“Contemporary biocapitalism produces ‘nothing’ except its own species”1.
On April 11, 2014 the British newspaper The Guardian published an article whose first line read: “Scientists have successfully implanted vaginas grown in laboratories into four teenage girls who have a congenital condition which meant their own did not develop properly.” A pilot medical study, also published on that day, empirically demonstrated the efficacy of tissue engineering technologies to construct and implant organically compatible vaginal canals in female bodies. How, and to what extent, are these four teenage girls, their bodies and their ostensibly pathophysiological processes, here constituted as medicalized objects? What sort of ontological impact does this technological achievement have on the construction of contemporary subjectivity?
Vaginal aplasia, or the absence of a developed vagina, can either be caused by genetic and teratogenic disorders or it can derive from acquired ailments such as cancer or trauma. The four girls mentioned in the Guardian article originally received this pioneering regenerative treatment in 2006. They suffered from variants of a genetic condition of embryonic arrest named Mayer-Rokitansky-Küster-Hauser Syndrome, or MRKHS, which affects a ratio of between 1 in 1500 and 1 in 4000 bio-women at birth2. As the second most probable cause of absent menstrual cycles, this condition is currently treated through surgical interventions that range from dilation to robotically-assisted surgical techniques. The reconstructive approach often taken in these cases involves the dissection of a canal that makes space for a neovaginal passage, which is subsequently lined with a graft of decellularized tissue3. Briefly, surgical grafts can be of three types: auto-, when a portion of living tissue is taken from one part of the body and placed in a different site of the same body; allo- , when the living tissue is sourced from another individual from the same species; and xeno- , when the graft is obtained from a different species. The latter two approaches have proven pernicious in terms of long-term postoperative complications4.
In the 1990s, a team of scientists working between Mexico City and North Carolina proposed a new strategy for creating genito-urinary structures by using tissue engineering techniques to generate new, immunologically compatible urinary and genital tissue, wherein biodegradable matrices are seeded with autologous cells (i.e., cells from the same individual) to form new tissue that is histologically5 and functionally similar to a vagina.
In 2006, when the technology and disciplinary knowledge had advanced enough to permit experimental tests on humans, the surgical team selected to focus on these four young girls, aged 13 – 18, with congenital vaginal aplasia due to MRKHS, as well as additional complications such as absent uteri and anorectal malformations. The pioneering procedure was carried out according to established scientific protocols: firstly, scientists collected cell samples through a vulvar biopsy smaller than a postage stamp and cultivated the cells in a sterile, growth-culture medium that was calculated, using morphometric analysis6, to approximate the ideal dimensions of each new organ, according to the proportions of each girl’s pelvic cavity7. The engineered scaffolding composed of biomaterials, eventually to be absorbed by the body, was then seeded with their own cells and, once sufficiently cultivated to be stable, was surgically implanted into their bodies, where the cells continued to grow and become increasingly entangled with the surrounding environment, eventually resulting in the vascularization of the new tissues.
This is the first time that regenerative medicine was used to create and implant a whole organ that was never there in the first place8. Historically, the field of regenerative medicine has primarily been concerned with modulating what we see as “natural” and “able”. It emerged in response to an overwhelming surgical demand, in recent decades, in light of tissue and organ failure and shortage of organ donors, to be able to use tissue from one part of a body in another. The field of transplantation emerged in the 19th century, when ailments started to be identified with their anatomical correlations. In order to advance surgical practice and expand disciplinary knowledge, anatomists would collect, sort and process normal and pathological specimens, such as tissue, organs, tumors, skeletons, body stones and fetuses, to be used in medical education. This led to the development of better methods of tissue and organ conservation. Simultaneously, dissections and anatomy classes became progressively more essential to medical training in order to investigate the functions of corporeality9. Public dissection of vagrant bodies (mostly mendicants and prostitutes) assigned medical value to the abject body and resulted in an increasing number of technical and surgical innovations that eventually made it possible to successfully graft selected organs. By the mid-19th century, bodysnatching had become a common practice in European countries with developing scientific and colonial discourses, such as France, England, and the Netherlands, by which entire bodies and body parts could be bought and sold as commodities.
The same century also witnessed a transformation of the classical notion of value, from its having been regarded as a function of trade, exchange and circulation, to the articulation of the temporal process of labour, force and fatigue as the indispensable and original source of all value10. As modern political economy presupposes its subjects as abstract units of economic value, it also signals, according to Michel Foucault, the passage from monetary representation to production11. The body and its organs are elevated to another regime of value, for it becomes that which produces and reproduces; thus demographics and economic growth become irreversibly entangled. As Melinda Cooper writes, in her Marxian feminist study Life as Surplus: “Henceforth, political economy will analyze the processes of labor and of production in tandem with those of human, biological reproduction – and sex and race, as the limiting conditions of reproduction, will lie at the heart of biopolitical strategies of power”12.
This historical diversion serves to illustrate that the commodification of bodies and body parts is not specific or limited to contemporary market logics; competing regimes of corporeal value, often imbricating medical advancement and colonial enterprise, were already characteristic of the early modern discourse of historical progress. Albeit part of this historical legacy, contemporary biotechnology functions according to a post-fordist production model. Economists cite the 1970s as the period of transition to a post-industrial era that has been characterized by a new type of “governmentality of the living”13, within which new medical research interests combine the adjudication of normative, and therefore at once also intrinsically economic values with the study of the biochemical, molecular and cellular structures of the body14, in the service of a new form of capitalism that seeks to maximize the productivity of living structures through strategies of circulation, diversification and regeneration15. In a parallel series of biotechnological developments, there has been a corresponding proliferation of legislative and economic regulations that capitalize on our somatic architectures. By manipulating organic elements, biotechnology industries render them speculative assets, subject to patent laws and trade market investment.
Returning to transplantation, the beginning of the twentieth century was marked by a medical crusade for greater understanding and control of the complex immunological responses of the body, in order to prevent the rejection of transplanted organs and tissues. In 1949, the hormonal substance cortisone was first shown to prevent intra-species graft rejection. A decade later, cyclophosphamide, an anticarcinogen agent, was also shown to suppress the formation of antibodies, and was experimentally applied to bone marrow transplantation. However, it was not until the mid-1970s, with the advent of cyclosporin, that the field of chemical immunosuppression began to be transformed, with the development of newer drugs. Initially developed as an antifungal, cyclosporin was paradoxically found to be toxic in rodents, while, however, enabling skin grafts between them16. Once formulated for human use, the substance proved to offer a great improvement in human kidney transplantation at a time when a diagnosis of renal failure was effectively a death sentence. Inasmuch as large state funds have subsequently been directed towards investigating the potentialities of regenerative medicine, namely tissue engineering and stem cell research, such research has effectively become a public matter.
The innovative character of the field of regenerative medicine lies in the deep knowledge and manipulation of the healing mechanisms of the body, their curbing and acceleration. The ultimate promise of regenerative medicine is that which post-war science fiction has impregnated our cultural and media landscape with: absolute freedom from the unpredictable constraints of the material body. As a public project, regenerative medicine not only perpetuates, but begins to reformulate the long tradition of thinking in terms of the “social contract” between individuals (as bodies), and the body politic, in both sociopolitical and biomedical terms. To wit: the wider body politic invests in developing technologies that will bring one “back” to the biomedical norm. Under this normative regime, regenerative medicine produces what Catherine Waldby calls biovalue, the profitable reformulation of living processes that counteract the possibility of material obsolescence17. Even as some juridical systems begin to problematize biomedical practices and reflect on contested social territories such as gender reassignment, the allocation of research funding for non-normative medical procedures remains limited.
Imagine a present-day Leviathan whose body is composed of millions upon millions of undifferentiated cells and molecules; that, together, they forcefully hold the sword that institutes the law of nature.
How else does a technologically designed vagina integrate (with) the biopolitical regime? On the same day the Guardian article was published, an interview with one of the four unnamed, now adult bio-women who received an engineered vagina was also released18. When asked about being diagnosed with MRKHS, one of the women was unsure about whether it was a more physically or emotionally devastating experience, “because of the moment you are told that you won’t be able to have children.”
Contra enlightenment ideals of human perfectibility, rationality and agency, physical or mental impairment is seen as an impediment to the realization of the “human telos”. Vaginal aplasia thus poses the body politic with a conundrum, in that it differs from the “ideal of nature”, thus depriving these girls (at least, those that do have a partly functioning reproductive system with uteri and ovaries) from the possibility of fulfilling their telos of reproduction. Vaginal aplasia not only divests them of the possibility of vaginal penetration, it disables them from enacting the control of their own reproductive systems, by e.g. consuming the contraceptive pill. Therefore according to Beatriz Preciado’s thinking of gender programming as a historical technology that produces affections, desires, actions, beliefs and identities through the anatomical certainty of being a man or woman19, they are thus far incapacitated for the actualization of their assigned gender norms.
The four teenagers became objects of study for eight years, part of the scientists’ plan to collect long-term data, in order to determine whether there was any “deterioration of function [once] coitus was initiated in every patient over time”20. Coitus, in this medical parlance, means normative sexual intercourse in accordance with The Female Sexual Function Index (FSFI), a “self-report instrument for the assessment of female sexual function” devised in 200021. This statistical index originated as an epidemiological study of Female Sexual Arousal Disorder, but has become ubiquitous for the clinical interpretation of desire, subjective arousal, lubrication, orgasm, satisfaction, and pain. The figures collected from the FSFI indicate positive rates for each of the individual fields. “Truly I feel very fortunate because I have a normal life, completely normal,” one of the women was quoted as saying in response to the impact this surgery had on her22. The institutional heteronormalisation of their bodies is shaped in the promise of self-realization and the value of being “normal”, a promise in which gender programming meets a contemporary Hobbes’ Leviathan, one fueled by neoliberal capital accumulation.
“At the beginning,” one of the women continues, “it wasn’t easy, thinking that part of your body was going to be made in a laboratory23”. Read against other conceptual instruments of posthumanism and feminist science and technology studies, according to which contemporary biomedicinal progress can be seen to inadvertently disturb the ontological category of the “human”, the technological crafting of “normality” could catalyze its reformulation, investing new sets of presuppositions and hypotheses between the body and its gendered ecology.
The refusal of normative reproduction and the unpacking of sex, sexuality, sexual identity and pleasure-performative practices undertaken via feminist and queer politics are effective instruments and tactics with which to question such episodes; however, as above, I would also argue for this anatomical experiment to be contextualized in a broader discussion of contemporary social contracts and shared social ethics as these converge with gender norms. Most importantly, in light of sex reassignment treatments, the technological possibilities ushered by this series of biomedical innovations urges a redistribution of research resources and, ultimately, encourages a reconsideration of the notion of the stable, identitarian self of the gendered body. Wherein the economic rationale of biotechnological research and its generative technologies were here employed to naturalize sex, by opening up the potentialities of remaking the morphogenesis of the body, they could also be used to create a critical vocabulary of deviance that can unsettle conventional scientific discourse and praxis.
For their comments and suggestions, I would like to thank Carolin Ackermann, Andrea Zarza-Canova, Nicholas Axel and the editor Rebecca Bligh.
- 1. Beatriz Preciado, Testo yonki. Barcelona: Espasa, 2008, p. 44.
- 2. See Raya-Rivera, Atlántida M. et al., “Tissue-Engineered Autologous Vaginal Organs In Patients: A Pilot Cohort Study,” in: The Lancet, Vol. 384, 2014, p. 329, based on a population study of MKRHS incidence in Finland.
- 3. Decellurization is a process used in biomedical engineering by which the complex composition of tissue or organ surfaces can be preserved by removing cell remnants.
- 4. According to Raya-Rivera, Atlántida M. et al., grafts which do not contain all the elements of native vaginal tissue might lead to wearing out and shortening of the tissues and muscle. Ibid, p. 329.
- 5. A term concerning the microscopic anatomy of tissue.
- 6. i.e., shape analysis.
- 7. Raya-Rivera, Atlántida M. et al., “Tissue-Engineered Autologous Vaginal Organs In Patients: A Pilot Cohort Study,” in: The Lancet, Vol. 384, 2014, p. 330.
- 8. Anthony Atala at Wake Forest Institute of Medicine.
- 9. Margaret Lock, “The Alienation of Body Tissue and the Biopolitics of Immortalized Cell lines,” in: Commodifying Bodies, Nancy Scheper-Hughes and Loïc J. D Wacquant (eds.). London: Sage Publications, 2002, p. 66.
- 10. Foucault on the work of David Ricardo, a British economist who inaugurated the modern science of economics, founded on this reformulation. Michel Foucault, The Order of Things. New York: Pantheon Books, 1973, p. 254.
- 11. Michel Foucault, The Order of Things. New York: Pantheon Books, 1973, p. 254.
- 12. Melinda Cooper. Life as Surplus: Biotechnology and Capitalism in the Neoliberal Era. Seattle and London: University of Washington Press, 2008, 7.
- 13. In 1972 the Club of Rome commissioned a report to the Meadows Team entitled “The Limits to Growth” set to explore how exponential growth interacted with finite resources. In its reception the report instigated the idea that fordist manufacture had entered a period of irreversible decline
- 14. Beatriz Preciado. “Pharmaco-pornographic Politics: Towards a New Gender Ecology” in Parallax. Vol. 14, no.1 (2008), 105.
- 15. Catherine Waldby, and Robert Mitchell. Tissue Economies (Durham: Duke University Press, 2006), 31.
- 16. C. Watson and J. Dark. “Organ Transplantation: historical perspective and current practice,” in: British Journal of Anaesthesia, Vol. 108, 2012, p. 130.
- 17. Catherine Waldby. “Stem cells, tissue cultures and the production of biovalue” in Health, Vol. 6, no.3 (2002), 305-323.
- 18. Email interview conducted by Catherine de Lange and Maria Garrido published April 11, 2014 in New Scientist online. Accessed April 12, 2014.
- 19. Gender programming is part of Preciado’s philosophical toolkit for the unpacking of sex, sexuality, sexual identity and pleasure as performative practices through an in-depth reading of the new social-political order of big science, global media and neoliberal powers, after Foucault, and Deleuze. See Beatriz Preciado, Testo yonki. Barcelona: Espasa, 2008. “Pharmaco-pornographic Politics: Towards a New Gender Ecology,” in: Parallax. Vol. 14, no. 1, 2008.
- 20. Raya-Rivera, Atlántida M. et al., “Tissue-Engineered Autologous Vaginal Organs In Patients: A Pilot Cohort Study,” in: The Lancet, Vol. 384, 2014, p. 335.
- 21. Rosen et all. “The Female Sexual Function Index (FSFI): A Multidimensional Self-Report Instrument For The Assessment Of Female Sexual Function” in Journal of Sex & Marital Therapy, Vol.26, no.2 (2000) 191-208.
- 22. Peter Walker, “Vaginas grown in labs successfully implanted into girls with rare disorder” in The Guardian online, 11 April 2014. Web. Accessed April 12, 2014.
- 23. Catherine de Lange and Maria Garrido. “My lab-grown vagina and hopes for a family” in New Scientist online, 11 April 2014. Web. Accessed April 12, 2014.