Happy Friday! Normally we talk about penises at the end of the work week, but that’s not really fair, is it? After all, only half of us have them. So today I’d like to discuss a body part a little closer to my own heart: the vagina. Actually I’d like to talk about women who lack a vagina, and the multitude of techniques physicians have employed to give them one.
I hadn’t thought about this problem or its solution until recently, when I stumbled across an article about lab-grown vaginas. They exist. And this isn’t some rodent study, folks. Researchers at the Wake Forest Institute for Regenerative Medicine implanted these vaginas into four teenagers in Mexico City. The women suffer from a rare congenital condition known as Mayer-Rokitansky-Kuster-Hauser (MRKH) Syndrome that results in incomplete development of the reproductive tract. Most women with MRKH lack a uterus, and their vaginal canals may be missing or underdeveloped. To help these girls, the research team took a bit of tissue from the vulva, grew the cells in a dish, and seeded them onto a biodegradable scaffold that they hand sewed into a vagina-like tube. The team implanted these vaginas between 2005 and 2008, and the results of this pilot study — reported for the first time this spring — are truly amazing. These ladies now have fully functional vaginas that are nearly indistinguishable from the real thing.
A functional lab-grown vagina is pretty amazing. But what’s even more astounding is that physicians have been trying to solve the problem of the missing vagina for more than 2,000 years, long before antibiotics or anesthesia or even routine hand washing. To say that the earliest efforts were crude is putting it mildly. Celsus, a Roman medical writer and historian, advised that the flesh “be laid open with a single straight cut.” That gives you a hole, but you need to prevent the wound from simply closing. So into that hole, he recommended inserting “wool rolled lengthwise, dipped in vinegar.” And just when the wound begins to heal, that’s when you slide in “a lead tube smeared with cicatrizing ointment.” We don’t have studies to show how the women who received this treatment fared, but I’m going to take a wild guess and say ‘poorly.’ The technique developed by the Greek physician Soranus’ wasn’t much better. He replaced the wool and vinegar tampon with linen dipped in wine. “The areas must be irrigated with honeyed water,” he wrote. And instead of a lead tube, he suggested tin.
The science of creating vaginas for the vagina-less continued like this, with surgeons cutting holes and shoving terrible things into them, until the latter half of the nineteenth century. That’s when C.L. Heppner, a Russian surgeon, came up with the idea of lining the hole with tissue from the labia and thighs. It was an improvement, if only a modest one.
These early fixes failed more often than they worked. But even when the procedure was successful, the surgeon’s handiwork wasn’t always well received. Robert Abbe, a physician in New York, formed a vagina in one patient by folding the woman’s labia into the incision and stitching them in place. Despite “excellent healing,” the two-inch vagina Abbe had created failed to impress the woman’s husband. “The married couple soon separated,” he wrote. His second attempt, however, had better success. Abbe lined the canal with grafts taken from the thigh, a procedure that required his patient lie down for four weeks, her new vagina stuffed with “gauze liberally smeared with lanolin” and later large vaginal plugs. Although the canal he created shrunk slightly in subsequent months, Abbe noted that it remained “a practical and competent canal, fulfilling at least one of its functions, and giving gratification to the mated couple.” But it wasn’t yet clear that thigh grafts were the best way to line a vagina. Surgeons experimented with a whole host of other tissues too — a piece of intestine, a chunk of bowel (patients sometimes complain of a foul odor), strips of skin from the buttocks, and the mucus membrane from a giant clitoris that had been amputated from another patient.
For centuries, surgery (often painful and arduous) was the only option for women with missing vaginas. Then, in 1938, a New York physician named Robert Frank proposed a nonsurgical option [PDF]. He found that patients could create their own vaginas by pressing progressively larger pyrex tubes against the delicate tissue between their legs for half an hour intervals. “Within six to eight weeks, the full length of the vagina, 2 1/2 to 2 3/4 inches has been reached,” he wrote. (Helpful hint: If you don’t have a set of pyrex tubes, it seems a plain old penis will work in a pinch. A Norwegian researcher reports that four teenage girls developed vaginas simply by repeatedly attempting to have sex.) Frank tried this method on six patients. Five of them developed vaginas. The therapy didn’t work for one woman, but Frank blamed this failure on his patient’s “uncooperative attitude” as well as her “stupidity.”
Frank’s “bloodless and simple procedure” may not seem like much of a breakthrough when compared with implanting a fancy lab-grown vagina, but it’s still recommended as a first line therapy. Dilation doesn’t require risky surgery or anesthesia, yet in 85% to 90% of cases it produces a functional vagina. Sometimes the best fix is the simplest one.
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Image credit: Hey Paul Studios via Flickr
Ow, ow, ow! Still crossing my legs at the vinegar and wine solutions – boy would that hurt on a fresh wound.