Having worked for many years as a nurse practitioner in gynaecological settings, and more recently having graduated as a cultural anthropologist, Christine Labuski is ideally placed from both a clinical and an academic standpoint to carry out the study of female genital pain on which this book is based. The research was conducted in a specialist clinic for women experiencing vulval pain, a chronic or long term condition which is not well understood, but which can result in severely restricted functioning and quality of life. The clinic was situated within a research hospital in the USA and the study involved participant observation of clinic consultations and treatment sessions (of around 100 women), followed by discussions with patients and clinic staff. More formal interviews with 42 women patients were also undertaken. The issue that Labuski sets out to explore is how women experience and describe vulval pain in a context where societal norms dictate that genitalia, and particularly the vulva, should not be discussed openly (hence the ‘down there’ in the book's title). Distaste towards female genitalia, she argues, is socially conditioned and mired in discourses of pollution and taboo, with honest anatomical descriptions erased or muted. In doing this, Labuski is following the tradition of writers such as Elizabeth Grosz, Emily Martin and Victoria Grace, who all in different ways critique the invisibility of, or revulsion towards, the female body or its functions. However, when a woman experiences vulval pain she, and those with whom she is intimate, can no longer ignore that part of her body, although many postpone or avoid doing so publically. The invisible becomes highly visible. The stories and observations described and analysed in the book demonstrate how vulval pain is not purely physical, and cannot be successfully managed without attending to the cultural dimensions of bodily parts. Three concepts are used as analytical categories in order to explain the intersection of medicine and culture: genital dis-ease, unwanted sexual experience, and genital alienation. The concept of ‘unwanted sexual experience’ is particularly well utilised in moving on from a simplified cause and effect relationship between sexual abuse and gynaecological pain (a feature of much clinical and psychological research) to recognising a more nuanced relationship between past experiences and current pain. A consequence of such unwanted experience may be genital dis-ease and genital alienation, which demonstrates the interaction between the three concepts in interpreting the women's stories. This book fuses description of the observations and interviews with analysis, so that anthropological interpretation is interwoven with the stories. The result is a rich ethnographic study in which the views and experiences of the various actors, patients and staff engaged in the clinical and cultural milieu of the clinic are explored within what Labuski calls the cultural disavowal of the vulva. She reports that both her position within the clinic and also meeting with women in social settings (accompanying them to appointments, meeting them for coffee or meals, and going to their homes) allowed her to get much closer to them and to the clinic staff in the study than many researchers are able to do. She believes that this allowed her greater access to the context of their lives in which the pain and its treatments took place. The participants were mainly white, insured (this is an American study), well-educated and self-defined as ‘straight’, which reflects the social and economic make up of clinic patients, and the description in the book of the patient pathway to the clinic also demonstrates how the patients and the clinic staff were highly selected. Other than this description of the fieldwork setting and participants, there was a lack of methodological transparency regarding the study and how its various elements come together as a consolidated piece of research. However, I understand that this is not uncommon within anthropology, although it may raise questions of methodological rigour for readers from a sociological background. This is a very readable book, and the stories and anthropological analyses contained within it provide a graphic account of the long history of pain and the difficulty for women in expressing their pain and the struggle to find sympathetic doctors and for effective treatment. It is an insightful text for social scientists and clinicians involved in women's reproductive health. Much of the analysis is consistent with previous research, including my own, on the experience of endometriosis and unexplained pelvic pain, which also points to the way in which societal attitudes towards gynaecological symptoms compound problems faced by women in the health care system and within their everyday lives. Christine Labuski adds to this body of work. It is however, rather a long book and quite specialised, so its usefulness to a general sociology of health audience may be more limited.
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Open Access
Jun 6, 2024
Marieke Dewitte + 4
