‘For So Long, Women Have Been Marginalized by Medicine’

If you spend any time on Twitter, you probably know about Dr. Jen Gunter. The outspoken Canadian American ob-gyn has made a name for herself writing about women’s health online, starring in her CBC docuseries, Jensplaining, and debunking the questionable health advice that’s sometimes featured on Gwyneth Paltrow’s lifestyle website, Goop. Gunter, who practices in California, has just published a new book, The Vagina Bible—it’s basically a user’s manual for anyone who has one. In it, she talks frankly about sometimes hush-hush subjects: STI prevention, how to talk to your doctor about sex, whether food affects your vaginal health (no), and what menopause is really like. She also uses her expertise to wean you off Dr. Google, detailing how to find reliable medical information online. This interview has been edited and condensed for clarity.

Lizzie O’Leary: What was the moment that made you say, “You know what—I want to do more than be a provider who sees patients in a clinical setting”?

Dr. Jen Gunter: I was realizing that my writing was actually helping some people. I would get feedback [like], “I used your IUD article to advocate for myself because my gynecologist told me that I couldn’t have an IUD [since] I had never been pregnant. I showed your article and I was like, ‘Dr. Gunter said that I can have an IUD. Can I have one?’” I got that feedback and was like, Wow, that’s awesome.

And I’d hear the same thing from some colleagues: “Oh, I printed your blog post out about why you shouldn’t eat your placenta, and I use that as a handout.” I thought, Man, I feel like maybe I’m doing a little bit of good here outside the office.

O’Leary: This book is called The Vagina Bible, but most of the time you’re talking about the vulva, not the actual vaginal canal. Why do you think we’re so freaked out by the word vulva and don’t use it?

Gunter: I don’t know, and in fact I had a little tussle with my publisher about it. I wanted to call it The Vagina and the Vulva Bible, but they said that people will just drop the vulva part, and it won’t resonate the same. I think they’re absolutely right, which is infuriating on one level, but the whole goal is to have people read it.

And I don’t know why the word vulva is just not discussed. I have friends who graduated from Yale master’s programs, and they’re shocked when I tell them, “You know, it’s not called the vagina on the outside.”

I don’t know the forces, but I think that certainly a lot of women’s anatomy has been neglected, a lot of women’s physiology, a lot of women’s symptoms have been neglected.

O’Leary: There’s a lot of language in here about the patriarchy. It’s hard to think about something that maybe you thought yourself, or you’ve been taught, and say, “Wait a minute, maybe this is sort of internalized patriarchal thought?” How did you think about approaching that without turning off readers and saying, “You’re wrong”?

Gunter: Because I have a vulvar- and vaginal-diseases clinic, I know a lot. It’s my area of expertise, but you have to fact-check everything. And a couple of things that I thought were surely true, I was like, “Oh my God.” Like, how does that wording, or that symptom, or the way we approach that condition, how does that benefit the patriarchy? The example I give is that women suffer more physically from incontinence than they do from vaginal discharge. But there’s article after article in women’s magazines about bad discharge. And the only answer I can come up with is: Men don’t like vaginal discharge, so in bed they’re like, “Clean that shit up.”

O’Leary: You’ve gone head-to-head with Goop. Why do you think this kind of misinformation and pseudoscience is flourishing right now? Why is it so catchy?

Gunter: Well, I think for so long, women have been marginalized by medicine, and they have not been listened to. And these people that inhabit these other spaces—the gap—they sound so science-ish and so inviting. It makes sense if someone hasn’t listened to your symptoms, and you’ve gone to three doctors—each of which was a 15-minute appointment—and you’ve left feeling upset, that the person who told you that every single thing you’re experiencing is valid [is the person you would listen to].

And the other person is acting like they’re going to help you, but they don’t have facts. I think that misinformation has been around since the beginning of time with women’s bodies. That’s how women have been controlled. Like, “You can’t come to a religious service—you’re on your period.” “Your uterus is filled with toxins.” “You’re dirty; you’re unclean.”

This language of purity and cleanliness and naturalness has been weaponized against women since the beginning of time. And, you know, those are the same words that the natural movement uses.

O’Leary: You use the term Big Natural.

Gunter: Yeah. They’re a trillion-dollar industry—supplements and natural stuff. And the thing that kills me is people are always like, “Oooh, Big Pharma.” But at least Big Pharma tests the drugs. I mean, they might not give us all the data, which is bad. But Big Natural gives us no data. It’s just bizarre to me that we think of Big Natural as good and Big Pharma as bad; they’re both capitalistic enterprises making money.

O’Leary: You know, a lot of this—the ideas of toxins and goddesses, etc.—is in a context of women’s empowerment.

Gunter: [Laughs]

O’Leary: Tell me why you think it’s not.

Gunter: Because you’re telling people less about their bodies! You’re actually, like, using mysticism and magic, which doesn’t exist.

O’Leary: Is it harmful? If I say, “I feel like a divine goddess today,” does it matter?

Gunter: That’s different than a divine goddess telling you to buy these expensive rocks from someone to heal your chronic pain. I’m all for people feeling like goddesses. I’m all for people using whatever empowers them to get through the day. But the information that you receive about your body, how it works, and how you should treat it should be factual.

I would say that I could summarize my beliefs as “informed consent.” So if you’re informed about everything, if you hear that supplements do not increase longevity—in fact, they might be associated with shortened life span—and at best you’re making expensive pee and at worst you might actually be feeding cancer cells (we don’t know), if you hear all of that and you choose to still take supplements, well, you made an informed choice. But if you hear, “Oh, you know these supplements are going to connect you to your divine inner self,” that’s not informed consent. That’s misinformation. You haven’t used factual information to reach the decision. That’s what I really care passionately about—for women, for men, for every person to have that so they can decide what they want to do with their body.

O’Leary: I think about my own experience—I have severe endometriosis. It took me 21 years to be diagnosed. How does medicine win back the faith of women who have been marginalized or mistreated by the system and say, “We’re here to help”?

Gunter: I’m board-certified in chronic pain. And when I hear stories just like yours, I’m devastated because I think, If you came to my clinic, that would not have taken us 21 years. It takes me six to nine months to work through the algorithm of pelvic pain to figure out what you have. I don’t have an answer, and I wish I did, and it bothers me because I hear it all the time.

I want to fix medicine. I hope many doctors read my book, because I see women affected by the myths that doctors have told them all the time. I wanted women to have a textbook on their shelves so they could hear what they’re being told or read about their condition and then pull the textbook down and say, “Okay, what does Gunter say about this?” Free from all the clickbait and the bias that you see online. Because a lot of information we get online about health comes from people selling products, or doctors selling their special laparoscopic surgery or their special laser. I mean, there’s predation from doctors just as much as there is predation from the natural movement.

O’Leary: There’s a lot in this book about sex. Ob-gyns usually don’t talk to women about sex. Are there ways to start that conversation with your doctor if they’re not bringing it up with you?

Gunter: Yeah, I mean it is really odd to me that a lot of ob-gyns don’t. That’s, you know, who I am, and I kind of figured that’s part of the gig, right? I think that if you have a sex-related problem and your doctor is not listening to you, then the best thing is to try to find someone who does. And that can be hard, especially if you live in a small town where there aren’t, like, 20 people to go to. Start with a sex therapist, and ask if they have any recommendations, any ob-gyns that they work with regularly.

O’Leary: This book doesn’t focus on abortion, but you have written a lot about it, and you have been an abortion provider in the past. What don’t you think we include or understand in our public conversations around abortion right now?

Gunter: I think the biggest issue with public conversation about abortion is still euphemisms and the defensive position. I think that people who are pro-abortion—because I really prefer that language, as opposed to “pro-choice” … Choice is like choosing between methods of contraception. Women know when they’re pregnant what they want to happen—if they want to keep the pregnancy, if they want to have an abortion.

And I also insist on calling the other side “forced birthers,” because that’s what they are.

O’Leary: I noticed that in your language. They would object to that.

Gunter: Well, they can. I’m happy to have a conversation with any of them on any television show to set them straight. I mean, if they were really pro-life, they would want universal health care, and they’d be picketing tobacco, and they would care about children in cages dying, and they would care about a universal measles vaccine.

O’Leary: Are there other things that you think we don’t talk about when we talk about abortion, that are still sort of shrouded in euphemism?

Gunter: I think that this idea that abortion should be rare. You know, the whole Bill Clinton thing, that it should be safe, legal, and rare. Why should it be rare? It should be what it is. We don’t say appendectomies should be rare. If you have appendicitis, you should have an appendectomy.

I just feel this whole idea that agreeing to it being rare means that there is some kind of implicit or internalized idea that you think there’s something wrong with abortion. And then you’re in a defensive position, and a defensive position has got us where we are now.

O’Leary: Is there anything else more broadly that I haven’t asked you that you think is important for me to know?

Gunter: I guess the only thing is I hope doctors and physical therapists and pharmacists read the book as well, because I’m challenging a lot of myths. You know, there’s still lots of doctors telling women to wear white cotton underwear. That was the first thing that got me into trouble in medical school. I was like, “Dude, how does the color of my clothes affect what happens to my body?”

O’Leary: Wait a minute. I thought women with vulvodynia are often told to wear pure cotton underwear? What’s wrong with that?

Gunter: There’s no basis to that. You should wear what’s comfortable. But how does the color of it affect your skin? It doesn’t—that’s a purity myth!