Hi, I'm Wendy Zuckerman 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.
We have a case report for you that could perhaps top all case reports.
And to process it all, we've got a friend of the show and science journalist, Joel Werner.
Hello, Joel.
Hey, Wendy.
Oh, boy, boy, boy.
The case report to top all case reports.
Like, you're coming in hot.
Let's do it.
Let's do it.
Okay.
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.
Wow.
That is some hype.
All I have to say is Wendy, Wendy, Wendy.
Let's get into it.
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.
Wow.
Shit got out of control there, didn't it?
It sure did.
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.
Doctors examine her.
What do you think's going on, Joel?
Like, I've got two kids and that sounds like contractions.
Yes.
Yes, okay.
Yes, she is pregnant.
Wow.
Fully in labour.
Yeah.
She didn't know she was pregnant.
She didn't 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.
No vagina.
What?
Yeah.
So she's pregnant.
She's not intersex.
She's not trans.
But she has no vagina.
So what is down there?
It's like as a Barbie doll situation.
Yeah.
We're going to get to that just after the break.
Welcome back.
Before the break, we told you about a 15 year old who was pregnant and in labour. 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.
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.
Mayor Rokitansky-Kusterhauser syndrome.
It's a mouthful.
It's 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.
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.
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.
How did the sperm get in?
And I guess part two, how does the baby get out?
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 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.
And so turned 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?
Oh yeah, I can't stop thinking about it.
The knife has to be, it's Chekhov's knife, right?
It's Chekhov's knife.
Okay, so it seems that that fight all started because her ex-lover caught her going down on her new partner.
And doctors think that this wild combination of giving fellatio, swallowing the sperm...
And the fight might have led to this pregnancy.
What?
This is like I'm imagining the cum going on, some sort of like Hot Wheels roller coaster ride where it like shoots out of one hole and dives into a different hole.
I mean, so that is the adventure we are about to go on.
Wow.
All right.
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.
Sneak your 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, Ketty Foster-Keys, asked Neil, are the stomach and the uterus connected in any sort of way?
Not without a knife.
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.
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.
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.
Other science journalists as well.
I'm just perpetually shocked at the moment.
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 immobilize 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 of this woman not having a vagina.
Here's Neil.
I've never seen sperm survive in the 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?
Was she caught in the act?
And so the sperm could like maybe have just been freshly in the stomach.
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.
Okay.
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...
It's this perfect storm of, like, eating and swallowing the cum and getting stabbed in the stomach.
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.
What they say in the case report is that she vomits.
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.
So he'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 that 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.
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 should be in the pelvis and the hole was in the stomach.
So we still have a Hot Wheels ride to go down.
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.
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.
Look, do you know those guys who overanalyze the Zapruder film of JFK's assassination and they're rewinding it and going oh, the bullet had to have come in through there.
Neil reminds me of one of those guys.
He's just gone.
No look, it sounds far-fetched, but maybe there's this magic sperm that can rollercoaster its way through the abdomen and then magically fertilize it.
So that is one way, maybe, after the break, the final unbelievable chapter.
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 was 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.
Unbelievable.
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.
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.
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 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.
Here's Neil.
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.
Yes.
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.
And by the way, deal.
Amazing.
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 100 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.
But this is like the perfect example of life finding a way.
The ever occurring and somehow there's a healthy child at the end of it.
Yeah.
And we 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, sperma-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.
Wow.
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 sort of should have been wasn't totally closed off.
Maybe there was a tiny hole in there that was missed and sperm disappeared.
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.
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, are there other mechanisms by which this could have occurred?
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?
Nothing is impossible.
Like as a physician, also, you have to, you know, you see all kinds of extraordinary things.
Wow.
Now, do we know what happened?
Is there any resolution to the love story?
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.
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.
Thanks, Joel.
Thanks, Wendy.
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 3000 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.
This episode was produced by Aketi Foster-Keys with help from Wendy Zuckerman, 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.
