Raise your hand if you have a uterus. Now keep your hand raised if you asked for that uterus. Anyone…? I didn’t think so. So imagine you’re a woman in 100 CE and you come down with a disease that no (male) doctor can seem to figure out. The solution? Blame it on the uterus. Because there couldn’t be a legitimate medical explanation for your very real symptoms of insomnia, muscle spasms and loss of sex drive, could there? You’re a hysterical woman with a uterus just looking to cause trouble! Ancient, medieval and early-modern doctors even worried about uterine suffocation, in which the “wandering womb” compressed and injured other organs. Ouch!

The recommended treatment prescribed by (male) doctors for these various uterine illnesses? Sexual activity with your husband, of course! Hopefully, you’ll fall pregnant because babies fix everything and a woman’s purpose in life is motherhood. But at least orgasms were commonly believed to aid in conception, with medical texts emphasizing the importance of sexual pleasure for the wellbeing of women, marriage, family and society. I’m guessing the (male) writers of those medical texts had no idea just how many women were faking it…

To accommodate the importance of genital stimulation to women’s health while restricting its pleasures to heterosexual marriage, those ancient, medieval, and early-modern doctors de-eroticized treatments by referring patients to female healers. In the 19th century, when Swedish gynecologist Dr. Thure Brandt popularized bimanual massage for the treatment of pelvic disease, he advised his female therapists to err on the side of causing pain, rather than pleasure (as if no female has ever had a homoerotic fantasy before).

With all this talk of orgasms and genital stimulation, if you happen to be a woman, I know exactly what you’re thinking: what about my vibrator?! The popular origin story of the vibrator – that Victorian doctors used them to masturbate their repressed, hysterical female patients to orgasm – is false, a myth that persists because it titillates the imagination while reinforcing gender stereotypes. Classic. Though not explicitly advertised as such, early vibrators likely were used by women to achieve orgasm in the same way they are most commonly used today: at home, by their own choice and in their own hands. No faking necessary.

So one might wonder: why do so many women fake orgasms when they’re with a sexual partner? And why is it so difficult for some women to get aroused in the first place? I mean, sure, there’s societal pressure to stroke your partner’s ego by ensuring them they satisfied you (even if they didn’t even come close). And there’s always a long list of household chores and errands taking up valuable brain space. And don’t get me started on the warped perception of pleasure that’s been ingrained in so many impressionable brains by the porn industry. But have you ever stopped to think that maybe for women it’s just not that easy to get there?

Vulvas are complicated. There’s the clitoris, vestibular bulbs, labia minora, and urethra, just to name a few anatomical features. A lot of women aren’t even familiar with how their vulvas really work which means most men don’t stand a chance when faced with the challenge of figuring it out under the covers in a dark room. But for the layman, each of the parts listed above consists of one of two types of sexually responsive vascular tissue: erectile tissue and non-erectile tissue. I’m pretty sure you can decipher the difference yourself but give us a call if you need an explanation. Just kidding. You can google it. Basically, when stimulated, the vascular tissues that comprise the female genitalia increase in blood flow causing that tingly sensation (I hope) we’ve all felt in our nether regions.

But it doesn’t stop there! We haven’t touched on the anterior vaginal wall periurethral glands or the Gräfenberg spot (better known by its street name, the G-spot). The G-spot gets a lot of press for being a particularly sensitive erogenous area, but let me tell you where you can find the real story: those anterior vaginal wall periurethral glands. These glands stain positively for prostate-specific antigen, consistent with prostate tissue. Some researchers have further speculated that these glands are responsible for the production of “female prostatic fluid” which is emitted during female ejaculation upon G-spot stimulation. Recent evidence even supports the notion that the anterior wall of the vagina encompassing the G-spot and the periurethral glands likely includes a complex system of multiple tissues involved in female sexual response, recently renamed the G-zone, including but not limited to the female prostate.

THAT’S RIGHT LADIES. So next time a man in your life tries to tell you they’re superior because they have a prostate (that happens…right?) you can hit them with this little nugget of science and say “Guess what? So do I!” *Cue the mic drop*

I know this may be hard to believe (pardon the pun), but did you know that Big Dick Energy preceded our favorite SNL comedian Pete Davidson by more than 5,000 years? This modern pop culture phenomenon has roots dating back as far as the 4th millennium BCE when Min, the Egyptian god of fertility and harvest, appeared on tomb walls with his right hand on an erect penis. And in the 2nd century CE, Romans often placed a statue of a small man with an enormous erect penis to protect their gardens. The small man with the big penis came to be known as Priapus and his appendage was often depicted as being larger than his body. There wasn’t a rabbit in town who would dare touch those carrots.

Throughout history, man’s obsession with giant erections hasn’t waned. I want to emphasize “man” here because we all know it wasn’t the ladies going, “You know what would make this item look better? A big ole penis.” But nonetheless, depictions of gods or men with an erect penis appeared on Greek pottery, vases and statues, and on Roman oil lamps and wall frescoes. The Romans even had a talisman, the fascinum, in the shape of an erect penis that was thought to provide protection from the evil eye, the malevolent energy caused by envy. In a matchup between the evil eye and the one-eyed monster, I guess we know who wins!

But the fascination didn’t stop at paintings and statues. The ability to get it up has been of keen importance to men since ancient times, too. Egyptians and Romans ate animal testes to increase erections…yum! And in China, the Yellow Emperor texts from 2500 BCE describe mixtures of many herbs to help improve erectile function. And if those natural remedies didn’t do the job? You were kind of out of luck until the 1500s when science finally started to get a boner for, well, boners. People began to experiment with penile implants, electrical stimulation and injections to name a few. But it’s not until the 1900s that things got really interesting…

I like to call this time The Boner Boom. Erectile dysfunction treatments began popping up all over the place. At one point, there were at least 15 different types of prostheses available. Female Sexual Dysfunction? Never heard of it. Penile implants? HOTTEST NEW TREND IN MEDICINE. In 1936, Bogoras described using extracorporeal rib cartilage for penile reconstruction. In 1952, Goodwin and Scott described using synthetic material for an extracorporeal acrylic penile implant. These were eventually abandoned however, due to difficulties with penetration, irritation of the glans, intractable pain, and extrusion of the implant through the skin or urethra. Sexy. Finally, 1974 saw the birth of a new era in the treatment of ED with the use of two safe and effective penile prostheses: the Small-Carrion semirigid prosthesis and the Scott-Bradley-Timm inflatable penile prosthesis. Even today, the penile prosthesis remains the gold standard for the treatment of patients with medical refractory ED.

What if you were a sufferer of severe organic erectile dysfunction and penile implants just weren’t for you? Don’t worry! Medicine fixed that by the 1980s. In 1983, Giles Brindley proposed large doses of oral phenoxybenzamine to treat patients with ED. In fact, Brindley decided to put his money where his penis was by showing the effects of phenoxybenzamine on his own member at the1983 AUA Annual Meeting. Wearing bulging sweatpants, he paraded through the aisles asking people to feel it to make sure it wasn’t a penile implant. Talk about Big Dick energy! While unorthodox, the Brindley injection lecture forever changed the sexual medicine world. Almost 40 years after the demonstration, we continue to use the intracavernosal injection as a safe and effective treatment for ED.

Small note: as of 1998 (almost two decades after the Brindley injection), the only diagnosis of Female Sexual Dysfunction to be found in the medical community was in the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorder. Seems fair, right? *insert eye roll here*

And of course, we can’t cover the history of ED without talking about the little blue pill. In 1986, Pfizer was working on an oral treatment for angina, a type of chest pain caused by reduced blood flow to the heart. When preclinical tests on animals were successful, clinical trials of sildenafil commenced in 1991. Imagine everyone’s surprise when sildenafil showed no clinically significant effect on angina in humans, but caused erections as a side effect! Two short years later, the first trial of sildenafil for the treatment of ED was initiated, and by 1998 Viagra was FDA approved and on the market. Need I remind you that Female Sexual Dysfunction was still only considered a mental disorder at this time? Because I just did. But there is some light at the end of the male-dominated tunnel because the approval of sildenafil (finally) sparked the study of women’s sexual health as a biopsychosocial field.

We all know what happens when men reach middle age: their desire for sports cars goes up while their desire for sex goes down. I’m joking. Kind of. From the beginning of recorded history, there has been an awareness that men experience a loss of vigor, sexual ability and desire as they reach their middle to later years. While it took some time to identify testosterone levels as a contributing factor, man has known for ages that the testicles, and whatever they produce, contribute to muscle, vigor and sexual desire.

In the 19th and early 20th century a number of interesting procedures were designed and tested in an effort to improve this “loss of vigor” faced by some middle-aged men. In fact, in 1889, Charles Edouard Brown-Sequard injected himself with testicular extracts and reported an increase in “his vigor and feeling of well-being…but the effects were transient.” Even so, within a year, more than 12,000 physicians were administering testicular extracts to patients. Seems legit.

By the 1900s the situation had escalated exponentially with testicular implants becoming all the rage. Between 1917 and 1926, Serge Voronoff performed over 500 experimental transplantations on sheep, goats and bulls, grafting testicles from younger animals into older ones. He concluded that older animals with transplanted testes regained the vigor of the younger animals from which the testes derived. So the obvious next step was to try it out on humans! Voronoff’s first official transplantation of monkey testicular tissue into a human was in 1920. Thin slices of testicles - a few millimeters wide - from chimpanzees and baboons were implanted inside the patient’s scrotum. And much like other questionable medical procedures discovered in the 20th century, it took less than 10 years for more than 500 men to be treated with monkey testicular implantation.

Seems even more legit. However, by 1935, these “rejuvenation” procedures involving testes were obsolete due to criticism that the data supporting the treatment as effective was, in fact, not legit at all.

That same year, testosterone was first officially isolated and identified, with synthesis of the hormone quickly following in 1939. The synthesis of testosterone led to its clinical use within a few short years. But by the 1960s, its effects were beginning to be linked to certain health issues. Since men have higher rates of heart disease and more testosterone than women, it was believed that the hormone likely contributed to heart disease. However, population-based studies in the 1980s showed just the opposite. Men with the lowest levels of testosterone were the ones facing an increased risk and greater severity of coronary artery disease compared to men with higher levels of testosterone.

Unfortunately, in 2013, an observational study was published reporting an increased risk of heart attacks, stroke and death in men who received a prescription for testosterone compared with men who did not receive a prescription. And thanks to the media craze that surrounds all things even mildly controversial in the 21st century, this single article created a false impression among the public and the medical community that testosterone therapy is dangerous for the cardiovascular system. FAKE NEWS. Recent literature has been highly reassuring that testosterone therapy is not associated with cardiovascular risk, so you may now return to your regularly scheduled programming.

It’s 2022. And although Marty McFly would probably be disappointed with our lack of flying cars and self-tying shoes, I like to think he’d be pretty impressed with the advances we’ve made in the field of medicine. That being said, there is still so much about the human body that we don’t understand and the expectations of the population have a tendency to be a bit… unrealistic. Add to that the effects of under-regulated and over-promoted medical marketing in the United States and you have a recipe for the spread of misinformation. Now, more than ever, patients are prey to advertisements promising regenerative therapy cures for erectile dysfunction, anorgasmia and vaginal rejuvenation. It’s important to remember regenerative therapies must all be considered experimental and results should never be guaranteed.

That being said, there are some pretty incredible treatments working their way through clinical trials that could have a lasting impact on issues like erectile dysfunction in men and painful intercourse in women. For instance, shockwave therapy, which originated after World War II and has been used to bust kidney stones since the 1980s, has come full circle and is now being considered as an option for battling erectile dysfunction. Although not yet FDA-approved specifically for erectile dysfunction, low intensity-ESWT (LI-ESWT) has been shown safe in recent studies and clinical trial results are promising. Research continues, and further applications may include dyspareunia, female stress incontinence and persistent genital arousal disorder in women and men.

Stem cell therapy and platelet-rich plasma are two additional regenerative therapies of the future for which researchers have high hopes in the treatment of erectile dysfunction. Stem cell therapy is an exciting application of restorative medicine with a theoretical promise of disease “cure.” At the current time, phase 1 and 2a trials have been performed using stem cell therapy for the treatment of erectile dysfunction and have shown it as a safe approach. Future trials will need to be designed to demonstrate efficacy in men with severe erectile dysfunction, but for patients all over the world, stem cell therapy represents an opportunity to restore normal penile vascular function. In much the same vein, platelet-rich plasma has the potential to heal damaged tissues and, in a clinical study, two PRP intracavernosal injections in a one-month interval were shown to be safe and effective for the improvement of erectile function in patients with mild to moderate erectile dysfunction. More research is needed.

And although research and advances in treating female sexual dysfunction have historically been severely neglected by the medical community, I am happy to report that we’re also working on regenerative therapies with the potential to positively impact the sexual health of women. In 1917, Albert Einstein introduced the concept of stimulated emission for energy balance, the primary principle of the laser (light amplification by stimulated emission of radiation). Scientists are now using the effects of lasers to treat aging-related and atrophic conditions in menopausal or premenopausal women with estrogen deficiency. Fractional CO2 laser, a non-hormonal strategy, regenerates vaginal and vestibular tissue in estrogen-deficient women, significantly alleviating symptoms related to atrophy like vaginal narrowing and shortening and vaginal tears, helping to improve sexual function. So for once in this exhibit – LET’S HEAR IT FOR THE GIRLS AND THEIR ABILITY TO ENJOY SEX!