On my nightstand right now is a captivating analysis by sociologist Rene Almeling. In her most recent book on the “missing science of men’s reproductive health,” she argues that what scientists don’t study can be as important as what we do and can shape the way we view our world.
Almeling took a look at troves of old medical association records to trace the history of “andrology” — the medical specialization that almost was! American doctors in the nineteenth century created and nurtured the specialization of gynecology, but Almeling provides answers to why we don’t have an equal specialization for the male reproductive system. She discusses the finer points of why urology is not necessarily the male equivalent of gynecology in later parts of the book, so if you were wondering about urology, you’ll have to read the book along with me. More important to the research that has fascinated me in recent months is the metaphor she uses to explain the missing specialty.
I’m paraphrasing her metaphor here, but briefly — imagine you are some kind of wildlife photographer whom has a special interest in photographing ladybugs. This is not unreasonable. Ladybugs are cute. They look like little pieces of hard candy. If you are a photographer with special interests in bugs, you probably have a special lens and know of specific tricks on how to photograph small creatures. The photos you produce, for no malicious reason, will invariably miss the larger environment your subject is in. If you are taking a picture of a ladybug, you are probably missing the garden or other animals just out of frame.
Again, I’m paraphrasing Almeling’s metaphor. In the case of male reproductive health, the missing specialty is in part due to the equating of women’s bodies as exclusively reproductive. This belief is then perpetuated by the continued absence of a study of male reproduction at the same level and importance as women’s reproductive health. The gap in knowledge (or as I call it, the “hole”) leads to more gaps.
Almeling’s study of how holes create holes echos the argument of Ellis Monk in his controversial paper on “infracategorical inequality.” Monk doesn’t think that sociology’s obsession (my word, not his) was fruitless. However, if we focus on inequality among competing groups (e.g., Black-White, men-women, gay-straight), we’ll miss out on the inequality within groups. As the US becomes majority-minority, these in-group differences are gonna matter, but will sociology (and American laws) meet the challenge? I’m a bit pessimistic considering the case of anti-caste discrimination in California.
Another example of gaping (I said it) holes in research caused by myopic specialization is in the ever-confusing research on gay men and HIV. David Halperin has an elucidating book of essays where he argues something similar to Almeling: the over emphasis of HIV spread in gay men among researchers (some of whom are well-meaning allies and queens) had led to the equating of gay men and HIV. Of course, in the US, the outbreak of HIV was initially concentrated among gay men and new incidences are highest among young men who have sex with men of color (a mouthful). However, the focus on HIV and gay men has consequences beyond equating gay men and HIV. One of them, in my opinion, is the dearth of research on evidence-based recommendations for things important to gay men.
Take grooming. Lots of gay men love to keep their peaches smooth and clean for the off chance that things spice up. Of course, if researchers and doctors only focus on how HIV continues to spread among gay men or why gay men don’t take PreP even when they are in monogamous relationships (when they are arguably the least likely to contract HIV), we end up with nonsense like this:
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Essentially, shaving your butt could lead you to get a very serious form of ingrown hair (my simplification) on your crack. Okay, fine. Here’s my problem with this: what is the research on how often this is happening, to whom, and what correlates with higher risk of pilonidal cyst? The Mayo Clinics website cites obesity and sedentary lifestyle along with being a white guy (interesting!) and having thick, coarse hair as risk factors. Of course, that’s not the framing this influencer leads with, right? The framing is that this is something to be of concern to those who shave to be sexy for their (gender neutral) partner.
Maybe I’m the homophobe (I am, but for other reasons) in this situation for assuming the message was intended for gay men. Of course, ANYONE can shave their ass. I’d love to meet the ladies who keep their peaches smooth (no shade). It takes scrolling through Gay Twitter for a millisecond to know that some parts of gay circles engage in grooming of their peach fuzz for the absolute fun of it. It’s a part of keeping a certain “look” some gay men find sexy and want to signal to tops other gay men.
Without research (and when we focus on why monogamous gay men aren’t on PreP), we leave the door open for irresponsible health influencers (regardless of their MD or PA status) to spread messaging without any basis in the literature. The same Mayo Clinic website above says that keeping clean, losing weight, and getting up for a walk is all I need to prevent pus sacs on my ass crack. How this influencer went from these prevention measures to “avoid it altogether” is a mystery to me. Is there published research on best practices or harm reduction practices for grooming? I’m not sure. I’m interested to look into this when I have the chance to dig through the piles of HIV research to see if doctors have started thinking about this.
Back in the day when “andrologists” were trying to convince their skeptical colleagues in other specialties, they argued the same thing I just did: if we leave gaps in human knowledge, charlatans will take the opportunity to fill them. The nineteenth century was full of Grandpa Simpsons peddling tonics to men to embarrassed to see a doctor about their sexual impotency or other concerns in the region.
As a side note: sometimes medical professionals aren’t the last word on everything related to the human body. I know that’s heresy to those in the medical field and maybe career suicide for me as a medical sociologist in training, but other people…have…jobs…too. There are these things called estheticians who — are required to be licensed and trained in many states — know the best way to clean your tushy without cracking the crack. The TikToker above might also be unfamiliar with waxing and other non-shaving ways to get a smooth booty. Nair, among many others, but I digress.
In short, like donut holes, research holes are just as important as the rest of the donut the stuff we study.