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If you have a vagina you know that most of the time it is without sensation. How does your spleen feel? How do your kidneys feel? How does your pancreas feel? Luckily, we have no idea how these things feel. The vagina is mostly like a pancreas and feels nothing. If it feels something, it is either erotically engaged or ill.
All this is obvious if you have one. But half of us don't.
I have one, and something went wrong with it.
Some days my vagina felt as if somebody had put a cheese grater in it and scraped. Some days it felt as if someone had poured ammonia inside it. Some days it felt as if a little dentist was drilling a little hole in it. The strangest thing was that all these sensations occurred in one inch-long part on the left side. The rest of it was fine.
It's a yeast infection, said my gynecologist in June.
On one side? I asked.
I guess it's localized, he said. Here, try this.
This was some antifungal cream. It didn't work.
Hmm, he said, when I returned after a week. Try this.
This was a three-day course of medication in a little bullet that I popped into a plunger and inserted nightly. It didn't work.
There's a stronger version, he said. Let's try that.
That was a cream in a tube. I filled a new plunger with cream and plunged it in. My vagina didn't like that. It became bright red and swollen and hurt worse for four days.
Let's try the pill form, said my gynecologist.
I popped the pill. It made me queasy for two days, but it didn't hurt my vagina.
Now let's do a culture, he said. He emerged from his lab grinning. Not a trace ofyeast.
Why does it still hurt? I asked. And why are there red spots here and here? I pointed to the two red spots, one under my clitoris and one on my inner lip. They hurt particularly, I said.
Irritation, he said. Let's try estrogen cream. Use it for ten days. It increases the blood supply and will help it heal.
Estrogen cream dribbled out of me all day long, but for about a week my vagina returned to normal—I didn't feel it. Then it began to twitch and zing again.
That can happen, said my gynecologist.
The estrogen cream causes a yeast infection.
Oh no! I said. Now I'm back where I started.
You're not meant to use it every day, he explained. Twice a week—but I thought it might clear things up.
It did, for a while, I told him.
Let's treat the yeast infection and see where we are.
I went back to the bullet in the plunger.
I like my gynecologist. He is a robust gentleman of Italian origin with a resonant voice and large soft hands. His waiting room used to be decorated with pictures of babies he'd delivered. These days it's decorated with booklets about menopause. Malpractice insurance for obstetricians is very high, I guess.
I met my gynecologist twenty years ago when I had a cyst in one of the glands in my vagina. That was when I found out how lousy a vagina could feel. He removed this cyst in an operation called a marsupialization—because it makes a little pouch in the vaginal wall where the duct of the gland opens. That way, the gland can't get blocked again.
You know, I said to him after the bullet in the plunger hadn't worked for the second time, it hurts in the same spot as the Bump, or close to it.
One of the good things about having a doctor for twenty years is that you make a language together. "The Bump" is what we call that cyst he removed. Also, after twenty years I'm used to having conversations with him over the top of a sheet while he's got his head between my legs.
In a way, I continued, it feels as if the Bump has returned. It's phantom Bump!
The Bump can't return, he said. But I see what you mean. It's inflamed there. Those red spots are gone, though.
Now what? I asked.
Let's not treat the yeast infection. It'll resolve on its own, usually. Use the estrogen cream twice a week. It will help clear the inflammation, and it increases lubrication. Maybe some of this has to do with less lubrication.
But there isn't less, I said. It's just the same. And wasn't my estrogen level normal?
It was, he said. Three months ago it was.
Sometimes it hurts when I have sex, I said. That's what worries me. You can get a psychological problem from that—associating sex and pain.
Use estrogen, he repeated. And don't avoid sex. You know—he leaned over confidentially—they have shown that the more you use the vagina, the better its health.
My gynecologist had told me this before. That's another thing I like about him. He's very much in favor of sex. So am I, except when it hurts.
I went home with my estrogen cream and my resolve to have sex and maintain vaginal health.
But my vaginal health was declining.
New bad things started to happen. Sharp lines of zinging pain, like a toothache, began to radiate from my former Bump site to the edge of my outer lip, culminating in a dot of soreness. Two things made this worse: driving a car and wearing pants. Then in September, the red spots returned. I went back to the gynecologist.
It's cancer, I told him.
No it isn't, he said. He scraped a bit of skin off and went into his lab. It's not cancer, he repeated when he came out.
Is it herpes? It doesn't feel like herpes.
It's not herpes.
How do you know it's not cancer? I asked.
Cancer doesn't come and go, he said. Cancer just gets worse.
So what is it? I asked him.
I don't know, he said.
Listen, I said, everything's getting worse. I'm really having trouble with sex. My vagina hurts all the time now. If I have sex it hurts more, but it never doesn't hurt.
I know, said my gynecologist, but I don't know why. He walked over to the window and looked out. Western medicine doesn't know everything, he said. He turned back to me. I think maybe you should go to an alternative health center.
I was astonished. He was sending me to an herbalist!
There's a very good one here, he went on. They're not cranks. They're real doctors—I know some of them. They specialize in women's health. They aren't going to wave crystals over you or something. I think you ought to try them.
He was washing his hands of me! After twenty years.
But what is it? I asked him. What's wrong with me?
I don't know, he said. Try the alternative health place. The mind and the body—he wiggled his hands around. You have no bacterial infection. You have no fungus. You have no herpes. You have no cancer. I can't tell you why this is happening, but maybe they can.
Q: What is your book about and what made you decide to write it?
A: My book is about a peculiar malady of the vagina and how having it affected my life. So it's about sex and how sex fits into life. It's also about disease generally, and what it's like to be ill. I didn't decide to write it; I found myself writing it. I was involved in such a confusing medical maze that I started taking notes to try to keep things straight. One doctor said one thing, one doctor said another, and I felt I needed to document all of it -- partly because I couldn’t remember it. As I was doing that, I realized it was funny, and wacky. So I kept writing it.
Q: So it was therapeutic to write?
A: Not exactly. I don't like that notion that writing is therapeutic. Therapy is therapeutic. Writing is writing. It was practical to write it. I needed a chronology in order to give each new doctor a proper history. And then it became a sort of mystery novel. I admit, I got some satisfaction from noting all the contradictory theories and advice.
Q: It’s so direct and personal. Did you have any hesitation about publishing it?
A: I did, and I still do! I know, for instance, that the book raises questions about my current sex life -- have I got one, mainly -- and I'm not eager to answer those questions. But the general feeling these days seems to be that I must. People assume that if you're willing to say something about personal matters, you must say everything. You're a bad sport if you don't participate in total self-revelation. Girl, Interrupted provoked this reaction too at times. Why didn't I tell everything about my family? Since this book is about even more intimate things, I imagine the desire to know will be correspondingly more intense -- and as we all know, there really isn't anything more interesting than somebody's sex life.
Q: So how is your sex life?
A: Next question. Well, that won't do, I suppose. I've decided that sexual inactivity is something that is worse to admit to than lack of money. It's the new taboo. I don't have sex: Who's willing to say that? Just about nobody. And yet, is it that bad not to have sex? Did anyone die from not having sex? It's not as bad as having no heat or no food or no health insurance. But there's something truly humiliating about it, isn't there?
Q: One of the doctors suggests that your problem is simply part of menopause. Is he right?
A: The research I did indicates No. Plenty of women in or approaching menopause don't have this problem. And plenty of quite young women do. It does not appear to be triggered by the hormonal changes of menopause.
Q: But many women at the age of menopause do have problems with lack of desire and with enjoying sex.
A: That may be, but their problems are not this particular array of symptoms. Usually their problems can be resolved or improved with hormonal regimes, or even with yam powder or whatever that stuff is. It's a different problem. But what do I know? I'm not a doctor.
Q: I want to return, for a moment, to a previous question. Why did you withhold information about your family in Girl, Interrupted, and why are you now unwilling to answer the natural follow-up questions about your current sexual functioning?
A: In my previous book, I felt the details of my own family's behavior were beside the point. The book wasn't a case history. It was more a travelogue about the country of mental illness. In a sense, this is a similar book, though it is, I admit, more of a case history -- my own case. But both books describe how a certain sort of invisible awkward functioning catapults you into another world, and changes your relation to the everyday world.
Sometimes I think people have forgotten that memoirs are books. This isn't a CAT scan of my emotional life, it's an artifact, structured and arranged by me to provoke certain emotions in you. I'm describing events in the way I would like you to imagine them. I'm manipulating you. That's called writing. You may or may not enjoy the way I manipulate you. But I think you shouldn't forget that I am doing so. Well, perhaps if you get so caught up in the book -- that's the ultimate compliment, to forget the writer's machinations.
Q: What happens to women in our society as they age and their sexuality slows or becomes muted, if it does?
A: Women in American culture are simply sex objects. We don't have a firm reason for existence if we're not sexually attractive. This sounds overstated, but it really isn't. You have only to look at the usual suspects -- advertising, movies, TV, etc. -- to see that it's true. The obsession with body-part improvement. It's insane. Breast lift. Tummy rearrangement. Someday people will look back and marvel at our idiocies.
I'm not saying that a woman's reason for existence is to be a sex object. It isn't. It's men's reason for our existence. Doris Lessing has a marvelous scene in a novel where a woman in middle age is passing a construction site where the guys are eating lunch and enjoying foot traffic. She's preceded by a young, pretty woman, at whom they whistle and call out admiring (or insulting, depending on your political stance) things. They haven't got anything to say to her, of course. She goes around the corner and she rearranges herself, she turns herself into a "woman." She improves her posture and fluffs up her hair and walks past them again with the desire to be attractive. And they pay her the compliment of whistling and admiring. Then she goes past again, only this time she's back in her own, middle-aged woman thoughts. And they ignore her again. I remember reading this years ago and knowing, absolutely, even though I was in my early twenties at the time, that this was true. So women have to deal with that. Whether our existence really is our own or only relational -- only activated by male interest.
Q: There's been much openness about male sexuality lately, erectile dysfunction and so forth, yet female sexuality has remained somewhat taboo. Do you think your book will change that?
A: This is complicated. I think one reason there's more discussion of male sexuality lately is that there is now something to do about impotence. There's, plainly speaking, money to be made from impotence, because there's a pill for it. When there's a pill for a female orgasm, we'll hear a lot more about female sexuality. And I don't think there ever will be, because female orgasm seems to be much more complicated than male orgasm.
Plus, I think the erect penis has a power over the human imagination that nothing can compete with. It always has, and it always will. It's an engineering and physiological miracle.
But I don’t really care about all that. I don't think it's a bad thing that women's sexuality remains obscure, veiled, medically opaque and conversationally taboo. One of the only powers women have over men, now that we seem to have lost the power to say no to sex, is that men do not actually know if women are enjoying themselves in bed. This is our secret. Our erotic workings are hidden, and men have to rely on our reports to a large extent. And our reports might be false. This drives some men crazy, this idea that we might be faking. And it's true. We might be. Women have an unfortunate physiological capacity to engage in sexual relations that are of little or no interest to us. Men don't. They probably envy us.
I'm all for the secret quality of women's erotic lives. Then I go writing this book, undercutting my own argument. But actually, I don't think my book tells all that much. So I don't think my book will change the discussion.
Q: Continuing in that vein, descriptions of the erotic lives of women who are no longer "young" are rare as well. Is this taboo addressed in your book?
A: To some extent. There is a discussion of why it's "icky" when older women are interested in younger men but it's perfectly natural -- even rakishly appealing -- when older men are interested in younger women. I didn't explore this very far. I hope someone else will write a whole treatise on the older woman as repulsive/fascinating sexual predator, which is how I think the erotic drive is perceived in older women. Predatory -- even if they aren't focused on motorcycle riders in their twenties, as I am in my book.
Remember, though, this is a particularly American problem. Colette wrote two of her greatest books, Cheri and The Last of Cheri, about a much older woman and a much younger man and love -- not only sex, but love, between them. This wouldn't fly in our country! As I say in the book, though, for Americans, sex is about reproduction (our Puritan roots, perhaps). With no capacity for reproduction, the older woman is an anomalous, category-breaking and therefore creepy specimen.
Q: Your medical condition was never fully or definitively diagnosed. Is it possible it was simply the symptom of an unhappy relationship?
A: That question is the book! Is it in the head or in the crotch? And, is there any difference between the head and the crotch? In the end of the book I say that there isn't any difference, that the distinction between the mind and the body just doesn't work. I don't know if I truly believe in this. But I nearly believe it. Anyhow, I don't provide an answer in the book, and I can't provide one now. It's the great question.
Q: Where does the title come from?
A: It's a line from a Buñuel movie, Viridiana. The movie's about a bunch of hobos and peasants who take over a country mansion that belongs to a rich woman who's been trying to help them. There's a scene in which all these drunk, dirty characters are sitting at a banquet table and someone says, "Let's take a picture!" A woman gets up and faces the group, so her back is to us, the audience. Where's the camera, someone calls out, and she says, "I'll take it with the camera my mother gave me," and she pulls up her huge peasant skirts, exposing her bottom to us and her you-know-what to them.
I have to confess that she actually says, "I'll take it with the camera my father gave me," and I remembered it wrong.
In Latin and Italian -- maybe in Spanish too -- camera means room. Camera obscura means dark room. That's where we get the word for the thing that takes photographs. And the vagina is a dark, private room. For some women, it's the closest they're going to get to having a room of one's own. And I feel that the vagina is a gift from the mother, the passing down of gender. Though my father pointed out to me that since it's the sperm that determines the sex of an embryo, it really should be the camera my father gave me. Buñuel was right. So I guess I've taken poetic license all over the place.
Q: Do men and women have different approaches to medical problems?
A: I imagine. Men stereotypically are thought to want to act rather than to discuss, to want to just Fix It. There's probably a lot of truth in that. Women are more likely to want to know Why, and Why did I get it? Also, because women's bodies are more "medicalized," we are more comfortable with doctors -- although, that could be an argument for being less comfortable. We're more used to them, I think. Almost every life stage for women involves a medical profession: adolescence necessitates birth control, pregnancy involves the entire medical network, now menopause has become a medical problem, mammograms -- all that stuff. Some guys probably don't go to a doctor until they're quite ill, if they're lucky, not till late in life.
This is bound to create different approaches to the profession.
Q: In this book and your previous memoir, the doctors you meet don't, or can't, give clear diagnoses of the problems you confront. Should there be a clear-cut medical response to our difficulties?
A: I don't see how there can be a clear-cut response when neither we nor the medical profession truly understands half of what's going on in our bodies. Some things aren't so mysterious -- appendicitis, many aspects of heart disease, broken leg. But then there's a whole world of mystery: inflammatory things, autoimmune things, sexual things, cancer things. Just because something is treatable, as many cancers now are, doesn't mean they're understood fully. And then there's the opposite problem: understanding but no cure. Though usually, a fuller understanding would lead to a better treatment.
But things that are tempered by or created by psychological states -- if you can make the distinction between psychological states and physiological ones, which I'm not so sure of -- are more difficult to understand and to treat.
Part of my point here is that not everything can be fixed. Not everything can even be improved. My two best doctors were the ones who admitted they didn't understand, really, what was going on or how to help me with it. That was healing for me. They acknowledged my suffering, they didn't tell me it wasn't there, but they didn't pretend that they could fix it.
Healing is complicated. Sympathy and listening are a big part of a doctor's job, and few have time for it these days. That's hard. I think it's as hard for the doctors as it is for their patients, because the doctors know this is part of their job.
Q: Is it the ambiguities of the situation that drew you to write about it?
A: Certainly. Ambiguity is fruitful to think about. And ambivalence. I was ambivalent about getting cured of my disease. It was useful to me, as I showed a number of times in the book. And disease can be useful. This goes back to the previous question. A good doctor might intuit why a certain patient needs a certain ailment, and try to address that with the patient. I'm talking about a doctor who had nothing to do except take care of thirty patients a week -- a doctor who's been made extinct by the state of modern medicine. They just don't have that kind of luxury anymore.
The ambiguity of physical existence fascinates me, maybe because I live so much in the head. I spend most of my time alone at home thinking or reading, now and then writing. So when my body acts up, squawking about something, it really gets my attention, since half the time, I'd guess, I act like I haven't got a body at all.
Q: What can men learn about women from reading your book?
A: A few secrets of the trade of being women? Maybe that we're not that different? It's so hard to say. I'm not a man, after all, so I can't assess it. And since I wrote the book, I can't objectively consider how it might instruct or inform anyone, man or woman.
I think of another marvelous scene in a novel, though I don't remember whose novel. It feels that it must be by Philip Roth. At any rate, there's a young man, a teenager, I guess, being amazed that girls have breasts. They just walk around with them all the time, he tells himself, they could touch them anytime they wanted to! Just touch them! As women know, this is quite a different approach to breasts from the one taken by the possessor of them, who spends her time assessing them in a dissatisfied way, usually: They're too small, they're too big, they sag, whatever. Have you ever encountered a woman who was pleased with her breasts? Certainly, we don't find them sexually compelling. They're just our breasts.
So I hope that men reading this book, men for whom the vagina is an amazing fact hiding between our legs, men who think wow, they have those things, right there, they could touch them, they got 'em, right between their legs, this book can say: Yup, we've got 'em, and they can be a pack of trouble.