tag:theconversation.com,2011:/au/topics/womb-6768/articlesWomb – The Conversation2023-05-26T11:23:05Ztag:theconversation.com,2011:article/2063032023-05-26T11:23:05Z2023-05-26T11:23:05ZAdenomyosis: from symptoms to treatment, two women’s health experts explain this little known condition<figure><img src="https://images.theconversation.com/files/528324/original/file-20230525-23-2jpr6q.jpg?ixlib=rb-1.1.0&rect=8%2C0%2C5329%2C3553&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/young-woman-suffering-strong-abdominal-pain-1254094441">Leszek Glasner/Shutterstock</a></span></figcaption></figure><p>BBC presenter <a href="https://www.bbc.co.uk/news/av/uk-65670355">Naga Munchetty</a> recently revealed that she suffers from <a href="https://www.nhsinform.scot/healthy-living/womens-health/girls-and-young-women-puberty-to-around-25/periods-and-menstrual-health/adenomyosis">adenomyosis</a>, a chronic condition that affects the uterus. She spoke of how her pain can leave her unable to move and how a recent flare-up was so intense her husband had to <a href="https://inews.co.uk/news/health/adenomyosis-naga-munchetty-condition-endometriosis-2356366?ico=most_popular">call an ambulance</a>.</p>
<p>Yet many people have never heard of this condition, despite it affecting as many as <a href="https://www.sciencedirect.com/science/article/abs/pii/S1521693406000319?via%3Dihub">one in five women</a>.</p>
<p>Adenomyosis can cause symptoms including irregular and heavy menstrual bleeding and pelvic pain. The severity of symptoms varies between patients – up to <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6419978/#">one-third of women</a> with adenomyosis may have minimal or no symptoms at all. </p>
<p>The condition can also affect <a href="https://academic.oup.com/humupd/article/25/5/593/5533432?login=false">fertility</a>. Women with adenomyosis who do become pregnant have <a href="https://www.rbmojournal.com/article/S1472-6483(20)30528-9/fulltext">an increased risk</a> of miscarriage, pre-term delivery, pre-eclampsia and bleeding after delivery. </p>
<p>So what causes adenomyosis, and how is it diagnosed and treated? There’s still a lot we don’t understand about this condition, but here’s a bit about what we know so far.</p>
<h2>What causes adenomyosis?</h2>
<p>There are two key layers in the uterus. The endometrium is the inner layer where embryos implant. If there is no pregnancy, this layer is shed during a period. The myometrium is the muscular layer of the uterus. It expands during pregnancy and is responsible for contractions. In people with adenomyosis, endometrium-like cells are found in the wrong place – <a href="https://www.mdpi.com/1422-0067/22/20/10974">the myometrium</a>.</p>
<p>Although a large number of women with adenomyosis have endometriosis as well, adenomyosis is a distinct disease from <a href="https://www.nhs.uk/conditions/endometriosis/">endometriosis</a>. In endometriosis, endometrium-like cells are also found in the wrong place, but in this case outside of the uterus, mainly in the pelvic cavity.</p>
<p>Thanks to <a href="https://endometriosis.ca/">research</a>, <a href="https://endometriosis.org/">public engagement</a> and <a href="https://www.frontiersin.org/articles/10.3389/fpain.2022.889990/full">social media</a>, awareness of endometriosis has increased in recent years. Yet adenomyosis is still relatively unheard of.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/adenomyosis-causes-pain-heavy-periods-and-infertility-but-youve-probably-never-heard-of-it-104412">Adenomyosis causes pain, heavy periods and infertility but you've probably never heard of it</a>
</strong>
</em>
</p>
<hr>
<h2>Diagnosis options are changing and improving</h2>
<p>Adenomyosis is a difficult condition to diagnose. Historically, the presence of endometrium-like cells in the myometrium could only be verified by pathology assessment where the myometrium is <a href="https://www.mdpi.com/1422-0067/22/20/10974">examined under a microscope</a> after a hysterectomy (surgery to remove the uterus). </p>
<p>Recent years have seen increased diagnoses with the development of imaging technologies such as <a href="https://karger.com/goi/article-abstract/85/2/118/153958/A-Classification-Proposal-for-Adenomyosis-Based-on?redirectedFrom=fulltext">MRI</a> and detailed <a href="https://www.ajog.org/article/S0002-9378(09)00276-2/fulltext">pelvic ultrasound</a>. Although adenomyosis is now commonly identified without the need for a hysterectomy, doctors are still working towards developing a standardised method for non-surgical diagnosis. </p>
<p>As a result, it remains uncertain exactly how many women have adenomyosis. Although we know that <a href="https://www.sciencedirect.com/science/article/abs/pii/S1521693406000319?via%3Dihub">around 20% of women</a> having hysterectomies for reasons other than suspected adenomyosis are found to have evidence of the condition on pathology assessment.</p>
<h2>Adenomyosis is a complex condition</h2>
<p>The type of adenomyosis tissue growth in the myometrium can be either focal lesions (affecting a part of the uterus) or diffused (affecting a wide area of muscle). Adenomyosis can be further classified depending on the depth of endometrial-like tissue invasion into the myometrium. Scientists and doctors are still investigating whether the type or depth of the lesions <a href="https://link.springer.com/article/10.1007/s13669-022-00337-4">relates to symptoms</a> – the severity of symptoms and lesions don’t always tally.</p>
<p>We don’t yet understand why some women develop adenomyosis, though <a href="https://academic.oup.com/humrep/article/27/12/3432/652839">evidence shows</a> there is an increasing prevalence with age. </p>
<p>It is thought that the region between the endometrium and myometrium becomes damaged, either by the <a href="https://www.imrpress.com/journal/CEOG/24/1/pii/1997012">natural processes</a> of the menstrual cycle, pregnancies and childbirth, or medical procedures. In some women, damage to the endometrial tissue layer does not heal as it should and the endometrium-like cells enter and grow abnormally into the myometrium. These disrupt the normal functions <a href="https://rep.bioscientifica.com/view/journals/rep/164/5/REP-22-0224.xml">of the myometrium</a> leading to pain and bleeding. </p>
<p>It’s possible that a variety of mechanisms may contribute, and that there is not one common disease-causing factor behind adenomyosis. </p>
<h2>How is adenomyosis treated?</h2>
<p><a href="https://www.sciencedirect.com/science/article/pii/S001502821830013X#tbl1">Treatment strategies</a> include hormonal medications such as oral contraceptives, progesterone-containing pills, the insertion of a progesterone-releasing coil (for example, Mirena), or a drug called <a href="https://www.cancer.gov/publications/dictionaries/cancer-terms/def/gnrha">GnRHa</a> that stops the natural production of sex hormones. Non-hormonal treatments include <a href="https://www.nhs.uk/medicines/tranexamic-acid/">tranexamic acid</a>. These treatments aim to minimise menstrual bleeding. Pain is often treated with <a href="https://patient.info/medicine/mefenamic-acid-for-pain-and-inflammation-ponstan">non-steroidal anti-inflammatory drugs</a>. </p>
<p>Treatments that work for some women don’t for others, adding weight to the argument that there’s more than one type of adenomyosis. Treatment strategies should be tailored to patients, depending on their fertility wishes and symptoms.</p>
<p>If medical treatments are not providing adequate relief from symptoms, there are surgical options, namely removal of the focal lesions or a hysterectomy. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/endometriosis-three-reasons-care-still-hasnt-improved-157457">Endometriosis: three reasons care still hasn't improved</a>
</strong>
</em>
</p>
<hr>
<h2>What lies ahead?</h2>
<p>Although adenomyosis is a common disorder that affects many women, including those of reproductive age, it doesn’t receive enough clinical and research attention. There is also a <a href="https://www.mdpi.com/1660-4601/18/23/12386">lack of knowledge and awareness</a> around adenomyosis among many healthcare professionals and the public. This needs to change so we can improve our understanding of the condition, diagnosis and treatment options. </p>
<p>Scientists and doctors who specialise in adenomyosis are still on the quest to find an accurate, non-invasive diagnostic method, and hopefully, one day, a cure.</p><img src="https://counter.theconversation.com/content/206303/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Adenomyosis can be debilitating, causing symptoms including irregular and heavy periods and pelvic pain.Jen Southcombe, Principal Investigator/Group Leader, Nuffield Department of Women’s and Reproductive Health, University of OxfordNura Fitnat Topbas Selcuki, PhD Candidate, Nuffield Department of Women’s and Reproductive Health, University of OxfordLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1616112021-05-27T10:38:23Z2021-05-27T10:38:23ZGrowing human embryos in the lab and why scientists just tweaked the rules – podcast<figure><img src="https://images.theconversation.com/files/402947/original/file-20210526-21-1u5rsa0.jpg?ixlib=rb-1.1.0&rect=0%2C52%2C4865%2C3540&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Illustration of an early stage human embryo. </span> <span class="attribution"><span class="source">nobeastsofierce via Shutterstock</span></span></figcaption></figure><p>In this week’s episode of <a href="https://theconversation.com/uk/topics/the-conversation-weekly-98901">The Conversation Weekly</a>, as new scientific guidelines are released on embryo research and the use of stem cells, we talk to experts about what’s changed – including a recommendation to relax the 14-day time limit for human embryo research. And we hear about a wave of romantic comedy films emerging from South Africa that are re-imagining the city of Johannesburg. </p>
<iframe src="https://embed.acast.com/60087127b9687759d637bade/60af6da2a7e7e20012444626?cover=true" frameborder="0" allow="autoplay" width="100%" height="110"></iframe>
<p><iframe id="tc-infographic-561" class="tc-infographic" height="100" src="https://cdn.theconversation.com/infographics/561/4fbbd099d631750693d02bac632430b71b37cd5f/site/index.html" width="100%" style="border: none" frameborder="0"></iframe></p>
<p>It’s been five years since the last set of guidelines from the International Society for Stem Cell Research (ISSCR) were published. Since then, scientists have made significant developments in stem cell and embryo research – including the creation of <a href="https://theconversation.com/researchers-have-grown-human-embryos-from-skin-cells-what-does-that-mean-and-is-it-ethical-157228">human embryo models</a> and the <a href="https://theconversation.com/first-human-monkey-embryos-created-a-small-step-towards-a-huge-ethical-problem-159355">first human-monkey embryos</a>. </p>
<p>Now, <a href="https://www.isscr.org/policy/guidelines-for-stem-cell-research-and-clinical-translation">new ISSCR guidelines</a> have just been published. One of the most significant shifts concerns what’s called the 14-day rule. This has prohibited researchers – by law in some countries, <a href="https://www.legislation.gov.uk/ukpga/2008/22">such as the UK</a> – from growing human embryos in the lab for more than 14 days. The revised guidelines no longer strictly prohibit this, rather they recommend that a panel of experts should approve research proposals on a case-by-case basis. And they also call on countries to start national conversations about the issue and whether such research should be allowed.</p>
<p>The ISSCR guidelines are not international law, but their recommendations are used by countries around the world to guide their own national regulations and legislation. And also by countries that don’t have laws governing this kind of research using embryos and stem cells. </p>
<p>For this episode, we talk to Megan Munsie, deputy director for the Centre for Stem Cell Systems at the University of Melbourne and one of the scientists who sat on the panel that reviewed the guidelines. She tells us there have been advances that mean that we can now grow sperm-egg embryos for more than 14 days, “and the guideline is calling for consideration about whether we should”. She says that in a very small number of cases there may be justification for doing so.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/new-global-guidelines-for-stem-cell-research-aim-to-drive-discussions-not-lay-down-the-law-161578">New global guidelines for stem cell research aim to drive discussions, not lay down the law</a>
</strong>
</em>
</p>
<hr>
<p>The guidelines stress that doing research using human embryos should be a last resort – only turned to if there is no other way to get the same information. And this is where human embryo models come in. We speak to Jun Wu, assistant professor in molecular biology at the University of Texas Southwestern Medical Center, whose lab recently <a href="https://www.nature.com/articles/s41586-021-03356-y%C2%A0">made a breakthrough</a> by creating a human embryo model, called a blastoid, using human pluripotent stem cells. He explains how he did it and why this kind of research is so important to help understand what happens in the earliest stages of pregnancy, when the embryo implants into the womb lining. “This process of implantation is essentially a black box,” Wu says. “We don’t know much about it.” </p>
<p>And we speak to César Palacios-González senior research fellow in practical ethics at the Uehiro Centre for Practical Ethics at the University of Oxford, about some of the moral dilemmas that the 14-day rule and research using human embryos provoke. “Philosophers like myself love thinking about these things,” he told us. “The main ethical question that people have in mind is the moral value that human embryos have, and if actually we should even be carrying out this particular type of research.” He explains the arguments on both sides. </p>
<p>In our second story (at 25:20), we head to South Africa, where a wave of romantic comedies has hit the big screen in recent years. Many of these films are set in Johannesburg – a city that’s had a violent portrayal in film. Pier Paolo Frassinelli, professor of communication and media studies at the University of Johannesburg has <a href="https://www.tandfonline.com/doi/abs/10.1080/02533952.2021.1899734?journalCode=rsdy20">just published new research</a> looking at the way Black South African filmmakers are now portraying Joburg in a different light through these romcoms. “Even though the films try to present a certain image of upper-middle-class Johannesburg, the films cannot quite push away the tensions, the contradictions, the complexities of the city,” Frassinelli tells us. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/south-africas-romcom-revolution-and-how-it-reimagines-joburg-159255">South Africa's romcom revolution and how it reimagines Joburg</a>
</strong>
</em>
</p>
<hr>
<p>And Wale Fatade, commissioning editor at The Conversation in Lagos, Nigeria, gives us his recommended reading. </p>
<p>The Conversation Weekly is produced by Mend Mariwany and Gemma Ware, with sound design by Eloise Stevens. Our theme music is by Neeta Sarl. You can find us on Twitter <a href="https://twitter.com/TC_Audio">@TC_Audio</a>, on Instagram at <a href="https://www.instagram.com/theconversationdotcom/?hl=en">theconversationdotcom</a>. or via email on podcast@theconversation.com. You can also sign up to <a href="https://theconversation.com/newsletter?utm_campaign=PodcastTCWeekly&utm_content=newsletter&utm_source=podcast">The Conversation’s free daily email here</a>.</p>
<p>A transcript of this episode will be available soon. </p>
<p>News clips in this episode are from <a href="https://www.youtube.com/watch?v=GF1ZoSLMZVo">ABC News Australia</a>, <a href="https://www.youtube.com/watch?v=C9V3mqswbv0">AP News</a>, <a href="https://www.youtube.com/watch?v=oBMDMXDftnM">Rififi Pictures Trailer: Tell me Sweet Something</a>, <a href="https://www.youtube.com/watch?v=teS_BiLulVs">Showmax, Trailer: Happiness is a Four Letter Word</a>, <a href="https://www.youtube.com/watch?v=9gcty69_R74">Mrs Right Guy Official, Trailer: Mrs Right Guy</a>, <a href="https://www.youtube.com/watch?v=DyLUwOcR5pk">Sony Picture Entertainment: District 9 - Official Trailer</a> and <a href="https://www.youtube.com/watch?v=t6EohBg3QoY">Movieclips Classic Trailers, Trailer: Jerusalema</a>. </p>
<p><em>You can listen to The Conversation Weekly via any of the apps listed above, our <a href="https://feeds.acast.com/public/shows/60087127b9687759d637bade">RSS feed</a>, or find out how else to <a href="https://theconversation.com/how-to-listen-to-the-conversations-podcasts-154131">listen here</a>.</em></p><img src="https://counter.theconversation.com/content/161611/count.gif" alt="The Conversation" width="1" height="1" />
Plus, how a new wave of South African romcoms is reimagining Johannesburg. Listen to episode 17 of The Conversation Weekly podcast.Gemma Ware, Head of AudioDaniel Merino, Associate Breaking News Editor and Co-Host of The Conversation Weekly PodcastLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1257092019-11-10T18:57:09Z2019-11-10T18:57:09ZWe may one day grow babies outside the womb, but there are many things to consider first<figure><img src="https://images.theconversation.com/files/300419/original/file-20191106-88403-1g6r0ys.jpg?ixlib=rb-1.1.0&rect=1%2C4%2C997%2C744&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Researchers are developing artificial wombs as we speak. So we need to talk about the pros and cons before science fiction becomes reality.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-illustration/fetus-tank-54671101">from www.shutterstock.com</a></span></figcaption></figure><p><em>This is one of our occasional Essays on Health. It’s a long read. Enjoy!</em></p>
<p>The idea of growing babies outside the body has inspired <a href="https://daily.jstor.org/on-the-history-of-the-artificial-womb">novels and movies</a> for decades.</p>
<p>Now, research groups around the world are exploring the possibility of artificial gestation. For instance, one group <a href="https://www.nature.com/articles/ncomms15112">successfully grew</a> a lamb in an artificial womb <a href="https://www.huffingtonpost.com.au/2017/04/26/an-artificial-womb-has-successfully-grown-a-lamb-for-four-weeks_a_22055661/">for four weeks</a>. Australian researchers have also experimented with <a href="https://www.gizmodo.com.au/2019/03/artificial-wombs-are-getting-better-and-better/">artificial gestation for lambs</a> and <a href="https://www.wired.com/2011/09/artificial-shark-uterus/">sharks</a>. </p>
<p>And in recent weeks, researchers in The Netherlands <a href="https://www.theguardian.com/society/2019/oct/08/artificial-womb-dutch-researchers-given-29m-to-develop-prototype">have received €2.9m</a> (A$4.66m) to develop a prototype for gestating premature babies.</p>
<p>So it’s important to consider some of the ethical issues this technology might bring.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/from-frozen-ovaries-to-lab-grown-babies-the-future-of-childbirth-59912">From frozen ovaries to lab-grown babies: the future of childbirth</a>
</strong>
</em>
</p>
<hr>
<h2>What is an artificial womb?</h2>
<p>Growing a baby outside the womb is known as ectogenesis (or exogenesis). And we’re already using a form of it. When premature infants are transferred to humidicribs to continue their development in a neonatal unit, that’s partial ectogenesis.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/300421/original/file-20191106-88382-e2xvkf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/300421/original/file-20191106-88382-e2xvkf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/300421/original/file-20191106-88382-e2xvkf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/300421/original/file-20191106-88382-e2xvkf.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/300421/original/file-20191106-88382-e2xvkf.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/300421/original/file-20191106-88382-e2xvkf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/300421/original/file-20191106-88382-e2xvkf.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/300421/original/file-20191106-88382-e2xvkf.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">When premature infants are transferred to humidicribs to continue their development in a neonatal unit, that’s partial ectogenesis.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/incubator-sick-newborn-baby-neonatal-intensive-1532105090">from www.shutterstock.com</a></span>
</figcaption>
</figure>
<p>But an artificial womb could extend the period a fetus could be gestated outside the body. Eventually we might be able to do away with human wombs altogether.</p>
<p>This may sound far-fetched, but many scientists working in reproductive biotechnology believe that with the necessary scientific and legal support, full ectogenesis is a real possibility for the future.</p>
<h2>What would an artificial womb contain?</h2>
<p>An artificial womb would need an outer shell or chamber. That’s somewhere to implant the embryo and protect it as it grows. So far, animal experiments have used <a href="https://onlinelibrary.wiley.com/doi/pdf/10.1002/zoo.2042">acrylic tanks</a>, <a href="https://onlinelibrary.wiley.com/doi/pdf/10.1002/zoo.2042">plastics bags</a> and uterine tissues removed from an organism and artificially kept alive.</p>
<p>An artificial womb would also need a synthetic replacement for amniotic fluid, a shock absorber in the womb during natural pregnancy. </p>
<p>Finally, there would have to be a way to exchange oxygen and nutrients (so oxygen and nutrients in and carbon dioxide and waste products out). In other words, researchers would have to build an <a href="https://www.ncbi.nlm.nih.gov/pubmed/811007">artificial placenta</a>. </p>
<p>Animal experiments have used complex <a href="https://www.newscientist.com/article/mg13418180-400-japanese-pioneers-raise-kid-in-rubber-womb">catheter and pump systems</a>. But there are plans to use a mini version of <a href="https://www.mja.com.au/journal/2009/191/3/extracorporeal-membrane-oxygenation">extracorporeal membrane oxygenation</a>, a technique that allows blood to be oxygenated outside the body.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/the-business-of-ivf-how-human-eggs-went-from-simple-cells-to-a-valuable-commodity-119168">The business of IVF: how human eggs went from simple cells to a valuable commodity</a>
</strong>
</em>
</p>
<hr>
<p>Once these are in place, artificial gestation could one day <a href="https://www.sciencedaily.com/releases/2018/07/180703084127.htm">become as common as IVF</a> is today, a technique <a href="https://www.theguardian.com/society/2013/jul/12/story-ivf-five-million-babies">considered revolutionary</a> a few decades ago. </p>
<p>And just as in the case of IVF, there are many who are concerned about what this new realm of reproductive medicine might mean for the future of creating a family.</p>
<p>So what are some of the ethical considerations?</p>
<h2>Artificial wombs could help premature babies</h2>
<p>The main discussion about artificial wombs has focused on their potential benefit in increasing the survival rate of extremely premature babies. </p>
<p><a href="https://jme.bmj.com/content/44/11/75">Currently</a>, those born earlier than 22 weeks gestation have little-to-no hope of survival. And those born at 23 weeks are likely to suffer a range of disabilities. </p>
<p>Using a sealed “<a href="https://www.theguardian.com/science/2017/apr/25/artificial-womb-for-premature-babies-successful-in-animal-trials-biobag">biobag</a>”, which mimics the maternal womb might help extremely premature babies survive and improve their quality of life.</p>
<p>A biobag provides oxygen, a type of substitute amniotic fluid, umbilical cord access and all necessary water and nutrients (and medicine, if required). This could potentially allow the gestational period to be prolonged outside the womb until the baby has developed sufficiently to live independently and with good health prospects.</p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/dt7twXzNEsQ?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">Premature lambs survived for four weeks in a ‘biobag’ at the Children’s Hospital of Philadelphia (Tech Insider/YouTube).</span></figcaption>
</figure>
<p>An artificial womb might provide an optimum environment for the fetus to grow, providing it with the appropriate balance of hormones and nutrients. It would also avoid exposing the growing fetus to external harms such as infectious diseases. </p>
<p>The technology might also make it easier to <a href="https://academic.oup.com/medlaw/advance-article/doi/10.1093/medlaw/fwz014/5510054?fbclid=IwAR1WMf6ZzWD5YgbQZBWHNDuCznVrNEMnL-a-8mlhrTb7Ar_jhWVBBb2rk5">perform surgery on the fetus</a> if needed.</p>
<p>And it could see the end of long-term hospital stays for premature infants, saving health care dollars in the process. This is particularly noteworthy considering some of the <a href="https://www.medibank.com.au/livebetter/newsroom/post/medibank-reveals-its-most-expensive-claims">largest private insurance payments</a> are currently for neonatal intensive care unit expenses.</p>
<h2>Artificial wombs could help with infertility and fertility</h2>
<p>This emerging reproductive technology may allow women who are infertile, either due to <a href="https://www.theguardian.com/lifeandstyle/2017/sep/04/artifical-womb-women-ectogenesis-baby-fertility">physiological or social reasons</a>, with the chance of having a child. It may also offer opportunities for transgender women and other women born without a uterus, or those who have lost their uterus due to cancer, injury or medical conditions, to have children. </p>
<p>Similarly, it could allow single men and gay male couples to become parents without needing a surrogate.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/300423/original/file-20191106-88372-iwxt0d.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/300423/original/file-20191106-88372-iwxt0d.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/300423/original/file-20191106-88372-iwxt0d.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=401&fit=crop&dpr=1 600w, https://images.theconversation.com/files/300423/original/file-20191106-88372-iwxt0d.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=401&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/300423/original/file-20191106-88372-iwxt0d.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=401&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/300423/original/file-20191106-88372-iwxt0d.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=504&fit=crop&dpr=1 754w, https://images.theconversation.com/files/300423/original/file-20191106-88372-iwxt0d.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=504&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/300423/original/file-20191106-88372-iwxt0d.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=504&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Artificial wombs could allow gay men to become parents without needing a surrogate.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/gay-couple-using-laptop-kitchen-522801235">from www.shutterstock.com</a></span>
</figcaption>
</figure>
<p>Will this lead to a broader discussion about <a href="https://www.theguardian.com/commentisfree/2017/may/01/artificial-womb-gender-family-equality-lam">gender roles and equality</a> in reproduction? Will it remove potential risks and expectations of pregnancy and childbirth currently only affecting women? Will this eliminate commercial surrogacy? </p>
<p>Equally, artificial wombs could help fertile women who for health or personal reasons choose not to be pregnant. It would allow those whose career choices, medication or lifestyle might otherwise expose a developing fetus to malformation or abnormality. </p>
<h2>Artificial wombs may harm women, reinforce inequality and lead to discrimination</h2>
<p>The prospect of artificial wombs might offer hope for many, but it also highlights a number of potential hazards.</p>
<p>For some women, using an artificial womb for gestation to continue might seem like a welcome alternative to terminating a pregnancy. But there are fears that other women thinking about an abortion might be compelled to use an artificial womb to continue gestation.</p>
<p>Whether artificial wombs should be allowed to influence a woman’s right to choose <a href="https://www.ncbi.nlm.nih.gov/pubmed/2904469">is already under debate</a>.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/whats-mothers-day-if-youve-been-born-in-a-machine-and-raised-by-robots-58631">What's Mother's Day if you've been born in a machine and raised by robots?</a>
</strong>
</em>
</p>
<hr>
<p>Artificial wombs might also further increase the gap between rich and poor. Wealthy prospective parents may opt to pay for artificial wombs, while poorer people will rely on women’s bodies to gestate their babies. Existing disparities in nutrition and exposure to pathogens between pregnancies across socio-economic divides could also be exacerbated.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/300425/original/file-20191106-88394-g7i272.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/300425/original/file-20191106-88394-g7i272.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=401&fit=crop&dpr=1 600w, https://images.theconversation.com/files/300425/original/file-20191106-88394-g7i272.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=401&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/300425/original/file-20191106-88394-g7i272.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=401&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/300425/original/file-20191106-88394-g7i272.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=504&fit=crop&dpr=1 754w, https://images.theconversation.com/files/300425/original/file-20191106-88394-g7i272.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=504&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/300425/original/file-20191106-88394-g7i272.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=504&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Artificial wombs might further increase the gap between rich and poor.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/image-gap-between-rich-poor-1108746449">from www.shutterstock.com</a></span>
</figcaption>
</figure>
<p>This raises issues of distribution of access. Will artificial wombs receive government funding? If it does, who should decide who gets subsidised access? Will there be a threshold to meet? </p>
<p>Other issues concern potential discrimination individuals born via an artificial womb may face. How do we prevent discrimination or invasive publicity and ensure individuals’ origin stories are not subject to negative public curiosity or ridicule?</p>
<p>Others might consider artificial wombs to be deeply repugnant and fundamentally against the natural reproductive order.</p>
<h2>Preparing for future wombs</h2>
<p>Currently, there is no prototype of an artificial womb for humans. And the technology is very much in its infancy. Yet we do need to consider ethical and legal issues before rushing headlong into this reproductive technology.</p>
<p>Not only do we need to ensure the technology is safe and works, we need to consider whether it’s the right path to take for different circumstances.</p>
<p>It might be easier to defend using artificial wombs in emergency situations, such as saving the lives of extremely premature neonates. However, using them in other circumstances might need broader social and policy considerations.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/we-must-develop-techno-wisdom-to-prevent-technology-from-consuming-us-91656">We must develop 'techno-wisdom' to prevent technology from consuming us</a>
</strong>
</em>
</p>
<hr>
<p>Without first establishing clear regulatory and ethico-legal frameworks, the development and release of artificial wombs could be problematic. We need to clearly outline pregnancy termination rights, parenthood and guardianship issues, limitations to experimentation, and other issues before the technology is fully realised and available. We need to do this soon rather than allowing the law to lag behind the science. </p>
<p>We recommend:</p>
<ul>
<li><p>approved protocols for testing artificial wombs that gradually extend the gestation period </p></li>
<li><p>funding that prevents discrimination on socio-economic grounds. This might be in the form of government funding to ensue a wide range of groups have access to the technology </p></li>
<li><p>clear legal guidelines for the status of ectogenetic embryos and fetuses, including what happens if prospective parents die, divorce or disagree on how to proceed</p></li>
<li><p>guidelines for access that calm public fears about misuse of emerging reproductive technologies.</p></li>
</ul>
<p>It is easy to get carried away with visions of utopian or dystopian societies. As radical and futuristic as artificial wombs might sound, it is important to pause and reflect on the present. </p>
<p>While this technology may solve some existing problems concerning inequality in reproduction, there are many other issues that demand our immediate attention.</p>
<p>Improving maternal health services, equal opportunity in the workplace, and reducing the impact of poor social determinants of health on fetal outcomes are all pressing concerns we must address now before we can consider what the future of reproductive biotechnology might hold.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/where-we-come-from-determines-how-we-fare-the-fetal-origins-of-adult-disease-3581">Where we come from determines how we fare – the fetal origins of adult disease</a>
</strong>
</em>
</p>
<hr>
<img src="https://counter.theconversation.com/content/125709/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Yes, there are pros and cons of this new reproductive technology. But there are many other issues about maternal and child health we need to tackle first.Neera Bhatia, Associate Professor in Law, Deakin UniversityEvie Kendal, Lecturer in Bioethics and Health Humanities, Deakin UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1231232019-09-13T11:37:30Z2019-09-13T11:37:30ZThe womb isn’t sterile – healthy babies are born with bacteria and fungi in their guts<figure><img src="https://images.theconversation.com/files/291348/original/file-20190906-175686-1xbfpqd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">New research suggests that a newborn is exposed to bacteria and fungi in the womb.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/search/newborn+baby+and+hospital?search_source=base_landing_page">stockce/Shutterstock</a></span></figcaption></figure><p>For the last hundred years, scientists have believed that humans develop in a womb that remains sterile and completely isolated from the collection of bacteria, fungi and viruses that make us sick when we emerge into the outside world. </p>
<p>This theory was largely based on the fact that it was very difficult to grow live microorganisms collected from this part of the body in the lab – so scientists assumed there <a href="http://doi.org/10.1038/d41586-018-00664-8">weren’t any to find in the womb</a>.</p>
<p>However, there have been several important findings this year in this area of research. My team at the University of Tennessee and two other groups showed evidence that microorganisms are likely present inside the womb during normal development. Specifically, my team has discovered <a href="http://doi.org/10.1096/fj.201901436RR">fungi in the gut of newborns at birth</a>. Our work suggests that fungal DNA and possibly live fungi may cross the placenta from mother to fetus as a normal part of pregnancy.</p>
<p>In addition to being a research scientist, I am also a physician who cares for preterm infants in intensive care. My work with these tiny babies got me wondering about when human bodies begin their first partnership with the fungi that naturally live in our guts. Humans all have bacteria and microscopic fungi, like the yeasts that make bread rise or beer ferment, that live in and on our bodies as our partners. In my laboratory we are striving to understand when the bacteria and fungi that live in and on the baby begin to form this healthy relationship. </p>
<h2>Is the womb really sterile?</h2>
<p>The question of whether the womb is sterile began several years ago when a team in the maternal-fetal medicine laboratory of <a href="https://www.bcm.edu/people/view/kjersti-aagaard-m-d-ph-d/b153a614-ffed-11e2-be68-080027880ca6">Kjersti Aagaard</a> published <a href="https://directorsblog.nih.gov/2014/05/28/not-sterile-after-all-the-placentas-microbiome/">impressive research</a> revealing the <a href="http://doi.org/10.1126/scitranslmed.3008599">fetus could be exposed to bacteria</a> during pregnancy – effectively debunking the century old sterile womb hypothesis. </p>
<p>But in the past few months a heated debate has erupted as a group of <a href="https://doi.org/10.1111/1471-0528.15896">scientists suggested</a> that researchers, including Aagaard, had mistaken environmental bacteria contaminating their samples for bacteria living in the placenta. They claimed there were not any bacteria in the placenta and that the womb was sterile, as most scientists had originally believed.</p>
<p>Adding more support to her previous findings, <a href="https://doi.org/10.1016/j.ajog.2019.04.036">Aagaard published a study in August</a> that used a glowing dye to see bacteria in the placenta under a microscope. Another group also <a href="http://doi.org/10.1172/jci.insight.127806">published similar findings in humans and mice</a>. These studies and our own lend even more support to the new idea that the womb in not sterile. </p>
<p>But still no one knew when infants come in <a href="https://doi.org/10.1096/fj.201901436RR">contact with their first fungi</a>. Before I could understand if this process was going wrong in preterm babies and making them sick, I needed first to learn how it is supposed to happen in healthy babies. </p>
<h2>Detecting fungi</h2>
<p>To address that question, my colleagues and I collected samples of meconium from 37 mature-term babies, who were born after 37 weeks of pregnancy. We also collected samples from 34 preterm babies who were born before this stage. Meconium is the sticky tar-like material that babies pass within the first day or two of birth before they produce normal stools. </p>
<p>We then grew the microorganisms from the meconium using oxygenless chambers that mimic the airless environment of the gut. To categorize the microbes, we employed a new technique that uses DNA to identify the genus of microbes in a sample. </p>
<p>To our surprise we found fungal DNA in nearly all the babies – even in preterm infants born after only 23 instead of the normal 40 weeks of pregnancy.</p>
<p>We measured a gradual increase in the amount and kinds of fungi from each baby, depending on how long he or she had stayed inside the mother before birth. This increase over time supports the idea that colonization by fungi is a natural process and that fungi slowly and steadily accumulate in the fetus during pregnancy.</p>
<p>The differences in gut bacteria and fungi between preterm and term babies were very consistent and stark. It was possible to accurately predict whether the meconium sample came from a baby that was full-term or premature. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/292134/original/file-20190912-190016-8gciyn.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/292134/original/file-20190912-190016-8gciyn.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/292134/original/file-20190912-190016-8gciyn.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/292134/original/file-20190912-190016-8gciyn.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/292134/original/file-20190912-190016-8gciyn.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/292134/original/file-20190912-190016-8gciyn.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/292134/original/file-20190912-190016-8gciyn.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Could the birth of babies prematurely be linked to the types of microbes and fungi in the womb?</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/doctor-auscultate-premature-newborn-on-breathing-765326704?src=So92oqKALiQ1M6TDtevScg-1-28">mindfullness/Shutterstock.com</a></span>
</figcaption>
</figure>
<h2>Fungi are in the normal newborn gut at birth</h2>
<p>However, one striking difference was that the fungi <em>Candida</em> was found in more preterm infants. The gut communities of several preterm infants in our study were dominated by <em>Candida</em> – some were almost entirely <em>Candida</em>. Unlike the majority of the fungi we studied, which are naturally present in the gut, this made us wonder if having too much of this fungi too early in life might be one of the many causes of preterm birth. Normally <em>Candida</em> lives harmlessly in our guts, but it can occasionally trigger yeast infections; if it invades the blood, it can make a preterm infant very sick.</p>
<p>Our team is exploring how fungi begin to colonize the newborn gut and what happens when this process goes awry. While there are many possibilities that remain to be explored, if the formation of early fungal communities does not proceed as usual it could lead to developing <a href="http://doi.org/10.1016/j.jaci.2017.08.041">asthma</a> and potentially <a href="http://doi.org/10.1038/srep14600">obesity</a>. In order for scientists to understand if this process is not happening correctly, we need to understand how the first fungal communities are supposed to form in newborns. Our study is a key first step down this path.</p><img src="https://counter.theconversation.com/content/123123/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Kent Willis does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Fungi live in everyone’s gut – but now a new study reveals that this colonization may begin before birth.Kent Willis, Assistant Professor of Neonatology, University of TennesseeLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/805812017-07-07T14:38:05Z2017-07-07T14:38:05ZMedical law expert on womb transplants, unisex pregnancy, and the ‘right to gestate’<figure><img src="https://images.theconversation.com/files/177328/original/file-20170707-3035-v0l2yx.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p>Could a womb be transplanted into a transgender woman – or even <a href="http://tsq.dukejournals.org/content/1/1-2/61.full">cisgender</a> (non-transgender) men? Could pregnancy soon be unisex? These questions may sound as though they come from a sci-fi novel, but this week these speculative questions were seriously posed in mainstream media.</p>
<p>Vincent, the first child born following a uterine transplant, was born in Sweden in 2014. This marked the end of a long and hard-fought global race to perform the first “successful” human uterine transplant. <a href="https://www.ncbi.nlm.nih.gov/pubmed/28357688">Swedish research trials</a> recently reported there have now been six healthy live births via womb transplants. These are the only successful human attempts so far, but globally teams are seeking to emulate the success of Sweden. Clinical trials of uterine transplantation are underway in <a href="http://jamanetwork.com/journals/jama/fullarticle/2606524">North America</a>, <a href="http://onlinelibrary.wiley.com/doi/10.1111/1471-0528.13963/abstract">Europe</a> and <a href="http://annx.asianews.network/content/japanese-team-aims-perform-uterine-transplants-36967">Asia</a>.</p>
<p>The primary purpose of a human uterus transplant is to restore fertility in female patients. Prior to the success of these trials, for a woman lacking a functioning uterus the only way genetic motherhood could be achieved is through surrogacy. And, as a path to parenthood, surrogacy is far from unproblematic. It can be an emotionally draining method of founding a family and in the UK the practice is <a href="http://www.jordanpublishing.co.uk/practice-areas/family/news_and_comment/the-regulation-of-surrogacy-in-the-united-kingdom-the-case-for-reform#.WVzYDITyuUk">shrouded in legal uncertainty</a>. </p>
<p>Furthermore, <a href="http://jme.bmj.com/content/medethics/20/2/87.full.pdf">research demonstrates</a> that many women attach a great importance to the experience of gestation and pregnancy. Womb transplantation allows women suffering from <a href="https://www.ncbi.nlm.nih.gov/pubmed/17592442">infertility due to womb abnormalities</a> the unique experience of gestation, pregnancy and childbirth. But the technology also raises broader societal concerns as to whether publicly funded healthcare systems such as the UK’s National Health Service (NHS) <a href="http://jme.bmj.com/content/42/9/559">should fund such procedures</a>. Just as the state helps fund IVF for women who cannot conceive, <a href="http://jme.bmj.com/content/early/2016/03/03/medethics-2015-103231">I have argued</a> that there are strong grounds to allow for public funding for those who cannot gestate.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/177338/original/file-20170707-30715-1hdq5rz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/177338/original/file-20170707-30715-1hdq5rz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/177338/original/file-20170707-30715-1hdq5rz.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/177338/original/file-20170707-30715-1hdq5rz.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/177338/original/file-20170707-30715-1hdq5rz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/177338/original/file-20170707-30715-1hdq5rz.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/177338/original/file-20170707-30715-1hdq5rz.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Are womb transplants comparable to IVF?</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
</figcaption>
</figure>
<p>But these developments also raise further questions. Unlike the transplantation of other vast organs, womb transplantation is not intended to save life, but to create life. If women can receive womb transplantation, some have queried whether the procedure may also work in trans women and, even more controversially, in men. Mats Brannstrom, who led the Swedish trial, <a href="https://www.scientificamerican.com/article/how-a-transgender-woman-could-get-pregnant/">has said</a> his inbox is now inundated: “I get e-mails from all over the world on this, sometimes from gay males with one partner that would like to carry a child”. </p>
<p>While in theory a womb transplant in trans women and men may be possible, in practice there are anatomical barriers that would have to be overcome due to differing shape of the pelvis, which in trans women is much narrower than those in cis women. But there is no reason to think such barrier might not be overcome.</p>
<p>In the UK, the Gender Recognition Act 2004 gives trans women who have gender reassigned the same rights as their female counterparts. So if womb transplantation becomes clinical treatment in the UK for women who are unable to gestate, could a trans woman claim, under this legislation, that she too has a right to a womb transplant?</p>
<p>While some have <a href="http://jamanetwork.com/journals/jama/article-abstract/407931">advocated</a> the “reproductive needs” of trans women, who may have strong desires to experience gestational motherhood, it has also provoked opposition. Julie Bindel <a href="https://www.thetimes.co.uk/article/transgender-women-have-a-right-to-be-pregnant-l0ctnpnvp">reportedly stated</a>: “This is not about transgender rights — it’s about a twisted notion as to what constitutes a ‘real woman’.” A <a href="https://academic.oup.com/jlb/article/3/3/636/2327861/Uterus-transplantation-does-procreative-liberty">debate is now needed</a> on whether it can be claimed that there is a right to gestate under the umbrella of procreative liberty or the right to a private family life. And if such a right to gestate does exist, does it applies only to those born female, or trans women and men also?</p>
<h2>A right to gestate</h2>
<p>In light of womb transplant technology we need to address whether or not there is a right to gestate, not whether or not the NHS should fund it – the question that has so far dominated media coverage. Finite public resources should not be invoked as a smokescreen to mask prejudices towards gender reassigned individuals who parliament has given clear rights to. If it is decided that women should be allowed womb transplants on the NHS, it follows given the legislation enacted by parliament that trans women have the same rights as their female counterparts.</p>
<p>In terms of the overblown hype over cisgender men becoming pregnant, even if womb transplantation in a male body becomes scientifically feasible, it would only be possible for men to carry a pregnancy if an IVF embryo was implanted into the womb. In the UK, assisting a male to become pregnant does not fall within the specified activities for which a licence can be granted to a fertility clinic when “bringing about the creation of embryos in vitro” under the <a href="http://www.legislation.gov.uk/ukpga/2008/22/contents">Human Fertilisation and Embryology Act 2008</a>. Therefore, implantation of an IVF embryo in order to assist a man to experience pregnancy, in the absence of a licence, would be liable to imprisonment or a fine upon conviction.</p>
<p>Almost 40 years ago, the birth of Louise Brown, the world’s first “test-tube baby”, prompted ethical and legal discussions and debates. As womb transplants move from science fiction to science fact, it is clear that reproductive science continues to propel us into uncharted territories and tests the very essence of legal and ethical principles, such as the right to procreative liberty and the right to private and family life. Does this encompass a right to gestate? It is clear that not all would interpret such a right, if there is one, as encompassing unisex gestation.</p><img src="https://counter.theconversation.com/content/80581/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Amel Alghrani does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>As womb transplants move from science fiction to science fact, we need to consider some ethical dilemmas.Amel Alghrani, Senior Lecturer in Medical Law, University of LiverpoolLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/516822015-12-04T12:00:43Z2015-12-04T12:00:43ZShould the NHS pay for womb transplants?<figure><img src="https://images.theconversation.com/files/104134/original/image-20151202-22442-cswvbo.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption"></span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p>The first <a href="https://theconversation.com/explainer-what-are-womb-transplants-and-who-could-they-help-50342">womb transplants</a> are due to take place in 2016. The experimental programme could allow 10 women with damaged or missing uteruses to give birth. If successful, the procedure is likely to be made available to more women who suffer from this particular type of infertility. But should such operations be made available freely on the NHS?</p>
<p>There are a number of arguments that people who feel uneasy about this prospect might make. One seemingly obvious objection that can be applied to publicly funding any fertility treatments is that they don’t save lives. But this argument simply doesn’t work. Some of the most important things the NHS does are quality-of-life interventions such as cataract operations, hip replacements and general pain relief. So the fact that fertility treatments are designed to improve rather than extend lives doesn’t make them different from widely accepted NHS procedures and isn’t a reason not to fund.</p>
<p>Another argument is that the NHS shouldn’t spend money on treating infertility because it isn’t a disease. This view is out of line with <a href="http://www.who.int/reproductivehealth/publications/infertility/art_terminology2.pdf">most official classification systems</a> – but some people remain sceptical. One reason for this is that infertility only harms people who want children. People sometimes think of alleviating infertility as being more a way of satisfying a desire for a <a href="http://www.theguardian.com/commentisfree/2015/sep/30/womb-transplants-medical-necessity-lifestyle-choice">certain lifestyle</a> than of treating a disease.</p>
<p>But while infertility is only directly harmful to those people who want children, that doesn’t mean that it can’t be a disease. Whether something is a disease is partly a matter of whether the person’s body is functioning as it normally would at any given stage of their life. So we expect a 25-year-old woman’s body to be capable of conception and pregnancy – if it is not, this is a pathological state, regardless of whether she wants children. Unwanted infertility can also have very <a href="http://www.health.harvard.edu/newsletter_article/The-psychological-impact-of-infertility-and-its-treatment">serious psychological side-effects</a> such as anxiety, depression and stress.</p>
<h2>Overpopulation</h2>
<p>Another approach is to argue infertility treatment shouldn’t be provided because of overpopulation. World population grew from <a href="http://www.scientificamerican.com/article/population-growth-climate-change/">1.6 to 6.1 billion</a> during the 20th century and, as well as pressures on food and water supplies, increasing global population makes it ever <a href="http://www.scientificamerican.com/article/population-growth-climate-change/">harder to tackle climate change</a>. Therefore (so the argument goes) it would be incoherent for governments to expend resources tackling climate change while at the same time spending public money on what is, in effect, creating extra people.</p>
<p>But restricting infertility services is unlikely to be a fair or effective means of achieving environmental goals. Treating infertile couples makes a comparatively small contribution to population size. In the UK in 2012, just <a href="http://www.hfea.gov.uk/docs/HFEA_Fertility_Trends_and_Figures_2013.pdf">2% of births resulted from IVF</a> and the figure for womb transplants would only ever be a tiny fraction of this.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/104135/original/image-20151202-22439-12pga3b.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/104135/original/image-20151202-22439-12pga3b.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/104135/original/image-20151202-22439-12pga3b.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/104135/original/image-20151202-22439-12pga3b.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/104135/original/image-20151202-22439-12pga3b.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/104135/original/image-20151202-22439-12pga3b.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/104135/original/image-20151202-22439-12pga3b.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Is giving birth really a ‘lifestyle choice’?</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
</figcaption>
</figure>
<p>Then there are questions of fairness. People who are biologically infertile are suffering from a medical condition that our health system has the technical ability to treat. Given this, denying them such treatment on environmental grounds seems ethically problematic. It would arbitrarily single out people with a particular disability (infertility) and require them to bear costs others don’t face. They would then either have to fund treatment themselves or, if they can’t afford it, be deprived of the opportunity to be a parent. Whereas if everyone paid evenly spread environmental taxes instead, no single person would need to bear such a high cost.</p>
<h2>Adoption and surrogacy</h2>
<p>Another suggestion is that, just as paying for everyone to have gold fillings rather than cheaper alternatives would be a waste of NHS resources, womb transplants are a wasteful solution to infertility when adoption and surrogacy arrangements are possible alternatives. But are these really adequate alternatives? Certainly not for those women who attach great value to the experience and process of pregnancy and childbirth.</p>
<p>In any case, adoption and surrogacy can be problematic. Potential adopters must often be willing and able to parent older children, missing out on the early months and years of development and precluding the chance to have their own “genetic child”. Surrogacy arrangements, meanwhile, are not legally enforceable in the UK – the surrogate mother can choose <a href="http://www.hfea.gov.uk/1424.html">to keep the baby</a> even if they are not genetically related. The ban on payments also makes it harder to find willing surrogates.</p>
<p>As with any medical treatment, womb transplants must first be shown to be cost-effective and safe. But if this can be done, there is no good reason to rule out NHS funding.</p><img src="https://counter.theconversation.com/content/51682/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Stephen Wilkinson receives funding from the Wellcome Trust.</span></em></p><p class="fine-print"><em><span>Nicola J. Williams does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Fertility treatments might be designed to improve rather than save lives but that doesn’t mean they shouldn’t be publicly funded.Stephen Wilkinson, Professor of Bioethics, Lancaster UniversityNicola J. Williams, Post-Doctoral Researcher in Applied Ethics, Lancaster UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/486932015-12-03T15:17:16Z2015-12-03T15:17:16ZWould you donate your womb when you die?<figure><img src="https://images.theconversation.com/files/104138/original/image-20151202-22461-1yvp3cx.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption"></span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p>The year 2018 could well see the <a href="http://www.theguardian.com/lifeandstyle/2015/sep/29/10-women-receive-go-ahead-for-first-ever-womb-transplants-in-uk">UK’s first babies</a> born to women who have received <a href="https://theconversation.com/explainer-what-are-womb-transplants-and-who-could-they-help-50342">womb transplants</a> because their own uteruses didn’t work properly or were missing. While such transplants have <a href="http://www.theguardian.com/society/2014/jan/13/womb-transplants-success-swedish-project">successfully taken place elsewhere</a> in the world, and have <a href="http://www.theguardian.com/science/2014/oct/04/woman-gives-birth-womb-transplant-medical-first">resulted in the birth</a> of apparently healthy children, the UK births will differ in one important – and ethically interesting – respect.</p>
<p>Previous transplanted wombs have been donated by living women, and often to individuals to whom they are related. In the UK, they will be donated post-mortem. This means that no operations will be needed to remove the wombs of any living women thus avoiding the risks that attend such procedures. However, it is debatable if this is the <a href="http://www.bionews.org.uk/page_567572.asp">morally preferable approach</a>.</p>
<p>The main issue is consent. Will women be happy for their wombs to be taken and used for childbirth by someone else after they die? It might be logical to think that if a woman was willing to donate her vital organs, she would also be willing to donate her womb. But this might not necessarily be the case. Donating organs might save a life. Yet while the desire to become pregnant and carry a child <a href="http://www.theguardian.com/lifeandstyle/2015/sep/30/meet-sophie-lewis-the-30-year-old-hoping-to-have-a-womb-transplant">is deeply felt</a>, womb transplantation is not a life-saving procedure. Will all women be happy to donate their wombs for what some might consider <a href="http://www.theguardian.com/commentisfree/2015/sep/30/womb-transplants-medical-necessity-lifestyle-choice">a “lifestyle choice”</a>?</p>
<h2>Organ donor pool</h2>
<p>In cases of live donation, the issue of consent is complicated but there is no question that it is given. This consent is called into question in the case of post-mortem donation. It appears the ten wombs intended for transplant will be taken from women who have signed the <a href="https://www.organdonation.nhs.uk/register-to-donate/">UK’s Organ Donor Register</a> (ODR). However, no information about womb transplant is provided to those who sign the ODR. While this is not surprising – it is a very new procedure – it is not clear how individual women might feel about their wombs being made available for transplant. </p>
<p>The ODR does provide registrants with some degree of control over the specific organs they wish to donate. And if womb transplants become more common, we would expect them to be added to the list of potential organs. But for the purposes of these ten experimental procedures, it would seem that the wombs of all currently registered women will be considered for donation alongside their other organs, if the worst were to happen.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/104137/original/image-20151202-22476-1p4pcrv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/104137/original/image-20151202-22476-1p4pcrv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=399&fit=crop&dpr=1 600w, https://images.theconversation.com/files/104137/original/image-20151202-22476-1p4pcrv.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=399&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/104137/original/image-20151202-22476-1p4pcrv.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=399&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/104137/original/image-20151202-22476-1p4pcrv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=501&fit=crop&dpr=1 754w, https://images.theconversation.com/files/104137/original/image-20151202-22476-1p4pcrv.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=501&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/104137/original/image-20151202-22476-1p4pcrv.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=501&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Tick box exercise.</span>
<span class="attribution"><a class="source" href="https://www.flickr.com/photos/magnus_d/4047845656">Magnus D/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
</figure>
<p>The NHS Blood and Transfusion service has confirmed it <a href="http://www.bbc.co.uk/news/health-34401940">will be working with the womb transplant team</a> and, no doubt, with others to consider how best to approach this issue. At present, the suggestion is that the transfusion service will seek consent from the families of those who are candidates for donation.</p>
<p>But Wales has <a href="http://www.bbc.co.uk/news/uk-wales-34964382">just become</a> the first part of the UK and the latest country to introduce a system of presumed consent where people have to opt out of becoming an organ donor rather than opt in. It’s reasonable to ask whether this will also apply to womb donation and, if so, whether this is legitimate? </p>
<h2>Impact on other donations</h2>
<p>As someone who does not have a womb I am not sure if these questions are ones that I should seek to answer, at least not in the first instance. But how we respond to them will likely inform our subsequent accommodation of <a href="https://en.wikipedia.org/wiki/Face_transplant">face and</a> <a href="https://en.wikipedia.org/wiki/Hand_transplantation">hand transplants</a> if and when these procedures become more common occurrences.</p>
<p>Even if most women feel no differently about their wombs than they do about any of their other transplantable organs there is, as yet, no evidence for this. Furthermore, regardless of what the majority think it is almost certain that some women will not wish to donate their wombs whilst being happy to donate other organs.</p>
<p>If we want these individuals to remain on the ODR – and thereby continue to be among the pool of potential life-saving organ donors –- we should give serious consideration to including “womb” (and “face” and “hands”) on the list of organs people can choose not to offer.</p>
<p><em>Now read this: <a href="https://theconversation.com/explainer-what-are-womb-transplants-and-who-could-they-help-50342">what are womb transplants and who could they help?</a></em></p><img src="https://counter.theconversation.com/content/48693/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Nathan Emmerich does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>The advent of womb transplants raises serious issues of consent for organ donors.Nathan Emmerich, Visting Research Fellow, Queen's University BelfastLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/492562015-10-19T16:08:20Z2015-10-19T16:08:20ZDo babies feel tickles in a different way to adults?<figure><img src="https://images.theconversation.com/files/98699/original/image-20151016-25117-h0kpmr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Ticklish?</span> <span class="attribution"><span class="source">Babyfoot via Michael Kempf/www.shutterstock.com</span></span></figcaption></figure><p>For a newborn baby emerging from the cosy womb, the outside world is much bigger, much colder and quite a different kind of place. At birth, the way newborn babies sense their environment changes dramatically. How do they make sense of all the new sounds, sights, smells and sensations? </p>
<p>Our <a href="http://www.sciencedirect.com/science/article/pii/S0960982215010714">new research</a> has focused on the way babies experience touch, such as tickling. We’ve found that young infants of four months old, unlike older infants, are pretty accurate at locating where they’ve been tickled, even with their limbs crossed. </p>
<p>In the womb there is a constant chain of tactile sensations occurring for the foetus to feel, but those touches might be experienced as rather lonely events, unrelated to the low-resolution sights, and the gurgling low-frequency noises of the womb.</p>
<p>In the outside world, the environment becomes much more multisensory. The tactile feeling of being picked up is likely to accompanied by sights such as a parent’s face or hands, and the sounds of voices. We don’t fully understand yet how infants link these kinds of sensory stimuli, and how long it takes them to figure out the way what they feel and what they see or hear fits together.</p>
<h2>Where’s that coming from?</h2>
<p>Our research at the <a href="http://www.goldsmithsinfantlab.org/">Goldsmiths InfantLab</a> has been investigating the early development of tactile perception for some time, looking particularly at the early development of how babies perceive where a touch is coming from in space.</p>
<p>Typically, we present little tactile buzzes to babies’ hands, one hand at a time, and in a random order so that the baby does not know where to expect them. The touches – which are like a little tickle – are delivered by what we call voice-coil tactors, small vibrating boxes which we wrap into the palms of the babies’ hands. When a buzz is presented there is nothing going on visually to indicate which hand received the touch. Any noises made by the tactors are masked so that the infants cannot tell where they are coming from.</p>
<p>In order to figure out what the babies can do, we look at video records of the infants’ movements. We measure whether they can accurately localise those buzzes, by moving their hands or moving their eyes towards the location of the tactile stimulus.</p>
<p>One of our most striking <a href="http://research.gold.ac.uk/7309/1/AJBremner_accepted.pdf">early findings</a> was that babies do not often look towards touches. Comparing six-month-old and ten-month-old babies, we found that whereas the older infants made eye and head movements quite quickly and accurately to the hand where they had felt a touch, the younger ones tended to make many fewer and less of such movements. It was as if they did not yet know how the visual world matched up to the tactile world of the body.</p>
<h2>Figuring out the outside world</h2>
<p>Our most <a href="http://www.sciencedirect.com/science/article/pii/S0960982215010714">recent findings</a> have looked in more detail at the question of whether babies perceive where a touch might be, not just on their body but in the outside world. One signature of this ability is a tendency, demonstrated by both young children and adults, to become confused about the location of a touch when our limbs are crossed over. </p>
<figure class="align-right ">
<img alt="" src="https://images.theconversation.com/files/98821/original/image-20151019-23239-p3ym82.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/98821/original/image-20151019-23239-p3ym82.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=800&fit=crop&dpr=1 600w, https://images.theconversation.com/files/98821/original/image-20151019-23239-p3ym82.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=800&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/98821/original/image-20151019-23239-p3ym82.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=800&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/98821/original/image-20151019-23239-p3ym82.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1005&fit=crop&dpr=1 754w, https://images.theconversation.com/files/98821/original/image-20151019-23239-p3ym82.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1005&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/98821/original/image-20151019-23239-p3ym82.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1005&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">A baby taking part in the experiment.</span>
<span class="attribution"><span class="source">Jannath Begum Ali</span></span>
</figcaption>
</figure>
<p>As we grow up, we learn from experience that our bodies and limbs tend to rest in particular places. For instance, we come to expect that our left hand is usually in our left field of vision, and our right hand is usually in the right field of vision. <a href="http://www.nature.com/neuro/journal/v4/n7/full/nn0701_759.html">We also expect</a> touches to our right hand to have originated from events to the right of us. However, if our hands are crossed, our left hand and the touches it feels are in right space, and our right hand and the touches it feels are in left space. This therefore confounds our expectations leading us into errors. </p>
<p>But if young infants haven’t learnt to localise touches in the outside world yet, they should make fewer mistakes than older infants when their hands are crossed. We tested this in four- and six-month-old babies – this time placing buzzes on babies’ feet rather than their hands. (Four month olds seemed quite unwilling to cross their hands over.) </p>
<p>The six month olds were quite good at localising touches when their feet were uncrossed. About 70% of the time, they moved the foot which had been touched. When their legs were crossed, their performance dropped to 51% – chance. But the young four month olds got the correct foot about 70% of the time – both when their legs were crossed and uncrossed. They did not seem to care which side of their bodies their feet were, simply responding to a tactile location on the body, and at a good level of accuracy to boot.</p>
<p>On the basis of this we argue that before six months of age, when a baby feels a touch on their foot or their hand, they don’t relate the touch to an object or event outside of themselves. They just feel the touch as a touch on their body and that’s all. We’re calling this “tactile solipsism”. To me this idea of what it would be like to be a baby feeling a touch is quite strikingly different to our own realities – if we’re right – it must be strange being a newborn baby.</p><img src="https://counter.theconversation.com/content/49256/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Andrew Bremner receives funding from the European Research Council (European Commission, Framework Programme 7), and the British Academy.</span></em></p>The world outside the womb is full of new sensations for a newborn. New research is explaining how they navigate it.Andrew Bremner, Professor of Psychology and Head of Department, Goldsmiths, University of LondonLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/370062015-02-06T11:59:58Z2015-02-06T11:59:58ZFloating wombs and fumigation – why Gwyneth Paltrow has ‘steam douching’ all wrong<figure><img src="https://images.theconversation.com/files/71226/original/image-20150205-28594-lf1xw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">'Steam douche' advocate. More like hot air. </span> <span class="attribution"><a class="source" href="https://www.flickr.com/photos/erprofe/4724824120/sizes/l/in/photolist-8cvXAQ-4JuRph-oJoMag-eMyuP3-9uShG3-9uShU9-9uShyd-qkdmjZ-q3YDWx-2shfWK-73m27F-cbTH45-yQ9Db-dcBBFq-d8KChG-53ieaP-53j7Sa-53icjB-53n3Qj-9csyBX-53nFdm-7HseUC-eifk37-bVLSka-8oc6sU-edC3iz-pouhKf-poHQpv-qkqatY-9eLFuT-53nGkQ-53ivwM-53itZM-53nLXJ-53itKg-53nGFE-53ivNt-53ivik-53nL3m-53nJDW-53nMfN-53iwbp-53nHSQ-53nLF7-53nJq7-pYczMC-8NezWf-5xBAMk-53rreC-53nLkf-53nqrs/">Erprofe</a>, <a class="license" href="http://creativecommons.org/licenses/by-nc/4.0/">CC BY-NC</a></span></figcaption></figure><p>Gwyneth Paltrow stirred up an interesting discussion with her latest recommendation for the spa fan: the <a href="http://goop.com/city-guide/infrared-saunas-detox-spas-and-the-best-spots-for-colonics/tikkun-spa/">Mugworth V-Steam</a>. As she put it: “You sit on what is essentially a mini-throne, and a combination of infrared and mugwort steam cleanses your uterus, et al. It is an energetic release …” </p>
<p>But as obstetrician and gynaecologist Jen Gunter simply says: “<a href="https://drjengunter.wordpress.com/2015/01/27/gwyneth-paltrow-says-steam-your-vagina-an-obgyn-says-dont/">Don’t</a>”. </p>
<p>For me this recalls a treatment used on women in ancient Greek medicine: the fumigation. Here, the woman sat while a jar full of healing ingredients was heated up in a hole in the ground, with the top of the jar firmly sealed except for a reed that passed the fumes from the jar into the woman’s vagina. </p>
<p>So why were fifth century BC Greeks doing this? They believed that the womb could wander round the body in search of moisture. This could put pressure on other organs. Also, because the womb had moved, the woman could not get pregnant because it was not in the right place to receive a man’s seed. Fumigating the womb inflated it so it could float away from wherever it had gone, returning to its correct location. </p>
<h2>The symbolism of ingredients</h2>
<p>What did they put in that jar? Often the ingredients had symbolic associations. Seal oil was used. This may have been because seals were thought to have magic power because they lived “on the edge”, between the land and the sea. Or it may have been because the male seal was thought to have a very large penis, or because, according to Aristotle’s History of Animals, in many ways seals looked like women. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/71232/original/image-20150205-28612-u3ldnv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/71232/original/image-20150205-28612-u3ldnv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/71232/original/image-20150205-28612-u3ldnv.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/71232/original/image-20150205-28612-u3ldnv.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/71232/original/image-20150205-28612-u3ldnv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/71232/original/image-20150205-28612-u3ldnv.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/71232/original/image-20150205-28612-u3ldnv.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Yes Aristotle, looks exactly like a girl.</span>
<span class="attribution"><a class="source" href="https://www.flickr.com/photos/taivasalla/2612474643/sizes/o/in/photolist-4YRBGg-bsuiSp-fFG6d8-5ahqQK-qfcohz-6z7iQt-6ydXCf-fFG5JZ-KYPqE-nqLVig-bVMkib-oR6Mah-6tTysB-4FfN6q-7AWGei-bfFRgp-833NWL-a5sYzQ-7YMUFr-cC5WNQ-4owH3i-nppeGR-5RUPk9-6YPpoP-4vNSjB-6C9ZRZ-4vHxFQ-9eLwb9-e6bpmE-jzWG8w-iTWJsi-fJAK7X-fJAKXK-cB13hq-9Aj3qV-o6YUrL-kaeXZP-5DXpRS-nmXKxE-fp3JDV-epCDV5-kd6cim-fpi7rU-5QZ6FT-ccHVB9-8TJ3vd-8ummzX-5amUPh-83XC1-9YLH7w-7L78A3/">Taivasalla</a>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span>
</figcaption>
</figure>
<p>Another option was a dead puppy, stuffed with sweet-smelling substances. Puppies may have symbolised fertility, because they were born in litters, while the sweet smells were there to attract the womb back. Or they may have been used because puppy meat was thought to be particularly wet, and the womb tended to travel in search of moisture, while sweet smells were warming.</p>
<p>A further option was garlic. Garlic also featured in a fertility test in which it was placed in the mouth or vagina, and then the physician checked if the smell went all the way through the body. A Hippocratic work called Nature of Woman recommends:</p>
<blockquote>
<p>Boil a head of garlic and apply it to the uterus; on the next day have the woman examine herself by palpating with a finger; and if her mouth smells, the sign is positive.</p>
</blockquote>
<h2>The role of mugwort</h2>
<p>What about the mugwort in the modern vagina steaming? This herb, <a href="http://upload.wikimedia.org/wikipedia/commons/d/dd/Artemisia_vulgaris_%E2%80%94_Flora_Batava_%E2%80%94_Volume_v5.jpg">artemisia vulgaris</a>, was also part of ancient Greek medicine. It was used to bring on a late period or cause an abortion. In ancient medicine you could not “miss” a period: as a woman your <a href="http://theconversation.com/four-weird-ideas-people-used-to-have-about-womens-periods-30623">wet and spongy flesh</a> would collect excess blood and it needed to come out every month unless you were pregnant. </p>
<figure class="align-left ">
<img alt="" src="https://images.theconversation.com/files/71233/original/image-20150205-28615-v07bon.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/71233/original/image-20150205-28615-v07bon.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=402&fit=crop&dpr=1 600w, https://images.theconversation.com/files/71233/original/image-20150205-28615-v07bon.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=402&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/71233/original/image-20150205-28615-v07bon.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=402&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/71233/original/image-20150205-28615-v07bon.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=505&fit=crop&dpr=1 754w, https://images.theconversation.com/files/71233/original/image-20150205-28615-v07bon.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=505&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/71233/original/image-20150205-28615-v07bon.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=505&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Mugwort: women love it.</span>
<span class="attribution"><a class="source" href="https://www.flickr.com/photos/transitioneduni/5099747116/sizes/l/in/photolist-8LDx9q-bDkYDq-bSfGBt-eVfx1c-8uhnNx-4LYuUx-oyT1Mw-6VZxuX-oUhd5M-oSfpsJ-oSfpGG-oSfphU-oUhcUr-oBMyKd-6QyKRd-6QuFn4-oxW7Jm-crsr69-bXegyT-crsrPd-cCVpru-nNoRHh-oJLTxg-ppb2aJ-ppb1Ls-pDtYsq-pFDKXE-ck8dPh-ck8dWs-c89jMh-8McQB5/">Transition Ed Uni</a>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span>
</figcaption>
</figure>
<p>In ancient Greek medicine mugwort was only used for women’s conditions. The herb was used to speed up childbirth and was mixed with wine and inserted into the vagina to cleanse the womb if there was a white discharge. It was also thought to open up the womb. This was important for fertility as the womb needed to be open for seed to get inside. </p>
<h2>Idea of ‘dirtiness’ still persists</h2>
<p>The interest in vaginal fumigation today seems to be linked to an idea that women’s sexual organs are somehow “dirty”. Referring to everything other than the womb as “et al” likewise suggests that these parts can’t be mentioned in polite company. But this risks making girls feel ashamed just to be female. And, as medical writers point out, the vagina is in fact <a href="http://www.nhs.uk/Livewell/vagina-health/Pages/keep-vagina-clean.aspx">a self-cleansing organ</a>. </p>
<p>The ancient fumigations didn’t carry the same ideas of “dirt”, but were more about women’s identity being based on the central organ of the womb, which was not firmly secured in its place. For ancient Greek medical writers, women’s sexual organs as such weren’t the problem; it was movement and/or the closure of the womb that needed attention. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/71234/original/image-20150205-28608-fmrhkv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/71234/original/image-20150205-28608-fmrhkv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=445&fit=crop&dpr=1 600w, https://images.theconversation.com/files/71234/original/image-20150205-28608-fmrhkv.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=445&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/71234/original/image-20150205-28608-fmrhkv.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=445&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/71234/original/image-20150205-28608-fmrhkv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=560&fit=crop&dpr=1 754w, https://images.theconversation.com/files/71234/original/image-20150205-28608-fmrhkv.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=560&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/71234/original/image-20150205-28608-fmrhkv.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=560&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Can you stand still please.</span>
<span class="attribution"><span class="source">Joethedork</span>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
</figure>
<p>The clients pictured on the spa’s website having the modern treatment with this ancient abortifacient herb <a href="http://tikkunmedical.com/wellness/v-steam/">look very happy</a>. It’s possible that ancient Greek women were less keen on having hot air passed into the vagina. Fumigations went on for several days, if the woman was strong enough to cope. It sounds horrible. </p>
<p>But even in this situation the ancient Greek woman was given a useful get-out. The physician asks her to insert the reed into the mouth of her womb, and he also says that she will know when it’s time to stop. I think the right answer here would be, “my womb’s back – get that reed out of here.”</p><img src="https://counter.theconversation.com/content/37006/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Helen King does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Gwyneth Paltrow stirred up an interesting discussion with her latest recommendation for the spa fan: the Mugworth V-Steam. As she put it: “You sit on what is essentially a mini-throne, and a combination…Helen King, Professor Emerita, Classical Studies, The Open UniversityLicensed as Creative Commons – attribution, no derivatives.