The contextual vulva

Research blogging on: Howarth H, Sommer V & Jordan FM. (2010) Visual depictions of female genitalia differ depending on source. Medical Humanities 36: 75-79.

stairwell of daily express by fionajay


Possibly my favourite work email I’ve ever written was the one to the head of IT, notifying her that, in the interests of science, I needed to access websites like and Here’s why:

The internet is an amazing resource for scientists in all manner of domains, one of which is human variation. You might think that after a hundred years of cross-cultural investigations of human diversity, and a much longer period of anatomical observations, we would have a fair idea of the variability in genital morphology. But this kind of information, like so much else to do with our bodies–and especially their sexual characteristics–is just not readily available.

Stemming from that, we asked the question: do visual depictions of female genitalia differ, depending on the kind of source they are from? Are the images that we see in medical textbook illustrations different in proportions from those seen in internet pornography? What about feminist “celebrations” of female anatomy? These are important questions, because we construct our ideas about the range of normal variation through experience, and if women express concern that their bodies are not “normal” in some way, then health professionals need to be aware of how “normality” is constructed. Spoiler: we found differences, as I’ll explain below.

This study was part of a wider project aimed at understanding variation and preferences regarding female genital morphology undertaken by Helena Howarth for her masters thesis at UCL, co-supervised by Volker Sommer and and myself. Only a few studies had measured actual female genitalia to try and get real-world estimates of the range of female morphology. Helena had the insight that readily-available internet pornography wasn’t simply a tremendous source of measurable variation, but that it might be a  contributing factor to our perceptions of normality.

Helena gathered a hefty amount of image data for her project, trawling through libraries, and finding internet images that she could take measurements from morphological landmarks – for example, the length of the labia minora, or the distance from the clitoris to the perineum. For my part in doing inter-rater reliability measurements, I can attest that this is about as far from “oh wow, surfing the internet for porn at work” as one can get.

What did we find? Two major things. First, that labial protuberance–how much the inner labial lips protrude from between the larger labia majora–was significantly less in the online pornography sample compared to that in the  feminist publications, with medical illustrations falling somewhere in between. Second, there was a less varied range in organ proportions in the pornography sample; all the measurements were highly correlated with one another, but this wasn’t the case in the other two sources.

What does this mean? As we stated in the abstract, there are public health implications:

Women and health professionals should be aware that specific sources of imagery may depict different types of genital morphology and may not accurately reflect true variation in the population, and consultations for genital surgeries should include discussion about the actual and perceived range of variation in female genital morphology.

It’s interesting that the feature we found that was most different (labial protruberance) is also the one that is most commonly requested in elective/cosmetic genital surgery. There has been a great deal of media attention paid to the rise in these surgeries in recent years, and responses that somewhat dismissively attribute this to fashion, unattainable body ideals or partner-pressure are not helpful. We suggested that it was important to explore how women arrived at their ideas about normality:

Genital variation is understudied, and we strongly encourage scientific and educational/artistic initiatives that promote clinical and popular understanding of the range of variation in genital morphology. Here, we were concerned with depictions in sources that may shape the perceived range of variation, therefore imagery samples are justified, but measurements of genital morphology should ideally be taken directly from life.

Some of those initiatives include the four great papers below; the work by the New View Campaign challenging the medicalisation of sex; and other public or online initiatives such as All About My Vagina, I’ll Show You Mine, Design-A-Vagina, amongst others I’ve surely missed (let me know!).

Here’s a link to the pdf of our paper. The journal, Medical Humanities, also published another paper by Shelley Wall on normativity in images of genitalia, focusing on intersex conditions, and both were featured in an accompanying editorial piece.

[1] Basaran et al. Characteristics of external genitalia in pre- and postmenopausal women. Climacteric (2008) vol. 11 (5) 416-421
[2] Lloyd et al. Female genital appearance: “normality” unfolds. BJOG : an international journal of obstetrics and gynaecology (2005) vol. 112 (5) 643-6
[3] Liao et al. Labial surgery for well women: a review of the literature. BJOG: An International Journal of Obstetrics & Gynaecology (2010) vol. 117 (1) 20-25
[4] Schick et al. Evulvalution: The Portrayal of Women’s External Genitalia and Physique Across Time and the Current Barbie Doll Ideals. J Sex Res (2009) 1-9

The tasteful metaphorical picture above is actually the stairwell of the Daily Express building in London.


when drug trials go wrong

The Beeb continues to report on the condition of the six young men who participated in a drug trial and are in intensive care. There’s an accompanying article interviewing a bloke who was due to take part, where he speaks about the motivations and incentives that are behind why men take part in these trials. There’s often a lot of money involved, and it must be very tempting.

I say must be, because as a woman, my chance to take part in a clinical drug trial (the Phase I, experimental kind) is virtually nonexistent. Dave from Bristol clearly needs to know this (scroll down). The requirements are overwhelming sensible: young and healthy bodies required for the initial rounds. Women are considered more problematic than men because we could be pregnant, or might want to get pregnant at some point, and drug companies don’t want to get sued for impeding fertility.

This has always irked me. Firstly, anyone pregnant or at risk of pregnancy (that would be carried to term)–of course they shouldn’t do a drug trial. Common sense. But presumably there may also be effects on male fertility as unforeseen as those on female fertility from new drug treatments. I can’t comment on the degree of “informed” and “consent” in informed consent in these things, as, well, I’ve not taken part. But presumably this is an issue?

Secondly–and this is an issue that goes beyond gender–it’s representative of a deeply embedded conception of the young man as the default model, medically speaking. I got cranky at my doctor a few months ago when she couldn’t tell me if a consistent pattern of change in my cycle was linked to coming off a (very very common) drug. Fine, I thought, I can search PubMed and nyah to to the overworked NHS. There was not one mention of cycle change patterns beyond “a number of women reported changes to cycle length”. This, if I recall correctly, in a thousand-odd sample.
Anyhow: best wishes to the men and their loved ones. I wish the slightly hysterical tinge to some of the reporting was tempered by a statistic or two showing the number of drug trials per year and the percentage–which I am certain must be low–that result in serious adverse reactions.

follow-up on Lawrence

Re yesterday’s post:

It’s an interesting essay. I think Science were right to reject it on the basis that it presented no positive suggestions for action. One could be left with only the message that the status quo is acceptable in some situations, if we accept that men and women bring different plates to the table.

The way I see it, there are a number of issues here.

1. The degree to which men and women are different at different things. I have no problem with this. Men and women ARE different. Different bits, different brains, different developmental experiences.
2. Where those differences come from and how they develop. I’m unable to discern what sort of take the author has here and to what degree he thinks in terms of nature/nurture and biology = unchangeable.
3. The culture of academia and how it favours certain traits–something which has a history in itself. With respect to the question of why all the women disappear as one moves into more senior positions, I think this is actually vastly more relevant than any on-average “suitability”.
4. “Is” and “Ought”. Just because women may be on-average more (for example) nurturing, doesn’t mean we ought to be happy with a predominance of women psychologists. The whole concept of “on-average abilities” should surely fly out the window when we are talking about highly skilled/intelligent/trained individuals, because we’re dealing with those people in the upper tail end of their respective curve, not the average 68%. What we should be happy with is an absence of the commercial model in academic culture, one that allows a diversity of people to be thoroughly considered on a number of qualities for any given position.

I was more interested in the mention of creativity and originality in science. It’s a tired old truism that it’s hard to be creative and viable in many areas of science, but I’d like to know what creativity actually means. How could I foster “creative” approaches to my own work? Answers, plz.