I. W. GREGORIO
IF ASKED TO IMAGINE THE origin story of a female urologist, most people probably wouldn’t picture someone who couldn’t say the word penis in public without blushing until her early twenties, or a girl who was so embarrassed about her body that she didn’t wear skin-tight shirts until college.
And yet here I am: The kid who changed her gym clothes in a bathroom stall through junior high is now someone who examines people’s privates on a daily basis. I spend thousands of hours a year talking about urinary incontinence, vaginal prolapse (look it up), erectile dysfunction, and premature ejaculation . . . with relatively more acceptable topics of dinner conversation such as cancer and kidney stones thrown in here and there.
In other words, I am 100 percent certain that Teen Me would have died of mortification if she’d known what her adult self would be up to. Modest is probably too tame a word with which to tag my younger self; repressed is more like it, but it doesn’t truly capture how my issues weren’t just about sex. They were about body image, gender-specific shame, and cultural boundaries.
How did a body-shy teenager end up working in the most risque specialty in medicine? It’s been a long road, one that I wouldn’t wish on anyone. But as I raise my young kids, I have hope that they can be spared my hang-ups. All I can do is try my hardest to break the taboos that surround our bodies. All I can do is keep trying to talk about subjects that aren’t initially comfortable, so future conversations won’t be quite so awkward.
I’ll continue to speak loudly, even as educators and parents have intense debates about what’s “appropriate” for what age.
It could save lives. I’ll show you how.
I was nine years old when I first felt that my body was not my friend.
My breasts had just started to grow in, and my grandmother had already impressed upon me that they were a source of shame.
“That shirt too tight. People think you bad girl!” she scolded, and thus began a progression of ever baggier T-shirts. In my defense, it was the eighties. But there isn’t a single picture of me in my early teens where I didn’t have the silhouette of a cereal box. I’d also patented a bust-reducing slouch, which could be differentiated from my book-reading slouch only by the tilt of my shoulders.
Looking back, it’s hard for me to pinpoint what my grandmother’s fears were. She raised me after my parents divorced, and she was clearly of a different generation. Was she afraid that I would be targeted, sexualized, or objectified? Was she afraid of what the appearance of my breasts signified to others about the type of person or student I was? Or was she actually afraid my clothes would be able to exert a subliminal influence on my character through a kind of Insta-Slut Mojo?
Either way, her objections stuck, along with all the other subtle reminders that good girls do not emphasize the things that make them feminine: I basically wore sports bras for most of my teenage years. My family never went swimming, and you can bet that I never went to school dances. I wore pants during the summer, except for the occasional knee-length skort when it was really hot. When I graduated from junior high school, I wore a dress that looked like it could have come out of Little House on the Prairie.
I should add that I never got the birds-and-the-bees talk, aside from health class and a very insightful kids’ biology book that my dad got me in fourth grade. Five years later, my best friend dressed up like a French maid for Halloween; I literally dressed up in a burlap sack (as a gravestone).
It wasn’t until I was sixteen that I realized my body was a source of power.
It was the first summer since puberty that I’d spent with my mother in Taiwan, and I was finally old enough to appreciate the joys of shopping. For much of my life, I’d lived on hand-me-downs from my aunt, who was more than a decade older than me. Let’s just say my style was a little bit . . . dated.
That trip to visit my mom changed everything. That was the year I fell in love with sundresses, the summer I got my first shorts that would fail a school dress code. My mother took one look at my bust-reducing slouch and grabbed me by the shoulders to force my chest out. “Ting xiong yi-dian,” she’d say. Stand up straight.
She also took me swimming a dozen times. The first day, I wore my towel until the minute I stepped into the pool and put it back on the second I stepped out. After each swimming trip, though, I relied on my towel less and less. I started to relish the lingering glances I would notice from some of the teenage boys. Boys in America never looked at me like that. It may have had something to do with burlap sacks.
I couldn’t exactly put my finger on it at the time, but part of my newfound ease with myself probably had to do with the fact that I was finally in a place where being Asian was the default, rather than an oddity. For the first two decades of my life, I detested my hair. I wished I were blond, or redheaded like Anne of Green Gables, and that I had locks that held a curl instead of wilting into limp, anemic waves. I hated that my friends teased me that I looked like I was squinting in all my class photos. Living for a month in a place where straight black hair and brown eyes were the standard of beauty changed the way I perceived my potential (and I was finally able to find a foundation to match my skin tone).
If this sounds a bit like that eye-rolling part of a teen movie when the ugly duckling removes her glasses and lets down her ponytail to finally become the babe she truly is, well, you’re kind of right. That summer with my mom gave me license to be proud of my boobs and legs, and the amount of attention I got definitely rose exponentially in the next few years.
So did my anxiety.
Even as I became more aware of my body’s potential, I became aware of its limits. Suddenly, I was aware of beauty all around me, and I cared that I could never attain it. I’d grown up with blinders on to personal appearance. This is not to say that I didn’t notice when someone was objectively attractive. I had eyes, and I spent time in checkout lines ogling fashion magazines like everyone else. The difference was that when I was little, I never yearned to be one of those cover girls. It just wasn’t a family value. I was never exposed to any of the fundamental knowledge required to look good. I never cared about makeup (which was expensive) or had an eye for flattering clothes (which were usually even more expensive). I knew nothing about the lengths to which people would go to style their hair (my grandmother usually cut mine) or to remove it. I still remember looking at one of my college friend’s photo albums and exclaiming, “You have your mother’s eyebrows,” only to have her raise those very perfectly shaped arches and say, kindly, “Actually, I pluck my brows.” The revelation.
Looking good is, after all, quite often a pain in the butt. It is also not very tasty. Objectively, as a doctor, I am totally on board with the idea of healthy diets. I recognize intellectually the importance of low cholesterol and good glycemic control, as does anyone who’s ever had to cut through the plaque-filled arteries of a man with heart disease or treated a dialysis patient whose kidneys failed because of diabetes. But food—good, savory, decadent, artfully prepared food—has always been my siren call. Like a wise person once said, some people eat to live, others live to eat.
Guess which one I am? And guess whose mother doesn’t particularly approve of this philosophy?
On the very day that I wrote this paragraph, my mother sent me an email reminding me to exercise regularly and eat more vegetables. PIGU TAI DA, BU HAO KAN, she wrote in all caps. That’s basically Chinese for “You’ve got a potbelly. You look awful.”
It didn’t take me too long after my ugly duckling moment to realize that any source of power can be used both for and against you.
We live in a world where beauty is currency, where certain bodies are perceived to be of greater value and others are devalued. As I became more aware of how I could increase the value of my body, I realized that sometimes I wasn’t willing to pay the price.
The cost of body privilege is threefold. It can be superficial: the things you do to yourself, such as regulating what you eat (in ways both ordered and disordered), wearing high heels, submitting yourself to electrolysis, or waking up at five in the morning to participate in socially approved torture at the gym. It can be external: the things that others do to you, like staring at your cleavage, discounting your intellect because of your looks, or justifying your rape by saying that you dressed like you wanted it. And it can be internal: the self-hatred you feel when you blame yourself for your inability to stick to a diet, the jealousy that flares when you’re afraid that you’re not matching an arbitrary standard of beauty.
In the end, you can control your body to some extent, but you can’t control how other people perceive you. Which is why oscillating between unnecessary shame and false pride, as I did for so many years, changes nothing.
It wasn’t until medical school that I finally started to understand the alternative to shame or pride: acceptance.
Starting in anatomy class—where we unzipped the bags covering naked cadavers and meticulously carved apart their bodies—medical school broke down everything it means to be human. In the end, a body is just an intricately orchestrated group of cells. Nothing more, and nothing less. In an anatomy lab, where baby doctors learn to appreciate the complex mechanisms that make life possible, every body is priceless.
Early on, too, medical professionals learn that normal is a range, not a singularity. Disease doesn’t discriminate against body type or facial symmetry. All bodies are, in the end, equal.
This detachment that doctors must use when treating patients can be baffling to people not in the medical field. In the case of urology, the ability to maintain a clinical distance can be shocking even to other physicians. One of my medical school friends once asked me how I can keep a straight face when I ask a patient about, say, premature ejaculation (protip: It’s treatable with antidepressants like Zoloft). The easiest way I can explain how mundane it’s become to examine a guy’s private parts is to compare it to the way a new parent’s perspective on breasts changes when a mom nurses their baby.
For many new moms, exhausted, engorged with milk, and with a baby wailing like a siren in arms, the sense of propriety that leads women to hide their boobs from prying eyes goes out the window. For many dads, watching their exhausted, engorged wives whip out their mammary glands while a baby wails like a siren in their arms is as sexy as watching a cow get milked. Honestly, they probably get more aroused by the instant silence when a baby latches on to a nipple than anything else.
New moms, like doctors, are just doing their job with the body parts they’re given.
At its worst, clinical distance can make people feel like they’re cars in for a tune-up. They can feel objectified in the worst possible way, treated like meat rather than as people. But at its best, medical perspective is liberating. The best doctors manage patients at their most vulnerable by giving them the knowledge that their source of embarrassment, whether it be their weight or their pubic hair, their breasts or their anuses, their penises or their vaginas, is nothing to be ashamed of.
Countless studies have shown that body shame keeps patients from seeking medical care time and time again. Overweight patients, who are already more likely to feel uncomfortable with their bodies, often put off regular checkups because they know they’ll be chastised and fat-shamed. Studies show that transgender people avoid seeing doctors out of fear of the judgment of medical professionals. Earlier this year, I treated a young man who noticed one day that there was a lump in his testicle. He did nothing for six months before another doctor was finally able to persuade him to see a specialist.
As a urologist, I see one or two men a month who refuse rectal exams because of embarrassment or fear of discomfort. The potential health problem that lack of screening causes is so dangerous that the Pennsylvania Urologic Association created a campaign for prostate cancer awareness called “Don’t Fear the Finger.” I have a giant blue foam finger—the kind people wave at baseball games—as proof of the prevalence of male discomfort with anal penetration. (I’ll bet the copyeditors for this anthology never thought that’d be something they’d have to proofread.)
And as someone on the other side of the exam table, I get it. Despite my years of training, even though I’ve quite literally seen it all, I sometimes struggle to defuse a patient’s embarrassment. When in doubt, I use humor, taking the cue from one of my senior attendings during residency, who used to distract men during their vasectomies by telling dirty jokes. I console patients with observations like, “Well, I can guarantee you that I’ve got the smallest fingers in my practice” (all of my colleagues are guys) and smile ruefully when I tell women with incontinence that they can blame it on their kids. I look people in the eye, shake their hands firmly, hoping through my body language to say, “There’s nothing to be embarrassed about. Just another day at the office.”
Even still, I make mistakes. Once in a while a joke lands like a lead balloon, or I’m running late so the exam seems rushed or cursory. Once a male patient joked, “That’s it? You didn’t even take me out to dinner.” The first time I treated a patient who was intersex (a biological condition in which a person has sex characteristics that fall outside of traditional conceptions of “male” or “female”), I stumbled over the words to use to explain that her vagina was shorter than average but could be dilated. Sometimes I slip when using pronouns with a transgender patient, or bend myself into contortions trying to find the right way to refer to their genitalia.
This last lapse makes me feel exceptionally bad, because people are obsessed with what’s “down there” in transgender and intersex bodies. That’s the fascination, right? What’s in their underwear is part of what makes it all of prurient interest, because people are uncomfortable with the idea that biology might not determine gender, after all.
The stigma associated with sex organs that don’t conform to societal expectations extends to men who have had penile injuries caused by cancer or military trauma—both of these groups have significantly higher rates of depression and suicidal thoughts because of the truly toxic association of anatomy with both masculinity and femininity. Is it possible that we still live in a world where a war hero doesn’t consider himself to be of any value unless he has a penis and testicles? Or where a woman is undesirable if she doesn’t have breasts?
In the complex economy of the body, of course, reproductive organs are the blue chip properties, to the point that if a man is castrated, he is “unmanned,” and women who are unable to bear children carry a maddening stigma to this very day. I’ve had a man with penile cancer tell me that he’d literally rather die than lose his penis, a high price indeed to pay for the body you want.
In a perfect society, what is under one’s fig leaf wouldn’t have anything to do with how a person is treated. The tricky part, of course, the underlying dominant paradigm that we’re working against, is the whole issue of making babies. Sexual reproduction does currently require a sperm and an egg, and a uterus to carry the embryo in. The ability to be a good parent, however, doesn’t. Neither does the ability to love. That more and more kids are growing up realizing the truth of this is one of the things that, above all, gives me hope.
After four decades on this earth, I still struggle at times to accept my body, even though at my most honest moments I understand that as an able-bodied woman of average weight and height, whose identity corresponds to her birth sex, there is very little about my body that is out of the ordinary. It’s easy for me to preach body acceptance to my kids, but harder to prepare them for the hordes of people out there who fetishize or revile bodies that fall outside the arbitrary definition of “normal.”
All I can do is tell them, candidly, that just because the parts of the body that their swimsuits cover are “private,” it doesn’t mean that they need to be ashamed—or overly proud—of those parts. Their minds and their kindness better represent their true value as people.
All I can do is educate them on the brilliance of human physiology, the mind-boggling cascades of enzymes and chemical reactions that make every body a wonder. Nowhere is this miracle more apparent than in a hospital ward, when you see so clearly that all bodies, in the end, fail.
All I can do is try to teach my children that there is no normal when it comes to being human; you can dissect a million bodies, and every one of them will be different, complex, and deserving of compassion.
It’s a compassion I didn’t have for myself when I was a teen, but I can hope.