Gross Anatomy

by Mara Altman

  With the exception of symbolizing something supernatural, birthmarks seem rather inconsequential and arbitrary, which is why I didn’t expect the medical community to be as hung up on them as I am. That was until I got in touch with Anna Yasmine Kirkorian, a pediatric dermatologist at Children’s National Medical Center in Washington, D.C. She specializes in birthmarks, even goes around the country giving lectures on the topic.

  Right away, Kirkorian threw a wrench in my belief system. “Birthmarks aren’t always there when a baby is born,” she said.

  At the very least, I’d thought it was safe to assume that a birthmark was a mark we had at birth. In actuality, she explained, a birthmark can appear anytime from birth until the first two years of life. “What makes it a birthmark,” she said, “is that it begins developing in utero.”

  She explained that while there are many categories of birthmark, the most common are pigmentation and vascular birthmarks. Pigmentation birthmarks occur when more pigment develops in one area of our skin. The most common types are moles, which are generally small and brown and can be slightly raised; café-au-lait spots, which are named for their coloring (coffee mixed with a large helping of milk); and the “slate-gray nevus” (previously known as a Mongolian spot), which often occurs on babies of Hispanic, Asian, and African descent. Nevi are bluish, therefore sometimes mistaken for bruises, and are commonly found on the back and buttocks.

  The pigmentation birthmark was not news to me, but the vascular birthmark, well, those are an entirely different beast. They are red because they are made up of a clump of blood vessels. Blood vessels! Who knew?

  The most common type is called a salmon patch, Kirkorian explained. More than 60 percent of babies are born with one of these red or pinkish blotches. “When one occurs on the back of the neck, it is called a stork bite,” she said. “When occurring between the eyebrows, it is called an angel kiss.”

  “Wait,” I said, “I think I have one of those.”

  Since I was born, I’ve had a red area on my forehead between my eyebrows. Though it’s faded over the years, it still brightens when I’m overheated or exercising. My mom always told me that it was due to my positioning in the womb, that I had my face so deeply lodged into her pelvic bone that I was permanently marked.

  “No, you weren’t squished,” Kirkorian said. “You’re just normal.”

  She explained that the area gets red because it’s full of extra capillaries. When I get hot or angry, more blood rushes to the face and therefore the birthmark is more visible.

  I was going to have to rethink my life. Who was I now that I wasn’t bludgeoned by my mom’s pelvis as a wee fetus? That was supposed to be my superhero origin story.

  Two other common vascular birthmarks are the port-wine stain, à la Gorbachev’s forehead, and the hemangioma, which, to sound less menacing, is referred to as a strawberry. It is somewhat bulbous and red like the fruit it is named after. Hemangiomas often disappear in the first few years of life, but surprise, sometimes they can grow inside the body—yes, you read that right: A birthmark can grow inside your body—and need surgical intervention so as not to disturb any organs.

  I now knew some of the different types of birthmarks, but not much else.

  “So how do birthmarks get there in the first place?”

  Kirkorian told me that most birthmarks are caused by a mutation in our skin. While we gestate, our genes can get a little screwy, but in a totally benign way. “If you were to just biopsy that part of the skin, you would find a genetic change that is not in the rest of the body.”

  Research into birthmarks is still in its infancy, but it appears that they might be hereditary. “It’s not like other traits where you have a fifty percent chance of inheriting it from a parent, but we are seeing that birthmarks cluster in certain families,” she said. “Hopefully soon we’ll figure out why that is.”

  This is where birthmarks get especially interesting. Birthmarks, like I’d hoped, can actually have a meaning. Now here’s the bad news: If it does have a meaning, it’s almost always bad. For the most part, these little skin oddities are perfectly normal, but sometimes they can signal that something went wrong during development.

  “The skin is kind of a mirror on the inside of the body,” Kirkorian said. She explained that only a few weeks after conception, we are a couple of balls of cells. Within those cells, there is the ectoderm, which is the layer of cells that come to form the brain and the spinal cord and also the skin. “So there is a special connection between the skin and the brain,” she said. “If I see unusual birthmarks, I’m wondering if something happened genetically early on.” She said that some of these birthmarks shed light on issues she might find in the brain.

  Researchers have found that children with six or more café-au-lait spots are more prone to have a condition called neurofibromatosis, a disorder that causes tumors to form on nerve tissue. Port-wine stains can be linked to Sturge-Weber syndrome, a neurological disorder that causes seizures and sometime paralysis. The doomsday list of birthmark-linked disorders goes on and on. Kirkorian said that weird birthmarks don’t necessarily spell disaster, but it’s always worth getting them checked out. “If you have something unusual like twenty pink dots, come on in,” she said. “It’s easy for us to take a look and we can move on from there.”

  This was all interesting stuff that I’d never known before. Too bad it was also so depressing. I’d had high hopes that this conversation was going to go in a different direction, so I tried to manipulate it toward hearts, butterflies, and slayer markings. “So are there any birthmarks that can signify something good?” I asked. “Like, say, maybe having a birthmark on your lower back that looks like a malformed continent could mean that you’re really smart?”

  A short and, I admit, appropriate condescending laugh spilled out of Kirkorian’s mouth. “That’s a cute idea,” she said, humoring me. She explained that many cultures have a birthmark mythology. “For example, some people think that moles on palms means you’ll get rich, but sorry, I don’t know of anything scientific that’s actually true.”

  I think she was saying that I might just have to start karate lessons on my own.

  “Look,” she said, “I think birthmarks are beautiful, and that’s enough right there.” She went on to pontificate about their astounding loveliness. “They are gorgeous in their many unique shapes, shades, and locations, adding individuality and diversity among this giant pool of humanity.”

  Kirkorian continued to go balls-out positive and wax poetic about our body markings—“They are decorative, like tattoos that we’re born with”—but as she did, I interrupted to tell her the very romantic role they’ve played in my life.

  I told her about my friend Kat, who came up to me last month, pointing at the middle of my forehead. I thought maybe she was going to tell me that she liked my new bang trim or, at the absolute worst, that I had a big whitehead ready to be popped, but instead, she asked, “Do you have lupus?” Lupus is an autoimmune disease that is often accompanied by bright red facial rashes.

  “It turns out,” I told Kirkorian, “that she was pointing to that same redness between my eyebrows that we’ve just identified as a benign and beautiful angel kiss.”

  Kirkorian laughed before releasing a short sigh. “Okay,” she admitted. “It’s true. Birthmarks, though lovely, can sometimes be challenging, too.”

  And with that, I felt satisfied.

  12

  The Eleventh Toe

  It’s early fall and I’m in the fitting room at Macy’s Herald Square location, trying on some sleek pants—black, snug, and made of some ubiquitous stretchy material. Those puppies fit my gams like maple syrup atop a short stack. I spank my own behind and then spin in circles while chanting “cha-ching.” I just won the pants jackpot! But then when I turn back to face myself in the mirror, something happens. My eyeline draws toward my groin.

  My vulva has vacuumed up the teensiest bit of fabric, creating the shape known notoriously
as camel toe.

  I suspect that I’m the only one who would notice this deviant crevice. We’re each our own worst critic, after all, and it’s not like it’s the Grand Canyon. I step outside for a second opinion. Without pointing toward anything specific, I ask the salesgirl what she thinks.

  “I love those pants,” she says, but then she purses her lips to the side while raising one eyebrow, “but I don’t know that they work.”

  A week later, I’m walking up Sixth Avenue with a friend when we spot a blond drenched in spandex; a conspicuous wedgie has crept up her front. I ask my friend what she thinks of the situation.

  “I judge,” she says. “I always judge.” She tells me that not even an attractive woman can pull off being attractive if she has a camel toe. “First, I assess what I consider to be the damage, like on a Richter scale for earthquakes. Is it just a hint of camel toe? Is it full-on up the vag so you can see two perfectly formed vag mountains? Is there underwear involved, and if so, which kind? Basically, I’m trying to figure out how this happened.”

  The camel toe we saw, according to her, was a 5.8.

  Two weeks later, I’m standing on a corner in the East Village while my dog sniffs the behind of another woman’s dog for so long that it’s getting awkward—we humans need to at least acknowledge each other. One thing leads to another thing leads to me finding out that this human is the CEO and inventor of a new underwear brand called Camel No. It is a type of panty featuring a thin silicone insert that obfuscates the outline of the vulva.

  “It’s not like it’s only for women with a loose, gaping vagina,” Maggie Han, the statuesque dog owner and outspoken proponent of seamless crotches tells me in a tone that makes me think twice about the possible gaping-ness of my own vagina. “We are all prone to toe, and toe is sacred,” she tells me. She’s so intimate with the phenomenon that she’s dropped the “camel” part of the term altogether.

  I am intrigued. I get her contact info.

  When I get home, I look up Han’s brand and find that it isn’t the only camel toe–prevention panty out there; there’s also Camelflage.

  In my life, I hadn’t given toe much thought. I kept it simple: I knew it was something to avoid. But after those consecutive run-ins with the infamous cleft, I began to think more deeply about the phenomenon. Inconsistencies abounded. Toe—the contour of our sacred parts—is exactly what you’d expect to see under skintight clothing, so why are we all repulsed and surprised when it happens? I’ll go out in the city with my ass cheeks dangling just below my cutoff shorts, but the mere outline of twat is a fashion no-no? It doesn’t make much sense. I was feeling very Seinfeld about the whole thing: I mean, what’s the deal with camel toe?

  * * *

  To find out why people had such strong opinions about labial skin and how it should be tucked (or untucked) below the belt, I began sleuthing in earnest. I expected the fashion crowd to know why toe was so abhorred, and I reached out to Hollywood stylist and TV personality Emily Loftiss, for whom the mere utterance of the two words caused discomfort. “It makes me instantly cringe,” she said. “Can we move on to the next subject now?”

  “What’s so bad about it?” I pressed.

  Loftiss wasn’t able to elucidate. “It’s just no no no absolutely not ever no,” she said.

  I contacted athleisure-wear designers. I wanted to know if there were tricks they used to prevent camel toes when designing leggings. But no one wanted their brand linked in print with vulvar cleavage. Most didn’t even respond, but Lululemon public relations coordinator Adrienne Watson at least wrote back: “We would like to respectfully decline at this time.” Another international brand would agree to speak only on background. That is the same request people make of journalists when they fear political retaliation, or jail time, or even assassination for their remarks.

  The fashion world, in other words, completely shut me down.

  I moved on to the average woman—maybe the everyday jegging-wearer would have thoughts on our aversion?—but the ladies I spoke to, like me, thought of toe solely in the context of how best to avert it. There was the thirty-five-year-old who told me that she’ll wear a panty liner like it’s a force field. Then there was Jessica, a thirty-four-year-old Broadway dancer, who thought she was more prone than others. “My theory is I get it because I have a ba-donk-a-donk,” she said, referring to her large ass. She suspects that her pants, in order to cover her substantial behind, have to make a shortcut through her front side. “So I always buy a bigger size than I want,” she said. Another chronic toe sufferer, twenty-eight-year-old Angela, has a unique method to counteract the vulvar infringement. “I shimmy the majora up a little bit and then I pull the labia minora out a bit,” she said, of her outer and inner lady lips.

  “What does that do?” I asked.

  “I’m evening out the landscape, know what I mean?” Essentially, she explained, she builds a wall of pussy each morning so that her pant seam can’t trespass her labial gates. “It never works for very long,” she admitted.

  Tactically, this was all very interesting—I’d never thought of such innovative fixes—but I was still hoping to peel away another layer of the toe onion, like why we all consider it so important to prevent.

  I needed to find someone who could talk about toe with nuance, someone who had spent years weighing its philosophical and sociocultural importance. Yes, it was time to call up Han of Camel No. She was clearly an expert on the matter. After all, she’s made it her career goal to foil toe. She must, therefore, know what’s at stake when our pants deceive us.

  We meet at Boulton and Watt, a hip restaurant in Manhattan. (Tabletops are made from distressed wood. There is exposed brick. Quinoa is on the menu.) When I spot her, she stands up and twirls around. “I wore some real toe creators so you could see how my underwear work,” she says. Her black pants are so tight they may as well be taped on, yet she’s correct; when I investigate, I do not see a trace of genitals.

  She tugs them upward from the waist. Still nothing. I am impressed.

  Over a beer, we chart the phenomenon (and backdrop for her burgeoning business) back to its origins. One hundred years ago, there was only one meaning for “camel toe”; it referred to the actual toe of a one- or two-humped animal known to live in arid regions. But then two societal shifts occurred, which gave the term its new meaning. The first was that we women began wearing pants, some of which were so tight that the contour of our anatomy became visible. Second, the Brazilian wax became popular. “The bush used to deflect seams from going up,” Han said. “Now there is no buffer.”

  I’d always had the feeling we weren’t giving the bush its due respect. Besides its ability to double as a suds-generating loofah, there are other pubic hair benefits we don’t talk about; when I get completely waxed, my pee stream is unwieldy, like a broken sprinkler. The bush, I realized, acts as a route, enabling streamlined and tidy urination. I didn’t bring that up, though, because it didn’t seem possible that this five-foot-eleven woman with Barbie contours and hair that looked like polished obsidian would be able to relate to a body function gone haywire.

  “But why a camel? It’s like the ugliest animal,” Han mused. “Couldn’t it be named something cuter like ‘koala paw’?”

  “Fair point,” I said.

  “Society likes to give us a hard time,” she said.

  I asked if certain crotches were more prone to the toe, but she said in her experience that’s a huge misconception; among all vulva owners, toe is an equal-opportunity invader.

  “It has to do with ill-fitting clothes,” she told me, “not someone gross and loose.” Mothers call her all the time and try to qualify why they need an order of her underwear. “I’m like, ‘Listen, lady, you don’t need to explain away about your kids and how loose it made you. I have no kids, I’m just tall and not stretched from a baby, but I struggle with the same issue.’” It was then that Han slapped the table to relay her sense of shock. “I can’t believe the extent some wom
en go to get rid of toe.” She told me that some get labiaplasty—plastic surgery for their vulva wherein bits and pieces of the inner or outer lips (or both) are snipped off. I’d known of the surgery, but it seemed too drastic to believe that toe might be the sole impetus for someone to go under the knife. “No need to anesthetize anyone,” Han said. “Let’s just do a Dr. Scholl’s here.”

  Han, I discovered, didn’t just do this for a quick buck; she approached her invention as if it might have as much impact on gender equality as Gloria Steinem did. She said that her underwear empowers women to take their mind off what they look like and focus on what they’re doing. “I want women to be free, I don’t want them to be in the middle of a kickboxing class and be like, ‘Fuck, dude, there’s my toe!’”

  But as we talked more, I felt disconcerted. I appreciated that Han was solving a problem and giving women solace where they have concern, but I also couldn’t help feeling disgruntled. Not only do we have to put our breasts in bras to protect innocent bystanders from a rogue hard nipple, but soon we’ll all be expected to own specific gear to keep our vag lips on lockdown as well.

  “What if women feel like it’s just one more thing they have to do?” I said. “Do you feel like you’re playing into this at all?”

  In other words, in twenty years, will women feel stifled by their caged vulvas and, in revolt, burn their Camel Nos? It seemed that by hiding that little crevice indefinitely—making it forever invisible—we might lose something else, too, but I couldn’t put my finger on what exactly.

  “You can feel however you want about it,” she said, “but I think it gives women peace of mind.” To her, walking around with camel toe is lewd and inappropriate. “There are kids outside”—she pointed to the window behind her. “And men can get sucked in. It’s like a tractor beam.”