Leah Hazard is a Harvard graduate and former journalist. She is now a practicing NHS midwife.
Below, Leah shares 5 key insights from her new book, Womb: The Inside Story of Where We All Began. Listen to the audio version – read by Leah herself – in the Next Big Idea app.
1. Empty wombs are not empty.
Until very recently, in the last 20 or so years, people thought that an empty uterus was empty. This concept, known as the sterile womb paradigm, originated in the early 20th century. He was inspired by strange experiments with newborn poop, as well as extremely old-fashioned ideas about female purity.
Today, new technologies for tissue sampling and analysis have revealed that far from being sterile and empty, the uterus almost certainly has its own microbiome: an environment filled with billions of microorganisms, including bacteria , fungi, viruses and yeasts.
Additionally, scientists believe that these microorganisms may play a key role in determining a person’s gynecological health. For example, an imbalanced microbiome could influence the development of uterine cancer and other diseases. The gut microbiome affects gastric conditions such as colitis and Clostridium difficile infections, and fecal microbiome transplants – the transplantation of mixed feces from a healthy donor to a diseased recipient – may be able to improve these conditions. . So why not something similar for wombs? If we can sample a person’s uterine microbiota – or even modify it, as we do with the gut – we could open up a whole new world of personalized and effective gynecological treatments.
2. We are wrong about gynecology.
Currently, billions of women and people with uterus suffer from painful periods: heavy bleeding and other devastating symptoms. It can take many years, with many painful, traumatic and expensive investigations along the way, to diagnose gynecological conditions such as endometriosis or fibroids. In addition to the immense personal toll, our inefficiency in diagnosing these conditions also has an enormous socio-economic cost – millions of dollars in sick days and reduced productivity. What if you could solve these problems by diagnosing illnesses using just a towel, cup or tampon and your phone?
“There is exponentially more research on semen, for example, than there is on menstrual blood.”
Scientists have discovered that each person’s menstrual blood contains a unique biochemical fingerprint. By collecting this stream in a towel, cup or swab, scientists can look for disease markers right at the source. One biotech company is even considering sending that scan straight from your tampon to an app on your phone, in turn generating a health report that goes straight to your doctor. The technology exists, but we are way behind in terms of funding and deployment. For what? It’s a whole different story. There is exponentially more research on semen, for example, than there is on menstrual blood. One can draw one’s own conclusions about what type of information is prioritized by funding agencies, and why.
3. If you are going to spray your vulva, proceed with caution.
Vulvar or vaginal steaming, or V-steaming as it is often called, is just one part of the huge industry of uterine wellness. This industry is a growing sector worth millions of dollars. Womb wellness is often touted by glossy and glamorous gurus as a way to use alternative therapies to balance hormones, improve fertility, and more. Some people argue that the womb wellness industry is dangerously exploitative, offering potentially harmful miracle cures at great expense to vulnerable people, and often culturally appropriating indigenous practices along the way.
However, the truth is more nuanced. Many women are increasingly disillusioned with the traditional industrial medical complex, whether due to high costs, long waiting times, or mistreatment due to racial and ethnic bias. In the future, reproductive health care must be accessible and effective. It must also, in turn, address the unmet needs of women and others who have turned to questionable womb wellness treatments out of desperation.
4. Guys can have wombs too.
Trans men, non-binary people, and cisgender men can have wombs. Some have a hysterectomy as part of a gender-affirming surgery program. Some of them don’t. Take the case of the 37-year-old British man who went to his doctor with bleeding genitals, or the 70-year-old Indian man who presented with testicular pain; each man was found to have a tiny, partially developed uterus that had lain dormant for decades.
“Some are undergoing hysterectomy as part of a gender-affirming surgery program.”
In the future, the gender lines between those who have a uterus and those who don’t will become even more blurred. It is already possible for a woman born without a uterus to receive a donated uterus and grow a fetus inside. As reproductive technology becomes more advanced, cisgender men may even be able to receive donor wombs, then go on to gestate babies in their own bodies, a prospect with almost unthinkable social implications.
5. The uterus is the link of choice.
The uterus is the most misunderstood but yet very legislated organ. Reproductive restrictions, and even reproductive violence, have been used as tools of oppression since the earliest days of recorded history. In My body belongs to me, a 2021 United Nations report, only 55% of women surveyed in 57 countries said they were able to make their own decisions about sexual and reproductive health and rights. That’s a whopping 45% of women who lack the basic human right to bodily autonomy.
When a person with a uterus does not have full control over their sexuality, fertility, and reproductive life cycle, that person cannot effectively contribute to a just and equitable society. We urgently need to improve our understanding of the womb, collectively and as individuals. The womb is where we all started, but how we think about it and what we do with it can tell us a lot more about where we are going.
To listen to the audio read by author Leah Hazard, download the Next Big Idea app today: