“The hymen is a useless piece of anatomy” - Dr. Tlaleng Mofokeng (South Africa) - 3/4
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Dr. T. reads from her own book. Photo credit: Zuzi.
My conversation with South African medical doctor and reproductive rights advocate Dr. Tlaleng Mofokeng is only getting started. After hearing about her motivations (part 1) and her voice (part 2), it’s time to ask Dr. T. about her book, Dr T., A Guide to Sexual Health and Pleasure. Grab a seat and fix yourself a drink, my friend, and join us!
Let’s dive into your book. I should start by saying that I loved it! It’s informative and disruptive in more ways than one could expect from a “guide to sexual health and pleasure”.
Thank you, Françoise, that means a lot.
I’m going to ask you to expand on some of the points you make in the book which I find powerful. First, you urge us all to stay away from the idea of normalcy when it comes to sexual health and pleasure. Is there really no norm?
At the clinic where I work, we get a lot of panicked calls from people, but they are not saying “I don't know what's happening, help me”. Instead, they tell us, “This thing that happened to my sister when she was eight weeks pregnant is not happening to me” or “My vagina doesn’t look like what I saw on this website”. And so, here I am in a consultation which I think is about STI screenings and pap smears, but as I take the patient’s medical history it becomes clear that this person is just taking the tests to prove that they are normal, because someone they know menstruates for three days and they menstruate for seven, so something must be terribly wrong with them.
There's a lot of anxiety that is manifesting itself in why and how people seek health care. Women especially compare each other's illnesses and share notes, forgetting that we don't have the same medical history and we don't know each other's future desires for health care, wellness or fertility. That anxiety is not just about our physiological processes. It’s about how our bodies look, how to handle relationships… Hence, we see lists that say, if you are married and you want to keep your husband from cheating, these are all things you must do. That’s rubbish. We are all normal in whatever form we are in.
By the way, that includes intersex individuals. We know from medical history and anthropology that there are other presentations of the way genitalia look externally, but for some reason, we only view the vulva and the penis as the only two variations of genitalia, we force people to only have external penis that looks a certain way and have a vulva that looks a certain way – or be considered abnormal. Even when we know that, statistically, intersex is a variation that’s as common as all the other variations. That’s why I’m so deliberate about talking about what normal is, but also breaking the definition thereof.
I noticed how effortlessly inclusive your work is of LGBTQIA+ individuals.
People always ask me, “how can we become LGBTQIA+ inclusive in our work?” In the book I was trying to show people how you can do it without going all, “Hey, look at me, I'm being inclusive.” It’s all about breaking down the misconception of what normal is and provide information for all people – each reader will use their own lens and get whatever information is most relevant to them.
If an intersex person reads my book, they will be affirmed. If you're transgender, you will find affirmation in the chapter where I'm talking about hormones, about prostate massage or about prostate orgasms. And if you are neither, that information may not be relevant at the time. And that's fine too.
You open your first chapter by asking: “When last did you look at your vagina?” and by inviting your reader to put the book down and get acquainted with how things actually look down there. I realized I had never done it so, well, I obliged – doctor’s orders, right? I must say, it kind of blew my mind! Why do you think it’s so important to look at our own vaginas?
That question gets everybody. Even women who are body positive. Even women who are sex-positive. Even feminists who are like, “yay, my body, my choice”. Whatever people say on Twitter, or whatever we read in Cosmo magazine, I can tell you that cis women don't have the relationship with their vagina that we think they have. I wanted that question in the book because I know that we cannot move the needle in this conversation without demystifying the vulva and the vagina.
There's so much power in looking at your vagina. I've seen people's faces light up when they take that mirror in the consultation room and look. People who had come to me and said, “My libido is very low. I don't enjoy sex.” People who had said sex is painful. Even people with full on vaginismus, meaning people who are completely unable to receive penetration in their vagina by a toy, a penis, or whatever. I do this exercise with all of them. And I see the change in their body posture, their facial expression. I see them light up.
It's like an icebreaker. People will then tell me what it feels like and what it means for them to look at their vagina. They will share untold stories about trauma they’ve suffered in their childhood. Some of them will seek therapy. Some of them leave my consultation room that same day and their problem has melted away. They came seeking medication or reassurance, and they leave with something completely different.
Wow! That’s incredible. Why do you think that exercise is so powerful?
I think it’s because of the religious, cultural, and all the other ways that the vagina is weaponized against cis girls and women. When you get reprimanded, you are accused of being a whore. When you get your first menstruation, you're accused of sleeping around. There’s just so much that we take on, that the vagina and the vulva take on. There are a million swear words, that specifically are used for the vulva and vagina. What we don't realize is how much of that has become our reality.
Sometimes all it takes is someone affirming that you can have a different relationship with your vagina. That in fact, this vagina is yours, it’s part of you and you should have pride over it. Your vagina is not something that just stays there and waits to be done sex to by some man. So yeah, it’s a fascinating exercise that I know holds a lot of power for cis women. That’s why I often start off with it.
“Your vagina is not something that just stays there and waits to be done sex to by some man.”
In the book you urge people with a vagina not only to look at it, but also to call it by its name.
Yes, I try to get cis women particularly to say vagina in their mother tongue. Whatever your language is, just say the words. When I give a speech or a workshop, I ask everyone to say the word. Even when I went on TV for the first time with my own TV show, the first thing I said was “vagina, vagina, vagina!”
Did they yell, “Please cut to commercial”?
Thank goodness, it was a production house that believed in my politics. They thought it was fantastic. It was amazing: you’d switch on your TV at seven o'clock, and all you heard was “vagina, vagina, vagina!” even before the opening sequence. Now, some people who see me in the street or wherever start shouting “vagina, vagina, vagina!” and that’s how I know these are people who know me well.
You know, I never heard the words vagina or vulva as a child. I don’t think my mum, bless her heart, ever taught me any name for it. The word I picked up from other kids was “njunju”, a curse word that means “monster”. I’m only now realizing the damage it’s done! So I’m trying to do things differently with my daughter, who’s three. I fight through my discomfort and I teach her to say vulva. The other day I slipped and, just like my own mother, I told my daughter, “go pee and don’t forget to wipe your bottom when you’re done.” She replied, “No mom, I’m just peeing so I’ll have to wipe my vulva.” At that moment I was like, damn. There’s been damage, but there’s progress. I might not be there myself yet, but if I keep faking it, she might just make it!
You can’t give to other people what you don't have. You can’t teach sex positivity or body positivity when you lack these things for yourself. So this book is for caregivers, for parents and for anyone who never had sex education and wants do things differently, but may not know where to start.
And it’s also why the book is a guide. It’s not to be read cover to cover. I want you to go to whatever section you need to consult today, and know that when you need more – and you will because life will get you there – you can come back for more.
Dr. T. holding a stack of her books. Can we talk about those nails? Photo source: Dr. T.’s Instagram page.
Here’s a statement you make in the book that made me holler: “In my opinion, the hymen is the most overrated piece of anatomy”. I screamed!
The hymen is a useless piece of anatomy. You can quote me on that. Useless. Let me tell you a story. A few years ago in one of South Africa’s districts, someone in the local government decided to do a bursary programme for young women aged 17-18 I think to study in college. And they included a clause in the applications saying that to the girls had to undergo virginity testing if they were to get the bursary.
What?!?
Oh yes. I completely lost all composure. I was very upset. What does academic merit have to do with the hymen? It shows how far the patriarchy will go. Using the hymen as a yardstick to decide who deserves an education. It just shows how patriarchy manifests itself around the bodies of women.
All around the world, the purity of women is highly regarded. People obsess over the genitalia of women and exceptionalize the hymen and the vagina as the one thing that you must preserve for your husband. Yet in the same communities, that same hymen and that same vagina are demonized when women decide to use them for their own pleasure. Why is it that they exceptionalize that piece of anatomy – which not all women are born with, by the way, and which is no sign of virginity among the women who do have it – but only when it serves men’s interests? That’s where the hypocrisy lies.
Another important point you make in your book is that “sexual pleasure is the missing link in many sexual health discussions”. Can you expand on that?
Public health likes to pretend that sex is devoid of pleasure. We talk about the pathophysiological, the economic and the political aspects of sex, but no one is talking about the actual reason why people are having sex. People are having sex because it’s nice. As a doctor, when you deny the fact that people are having sex for pleasure, you are denying yourself the opportunity to encourage your patients to use and negotiate for safer sex tools. It’s our job to give people information about sex that recognises that they seek sexual pleasure.
It’s our job to tell women that we yes, we know that the internal condom, or female condom as it’s called, looks big and intimidating. Only then can we educate women and explain: if the internal condom’s outer ring is so big, it’s because it protects your labia and some of your pubic area from even those STIs that don’t need bodily fluids to be transmitted. But you can still have pleasurable sex while using the condom: did you know that the outer ring is so big that if you put a lubricant on your clitoris and the outer ring rubs on it, it's lubricated? You are actually going to enhance your ability to have a clitoral orgasm as well as a vaginal orgasm from penetration, and to have even more pleasure.
By centering the pleasure approach, I find that I'm able to get more people to understand and have a different relationship with contraceptives because I affirm their fact that they have a right to sexual pleasure. I tell my patients that the medication I’m prescribing for high blood pressure could cause erectile dysfunction, and so I tell them about lubricants, about sex toys, about masturbation and delayed ejaculation. I tell them how to communicate with their partners and tell them “Look, the next few times we have sex might feel different because of this medication, so let’s manage expectations, or maybe let’s spend more time on foreplay.” I’m giving them all that information so I don't have to worry about my patient not taking his high blood pressure medication. But most doctors don’t, and then they go on to record patients as non-adherent. Let's practice medicine in its entirety. Let's not pick and choose what patients need to hear. Withholding information harms people.
“Public health likes to pretend that sex is devoid of pleasure.”
Why do you think most doctors don’t use that pleasure-centered approach?
Health professionals are people, you know, so they are prejudiced and judgmental. I was already worried about this as a young medical student. You know, I studied medicine at a time when South Africa was putting out a structural health system response to the HIV epidemic. There was a discussion about who were the vectors of the disease and the target of the public health messaging, and they decided that it was Black women and young Black girls. The idea then was that if Black women were not so hypersexual, if Black girls could keep their legs closed and focus on school, things would be fine.
I had a problem with some of the questions health professionals would ask patients about their sexual history. They would ask them “how many people are you sleeping with?” and nothing else. I was thinking, what is the purpose of this, beyond legitimizing the judgment healthcare professionals already have on women and young people? Those questions were always bubbling under for me.
Back then, most information and toolkits basically said: don't sleep around, you will get HIV, don't do this, you will get that. And we know fear messaging doesn't work. People don't come to doctors and nurses before they have sex. They have sex when we are not even there! We need to make sure people are informed enough to assess their own risks and negotiate for safer sex tools, whatever the context is that they are having sex in. It’s not the job of the medical community to judge people for how they have sex, when they have sex, with whom they have sex. I think public health would be more effective if we stopped being judgmental to our patients.
“I think public health would be more effective if we stopped being judgmental to our patients.”
This reminds me of an experience I had recently while I was doing some research work in the Sahel region. I spoke with several health professionals but also NGO staff who admitted that they were not telling girls and women that they had a right to get an abortion (after a rape or incest for example) because it was against their own religious values. What do you say to that?
It’s completely dishonorable. But that's the standard, and it pains me so much. That’s why I spend so much time working with medical students, young doctors, nurses and other allied professions like pharmacists. We cannot have another generation of health professionals who impose their culture and religion on vulnerable and marginalized patients.
Nobody forces a person who believes in a God that has all those rules to become a doctor, a nurse or a pharmacist. How dare they take those professions knowing that they are going to be obstructing people’s human rights? They are using their power to impose their personal views on people and obstruct care for selfish reasons. I say to them: there is no place for you in the medical profession. If you’re so spiritual, go and do theology. I know the words I use are very strong, but I’m using them deliberately. We should have no patience whatsoever for it.
“I say to them: there is no place for you in the medical profession. If you’re so spiritual, go and do theology.”
Young people are getting ill-timed pregnancies that change the course of their lives forever. Women literally die because they’re being denied safe abortions. Some of us die in childbirth. All that because doctors tell us: just say no and pray that you don't get horny. What nonsense is that? I live in a country where one in seven women is a rape survivor. Me saying no is not going to save me from being raped, so the least you can do as my healthcare provider is to not obstruct care.
But again, let’s take look at the people who these types of healthcare providers are hurting. It’s women and young people. It’s people who need an abortion and people who want contraception. Again, that’s patriarchy manifesting itself. Not just in the medical world, by the way! Why do you think so few lawyers fight for us women? It's easy to get a lawyer for medical malpractice, for a car accident, or for an orthopedic procedure that's gone wrong. But no one sees it of benefit to fight for women to access sexual reproductive health and care and rights. The legal system itself is patriarchal. Otherwise, we would be winning cases every single day!
There is one last statement I wanted to ask you about. You write in your book that “sex work is real work”. Sex work is a hugely divisive issue in the feminist movement, especially in Africa, so I really want to hear your take on this one.
When you have adults who are sex workers, who are consensually able to partake in sexual acts (not all of them have to be penetrative by the way), who are able to negotiate, when, how, with whom, and for what purpose they have sex, I think those people cannot be criminalized.
Criminalizing sex work is punishing women for being able to negotiate sex. That doesn't make sense. It's like cognitive dissonance. Those who don't support the decriminalization of sex work as a feminist issue are just showing their hypocrisy. What they’re saying to sex workers is, “You are so good at negotiating the terms of sex that I'm not supporting you.”
We should be learning from sex workers. Sex workers know how to protect themselves from STIs because they cannot afford to have them. Sex workers know how to put on a condom with their mouth during a blow job. You should learn, that’s a life skill, honey! (We laugh.) Yet we’re so caught up in sex and morality and in being agents of patriarchy, even within feminism. Why? Because it’s sex, because it’s women.
What we’re telling these women is: How dare you think that you have a right to be sexual? How dare you think you can enjoy being sexual? Then how dare you think you can negotiate how sex must happen and God forbid, how dare you charge men for it? Here’s the problem people have with sex work: it’s the fact that men have to pay for it.
“Here’s the problem people have with sex work: it’s the fact that men have to pay for it.“
I never thought about it that way.
Patriarchy is okay with women having sex as long as it’s extractive, as long as it’s forceful, as long as it’s violent. Sex workers are a walking middle political finger to patriarchy. That’s why patriarchy hates women who are sex workers so much.
It’s not like men who are policymakers stay away from sex workers! Members of Congress and of Parliament, these are the very people who are clients of sex workers. Some of the biggest scandals in politics start with sex – and I don’t mean a sex scandal between a congressman and his wife. It's always with a sex worker.
These men’s problem though, is that they want to replicate with sex workers what they do to women in all other industries and at all other levels of society. They want to be extractive, forceful and violent. And here come sex workers, spinning the whole thing on its head, and saying: not only will we be women, but we will be women who can negotiate sex. We will be women who enjoy sex. We will be women who even charge you for enjoying that sex. That's the problem people have with sex work and sex workers.
By the way, if I meet anybody anywhere, the views they have on sex work and abortion already tell me what kind of feminist they are, what kind of politics they have. So as I told you earlier, sometimes I introduce myself by saying I'm a sex worker. From the way people react to that statement, I’m able to know very clearly and very quickly already who I'm dealing with.
