When a hammer is your only tool, every problem looks like a nail.

I’ve started reading Naomi Wolf’s “Vagina: a new biography.” I’m only 17 pages in and I’m realizing I’ll have to do with it what I did with Sex at Dawn: a series of posts correcting the various problems.

Chapter 1 starts with Naomi Wolf looking for a medical explanation for why her orgasms don’t light up the world they way they used to. She’s feeling depressed (there’a an apparent causal narrative – the lack of luminescence in her orgasms is the CAUSE of the depression, not an early symptom of it…?). So she goes to her gynecologist, Deborah Coady.

Dr. Coady is “one of the few physicians who specializes in… problems with the pelvic nerve.” So guess what Dr Coady thinks is wrong with Naomi Wolf?

Yeah. Numbness from pelvic nerve compression.

When a hammer is the tool you’re an expert in using, every problem looks like a nail.

To be clear: Ms. Wolf went to the doctor because she noticed unwanted changes to “the emotional dimensions of my life and my sexuality” – she had no pain, not even any lack of orgasm itself. Her problem was “that the usual postcoital rush of a sense of vitality infusing the world, of delight with myself and with all around me, and of creative energy rushing through everything alive, was no longer following the physical pleasure I had certainly experienced.”

Symptom: lack of vitality and delight following orgasm. Diagnosis: numbness due to pelvic nerve compression. Obviously.

So she goes and gets an MRI and, low and behold, she had “lower-back degenerative spinal disease,” about which she was “very surprised, having never had any pain, or any problem with my back at all.” (NB – The presence of spinal degeneration need not be a symptom of anything at all (PDF).)

After “five minutes of probing” to learn about what may have caused this “serious injury,” which he insisted she “must have some memory of having sustained,” she recalls that she had fallen down the stairs once, two decades ago. Of this experience she writes, “I hadn’t felt much pain, but I had felt shaken. An ambulance 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.”

Really. Because when you’ve got a hammer in your hand, you’ll look and look and look for nails.

More tests, and it turns out, Ms. Wolf has “a mild version of spina bifida” and “the blow from twenty years before had cracked the already fragile… vertebrae.”

With no symtpoms, for two decades, until now.

To recap, so we’re clear: Ms. Wolf was born with a spine that was slightly “fragile and incompletely formed.” Most of three decades after that, she fell down the stairs with no apparent injury. Two decades after THAT, she experiences the first symptom: lack of vitality and delight following orgasm.

Treatment? Surgical placement of a fourteen inch metal plate in her spine, recovery from which requires a three month hiatus on lovemaking.

And the vitality came back – gradually, over the next six months or so.

Anyone familiar with the techniques of psychics and other frauds will know that fishing for information, eliciting cooperation, and using props (in this case, “unmistakable” MRI images) are common ploys.

I don’t think her doctors meant to deceive her. I think they were doing their best with the tools they had. And I think they had the wrong tools, and so they fell, as they could not help but fall, into the traps and fallacies that come with using the wrong tools: post hoc ergo propter hoc, confirmation bias, fundamental attribution error, belief bias. And we know that placebo is most effective when the intervention is hard core:

This will be an interesting book for me. Ms. Wolf reports experiencing it as REVELATORY that individual differences in neuroanatomy influence women’s orgasmicity from different kinds of stimulation. Apparently she believed (and believed therefore that EVERYONE believed) that lack of orgasms from different modalities was cultural training or being too inhibited etc. A woman’s own FAULT. Which I think many of my students believe also, but which is an utterly foreign to me.

So it’ll be interesting.

But in the first twenty pages, most of what I see is the fundamental problem with medical interventions around women’s sexual health. What mindfulness and sensate focus could have treated very effectively, her team treated with surgery on her spine.

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