Vagina (3 page)

With a heavy heart—afraid to hear that nothing could be done for me—I made an appointment with my gynecologist, Dr. Deborah Coady. In this I was extremely fortunate, since she is one of the very few physicians who specialize in the aspects of the female body that, it would turn out, I was being affected by: problems with the pelvic nerve.

Dr. Coady is a lovely woman in her forties, with soft light-brown hair that falls to her shoulders, and a face that has a certain expression of gentle fatigue and receptivity to others’ pain. Because of her specialty in female pelvic nerve disorders, and, in particular, in one of its painful variants, which thankfully I did not have, called “vulvodynia,” she often sees women who are experiencing a broad range of suffering. This has made her unusually careful and compassionate.

Dr. Coady examined me, asked questions in a quiet voice, and finally told me she believed I was suffering numbness from nerve compression. I was so panicked at this point about what I was losing in terms of the emotional dimensions of my life and my sexuality—and so terrified of losing any more—that she took me into her private office.

There, in an effort to reassure me, she showed me two “Netter images”—beautifully drawn full-color anatomical illustrations. Frank Netter was a gifted medical illustrator, whose images of various parts of the human body are visual classics, collected by some neurologists, gynecologists, and other specialists, to help them explain abstract medical realities, in a vivid way, to their patients.

The first image depicted the way that the pelvic nerves in women branch out to the base of the spinal cord.
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Another showed how a branch, which originates in the clitoris and dorsal and clitoral nerve, arches elegantly to branch to the spinal cord, while other branches curve sinuously, originating in the vagina and also in the cervix. The nerve branches from the clitoris and vagina go to the larger pudendal nerve, whereas the nerve branch originating from the cervix goes to the larger pelvic nerve.
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All of this complexity, I would learn later, gives women several different areas in their pelvises from which orgasms can be produced, and all of these connect to the spinal cord and then up to the brain.

Dr. Coady suspected that my problem was a spinal compression of one of the latter branches.

But she wanted to assure me that because of the way women were wired, no matter how bad the spinal compression that she suspected I had might prove to be, I would never lose the ability to have an orgasm, from the clitoris. Minimally comforted, I left her office, with an appointment for an MRI, and a referral to Dr. Jeffrey Cole, New York’s pelvic nerve man.

I met with Dr. Cole at the Kessler Institute for Rehabilitation, which he helps to lead, in Orange, New Jersey. A calm, quietly amusing man, with an old-fashioned, reassuring manner, he had looked at my initial x-rays, had examined my posture as I stood before him, and then had urgently written me a prescription for a hideous black back brace.

Two weeks later, I went back for a follow-up visit with Dr. Cole. Azaleas were now in bloom—it was still the loveliest part of the spring—but I felt almost faint as I sped into the suburbs in the backseat of a battered taxi. I was also very uncomfortable, since, for the past two weeks, I had been wearing the prescribed back brace. It extended from above my hips to below my rib cage, and it made me sit up perfectly straight.

I was really scared to hear what Dr. Cole had to say, since I knew he now had my MRI results. The MRI, Dr. Cole informed me, showed that I had lower-back degenerative spinal disease: my vertebrae were crumbling and compressed against each other. I was very surprised, having never had any pain, or any problem with my back at all.

He startled me by showing me the additional x-rays he had taken during the last appointment; there was no way to miss or misread it: on “L6 and S1,” my lower back, my spinal column was like a child’s tower of blocks that had slid, at a certain point, exactly halfway off central alignment—so that half of each stack of vertebrae was in contact with the other, but half of each ended in space.

I dressed and sat in Dr. Cole’s consultation office. He put me through an unexpectedly tough and direct interview: “Did you ever have a blow to your lower back?” “Did anything ever strike your lower back?” He said it was a serious injury and that I must have some memory of having sustained it. I repeated that I had no memory of any such trauma. When I finally realized what he might also be asking, I confirmed that no one had ever hit me.

But after about five minutes of this back and forth, I realized that yes, I had indeed once suffered a blow. In my early twenties, I had lost my footing in a department store, fallen down a flight of stairs, and landed on my back. I hadn’t felt much pain, but I had felt shaken. An ambulance had arrived; I had been taken to St. Vincent’s Hospital and x-rayed. But nothing had been found to be the matter, and I had been released.

Dr. Cole took in the information and ordered another series of images—this time a more detailed x-ray. He also performed an uncomfortable test in which he shot electrical impulses through needles into my neural network, to see what was “lighting up,” and what had gone dark.

In our third meeting, also at the suburban facility, I was back on the exam table. Dr. Cole explained that the new set of x-rays had revealed exactly what the matter with me was. I had been born, he explained, with a mild version of spina bifida, the condition in which the spinal vertebrae never develop completely. The blow from twenty years before had cracked the already fragile and incompletely formed vertebrae. Time had drawn my spinal column far out of alignment around the injury, which was now compressing one branch of the pelvic nerve, one of the branches Dr. Coady had shown me in the Netter image—the one that terminated in the vaginal canal.

I had been unbelievably lucky never to have had any symptoms until then, he said. Given the severity of my injury, it was fortunate that, though I had increasing numbness, I had had no pain. Much though I disliked working out, it seemed that a lifetime of grudging exercise had strengthened my back and abdomen enough to have kept any worse symptoms from manifesting until then. But time had done its work: where the two sections of spine were misaligned, the pelvic nerve was entrapped and compressed, and the signals from one of its several branches were blocked from moving up my spinal cord to my brain. The neural impulses from that part of my body had “gone dark.” I wondered if this had something to do with how I felt—or was not feeling—after sex, though I was too shy to ask. He explained that I would need to consider surgery to fuse the vertebrae, and to relieve the pressure on the nerve.

After I had walked for him so he could check my gait to make sure my legs had not been affected, and after he had measured my shoulders to be sure they were level, I mentioned to him—perhaps partly for a second opinion, for reassurance—that Dr. Coady had assured me that my clitoral orgasms would not be affected, even if the branch of the pelvic nerve that was injured did not ever get better. He agreed that that was correct; if the clitoral branch of the network were to be affected, it would have been so by then. The fact that that branch was unaffected was an accident of my wiring. And then he explained casually, “Every woman is wired differently. Some women’s nerves branch more in the vagina; other women’s nerves branch more in the clitoris. Some branch a great deal in the perineum, or at the mouth of the cervix. That accounts for some of the differences in female sexual response.”

I almost fell off the edge of the exam table in my astonishment.
That’s
what explained vaginal versus clitoral orgasms?
Neural wiring?
Not culture, not upbringing, not patriarchy, not feminism, not Freud? Even in women’s magazines, variation in women’s sexual response was often described as if it were predicated mostly upon emotions, or access to the “right” fantasies or role playing, or upon one’s upbringing, or upon one’s “guilt,” or “liberation,” or upon a lover’s skill. I had never read that the way you best reached orgasm, as a woman, was largely due to
basic neural wiring
This was a much less mysterious and value-laden message about female sexuality: it presented the obvious suggestion that anyone could learn about her own, or his or her partner’s, particular neural variant as such, and simply master the patterns of the special way it worked.

“Do you realize,” I stammered, not self-possessed enough in my astonishment to consider that the debate I was about to describe might not have been as momentous to him as it was to me, “you’ve just given the answer to a question that Freudians and feminists and sexologists have been arguing about for decades? All these people have assumed the differences in vaginal versus clitoral orgasms had to do with how women were raised . . . or what social role was expected of them . . . or whether they were free to explore their own bodies or not . . . or free or not to adapt their lovemaking to external expectations—and you are saying that the reason is simply that all women’s
wiring
is different? That some are neurally wired more for vaginal orgasms, some more for clitoral, and so on? That some are wired to feel a G-spot more, others won’t feel it so much—that it’s mostly physical?”

“All women’s wiring is different,” he confirmed gently, as if he were addressing someone who had become slightly unhinged. “That’s the reason women respond so differently from one another sexually. The pelvic nerve branches in very individual ways for every woman. These differences are physical.” (I would learn later that this complex, variegated distribution is very different from male sexual wiring, which, as far as we know from the dorsal penile nerve, is far more uniform.)

I was silent, trying to absorb what he had said. Women have so many judgments about themselves, I have found, based on how they do or don’t reach orgasm. Our discourse about female sexuality, which pays no attention whatsoever to this neural reality, which is the very mechanism of female orgasm, suggests that if women have trouble reaching orgasm, it is by now, in our liberated moment, surely, somehow, their own fault: they must be too inhibited; too unskilled; not “open” enough about their bodies.

Dr. Cole tactfully cleared his throat. He courteously sought to turn my attention back to my own predicament.

Dr. Cole referred me to Dr. Ramesh Babu, a neurosurgeon at New York Hospital, and that, too, was a very lucky thing. Irrationally, perhaps, I was immediately reassured to find that Dr. Babu, a suavely dressed and charismatic physician from India, had on his shelves among his neuroscience texts the same small statue of Kwan Yin, the Chinese goddess of compassion, that I had at home on my own bookshelves. Dr. Babu offered me an apple and then hectored me firmly but kindly on the need to operate without delay. Scarily, he wanted to put a fourteen-inch metal plate, with a set of attached metal joints, into my lower back, and fuse the damaged vertebrae. Fortunately, his will was just as strong as mine.

I scheduled the surgery. After a four-hour operation, I awoke, hideously groggy, in a hospital bed, the owner of this metal plate contraption, which fastened the vertebrae of my lower back together with four bolts. I had a vertical scar down my back that my boyfriend—in an effort to reassure me—described, referring to the punk rock band, as “very Nine-Inch Nails.” All these changes seemed like very minor issues compared with the hope I now had of regaining the lost aspects of my mind and of my creative life, via my now-decompressed pelvic nerve.

After three months I was allowed to make love again. I felt better but not completely recovered; I knew that neural regeneration, if it were to happen, could take many months. I continued to recuperate steadily for six months, eager but also scared to find out what would happen, if anything, to my mind once my pelvic nerve was really free of obstruction again. Would the nerve fully recover? And, more important—would my mind fully recover? Would I feel again that emotional joy, sense again that union among all things?

Thanks to Dr. Babu and perhaps to whoever in the cosmos may have taken my call, I had a complete neural recovery, which was not something any of the team had taken for granted. This particular kind of neural compression, though not unheard of, is seldom written about outside of medical journals, and I am a walking control group for the study of the effect of impulses from the pelvic nerve on the female brain. Because of how scant information is on this subject, I feel I owe it to women to put down on paper what happened next.

As my lost pelvic sensation slowly returned,
my lost states of consciousness also returned.
Slowly but steadily, as internal sensation reawakened, and as the “blended” clitoral/vaginal kind of orgasms that I had been more used to, returned to me, sex became emotional for me again. Sexual recovery for me was like that transition in
The Wizard of Oz
in which Dorothy goes from black-and-white Kansas to colorful, magical Oz. Slowly, after orgasm, I once again saw light flowing into the world around me. I began to have, once again, a wave of sociability pass over me after lovemaking—to want to talk and laugh. Gradually, I reexperienced the sense of deep emotional union, of postcoital creative euphoria, of joy with one’s self and with one’s lover, of confidence and volubility and the sense that all was well in some existential way, that I thought I had lost forever.

I began again, after lovemaking, to experience the sense of heightened interconnectedness, which the Romantic poets and painters called “the Sublime”: that sense of a spiritual dimension that unites all things—hints of a sense of all things shivering with light. That, to my immense happiness, returned. It was enough for me to have glimpses of it once again from time to time.

I remember being again in the small upstairs bedroom of the little cottage upstate; my partner and I had just made love. I looked out of the window at the trees tossing their new leaves and the wind lifting their branches in great waves, and it all looked like an intensely choreographed dance, in which all of nature was expressing something. The moving grasses, the sweeping tree branches, the birds calling from invisible locations in the dappled shadows, seemed, again, all to be in communication with one another. I thought: it is back.