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The Multispecies Microbial Vulva: Microbial Biopolitics in Care for Chronically Ill Vulvas

The microbiome - the community of microbes, bacteria, and fungi that exist in symbiosis with the human body- is essential to health. The human body is not purely human, but rather as made up of human-microbe entanglements. At first glance, relations between humans and microbes might seem primarily biological, but microbial bodies cannot be separated from the social and cultural context of their human symbiont.

Human- microbial entanglements are not individualised or boundaried processes, instead, how we understand and what we do about our microbes depends on our relational context. As such, microbes are subject to and reproduce biopolitical discourses. In this piece, I draw on ethnographic research in the Netherlands that explores the care practices of those living with chronic vulval microbial infections to theorise and think on how microbes are gendered, sexualised and moralised. Through a focus on douching as one particular care practice, I argue that microbial-human relations potentially reproduce heteronormative, patriarchal and phallocentric discourses on what it means to have a ‘good ’vagina'.

Recent conversations in science and medicine are increasingly focusing on the enormous importance of the microbiome for the health and holistic wellbeing of the body, ranging from the role of the microbiome in mental health, illustrated here, the relationship between the gut microbiome and healthy ageing, or the effects of the microbiome on improving the immune system, and potentially fighting cancer.

The microbiome is a complex community of trillions of viruses, bacteria, fungi, and microbes that collectively work to maintain health. Human-microbe relations are not merely biological, but deeply intertwined with the social and cultural context of their human collaborator. Microbial bodies can reproduce, and resist, the same biopolitical norms, ideas, attitudes and perceptions that effect the human body. I the case of those living with chronic vulval infections, gendered norms around the female body shape microbial perceptions. Societal notions of cleanliness, purity, and femininity intersect with vulval infections, subjecting human-microbial entanglements to powerful gendered, sexualised and moralising discourses on what it is to have a good body, a good life, and a good microbiome.

This work explores research on chronic microbial vulval infections - bacterial vaginosis (BV) and candida overgrowth, showing how care practices, such as douching with the aim of creating a ‘clean’, vagina, reproduces moralised, heteronormative and phallocentric discourses.

Messy Microbes

Human- microbe interrelations through infection can be messy. Sensorial signs demonstrate microbial imbalance: pus, bile, slime, vomit, blood, and discharge ooze from various orifices, accompanied by distressing smells, sensations, and textures. Chronic candida and BV infections are one such example. When the vaginal microbiome is in balance, everything works correctly. However, opportunistic pathogens can cause infections, presenting with vaginal discharge of varying consistencies and smells, pain, burning and itching.

For many, these infections recur in sync with their menstrual cycle, or after sexual relations. Those living with chronic conditions do not necessarily seek a cure, but rather to care for these potentially troublesome microbial relationships (for an overview of how I and other science and technology studies scholars understand ‘care’, see here).

My research explores people living with and caring for chronic BV and candida infections in the Netherlands, and focuses on the daily care practices that are done in order to support and maintain microbial vaginal health. I aim to understand how ‘good’ microbial care is done in practice for those with chronic infection., as well as aiming to destigmatise conversations around vaginas and vulvas, (for a deeper look into societal silencing of vaginas and vulvas see Labuski (2013) on vulvar dis-ease) particularly those considered ‘not good’ , such as infected, leaky, hairy, painful vaginas (see my previous work on chronic vulval pain.)

Douching and microbial discharge

To care for and maintain a balance vaginal microbiome when living with chronic infection, multiple and overlapping care practices are used, including eating, exercising, specific sexual and cleaning practices. Cleaning practices, including washing, douching, sitz baths, cleansing the external vulva, fasting and cleaning clothes in specific ways emerged as key daily practices for many people, associated with feelings of freshness, goodness, newness and purity. There was no one definition of ‘clean’, but rather multiple and contrasting contextual definitions arising through interviews. Douching, one such cleaning practice which involves cleaning the vaginal canal by sluicing it with liquid, provides a rich case through which to theorise on microbial biopolitics and the reproduction of gendered norms.

Whilst participants knew that douching makes BV and candida infections worse in the long term, many still engaged in it. Lorena explained:

Normally I will douche an hour or so before I’m going to have sex. I usually just use water and squirt it up there a few times- it kind of gets rid of any discharge or anything that might be hanging around, and gives me a clean feeling….it’s a kind of tight and dry feeling, and also means that it looks pink in there instead of the white that candida can leave. Sometimes all the discharge just feels too wet, you know, kind of slimy and I’m always worried that it will gross them out. So yeah, douching… I just feel more confident and feel that I am ready to have sex…” (Lorena, Zoom interview)

Douching, according to Lorena, can temporarily create a specific type of desirable vagina. To feel ready to have sex, in Lorena’s case penetrative sex with a male partner, her vagina needs to look and feel a certain way - pink and tight, as well as free from any trace of microbial discharge. Furthermore, by cleaning the vaginal canal, the vagina is constituted as something that can and should be penetrated, reproducing a phallocentric and heteronormative discourse of sex as penetrative.

Whilst she knows that a few days later her candida infection will flare and intensify, Lorena balances this with feeling ‘clean’, associated here with tightness and dryness. Feminine ideals of purity and cleanliness are evoked and, in this context, microbial sensorial traces or discharge, function as a barrier to having a ‘good’ vagina and good sex.

However, human-microbial entanglements are always . Whilst Lorena understands that a ‘good’ vagina is cleansed of microbial remnants, in others they are sexualised and considered indicative of a ‘good’ sexual encounter. Nienke tells me a story:

“…I was in the middle of a candida flare, and obviously had a lot of discharge …we decided to have sex anyways and he was really happy because when we were having sex he thought I was really wet ‘cos of all the discharge, that I was super turned on or something…”

Nienke’s story demonstrates a tension: within certain relational contexts, the sensorial traces of microbes are sexualised; discharge is evidence of positive sexual arousal. A ‘good’ vagina is wet, aroused, and ready for penetrative sex, but only in certain expected contexts. Nienke goes on to tell:

But later on he saw my underwear lying on the floor and obviously all the discharge was on it and he made me feel so bad, he basically said he didn’t want to see that lying around

When microbes become ‘matter out of place’, for example discharge in underwear or during a non-sexual moment, these microbial remnants are shameful and dirty. Through shaming, notions of what a ‘good’ vagina is not are evoked - dirty, leaky, wet and smelly.

What is key from these short vignettes is that human-microbes relations change depending on their social setting; microbes are valued and appreciated within certain contexts, and vilified in others. These relations replicate heteronormative and sexualised notions on how vaginas should be before, during and after sex, as well as delineating what ‘good’ sex is.

Throughout my research, penetrative sex was often the aim, conceived of as ‘real’ sex contrasting with other forms of non-penetrative sex. This phallocentric view of how sex ‘should’ be causes much distress and guilt for those who find penetration painful or uncomfortable (see for a discussion of the emotional effects of having a ‘non-penetrable vagina’.)

This privileging of penetrative sex is reproduced in human-microbe relationships. Vaginal discharge produced by microbes is simultaneously sexualised - celebrated as indication of arousal and useful during penetrative sex - and enacted as something that renders vaginas dirty, disgusting and ‘too wet’ through douching care practices, and used to evoke shame and notions on what it is to have a ‘good’ vagina.

Microbial Conversations

Through a closer look at more than human microbial forms of togetherness in chronic vulval infections, I have emphasised that not only are humans and microbes interconnected, but their relation is active, dynamic, and biopolitical. Whilst I have focused on microbial engagements that reproduce dominant narratives on female bodies, heteronormativity and sexual practices, my future research will be exploring how human-microbial relations are actually queering ideas on the gendered and sexualised body, as well as having radical potential to disrupt and rethink human-centred narratives (see here for conversations on queer microbial potential).


About the Author

Maya Lane is a medical anthropologist based at the University of Amsterdam, as well as a chronic illness advocate. Between teaching undergraduate courses, Maya also currently works as part of the multispecies ‘Caring for Pigs Project’ at the Meertens Institute, and ArtiC, an interdisciplinary working group exploring aesthetic interventions and care in an Amsterdam hospital.

Maya’s research interests include queer ecologies, multispecies care, eating and cooking practices, and she employees queer , feminist and crip theory throughout her work. Within her work Maya finds it important to make academic knowledge as accessible as possible, and tries to engage in feminist care practices throughout her research.

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