BODY AND MIND: Monologue on a gynaecological taboo TOP TO TOE: No other part of the body is so loaded with meaning. Jerome Burne puts the vagina into perspective
By JEROME BURNE
If you were compiling a list of totally impossible topics to put on the stage, the vagina would have to come near the top. Yet on St Valentine's day last month a staggering 18,000 people gathered in New York's Madison Square Garden tosee The Vagina Monologues.
The play is based on more than 200 interviews conducted by Eve Ensler with women about their vagina. First performed in 1996, it has been seen all over the US and in London, serving up what's been sniffily described as "reconstituted 1970s radical feminism".
Reconstituted or not, it has obviously hit a nerve. It has "outed" a topic more commonly confined to gynaecology consulting rooms, women's groups or porn websites; searching the web for the word "vagina" produced a list that included "carcinoma of the vagina" and "perverts' delight".
Perhaps no other part of the body is so loaded with meaning: a symbol of women's pleasure and power, the object of the most aggressive male sexuality, and a source of infection and disease.
Reference books are pretty straightforward about the anatomy. The word vagina originally means sheath - for a sword: no subtlety there. Guarding the entrance are the labia majora, formed from tissue that in males creates the scrotum, and the labia minora, which is packed with sweat glands. On either side of the entrance are the glands of Bartholins, which produce much of the mucus that lubricates the vagina.
Inside, the lining of the walls contain glycogen - stored starch - which is fermented by bacteria to produce lactic acid. This makes the vagina slightly acidic, which is very beneficial since most other micro-organisms don't like it.
But those same books can become comically turgid when dealing with the vagina and sex. Here is the Encyclopaedia Britannica on arousal: "(It) begins with psychogenic events in higher neural centres (which) cause excitation of sacral parasympathetic outflow, innervating vascular tissues". Nothing about the controversial G spot, described in one sex manual as "a spongy dime-size area on the front wall of your vagina about 2in in". While a clitoral orgasm causes contractions in the first third of the vagina, it is claimed that the G spot orgasm triggers spasms throughout the pelvic region.
Whatever the manuals say, the clitoris has a lot more physiological evidence on its side for being the site of the female orgasm. Not only is it the only organ of the body with no other function except pleasure, but it is also the most sensitive. With 8,000 nerve fibres, it has a concentration of nerves greater than the fingertips and tongue, and twice the number in the penis.
What's more, it has long been neglected by the medical profession. It was only two years ago that an Australian researcher discovered that the erectile tissue inside the vagina that is attached to the clitoris is at least twice as large as shown in all the most up-to-date anatomy textbooks.
Helen O'Connell, a urology surgeon at the Royal Melbourne Hospital, Australia, produced a radically revised map, using a new 3D camera. "There's a lot of erectile tissue down there that's not drawn in any anatomy textbooks," she says. "It's closer to the urethra and encompasses a far larger area of the anterior vaginal wall than most people thought."
Not only has it been wrongly charted in medical textbooks, but for much of this century they have actually ignored it. One study found that while the 1901 edition of that medical bible, Gray's Anatomy, clearly labels the clitoris, by 1948 the labels have been deleted. And Gray's wasn't the only one. Eight other anatomy textbooks published between 1950 and 1971 either had no clitoris at all or something that could be a clitoris but which was unlabelled.
If the vagina's role in sexual pleasure has been underplayed, there is no shortage of details on the possibilities of disease and infection.
Many micro-organisms seem to find a home there. Gonorrhoea, caused by the bacteria Neisseria gonorrhoea, has perhaps the longest medical history. In the 1970s, the blisters caused by the herpes virus emerged as a source of concern, along with a protozoan parasite known as trichomonas vaginalis, which causes inflammation and discharge.
For some years the fungal infection Candida has been a controversial source of problems. Some practitioners see it as affecting many women in a variety of ways, from an obvious discharge and inflammation to tiredness and debilitation. Others say it is often wrongly diagnosed and should not affect most women unless they have a damaged immune system.
The latest worry is infection by the bacteria Chlamydia trachomatis, which has no symptoms. Earlier this year new research linked it to cervical cancer and inflammatory heart disease. It is alarmingly common among young women; a recent survey found that one in three women under the age of 25 were infected.
But if the hazards of disease are not enough, the vagina has become the latest target for plastic surgery. In Los Angeles, women who describe themselves as having that "flippy floppy" feeling, are flocking to the Laser Vaginal Rejuvenation clinic run by David Matlock.
On offer is laser vaginal rejuvenation, for tightening the vagina for "enhanced sexual gratification", as well as the more radical option of designer laser vaginoplasty, which will aesthetically modify labia. Soon, Matlock promises, these procedures will be available internationally as a franchise. He has even developed a technique called hymenalplasty, which will give women a new hymen - apparently it is very popular among Middle Eastern women.
So is this cosmeticisation of the vagina a positive step for women or yet more slavish catering to men's wishes? It could undoubtedly be the topic of a monologue. The vagina is the body politic made flesh.