The first time I encountered Judy I was with Dr. Erlich, gathering fact sheets about vulvar pain conditions. Dr. Robichaud, the other physician at the Vulvar Health Clinic (VHC)[i], and a new resident entered the pod in a white-coated blur—animatedly conferring, hastily scribbling on forms that they were pulling from file cabinets, and getting on the phone to arrange an obviously urgent surgery for the woman whose story they had just heard. Amidst the chaos, Dr. Robichaud told us that their patient—Judy—had one of the severest cases of lichen planus (LP) that she’d ever seen: her labia were so fused together that she was urinating through a three-millimeter vulvar opening. The procedure that Dr. Robichaud was scheduling would both surgically correct the problem and evaluate how much of Judy’s vaginal patency it was possible to restore.
Judy was not the first woman I’d met whose genitalia were a source of distress. Prior to the fieldwork that I conducted in the VHC, I had been a nurse practitioner, and for almost fifteen years I managed the gynecological needs of uninsured and low-income women in several US cities. During those years, I observed that the majority of my patients knew little about their genital anatomy and I frequently attended to the repercussions of this: removing tampons or condoms believed by patients to be “lost” in their vaginas; excising vulvar warts for patients who struggled to understand their mode of transmission; and describing, often after the fact, the important differences between hormonal and barrier contraceptive methods regarding pregnancy and infection.
The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.