In short
Science Vs: How Do You Get Pregnant With No Vagina?
Podcast Overview
- Podcast Title: Science Vs
- Episode Title: How Do You Get Pregnant With No Vagina?
- Episode Description: The story of a 15-year-old girl in Lesotho who arrives at a hospital pregnant but without a vagina. The episode explores the science behind this unlikely case with expert insights from Dr. Neel Shah.
Episode Structure
- Introduction (00:00)
- Introduction by Wendy Zukerman.
- Overview of the new segment "Case Files" that delves into unusual case reports from medicine.
- The Case Report (04:12)
- Overview of a 1988 case published in the *British Journal of Obstetrics and Gynecology*.
- The scenario begins with a violent altercation involving the patient, leading to her hospitalization.
- The Pregnancy Discovery (14:37)
- The young girl returns to the hospital months later in labor, unaware she was pregnant.
- Doctors discover she has no vagina, making the situation unique.
Key Concepts and Discussions
The Case Background
- The young girl was involved in a knife fight, resulting in hospitalization.
- Post-recovery, she presents with severe stomach pain and is found to be in labor.
Vaginal Agenesis
- The girl has a condition called vaginal agenesis, where the vagina does not develop properly, leading to only a shallow skin dimple where the vagina should be.
- This condition occurs in approximately 1 in 5,000 individuals and can be associated with *Mayer-Rokitansky-Kuster-Hauser syndrome*.
The Mechanism of Pregnancy
- How did the sperm get in?
- The girl attempted penetrative sex but was unsuccessful due to her condition.
- She then engaged in oral sex, leading to a possible chain of events resulting in her pregnancy.
- Sperm Survival in Unusual Conditions:
- Discussion on how sperm could survive in the stomach despite the acidic environment.
- Examination of potential mechanisms, including recent ingestion of food, saliva's protective qualities, and possibly vomiting.
The Journey of Sperm
- After escaping from the stomach through a stab wound, sperm would need to navigate to reach the egg.
- The peritoneal cavity was identified as a more hospitable environment for the sperm.
Extraordinary Coincidences
- The episode highlights the improbable nature of the event:
- The girl experienced her first ovulation precisely when sperm was available.
- The birth resulted in a healthy baby, making the case exceedingly rare.
Medical Community Reactions
- The case led to skepticism among doctors.
- Discussion of alternative explanations, including the possibility of a small, previously unnoticed vaginal opening.
Conclusion
- The episode reflects on the incredible odds of this unique situation, emphasizing the phrase "life finds a way" as a narrative thread.
- The mother's ability to adapt to her new circumstance with her child is briefly explored, illustrating the complexity of life and biology.
Production Credits
- Produced by: Ekedi Fausther-Keeys with contributions from Wendy Zukerman, Michelle Dang, Rose Rimler, and Meryl Horn.
- Editing: Blythe Terrell.
- Fact-Checking: Diane Kelly.
- Sound Design: Bobby Lord.
Additional Notes
- The episode invites listeners to reflect on the limits of scientific understanding and the extraordinary nature of human biology. It encourages curiosity about how life can persist in even the most challenging circumstances.
Written by AI. May contain mistakes. Listen to the episode to check what was said.
Chapters
Tap a time to open that second in VOIntriguing Case Report
0:46 to 4:12
Discussion about a bizarre medical case involving a 15-year-old girl.
“The case report to top all case reports.”
Pregnancy Without a Vagina
4:13 to 6:22
Exploration of how a girl could be pregnant despite lacking a vagina.
“Before the break, we told you about a 15-year-old who was pregnant and in labor but has no vagina.”
The Journey of Sperm
6:23 to 9:56
An analysis of how sperm could survive and reach the uterus in this unusual case.
“Now back at the hospital, doctors and nurses were curious themselves about how the sperm got in there.”
The Anatomy Challenge
9:57 to 12:06
Discussion on the anatomical challenges and the potential journey of the sperm.
“And so the sperm could like maybe have just been freshly in the stomach.”
The Unbelievable Pregnancy Story
14:02 to 14:38
Discover the strange circumstances of a teen's pregnancy without a vagina.
“but maybe there's this like magic sperm that can like rollercoaster its way through the abdomen and then magically fertilize.”
The Anatomy of Coincidence
14:39 to 17:46
Explore the extraordinary coincidences that led to a successful fertilization.
“Here's where we're at based on the facts on the ground.”
Expert Opinions on Unlikely Cases
17:46 to 18:45
Hear from doctors about their skepticism and insights on the case.
“And by the way, the baby was born healthy.”
Believing in the Unbelievable
18:45 to 22:04
Reflect on the implications of such a rare occurrence in human biology.
“Yeah, and look, we reached out to the doctor who wrote the case report several times, but we didn't hear back.”
Transcript
Automatic transcript. May contain errors.0:00Dr. Neel Shah:Hi, I'm Wendy Zukerman and you're listening to Science Versus. Today on the show, a new segment that we're calling Case Files. And this is where we take case reports, which are basically stories from academic literature where really weird things have happened to patients that are often so out of the norm that doctors have to write them down for posterity. So think about the kid who went to the hospital with a case of blue balls. classic case report. But today, we have a case report for you that could perhaps top all case reports. And to process it all, we've got friend of the show and science journalist, Joel Werner.
0:46Dr. Neel Shah:Hello, Joel.
0:47Wendy Zukerman:Hey, Wendy.
0:48Dr. Neel Shah:Oh, boy, boy, boy.
0:50Wendy Zukerman:The case report to top all case reports. Like, you're coming in hot. Let's do it. Let's do it. Okay.
0:57Dr. Neel Shah:This story was published in the British Journal of Obstetrics and Gynecology in 1988. It begins with a lover's quarrel and ends with what might be one of the unlikeliest events in scientific history. But it's so unlikely that we're wondering if perhaps it is indeed a fairy tale with some nightmarish elements. One doctor told us it reads like Jerry Springer, quote, You don't see much in medicine that's published in this way.
1:29Wendy Zukerman:Wow. That is some hype. All I have to say is, Wendy, Wendy, Wendy. Let's get into it.
1:36Dr. Neel Shah:All right. We're in Lesotho, which is a very small country within the borders of South Africa. And the case report starts off like this. I'm just going to read it to you verbatim the first few sentences. Quote, the patient was a 15-year-old girl employed in a local bar. She was admitted to hospital after a knife fight involving her, a former lover and a new boyfriend. Who exactly stabbed whom was not quite clear, but all three participants in the small war were admitted with knife injuries.
2:12Wendy Zukerman:Wow. She got out of control there, didn't it?
2:16Dr. Neel Shah:It sure did. So this young woman comes into the hospital with a stab wound to the upper part of her stomach. They have a look and it's actually sort of punctured two holes into her stomach. The doctors operate on her, close up the wounds, keep her for observation. But ultimately, she gets to go home after about a week and a half and she's fully recovered. But of course, our story can't end there. Months later, she returns to the hospital with a very different issue. It's about nine months later, actually, and she's complaining of serious stomach pain. It's coming in these very intense waves where the pain gets really bad and then it goes away and then it comes back again.
3:01Dr. Neel Shah:Doctors examine her. What do you think's going on, Joel?
3:03Wendy Zukerman:Like, I've got two kids. That sounds like contractions.
3:08Dr. Neel Shah:Yes.
3:09Wendy Zukerman:Yes, okay.
3:10Dr. Neel Shah:Yes, she is pregnant.
3:11Wendy Zukerman:Wow.
3:12Dr. Neel Shah:Fully in labour. She didn't know she was pregnant. She did suspect something was up because her belly was getting bigger. Now, again, you might be thinking, OK, this happens. 15-year-olds, they get pregnant sometimes. But here's where things get strange. As the doctors started to get her ready to have this baby, they realised something a little bit different about this woman. She has no vagina. What? Yeah, so she's pregnant. She's not intersex. She's not trans. but she has no vagina.
3:52Wendy Zukerman:So what is down there? It's like as a Barbie doll situation?
4:00Dr. Neel Shah:Yeah, we're going to get to that just after the break.
4:14Dr. Neel Shah:Welcome back. Before the break, we told you about a 15-year-old who was pregnant and in labor but has no vagina. Okay. So let's just talk about this no vagina for a moment. So basically, when this woman was in the womb, the lower part of her vagina didn't develop properly. And this can sometimes be caused by a condition called vaginal agenesis. Right. Okay. It happens to about one in 5 ,000 people. And this case report said that where her vagina was supposed to be only a shallow skin dimple was present. So it wasn't like a Barbie situation. We think she had a urethra, the inner and outer lips of the vulva.
5:01Dr. Neel Shah:So all of that looked typical. But then instead of an opening where the vagina was supposed to be, there was skin with a little dent in it. So think about it like kind of pressing your cheek a little, like a little dimple. So no hole. And this condition is usually brought on by a syndrome with a very long name.
5:25Wendy Zukerman:Mayer-Rokitansky-Kuster-Hauser syndrome. It's a mouthful. It sounds like a law firm, to be honest.
5:31Dr. Neel Shah:Right. Well, this mouthful was said by Dr. Neil Shah. He's an OBGYN and the chief medical officer at Maven Clinic. He's based in Massachusetts. And he's treated people who have this condition before.
5:44Wendy Zukerman:When I was in residency, I took care of people at Boston Children's Hospital that would fly in from all over the world who had this syndrome.
5:51Dr. Neel Shah:Now, Neil told us that on top of the vagina that hadn't properly formed, people with this condition can also have a uterus that is not fully developed. But in this case, with the pregnant hero of our story, her uterus was fully formed, working perfectly, and could support a fetus, soon to be a baby. It just seems there was no vagina. So the big question is, of course.
6:17Wendy Zukerman:How did the sperm get in? And I guess part two, how does the baby get out?
6:21Dr. Neel Shah:Okay, so the baby got out by C-section. That's the quick one. Now back at the hospital, doctors and nurses were curious themselves about how the sperm got in there. And actually the case report says that, get this, as they were still closing her up from surgery, from the surgery of the C-section, quote, curiosity could not be contained any longer and the patient was interviewed with the help of a sympathetic nursing sister, end quote. Here's what they found out. The young woman had apparently tried multiple times to have sort of garden variety penis vagina sex, but was obviously unsuccessful due to the aforementioned lack of vagina.
7:09Dr. Neel Shah:And so turn to oral sex, which ends up being key here. So, Joel, do you remember that fight that broke out at the start of this story?
7:18Wendy Zukerman:Oh, yeah, I can't stop thinking about it. The knife has to be. It's Chekhov's knife. It's Chekhov's knife.
7:23Dr. Neel Shah:Okay, so it seems that that fight all started because her ex-lover caught her going down on her new partner. Ah. And doctors think that this wild combination of giving fellatio, swallowing the sperm and the fight might have led to this pregnancy. What?
7:48Wendy Zukerman:This is like I'm imagining the cum going on some sort of like Hot Wheels rollercoaster ride where it like shoots out of one hole and dives into a different hole.
8:01Dr. Neel Shah:I mean, so that is the adventure we are about to go on. Wow.
8:08Wendy Zukerman:All right.
8:08Dr. Neel Shah:So the first thing we need is some way for the sperm to get to the egg. And normally the sperm has a pretty direct route through the vagina, sneaky way up the cervix, yada, yada, yada, basically home free. But in this case, when she swallowed the sperm, it would have been stuck in her stomach. and our producer, Katie Foster-Keyes, asked Neil, are the stomach and the uterus connected in any sort of way?
8:40Wendy Zukerman:Not without a knife.
8:44Dr. Neel Shah:But we had a knife, right? But maybe we should start our Hot Wheels journey with the sperm inside the stomach because she's just swallowed it. Right. Because Neil actually told us that at that point, it should have been game over.
9:04Wendy Zukerman:Wow. Okay. The most extraordinary thing is that sperm does not survive acid. Gastric acid in the stomach is basically as acidic as it gets.
9:13Dr. Neel Shah:Yeah. So he's just shocked. And other doctors we reached out to as well, shocked that it would have survived the stomach at all.
9:20Wendy Zukerman:Other science journalists as well. Like, I'm just perpetually shocked at the moment.
9:24Dr. Neel Shah:So those stomach acids are so toxic to sperm. In one study, researchers actually looked into how different acids would affect sperm, whether it would immobilise or kill human sperm. And so they mixed semen with stuff that is generally less acidic than the contents of our stomach. And what they found was that within a minute, the sperm could no longer move. And within 10 minutes, all the sperm were dead. so based on that study the odds of the sperm surviving the stomach were perhaps even less than the odds of this woman not having a vagina here's neil i've never seen sperm survive in the
Read the full transcript
10:08Wendy Zukerman:stomach in my whole career so do they know what length of time there was between her going down on her new lover and her getting stabbed in, was she caught in the act? And so the sperm could like maybe have just been freshly in the stomach.
10:24Dr. Neel Shah:Yeah. It appears she was caught in the act. All of this must have happened quickly. It couldn't have just been sitting in the stomach because then sperm would have been dead. Absolutely. It has to have happened very fast. the swallow. And then, so we know saliva is a nicer pH for sperm. We also know that seminal fluid is not acidic. It's actually a little bit basic. So maybe the two of them acted like a coating to protect the sperm. On top of that, eating food can lower the acidity in your stomach. So maybe if she'd had a big meal before all this happened.
11:07Wendy Zukerman:It's this perfect storm of like eating and swallowing the cum and getting stabbed in the stomach.
11:15Dr. Neel Shah:That somehow the sperm survives. And one thing that Neil read in the case report made him think that maybe this did all happen quickly.
11:25Wendy Zukerman:What they say in the case report is that she vomits.
11:28Dr. Neel Shah:So what the case report actually says is that her stomach was empty when she had surgery. But Neil, knowing what he knows about medicine, reckons that that could be from vomiting. So maybe what happens is she swallows the sperm and it's somehow protected in the saliva and the seminal fluid. and then maybe she vomits and that act of vomiting propels a tiny bit of sperm out into the little hole in the stomach that the stab wound created.
12:04Wendy Zukerman:So here's Neil. So it basically has to be like perfectly positioned anatomically to be near the place where it would exit based on where the stab was. Which, you know, explains our exit from the stomach, but there's still, this is just the first step of a long journey, I'm imagining. Right. And then it gets even wilder.
12:27Dr. Neel Shah:Right. Because when it exits the stomach, like you say, it's not as if the egg is just hanging around saying, hello, I'm right here. The egg, it should be in the pelvis and the hole was in the stomach. So we still have a Hot Wheels ride to go down. Absolutely, yeah. Now, once the sperm gets out of the stomach, it moves into this liquidy space that's between the organs in the abdomen. It's called the peritoneal cavity. And this peritoneal cavity is actually a nicer place, we think, for the little fragile spermies to survive and thrive because the pH in the peritoneal cavity is about the same as vaginal fluid.
13:12Dr. Neel Shah:Ah, okay. Which is the stuff that protects the sperm as it travels through the vagina, right? For those who have a vagina. Now, there have been two other case reports that we found where sperm was found in the peritoneal fluid of men, suggesting that maybe it can survive there. And so from this peritoneal cavity, the sperm then would have had to have swum past the intestine, into the pelvis and ultimately to reach the egg.
13:46Wendy Zukerman:Look, this is, you know those guys who like overanalyze the Zapruder film of JFK's assassination and they're like rewinding it and going, oh, the bullet had to have come in through. Like Neil reminds me of one of those guys. He's just gone, no, look, it sounds far-fetched, but maybe there's this like magic sperm that can like rollercoaster its way through the abdomen and then magically fertilize. Was there a second tuna?
14:10Dr. Neel Shah:Exactly. So that is one way, maybe, after the break, the final unbelievable chapter.
14:37Dr. Neel Shah:Welcome back. Today on the show, how the teenager with no vagina got pregnant. Here's where we're at based on the facts on the ground. It looks like the only way this could have happened was that the sperm that she swallowed after giving oral to her boyfriend somehow survived the acids in her stomach, escaped the stomach through a stab wound, and then swam down the obstacle course that is her body and merged with the egg.
15:08Wendy Zukerman:Unbelievable.
15:09Dr. Neel Shah:Unbelievable. And by the way, we looked into this. There are a bunch of ways that the sperm is guided towards the egg because of things that the egg is doing. Like it releases certain chemicals that sort of say come hither to the sperm and there's changes to temperature and the flow of fluid in the body that can help guide sperm to the egg. But all of that stuff tends to happen when you're already pretty close to the target. It's not kicking in. up in the stomach.
15:38Wendy Zukerman:And I imagine that we haven't evolved to help sperm from, was it the peritoneal? Yes, cavity. The cavity to then find its way. It's not like we usually get sperm in this part of the body.
15:54Dr. Neel Shah:No, no, no, no. Which takes us to the final, rather unbelievable part of the story, which is the egg. What's very curious about what happened here is that we don't think that this young woman ever had a menstrual period before. Because without a vagina, there'd be no hole for the blood to escape into. And so if she had released an egg and this blood was coming down, the body really doesn't like blood in places it It shouldn't be, sort of. And so if it was pooling there, it would have caused her a lot of pain and she would have had to go to probably the hospital to deal with it. And plus, when they opened her up to deliver the baby, they would have seen blood from past periods and they didn't.
16:50Dr. Neel Shah:Here's Neil.
16:51Wendy Zukerman:Now, when they deliver her, her cervix is completely dilated and it empties into nowhere and there's no blood anywhere. And apparently she's never menstruated before. So the other extraordinary timing is this is the first time she's ever ovulated in her entire life. She's 15. And she ovulates at the exact perfect time for fertilization to happen. What? What? The series of coincidences are stacking up.
17:23Dr. Neel Shah:Yes.
17:24Wendy Zukerman:So the first time her body has ever released an egg, there just happens to be sperm that's made its way from oral sex, out a wound in her stomach from a stab fight, on a magical journey through her abdominal cavity, and then it fertilizes the only egg that's ever been there to be fertilized.
17:47Dr. Neel Shah:And by the way, the baby was born healthy. Here's the deal. Amazing.
17:51Wendy Zukerman:This baby is born at the expected weight and nothing apparently wrong with it because there's a lot of other things that can happen. She doesn't miscarry. So then you're like, in all of human existence, what are the odds that this happened once? So this is like the unicorn of all unicorns of all of medical cases. Yeah. Yeah, I would say so. You know, the odds are lower than the odds of one person being struck by lightning a hundred times. Wow. It's sort of, I mean, often when we're talking about these unbelievable stories in science, I think about that amazing documentary Jurassic Park and its famous line, life finds a way.
18:31Wendy Zukerman:But this is like the perfect example of life finding a way. The odds have been completely stacked against this fertilization event ever occurring. And somehow there's a healthy child at the end of it.
18:45Dr. Neel Shah:Yeah. Yeah, and look, we reached out to the doctor who wrote the case report several times, but we didn't hear back. He's now retired. We also asked a bunch of other doctors what they made of this report because it is so wild. And a couple of doctors said they just didn't believe it. Too unlikely. Others were like, maybe. One told us, quote, sperm are persistent little guys. and that doctor actually described a patient that they had had who had no obvious vaginal opening, who had apparently never had penetrative sex and also got pregnant and given birth to a kid with C-section as well.
19:28Wendy Zukerman:Wow.
19:28Dr. Neel Shah:So, yeah, she was like, you know, it's unlikely, but stuff happens. Some of the doctors that we heard from also said that there might be another explanation for what's going on here and that maybe that dimple where her vagina should have been wasn't totally closed off. Maybe there was a tiny hole in there that was missed and sperm somehow got in that way, just sort of the more regular way. And the fact that all of this happened, you know, some 40 years ago, one doctor told us that they didn't have the technology on hand that we use today to diagnose someone with vaginal agenesis. But still, they took a pretty good look in there and couldn't see a vagina.
20:15Wendy Zukerman:Well, this is the thing, you know, from the very first time you start studying science, you're told the simplest solution is often the accurate solution. And if this story we're being told is the simplest solution, like it makes you think, like, Like, are there other mechanisms by which this could have occurred?
20:35Dr. Neel Shah:Yeah. And, you know, but on the other hand, doctors pointed out, you know, this was a case report written in a legit peer-reviewed medical journal. As for Neil, he said, you know, it was extremely unlikely to have happened. But who knows?
20:55Wendy Zukerman:Nothing is impossible. Like, as a physician also, you have to, you know, you see all kinds of things. of extraordinary things. Wow. Now, do we know what happened? Is there any resolution to the love story?
21:08Dr. Neel Shah:The case report says that about two and a half years later, baby is still perfectly healthy. And in fact, it says, quote, by that time, the son looked very much like the legal father, the new boyfriend in the story. It says, quote, the young mother, her family, and the likely father adapted themselves rapidly to the new situation, and some cattle changed hands to prove that there were no hard feelings.
21:32Wendy Zukerman:I love these stories where they're just completely almost impossible coincidences that lead to an event. And it sort of challenges our notion of kind of like, what is likely, you know, like if this can be true, if this somehow is the way that that sperm and that egg found each other, then, you know, it gives you a sort of sense of like, I kind of like want to believe, like I want to lean in and just like believe that life will find a way.
22:04Dr. Neel Shah:Thanks, Joel.
22:05Wendy Zukerman:Thanks, Wendy.
22:10Dr. Neel Shah:And Joel Werner has a brand new podcast out. It's a historical thriller called Assassins. It's from the ABC, the Australian Broadcasting Corporation. And it's hosted by Aslan Pahari, who maybe you know as the hello, my friend guy from TikTok. He's really great. And each episode of Assassins tells the story of one of history's most shocking assassinations, from Abraham Lincoln to Tupac. And there's some science in some of the episodes, too. Like, for 3 ,000 years, the death of Pharaoh Ramses III was a mystery until some scientists came along and solved the riddle. You can find Assassins wherever you get your podcasts.
23:00Dr. Neel Shah:This episode was produced by Aketi Foster Keys with help from Wendy Zuckerman, Michelle Dang, Rose Rimmler, and Meryl Horn. We're edited by Blythe Terrell. Fact-checking by Diane Kelly. Mix and sound design by Bobby Lord.
23:15Wendy Zukerman:Music written by Emma Munger, So Wiley, Peter Leonard, Bumi Hidaka, and Bobby Lord. Thank you to all the scientists we spoke to for this episode, including Dr. Sarah Aykroyd, Dr.
23:25Dr. Neel Shah:Sarah Collins, Professor Adam Taylor and Dr. Kathy Flood. Special thanks to Joseph Lavelle Wilson and the Zuckerman family.
23:55Wendy Zukerman:But she doesn't pay.
23:56Dr. Neel Shah:No. It's a loss of a loss. It's very simple with Visa Steuer. And when she works, it's Kaching!
24:03Wendy Zukerman:That's it?
24:04Dr. Neel Shah:Safe! Visa Steuer.
24:06Wendy Zukerman:Now you're going to buy your money.
24:07Dr. Neel Shah:Now you're going to try it. Now you're going to buy more than 50 % of the purchases with less storage.
24:14Wendy Zukerman:For example, in paper-tout or even without additional storage. If your husband also plays a guitar, we offer you your new voice with a soundtrick. in the packaging of the manufacturer, based on Amazon-Data from the year 2025 in Great Britain and the EU.
From the publisher
It's 1988 in Lesotho, and doctors at a hospital see something they thought was impossible. A 15-year-old girl shows up pregnant and in labor, but she's missing something pretty crucial to her delivery: a vagina. So — how did this happen?? We go on a roller-coaster ride through the reproductive system with Dr. Neel Shah to find out.
Find our transcript here: https://tinyurl.com/sciencevsnovagina
In this episode, we cover:
(00:00) A small war
(04:12) How do you get pregnant without a vagina?
(14:37) The final unbelievable chapter
This episode was produced by Ekedi Fausther-Keeys with help from Wendy Zukerman, Michelle Dang, Rose Rimler, and Meryl Horn. We’re edited by Blythe Terrell. Fact checking by Diane Kelly. Mix and sound design by Bobby Lord. Music written by Emma Munger, So Wiley, Peter Leonard, Bumi Hidaka and Bobby Lord. Thank you to all the scientists we spoke to for this episode including, Dr. Sarah Ackroyd, Dr. Sarah Collins, Professor Adam Taylor, and Dr. Cathy Flood. Special thanks to Joseph Lavelle Wilson and the Zukerman family.
Science Vs is a Spotify Studios Original. Listen for free on Spotify or wherever you get your podcasts. Follow us and tap the bell for episode notifications.
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