Larry Forney would like you to talk about your vagina.
With your doctor, primarily. But, while you’re at it, it wouldn’t hurt to have a little chat with a friend or a colleague or spouse, too. All that silence and avoidance may not be good for you.
Forney is a researcher and professor at the University of Idaho who is studying the composition of “vaginal bacterial communities.” When he tells people what he does, he generally inspires two responses: the awkward, uncomfortable, looking-away variety, and the engaged, excited, why-haven’t-I-heard-this-before variety.
This tends to break down along gender lines, and it says something about the reasons a medical and research culture long dominated by men might still not know all that much about the subject. Forney says the “shh” factor remains strong, ranging from the reluctance of many women and their doctors to bring it up, to a juvenile inability to separate reproductive health from sexual sniggering, to cultural queasiness over “The Vagina Monologues.” That play proves two things: There is a lot to say about this subject, and there are plenty of people who aren’t that eager to hear it said.
A longtime researcher into the ecology of microorganisms, Forney was drawn into his current field more than a decade ago, after Procter & Gamble funded some studies into women’s health that leapfrogged off his inquiries into the microbial makeup of wastewater systems.
At the time, Forney assumed – as do a lot of doctors, he says – that a decent understanding of vaginal health existed. That we had some idea of what happens to girls when they mature, and what happens to women when they go into menopause. That there was a scientific understanding of what makes for a healthy vagina, and what happens when things go wrong – such as yeast infections or sexually transmitted diseases.
“And you say, ‘This must all be in the book,’ ” said Forney. “ ‘We haven’t neglected 3 billion people on the planet, have we?’ The answer is yes, we have.”
That’s the history of women’s health research in a nutshell. For a long time, maternity research was about the only line of scientific inquiry into the health of women. While there has been a major movement to change things – from the publication of “Our Bodies, Ourselves” in the 1970s to the formation of the federal Office of Research on Women’s Health in 1990 – it’s a little shocking to realize just how late some of these shifts are coming.
It was the mid-1990s, for example, by the time federal researchers were required to include women in clinical trials. And it remains quite possible that your insurance plan will cover a pill for erectile dysfunction but not basic contraception.
The last couple of decades have seen an explosion in efforts to expand research into women’s health. At the same time, scientific research into the “human microbiome” – all the billions and billions of bacteria that live all over us – has gotten a big push as well from the National Institutes of Health.
Forney’s research sits at the intersection of those paths. He and his colleagues recently undertook the first in-depth study of the molecular makeup of vaginal microbial communities. Their findings could change the whole approach to treating yeast infections, bacterial vaginosis, sexually transmitted diseases and HIV.
Yeast infections won’t kill you, but they can make you awfully miserable. They affect a lot of women – three-quarters will get one at some time in their lives. Forney argues that if men got them, men wouldn’t be getting them anymore, because the scientific community – which has gone after erectile dysfunction like Harry Potter on a Quidditch broom – would have wiped it out by now.
But what we know about them is surprisingly limited. The medical community has long assumed that pH levels in the vagina should be consistently low to be healthy. But Forney discovered something that seems only natural: All women are different.
“What wasn’t appreciated was the fact that different women had different types of bacteria in the vagina,” he said. “We found at least five distinct kinds of communities that were present. …
“Just think of a forest system, and you have all these different tree species and other plant species and they differ in how many there are and the kinds that are present and so on. And if you go to the Olympic Peninsula, you’ll see one kind of forest, with certain kinds of trees that are dominant and so on. If you go to the forests of the Amazon, you’ll still have lots of different trees and lots of different plant species, but they’re going to be entirely different.”
OK, junior foresters, you get the picture. The way these species interact and coexist helps protect women from disease and infection, and Forney’s research suggests that there are many different environments that can be healthy. There’s no one pH level, no one bacteriological makeup. It’s not yet certain what this will mean at the doctor’s office, but one thing seems clear: The one-size-fits-all approach doesn’t fit.
“You’re going to have to treat people as individuals,” he said.
And that, like it or not, is going to require a little talk.