An Owner’s Manual for the Vagina

A book review of The Vagina Bible: The Vulva and the Vagina – Separating the Myth from the Medicine by Jen Gunter, MD. New York: Citadel/Kensington Books, 2019. ISBN-13: 978-080653931. 432 pages. Paperback, $18.95.

Considering that half the population has one, the vagina has been plagued by an inordinate amount of myth and misinformation. There are many reasons. Prudery inhibits public discussion of anything to do with sex, women are embarrassed to talk about their private parts, patriarchal attitudes still prevail, religions have taught that women are inferior, most doctors have traditionally been men, and the vagina has been thought of as unclean. Dr. Jennifer Gunter has done women everywhere a great service by writing this book to set the record straight. Her declared “vagenda” is “for every woman to be empowered with accurate information about the vagina and vulva.” She is the perfect person to write such a book. She has a wealth of clinical experience, with 33 years in medicine and 24 years practicing gynecology. She is a gifted communicator with a long and successful career writing about medical matters. She is frank, unashamed, and generous about sharing details of her personal experiences, like the time she embarrassed herself by putting a condom on a man inside out. And her sense of humor shines through.

I am not a gynecologist, but gynecology was a big part of my practice as a family physician; I couldn’t begin to guess how many vaginas I’ve peered into and palpated. I thought I knew about vaginas, but reading this book taught me much that I didn’t know, and I discovered that a lot of what I thought I knew was wrong. I learned a lot, and I’m sure the average woman would learn even more. It’s not only educational, but entertaining, fun and easy to read, organized conveniently into short chapters. Each chapter ends with a “Bottom Line” summary of the important points. As an additional bonus, the book provides an education in science, critical thinking, and how to evaluate medical claims.

In 10 sections and 47 chapters, the book covers cleansing, menstrual products, douching, lubrication, menopause, sexually transmitted infections, pubic lice, yeast, probiotics, toxic shock syndrome, and much, much more. It covers everything women want to know plus everything they didn’t know they needed to know about. 

I’ll give you a preview of some of the intriguing facts in the book: 

  • Men are tested for prostate-specific antigen (PSA), but did you know women have PSA too? They secrete a small amount from their Skene’s glands, which are analogous to the male prostate.
  • The clitoris is the only body structure in either sex whose only function is to produce sexual pleasure.
  • After female genital mutilation (FGM), some women are still able to have orgasms.
  • Transgender men have 10 times greater risk of an abnormal Pap smear than cisgender women. 
  • The G-spot is a myth.
  • “A penis is not the most reliable way to achieve female orgasm.”
  • The commonly used stool softener Docusate is ineffective; no study has shown it works.
  • Changes in libido, sexual priorities, and satisfaction can occur after childbirth, but they also happen to gay men who adopt babies.
  • The bivalve vaginal speculum was invented by a woman.
  • White cotton underwear doesn’t protect against yeast infections.
  • There is no anti-candida diet.
  • People worry that chemicals like BPA are endocrine disruptors, but many plants are endocrine disruptors, including lavender and marijuana.
  • Gwyneth Paltrow is wrong: jade eggs for the vagina are bogus.
  • “There’s a lot of money in vaginal shame.” Douching and vaginal cleansing are unnecessary and can be harmful. Vaginal washing with soap increases the risk of HIV transmission by almost four times. One vaginal cleansing product has a “wonderful tropical scent.” Gunter snarks, “It’s a vagina, not a piña colada.” 
  • You can’t get pubic lice on your scalp hair, but you can get them on eyebrows, eyelashes, armpits, chest hair, and beards.
  • About toxic shock syndrome (TSS) and superabsorbent tampons: “I tried Rely when I was fourteen years old, and the tampon absorbed so much blood that getting it out was like giving birth to a giant Peach!”
  • There are products to make menstrual sex less messy, but she relies on her old standby, a navy blue towel.
  • Topical estrogens are safe. The FDA requires black box warnings about heart disease, cancer, and dementia, but these were based on an older study that showed a small risk with systemic estrogens. 
  • Bioidentical is a marketing term with no medical meaning.
  • Vaginal cannabis products are untested.
  • 70% of women who think they have a vaginal infection are wrong.
  • 30% of antibiotic prescriptions are unnecessary.
  • Probiotics are big business, but they are useless for healthy people. One study showed they delayed the return of healthy gut bacteria after antibiotics.
  • She explains why “well, it can’t hurt to try it” is bad advice.
  • “Surgically reducing the labia should be considered exactly the same thing as surgically reducing the size of the penis.”
  • 80% of women who have ever had sex with a man will have had at least one sexually transmitted infection (STI).
  • Pubic hair removal involves microtrauma and increases the risk of HPV and precancer of the vulva.
  • Unnecessary tests: “If the test is not going to change the plan, don’t order it.”
  • Human papillomavirus (HPV) can persist on sex toys, even after cleaning.
  • About 80% of people who are positive for herpes don’t know it.
  • Screening for gonorrhea and chlamydia is essential; untreated infections have serious consequences.
  • The yeast-industrial complex disseminates much false information. “Do I have a systemic yeast infection? Not if you are reading this book.” You would be very ill and in the hospital, maybe in the ICU.
  • Symptoms suggestive of urinary tract infection (UTI) only indicate a bladder infection about half of the time.
  • Cranberry juice doesn’t prevent bladder infections. Neither does emptying the bladder after sex.
  • Phenazopyridine, an over-the-counter bladder pain relief remedy, is safe to use for more than the recommended 3-day limit.
  • It’s silly to test your vaginal microbiome; it changes from day to day and even throughout the day.
  • Products can bring you joy, but don’t confuse that with medical benefit.
  • Douches are “cigarettes for your vagina.” Don’t use them.
  • Don’t use feminine odor anything: “that is choice patriarchy.”

Dr. Gunter asks says, “Why do we have a hymen?” and offers some possible answers. She gives valuable instructions to help a young girl insert a tampon for the first time. She says myths abound, but “Fortunately I have the antidote. Facts.” She is a breath of fresh air.

There is a whole chapter on how to find valid information on the Internet, how to identify reliable websites, and how to detect bias. Avoid websites that sell products or offer advice from celebrities. Watch for made-up words like detox. Avoid any website that mentions homeopathy as a valid treatment. Don’t rely on testimonials.

There is a chapter on old wives’ tales, debunking myths about apple cider vinegar, coffee enemas, drinking eight glasses of water a day, essential oils, alkaline water, kava, garlic, widespread yeast, vaginal tightening sticks, tea tree oil, and much more.

She says a full discussion of hormone replacement is beyond the scope of this book and says perhaps her next book should be The Menopause Bible. I hope she will go on to write that and maybe The Pregnancy Bible and other OB/Gyn related books.

The book concludes with these words:

“The patriarchy and snake oil have had a good run, but I’m done with how they negatively affect and weaponize women’s health. So I am not going to stop swinging my bat until everyone has the tools to be an empowered patient and those who seek to subjugate women by keeping them from facts about their bodies have shut up and taken a seat in the back of class. That’s my vagenda.”

It is a worthy goal indeed.

This book is an owner’s manual for the vagina that also offers an education in skeptical thinking about medical matters. I wish every woman everywhere had a copy of this book. And every girl. I can’t thank you enough, Jen, for creating this invaluable reference. I feel smarter now, thanks to you.

This article was originally published in Skeptical Inquirer

Dr. Hall is a contributing editor to both Skeptic magazine and the Skeptical Inquirer. She is a weekly contributor to the Science-Based Medicine Blog and is one of its editors. She has also contributed to Quackwatch and to a number of other respected journals and publications. She is the author of Women Aren’t Supposed to Fly: The Memoirs of a Female Flight Surgeon and co-author of the textbook, Consumer Health: A Guide to Intelligent Decisions.