text: Jacob Muselmann / photography: Viet Nguyen & Blake Brown
published 01.11.2020

After months of testing the pharmacologic effects of CBD on the vaginal smooth muscle in rats and humans, Vella, Manna’s cannabinoid-based sexual serum, was born. Now it was time to translate the science the formula hinges on.

In the arena of anatomy and physiology, words alone have always fallen short. So to best show the science behind it, Manna commissioned board-certified Medical Illustration Studios to show how the smooth muscle is pivotal to arousal in women.

But when the team set about to have them made, they quickly confronted an issue at least as old as the field itself.

“I myself didn’t know at the time how difficult it would be to find source material for the kind of anatomical story we were trying to tell,” says Manna’s Chief Design Officer Carolyn Wheeler. “Which is to say, we couldn’t find an existing representation—medical illustration or otherwise—that scientifically explained the physiological process of female arousal. This was both sad and exciting.”

Dr. Harin Padma-Nathan, Manna’s chief medical officer, is quick to point out that the science in these drawings isn’t anything new, but that they are unique in their focus on the role that the smooth muscle plays in arousal and orgasm.

About the illustrations

Unlike more well known muscles, such as the calf or bicep, smooth muscles are involuntary and not tied to tendons and bone. The reproductive smooth muscles in men and women consummate physical arousal: relaxing them lets blood flow in, which causes engorgement. In men, that means an erection. In women, this gives the vulva rigidity to support penetration and also helps produce lubrication. By nano-encapsulating cannabinoids to be water-friendly, Vella is able to deliver them to the smooth muscle, which relaxes it.

Smooth muscle relaxes during arousal. (Image copyright Manna Molecular)

A closer look at the illustrations accounts for the twofold effect: Blood fills lacunar spaces in the corpus cavernosum of the clitoris when the smooth muscle lining the spaces relax. This reduces the resistance to capillary filling of the spaces and these then balloon into pockets that, when filled, produce engorgement. Around the vaginal wall, the penetrative hallway, the influx of blood produced by smooth muscle relaxation results in a process called transudation, whereby a serum like watery lubricant is produced and released into the vaginal vault—another evolutionary upgrade to facilitate more comfortable, “successful” sex (if reproduction is your thing). Whatever the goal, it’s safe to say that comfortable and more pleasurable sex is something most people can get behind.

Relaxed smooth muscle allows blood to fill lacunar spaces in the clitoris, resulting in engorgement and subsequently lubrication. (Image copyright Manna Molecular)

Physiology aside, a mix of cultural and psychological factors often makes sexual health—and health in general—a hairier matter. Writing for Design Bias, a Vice series examining the often unintentional ways hegemony replicates itself in various fields, Rose Eveleth draws a line from medical illustrations to real-world implications.

In a 2014 study of more than 6,000 images from 17 anatomy textbooks, researcher Rhiannon Parker found that just 36% of images with an identifiable sex were female (and of those, 86% were white), relatively unchanged from similar studies in the early ’90s. The disparity raised scores on implicit, but not explicit, bias among medical students.

Though it’s not often distinguished, coronary heart disease, as Eveleth notes, presents itself differently in women than in men, which could be a factor in women being misdiagnosed at higher rates than men. Black women are three times more likely to die in childbirth than white women, which many experts say is mostly due to doctor bias.

“There are severe disparities in health literacy based on race and socioeconomic factors that we need to tackle by creating effective and widely accessible visuals that resonate with the increasingly dynamic makeup of our modern society,” says Jennifer Hollis, diversity committee chair of the Association of Medical Illustrators.

In the area of sex disparity, Dr. Nicole Prause, founder of Liberos, a sexual biotechnology firm, can attest. As a longtime researcher and educator of the odds and ends of sexual health, she’s familiar with the confusing messages women receive about orgasm.

“I think people have no idea what that’s supposed to look like or that that’s even supposed to happen. And I think a large part is because there’s no representation of it,” Prause says. “I have looked for the images, and I look everywhere—no holds barred, safety search off.”

One reason for the sex disparity is that female sexual organs, largely internal and unseen, are simply harder to access. “If you’re gonna cut it out of a cadaver, where do you make your cut?” Prause says. “How do you pull it out of the pelvis, and what is that gonna sever? And there, you’re definitely not gonna see it functional. So it’s a hard problem to solve.”

The other factor—and to which other disparities, such as race, gender, and age, can largely be ascribed—is the long legacy of white androcentrism that has for centuries pervaded nearly every facet of Western medicine, often exacerbating the misguided science of the times with a once-removed knowledge of the female experience. (Freud, for example, theorized that orgasm from clitoral arousal signaled an immature, psychologically underdeveloped female, whereas vaginally inspired orgasms indicated the opposite.)

Add to this that physiological signs of arousal are often harder to recognize for women themselves, rendering it a more subjective experience than it is for men.

In her book Bonk: The Curious Coupling of Science and Sex, researcher Mary Roach describes how in some studies examining female arousal, in which the participants’ feedback was compared with their physiological data during the time of arousal and orgasm, the correlations have sometimes been so low that researchers sometimes wonder whether physical changes should be taken to mean anything at all in terms of arousal. This is in line with a similar study Prause herself conducted at the University of Iowa, in which 20 masturbating women were asked to press a button at the onset of arousal and again at orgasm, where only about half the women’s responses matched up with the diagnostic indicators they were hooked up to.

This is not to say that the body doesn’t know what it wants. More than 70% of women say that clitoral stimulation was necessary or helpful in achieving orgasm, while just under a fifth report orgasming from intercourse alone. But if the mind plays a larger role in women’s arousal, it stands to reason that education—or lack thereof—could have more of an impact in its realization.

Extending this logic, I just had to ask Dr. Prause: So is it possible that some women may never orgasm simply because they don’t know what it’s supposed to look and feel like? Her answer may shock some men: Absolutely, yes.

“Even if you look to sex films and adult films, they’ll often use [artificial] lubricant to show something that appears to be wet, but you can still look at the vulva and plainly tell she’s not aroused,” Prause says. “To me, that’s one of the biggest oversights of sex education today—that is, vasocongestion is a more important sign of arousal than lubrication, because lubrication is affected by all kinds of things,” such as antihistamines and menopause.

With this dearth of representation, what, then, is left? Other images rush to fill in the gap, and with them, a ready sociosexual script. Without adequate knowledge of their bodies and needs, women, it seems, are often left to simply simulate what they see projected across the funhouse mirrors of culture.

“I’m reminded here of the expression ‘the map is not the territory,’” Wheeler says. “When you map or draw something, you gain the ability over others to speak to it with power and authority. You are determining the contents of its story.

“We think of Manna as guided by the exercise of figuring out what from the Western medical system to bring with us into this new industry, and what to leave behind,” she says. “Ultimately I see these medical illustrations as a way to talk more easily and openly about women’s sexual health, which still feels like a bit of a radical act.”

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