. If the first time you go in with symptoms, you’re told it’s yeast but it’s something else, you’ve been inaccurately educated. Women don’t know to describe their vulva and vagina differently. Women tell me they have a vaginal itch; I ask if it’s inside or where the clothes touch the skin. If you’re scratching outside on your vulva a yeast infection is much less likely.
Then there’s the fact that copayments are expensive, and you can buy yeast medications over the counter. Now we have a huge issue with resistance to antifungal medications. I’ll see someone who’s used an OTC product four times before coming in. Does she have a resistant organism, or did she never have yeast to begin with? Roughly two-thirds of people who use these products don’t have to.
WebMD: Your list “What I Would Remove from Your Bathroom” could clear up a lot of space in America’s medicine cabinets. If you had to choose just one item you wish women would stop using, what would it be?
Dr. Gunter: Wipes. How this became a thing for women and not men fascinates me. Wipes were meant to remove feces from baby’s skin. Why do women have a feces removal problem and men don’t? It plays into the idea that there’s something wrong with a normal vulva. If you have a fecal incontinence problem I can understand, but just for regular everyday use you don’t need them.
WebMD: The chapter full of dispelled myths was equal parts hilarious and disturbing. What does it say about us that we buy into so many unproven “treatments”?
Dr. Gunter: Old wives’ tales have been around since the beginning of time. You have to think about how women have been excluded from medical conversations. If all you have is the woman in the hut at the end of the bog, because it’s the only place you can say you have an itch, it’s been systemically marginalized since the beginning. Plus, people have always been vulnerable to snake oil. We all want quick fixes. That’s human nature. If I saw an ad for a pill to drop ten pounds with no side effects, my eyes would go to it.
It’s fascinating to me that now, instead of science being available for more people, women are capitalizing and becoming grifters, selling snake oil under the guise of empowerment. It’s not empowerment to spread misinformation about tampon safety so you can sell expensive organic tampons. Empowerment is factual information. Empowerment is the ability to make an informed choice. Selling people useless products is not it. With a bespoke wrapping, a pink ribbon, you’ve camouflaged your misinformation as feminism.
People need to be super careful about bias. It affects your ability to make an informed decision. You should always think about people’s motivation. What are they selling? Should you get your information about a product from the person manufacturing it? Every piece of health information that comes from Big Natural, look at it the same way. Look for information from someone with no investment in the product.
WebMD: Just to clarify, what do you mean by Big Natural?
Dr. Gunter: Everybody who’s not a pharmaceutical company, who’s selling you a product that makes claims about wellness.
WebMD: At the end of the book you say, “Power and health are inseparably linked.” What do you mean by that?
Dr. Gunter: Being the healthiest you can be allows you to be powerful. If you’re struggling with a medical condition, you’re at a disadvantage. If it’s optimally treated, you’re much better positioned to advocate for yourself. How can you sit in the doctor’s office and advocate for yourself without accurate information? Deciding how to spend your money, what medications you need to take, if the information is correct, that’s all empowering.
If you don’t have facts how can you navigate things? It’s like starting on a road trip with a nonfunctioning speedometer, odometer, and gas gauge. How can you hope to get where you’re going without factual info? And how can you possibly know if you’re being sold a scammy product, a patriarchal belief? It’s the ultimate way to weaponize someone’s body against them, if you don’t have factual information.