Lynn Harris

And yet while vulvodynia plagues millions of women, it is a misunderstood and understudied women’s health problem. An interesting comparison: In 1992, the National Institutes of Health funded 60 studies on endometriosis, another painful women’s health disorder that affects 5 and a half million women, compared with only six studies they have conducted on vulvodynia — ever. The latest research, done at Boston Brigham and Women’s Hospital and published in April’s Journal of the American Women’s Medical Association, found that 16 percent of women will experience chronic vulvar pain, described as a burning, stinging or stabbing sensation, either constant or on contact, ranging from annoying to disabling, and lasting three months or more. This “lifetime cumulative estimate” means that 14 million American women, of all races, will experience vulvodynia of some kind at some point — 5 percent of women before age 25. Vulvodynia strikes white and African-American women at similar rates, but for reasons yet undetermined, Hispanic women are 80 percent more likely to be affected.

And yet even though the condition is so widespread, roughly 30 percent of women will not seek medical treatment for vulvodynia, even when the pain is keeping them from having sex. Many assume from the burning and itching that they’ve got the yeast infection from hell (as do some doctors even when there’s no yeast present ) and — futilely — wind up mainlining over-the-counter Monistat. Some, depressingly, may not realize that intercourse is not supposed to be painful. And there are likely a handful who are so freaked out by vagina pain to begin with that they just keep walking around with their deep, dark, painful secret. Those who do seek treatment — generally those in the most pain — typically see five doctors before getting a proper diagnosis and worthwhile treatment options.

Readers with total “Sex and the City” recall may be thinking, hmm, vulvodynia, isn’t that what Charlotte had on the season premiere a couple of years ago? Yes. Problem is, on the show, Charlotte was told that her condition was not serious, “mostly just uncomfortable,” and was sent off with some pills to “get it under control” — which apparently worked by the following Sunday.

The subject of another high-profile case study was much less fortunate. In 2001 Susanna Kaysen, of “Girl, Interrupted” fame, published “The Camera My Mother Gave Me,” a spare, graphic account of her own battle with the debilitating vulvar pain. Kaysen writes (brace yourself): “Some days my vagina felt as if somebody had put a cheese grater in it and scraped. Some days it felt as if somebody had poured ammonia inside it. Some days it felt as if a little dentist was drilling a little hole in it.” Even when the pain fades temporarily, she knows it’ll come back, especially if she has sex with her then-boyfriend (who totally doesn’t get it). The constant presence, or threat, of pain thus transforms — narrows, disfigures — her entire life. “My vagina had died,” she writes. “I’d forbidden it to express interest in any person or activity, because I knew if I indulged it it would start up with that zing, sting stuff again. Exiled, starved, and in solitary confinement, it had eventually succumbed.”

Though she lives in the Boston area, the doctor capital of the world, Kaysen never found a workable medical treatment. Today, Kaysen hasn’t so much lost or won her battle; rather, she’s signed a treaty, with massive concessions. “Celibacy is a great cure!” she said wryly in a recent phone conversation. “I wasn’t interested in having sex again. The only thing I was interested in was not having pain. Pain eclipses desire.”

For Phyllis Mate, 54, executive director of the NVA, a mild form of vulvodynia started in her 20s and became such severe knifelike and burning pain in her late 30s that she could barely walk. She wound up in bed and on Percocet for months; her doctors were baffled. “It was the first time in my life I thought about suicide,” she recalls. “I remember saying to myself and my friends that if I had to live like this for the rest of my life, I’d rather be dead.” Mate still cannot wear pants or pantyhose, ride a bicycle, or sit for longer than about 30 minutes at a time without pain. But — with the help of anticonvulsant medication — the pain is not as constant as it used to be. “Now I have weeks where I’m doing pretty well and then weeks where I am doing very badly,” she says.

Is no one helping these women? Well, some doctors are trying. Complicating matters, however, is the fact that the term “vulvodynia” describes a condition, not an illness — it’s the symptom, not the cause. It means your vagina hurts like hell, period. It’s kind of like when you have “conjunctivitis,” which is basically “inflammation of the stuff covering the eyeball” — could be allergic, could be viral, could be bacterial, depending. As for vulvar pain, doctors struggle with diagnosis and treatment mainly because vulvodynia is what you have when you don’t have a specific infection or other vaginal disease. It’s often completely invisible, too.

“It’s a rule-out diagnosis,” says Dr. Elizabeth Gunther Stewart, a coauthor of the Boston study and author of “The V-Book: A Doctor’s Guide to Complete Vulvovaginal Health.” “There’s a long list of physiological, gynecological problems — like skin disorders and infections — that can cause pain but aren’t vulvodynia. People recognize that it exists but are still not very good at treating it. We’re just getting started in terms of giving women what they need.”

Here’s what doctors do know. Vulvodynia generally shows up in two forms. There’s Vulvar Vestibulitis Syndrome (VVS), which is pain around the vaginal entrance only upon touch or pressure (sex, gyno exam, even sitting), and there’s Dysesthetic Vulvodynia (DV), which is diffuse, unprovoked pain. Its various causes appear to include irritation or injury of the pudendal nerve (one of the main nerves in the genital region), allergies or chemical sensitivities (reactions to irritants either external, such as detergent, or internal, such as the salts called oxalates in urine), abnormality in the pelvic floor muscle (such as “hypertonicity,” or excess tension at rest), and genetic susceptibility to certain types of inflammation. Depending on what they think is the cause, doctors may try topical anesthetics or estrogen, tricyclic antidepressants (for pain, not depression), specialized physical therapy, or even surgical removal of troublesome nerve endings.

Pam Fischer, 50, a registered nurse in Naperville, Ill., finally found several likely culprits for the burning and itching that was so intense it kept her bedridden — “totally overwhelmed, just hoping it would calm down” — for weeks at a time. It turned out she not only has several allergies, but also fibromyalgia, a chronic pain condition that affects muscles and soft tissues — including, in some cases, the vulva. She now carefully selects only hypoallergenic products and takes the drug Guaifenesin — an expectorant used to liquefy mucus that also appears to have the effect of flushing pain out of tissues. The pain’s not 100 percent gone, but at least the mystery is. “It comes and goes, but I know the reasons for it,” she says.

Unfortunately, some treatments have their risks and downsides. For Leslie, surgery — removal of inflamed glands near the vaginal opening — had the opposite of the intended effect. “The doctor fucked up the nerves in the area and didn’t treat the underlying condition. That’s when it started hurting all the time,” she says.

For Christin Veasley of the NVA, surgery eventually reduced her pain by about 80 percent, but only after seven years of everything else — topical and oral pain medications, diet modification, etc. — failed or made matters worse. At one point she almost dropped out of college, not because of the pain, but because of the pain killers. “I couldn’t sit through class because the meds knocked me out,” says Veasley, now 28.

Highly specialized physical therapy has proven, in some cases, to be an effective and welcome alternative to treatments involving knives or drugs. Dr. Howard Glazer, a clinical psychologist and clinical associate professor in obstetrics and gynecology at Cornell University Medical College/New York Presbyterian Hospital, uses surface electromyography — the same technology used in electrocardiograms — to read the “electrical signature” of the pelvic floor muscle with a device like a little metal tampon. Once he is able to interpret a particular muscle abnormality, he can work with the patient on extremely precise inner exercises to correct it — which, he says, leads to pain relief in 80 percent of his clients. Call it very personal training: These are subtle and specific movements, says Glazer, not just the “kegel” exercises forever enshrined in women’s magazines.

Along similar lines, electrical stimulation that relaxes and strengthens the pelvic-floor muscles has really worked for Leslie. “My muscles in that area are always tense, like a fist that’s always clenched,” she says. She has an at-home electrical device that she’s supposed to use for 20 minutes a day (and, she says, an “amazing” physical therapist — trained by Dr. Stewart — who yells at her weekly for not using it enough). “It’s a little probe that you insert vaginally, and it gives off a current for about 10 seconds, then nothing for 10 seconds, then current for 10, etc.,” she says. “I saw something similar in the ‘Jackass’ movie — I think Steve-O attached it to his balls.”

Even though treatment techniques have expanded and improved, fundamental misunderstandings and misguided, incomplete approaches persist. “It’s not a gynecological disorder, it’s a pain disorder,” says Glazer. Sure, vulvodynia shows up below the belt, but it has more in common physiologically with pain syndromes than with other genital problems.

In fact, Phyllis Mate got relief only when she finally consulted a pain specialist. “He knew nothing about vulvodynia, but he knew something about pain,” she says. He recommended a cortisone and lidocaine injection that would anesthetize her pudendal nerve. The procedure reduced the pain by half, she says. She then started on the anticonvulsant medication that she’s been taking for the past 12 years.

Mate got lucky, apparently. Usually, when it comes to vulvodynia, “The pain management people have never heard of it,” says Stewart.

So when it comes to funding and other attention from the medical establishment, vulvodynia can get lost in the shuffle. At the National Institutes of Health, it’s currently categorized with Child Health and Human Development, which does include women’s health research, but which also leaves vulvodynia to compete for attention with everything from autism to teen pregnancy. The National Vulvodynia Association is working to support the National Pain Care Policy Act of 2003, which would establish a National Center for Pain and Palliative Care Research at the NIH. “There’s no central institute that funds pain disorders,” says Veasley. “This would be favorable for all pain conditions that aren’t getting enough attention.” The act was referred to a House subcommittee in May, and on Aug. 5, Sens. Tom Harkin and Russell Feingold participated in a congressional briefing to make the case for drastically increased funding for the study of vulvodynia.

Physicians must also remember that when it comes to chronic pain — especially the most traumatic kinds in the most sensitive areas — some of the pain becomes psychological. “The people I see have not been helped by a variety of treatments with a variety of practitioners and they’re very demoralized. By the time they come to me, they’ve got several things going on, not the least of which is the pain,” says Dr. Leonore Tiefer, a clinical associate professor of psychiatry at the NYU School of Medicine who treats vulvodynia patients — and often, their sexual partners — in her psychology practice. Sometimes the pain can mess with your head even after it’s gone. “Women come to me pissed off at the world,” says Glazer. “And at the outcome of treatment, when they report little to no pain, they may also report little to no sex. As a means of coping, these women have buried their libido, have redefined themselves as asexual. Only in the past few years have we begun to look at sexual rehabilitation as part of their treatment.” Both he and Teifer work to reintroduce patients to their sexual selves, to warm them up to be active again.

Leslie credits her psychologist with getting her to recommit to addressing the pain in the first place. “I had gone radio silent on the whole thing, hopeless. I decided I was just not gonna talk about that part of my life,” she says. “I got very discouraged. I felt like I was taking all these drugs, using all these creams, schlepping down to Philadelphia all the time [to see a specialist], and nothing was working. I didn’t want to deal with it anymore,” she says — not even in therapy. When talking about being single, Leslie recalls, “My therapist would say, ‘But you’re attractive and fun,’ and I’d say, ‘I think it’s about my mom.’ Finally I said, ‘Well, there is this one thing …,’ and he was, like, ‘You’ve gotta be fucking kidding me. You have to take care of this.’ He pushed me until I did.” After over 10 years of trying — and not — Leslie has finally succeeded in controlling the pain with a combination of neurological pharmaceuticals (again, for pain), loose clothing, and physical therapy.

Leslie is now back to dating and having sex. For her, the reacquaintance has been welcome, and the incidental or anticipated — but mostly bearable — pain worth it. “I didn’t resist going back to sex,” she says, “though it is something I’m thinking about when I’m on a date with someone I like. In those situations I’m always thinking, Will it hurt? As a result, I tend to use alcohol as a bit of a crutch, not only because it numbs the pain significantly, but also because it reduces my general skittishness.” She’s found that she’s able to talk about her condition with men, who have been “wonderfully understanding,” and, more important, with women. “I recently talked to a woman [with vulvodynia] who was really discouraged,” she says. “I sat her down and said, ‘You’re not alone.’”

Thankfully, Carrillo was eventually cured: of both her cancer and her self-blame. She ultimately divorced her husband, found support online and learned, as she says, that she has “nothing to be ashamed about.” But even with its happy ending, her story reveals a troubling reality: While STIs have reached pandemic proportions, the stigma surrounding them remains ugly — perhaps especially for women.

“You cannot get through a season of ‘Jersey Shore’ or ‘The Real World’ without an STI ‘joke’ implying that the person accused of having one is skanky and slutty, and saying ‘Ooh, watch out, you might catch something,’” says Adina Nack, Ph.D., a medical sociologist specializing in sexual health and author of “Damaged Goods? Women Living with Incurable Sexually Transmitted Diseases.” “And that person they’re talking about is almost always a woman. There’s a serious misconception that you have to be ‘promiscuous’ in order to contract an STI, and while men in our culture are rewarded for being sexually active, women are judged.” (Nack cites one woman in her practice who’d never even had sex, but who contracted an STI while — successfully — fighting off a rapist. Even she said, “I feel like a slut.”)

To be sure, STIs and their attendant stigmas are (as I’ve written before) no picnic for men, either. But their impact appears to be different, in certain ways, for women. Among the hundreds of people with STIs Nack has interviewed, she says, men tend to be more concerned about medical realities — the best treatment, the best protection for partners — while women focus on much broader, and harsher, implications that strike at the very core of their sexual selves: “Will I be rejected as ‘damaged goods’?” “Are my dreams for sex, love and happiness over?”

All that when, ironically, STIs are now so strikingly common that, as Nack says, “you should go out into the dating world assuming that the person you’re with has already contracted something, even though they may not know it. Even if someone says, ‘I’m ‘clean’ — I’ve been tested for everything,’ they’re either ignorant or lying, because we don’t even have definitive tests for everything.” (STIs are often asymptomatic and frequently go undiagnosed.) The CDC estimates that nearly 19 million new infections occur each year. At least half of the sexually active population will contract HPV at some point; 45 percent of women 20-24 have it already. It’s so prevalent, in fact, that the medical community considers HPV infection a virtual “marker” for having had sex at all. One in 5 adults, whether they know it or not, has herpes right now. In other words, statistically, your date is more likely to carry a sexually transmitted infection than to share your astrological sign.

Though many STIs are easily and effectively treatable, those who have them still live with threats: of painful outbreaks, other medical complications and (in the case of certain HPV strains) cervical cancer; of straight-up slut-shaming and outright rejection. Given how common STIs are — and despite efforts by, for example, writers at Jezebel to chip away at the stigma by indirectly or directly outing themselves — it’s pretty amazing how much dated stereotype and outright ignorance remains (which in turn can deter people from getting tested). People that both Nack and I interviewed tell tales of women with herpes who, when actually outed, were told by officemates to use separate work equipment, and by family members to use separate toilets.

And if people you’re probably not going to sleep with react badly, imagine having to tell someone you like-like. For single women (and of course men) with STIs, the fizzy fun of a promising new date is often flattened, they say, by fear of the looming, dreaded Talk. Michele Bouffidis, 43, of New Jersey, contracted herpes — her “rowdy tenant,” she calls it, though she experiences only rare outbreaks — from an old long-term boyfriend who didn’t tell her he had it until it was too late. Over the next five years, she dared disclose to three men; none stuck around. One, at least, took the time to consider, eventually telling her — gently and thoughtfully — that he didn’t want to take the risk. She totally understood, she says, but it still smarted. Another said, “You seem like a very classy girl — I would never have imagined you having that.” (Translation: “You slut.”) By the time No. 3 rolled around, Bouffidis was dispirited enough that she presented her diagnosis in a negative, “You’re not going to want to deal with this,” light, almost deliberately pushing him away. For three years, she didn’t date at all. “It was because I have herpes,” she confirms. “I didn’t want to deal with ‘The Talk’ any more.”

Kalani Tom, 40, of New York, usually uses e-mail to inform potential partners about her genital herpes (which she controls successfully with medication) to give them a chance to process the information on their own. Sometimes, it goes fine. “One guy said, ‘It’s gonna take a lot more than that to scare me off,’” she recalls. But the more she likes a guy, the scarier it is — and once, when the stakes were high, she choked. “He asked me if I had anything, and I said ‘no,’ ” she admits. “I was a coward. I didn’t want to be judged.” When she finally told him the truth, he was devastated — not just by her diagnosis, but by her dishonesty. (Fortunately, he tested negative.) Another recent prospect just bailed, too, upon hearing the news. But Tom — though quite contrite about her lie — remains hopeful, even defiant. “People may judge, but I know I’m not some repulsive horrible person,” she says.

Plenty of “seropositive” men and women — Nack herself included (and Michele, above) – are in happy, healthy relationships with STI-free partners willing to take on the medical logistics of avoiding transmission. “Not all potential partners are going to reject you,” she says. And many women and men with STIs have found support, community, friends (and more than friends) in online communities specifically for them. There’s an interesting, and ongoing, debate about whether dating sites for people with STIs are godsends or ghettos, but experts say they are — at least — great places for the newly diagnosed to get their groove back.

Kristin Andrews, 30, of Michigan, contracted herpes from an unfaithful boyfriend who, when he heard her diagnosis, called her “a slut and a whore and complained that now it’s gonna be hard for him to date,” she recalls. “For that first few weeks it was awful. I felt like I was one of the worst people in the world, disgusting and degraded and gross.” Then she found MPwH.net (short for Meet People with Herpes), where she got her “newbie” questions answered straightforwardly and reassuringly. Eventually, she arrived at the distinction that our society clearly — and dangerously — still refuses to accept. “I have herpes,” she says. “But it’s not who I am.”

If there’s been any elephant in any room, it’s been on MTV, since the launch of the network’s smash-success pair of reality series about teen pregnancy and motherhood. “For two seasons of ’16 and Pregnant’ and two seasons of ‘Teen Mom,’ we have never seen any pregnant teen seriously consider abortion,” media critic Jennifer L. Pozner, author of “Reality Bites Back,” has observed. While 27 percent of pregnant teens choose abortion, Pozner notes, “in MTV’s version of ‘reality,’ 100 percent of pregnant teens give birth.”

Late last night, that changed. MTV aired a 30-plus-minute interview special called “No Easy Decision,” in which three young women — including Markai Durham, who was featured last month on “16 and Pregnant” carrying her first pregnancy to term — spoke candidly about their decisions, as teenagers, to have abortions. Though MTV had not planned to promote the show, which appeared at the way-past-prime-time hour of 11:30 p.m., a leak by EW.com last week did just that — and had everyone prepared for the worst. Circling the wagons against nasty backlash, nonpartisan post-abortion support talkline Exhale, who partnered with MTV on the show, had already planned an online campaign called “16 and Loved” to act as sort of virtual clinic escorts for the young women outing themselves. Abortion-rights opponents smelled pro-choice conspiracy; abortion-rights supporters feared that the network — and especially “Dr. Drew” Pinsky — would tackle the subject with all the nuance and sensitivity of a Snooki Polizzi sucker punch.

But this member of the latter camp is relieved, delighted — and still amazed — to report that MTV got it right. Seriously, they nailed it. And by “nailed it,” I don’t mean they just did a great PSA for abortion. I mean they told the many-sided truth: that abortion is safe and common, that abortion has been made difficult to get, and, most importantly, that abortion is a complex decision made by complex human beings. (That thump you heard around 11:35 p.m. EST was the sound of 100 feminist media critics falling off our collective couches.)

Here’s Dr. Drew opening the show — and racking up stunned “FTW!”s (For The Win!) on Twitter right out of the gate: “About 750,000 girls in the U.S. get pregnant every year. And although nearly a third of these teen pregnancies result in abortion, we’ve never shown this choice on ’16 and Pregnant’ up until now. It can be a polarizing topic, and there’s quite frankly no way to talk about this and please everyone. Although controversial to some, abortion is one of the three viable options, and it’s among the safest, most common medical procedures in the U.S., so we thought it was important for us to discuss.”

In a wrenching produced segment, we then meet Markai and her partner, James, as they wrestle with their options for her unplanned second pregnancy, the result of a missed appointment for her shot of Depo-Provera. As a mother, Markai is tormented both by the prospect of terminating a pregnancy (or relinquishing a baby) and by the prospect of raising a child whose needs will splinter their already slim resources. Referring to her daughter, Zakaria — and reflecting the fact that 61 percent of women who have abortions already have children — she says, “I don’t want her to struggle because of my mistake.”

Through the rest of her segment, and in Dr. Drew’s follow-up interview with her and two other young women (Katie and Natalia), the show manages to include: medically accurate information about abortion procedures, the challenge of finding the birth control method that works for you, the positive presence of supportive family and friends, the compassionate voice of a clinic counselor (vs., for one, the cold depiction in “Juno”), the complex emotions of male partners, the cost of abortion ($750, in the case of Natalia, who sold her prom ticket back to school to help put together the funds), the cruelty of parental notification requirements (Natalie called the experience of securing an alternative judicial bypass “begging for permission to make your own decision”), the positive presence of supportive family and friends (in this case, African-American, a sadly rare portrayal), the normality of mixed feelings after the procedure (Markai says, insightfully, that she feels sadness but not regret), and the characterization of abortion as — in Katie’s words — “a parenting decision.” (In an extended interview available online, Natalia also describes the cruelty of being legally forced to view the pre-procedure ultrasound.)

All that in just over 30 minutes, all without scoldy shaming or down-our-noses voyeurism. Instead, this whoop-worthy kicker from Dr. Drew — “Hopefully this inspires us to be more compassionate when we think about abortions” — and, simply, three brave and articulate women who may have begun to raise the level of public, pop-culture conversation about abortion. Maybe it’s “just” MTV, but it matters (and God knows no one else is doing it).

“This isn’t just a television show. Media portrayals, real or fictional, don’t merely inform us — they form us,” as Gloria Feldt wrote in the Washington Post about “Friday Night Lights.” “And they miss the profound truth of women’s lives when they reduce broad issues such as sexual and childbearing choices to one word — abortion — and reduce abortion to a polarized, black-and-white debate.”

And as Dr. Drew himself said last night: “Having an abortion is not uncommon. But talking about it publicly is.” At this time, there are evidently no plans to repeat or extend the special, which was buried to begin with. So here’s a high-five to MTV for — finally, and so finely — getting this thing going.

But next time, how about prime time?

On the one hand, there’s the Gawker conclusion (shared by many), based on “in depth Internet research” revealing Cahoon on Facebook and her book on Amazon: She is “the world’s craziest dating expert” and the videos are “thrillingly real” (“please watch in splendid amazement”). On the other hand, there are those who say the videos — the costume changes! the cheesy soundtrack! the men! — are too thrilling, too splendid, too crazy to be real. Our appetite for irony is so voracious, our radar for hoaxes so sensitive, and (in some cases) satire has become so sophisticated, that indeed: These days, one could imagine Cahoon (or “Cahoon”) pulling off a head-spinningly elaborate pop-culture fake-persona long con: Joaquin Phoenix meets Stephen Colbert meets Tina Fey/Amy Poehler meets Carrie Bradshaw. (This was my take, initially. At least that’s what I was rooting for.) But the debate in the first place is a sign of our post-Blair Witch, post-reality TV, “I’m Still Here”/”Catfish“/”Jersey Shore”/YouTube times: We’ve become so jaded that it’s near impossible to distinguish between real life and a hoax — or a marketing strategy — and we’re always on the defensive for being duped. The argument over what’s real and what’s not has become, more than ever before, a major part of our reaction to art; the membrane between reality and imagination is getting more porous by the day. That mashup is what makes the Cahoon conundrum so captivating. She embodies an irresistible pop-culture zeitgeist two-fer: We thrill to a clueless train wreck; we smell a clever, clever rat.

But in all this investigation and vigorous discussion, one voice was missing: Katherine Chloé Cahoon’s. And so, I decided to call her up. Is Cahoon real or fake? The answer, at once disappointing and exhilarating: She is both.

“We meant to make the videos over the top,” she said from her home in Seattle. “I wanted to be like the travel hostess who says, ‘Come to Europe and all your dreams will come true!”" she says, still amazed that people seem to have thought otherwise. “The guys in the video called me and said, ‘They have to know we’re joking! I don’t really whip off my shirt in the gym and pose on the equipment!’” (On her website, Cahoon responded to the controversy by writing: “Of course they are parodies!”) But the videos — and the book — are also meant to be useful. These were tips the Vanderbilt grad gave to her friends upon returning to campus each fall with fabulous tales of being “manopolized” by suitors in Europe’s most “mantastic” hot spots. She explained one video tip to me about the festival of San Fermin: “If a woman wears red and white at the running of the bulls, it means you’re respecting Spanish culture, and men will want to meet you for that. And I really did have a friend who turned her sarong into a towel after spending the night on the beach!”

To some wiseass doubters, Cahoon’s claim that she meant to be funny would simply make her the Tommy Wiseau of dating advice. (Wiseau famously insisted — after his 2003 film, “The Room,” was cited as one of the worst films ever made — that it was, uh, supposed to be comedy.) But once you spend a little time with Cahoon and her Internet paper trail, it’s hard to do anything but take her at her honest, earnest word. Her ingenuousness, it turns out, is almost impossibly genuine. And that’s where she is totally for real.

The real vs. fake confusion, I think, arises from exactly what’s so beguiling about Cahoon: She actually has no idea how how funny she is. Because, really, her videos are reality magnified only about 1.3 times. In real life, she remains almost as guileless and dreams-come-true, unicorns-and-rainbows sincere as she is on-screen: Elle Woods, or Tracy Flick in a spun-sugar tutu, the über-achiever who, underneath all her cheerfulness, is actually cheerful.

Her videos look and feel awkward in part because it’s actually her dad (a photographer with no video experience) behind the camera. (For her own part, Cahoon says, she drew on what she learned at Vanderbilt in one semester of Intro to Filmmaking.) Also at Vanderbilt, Cahoon sparkled up the gridiron as a member of Danceline, the school’s official dance team. (Amazing Flickr proof lives here.) As a child, though banished from her beloved trampoline by a back injury, Cahoon took ballet six days a week and became an avid — in fact, prizewinning — gardener by age 12. The elaborate garden she created at her parents’ home in Seattle was inspired by a childhood poem she wrote called “Rainbow Ranch,” about stuffed animals who come alive and gather for tea. (In between meetings with Hollywood producers about the in-the-works film based on her book, she still maintains the garden, having spruced it up just recently for some children to come over and act out her poem.) “I love gardening,” she told me. “It’s kind of like writing in a way. You get to create something out of nothing.”

Cahoon does get stopped by people on the street, she says, who compliment her book and ask to take a photo with her. “I try to get to know my readers so I ask about them and there is always some characteristic we have in common,” she says. “One girl was in law school and loved to travel. One man worked for a major film studio. He said his entire office stopped and watched my videos. I feel fortunate to have the opportunity to meet these people.”

To someone raised on rainbows, of course, that “entire office” could have had only the best, the most laughing-with, intentions. But Cahoon is not unaware that there’s also been some laughing-at. And that, indeed, has cost her a bit of her innocence — her Internet innocence, anyway. “All the critical comments I read about me, my videos and my book were inaccurate. For example, one person claimed to have read my book, but her description of it was the opposite of what the book states. She related her own tips for meeting Euro men. These were straight out of my book even though she claimed I had omitted them. For example, she suggested learning some of the native language. Tip No. 19 in my book, entitled ‘Break Through Language Barriers,’ covers exactly this,” Cahoon says, displaying a refreshingly dated belief in the magical power of demonstrable fact. “Also, someone who made several false statements about my videos and book received comments from those who refuted every one with direct references. This did not stop her. She continued to make statements that were so false and vicious they fit the legal description of libel. After learning this, I realized that there are people on the Internet who enjoy making crude, hateful statements. Even when they know these statements are false, they do not care.” (By the way, her book’s reviews on Amazon have taken on a grand satirical life of their own. “Miss Cahoon is kind to her ignorant reader like a Swedish hostel manager might be kind to a single American girl who thinks Sweden is a rustic province of Wales and can’t for the life of her remember if she thought to tell her family she’d be abroad for a few weeks,” reads one.)

Cahoon has also learned that she’s hardly the only victim of online asshattery. “Recently, I saw a video featuring a model from one of the premier agencies. She was absolutely gorgeous. Yet there were venomous comments saying she was overweight. Some went so far as to call her fat. If this girl is fat then heaven help the rest of us!” she says. “What should she do? Quit modeling because some cruel people want to bring her down? Absolutely not! Taylor Swift, who is hugely successful and one of the sweetest girls, would not have written a song called ‘Mean’ if this were not a problem in our society.” Seriously! Europe may be looking better and better.

The Portwood saga caps an intense season on “Teen Mom,” and an intense two years for examining the nuances of domestic violence through the lens of pop culture. Of course, there’s never been any shortage of male-on-female abuse on TV, especially with ever-scummier reality shows in the mix. But lately what we’re seeing, perhaps more than ever, is female-on-male violence. Before Amber vs. Gary, we also — obviously — had Chris vs. Rihanna, along with the common and supposedly exculpatory allegation that she hit him first. We had slapsticky reports that Elin Nordegren started the whole thing by clocking Tiger Woods with a nine-iron. There was Eminem’s smash “I Love the Way You Lie” featuring, of all people, Rihanna on vocals, which whipped up debate about whether the song offered a groundbreakingly complex tale of relationship hell (with which Eminem is also familiar) or reinforced that old idea that, hey, maybe Rihanna did like the way it hurt. But one thing largely unremarked upon throughout the whole “LTWYL” micro-saga is that the violence is presented as, essentially, equal. In the song’s follow-up, “I Love the Way You Lie (Pt. II),” the woman (Rihanna singing lead this time) is not just complicit in the abuse; she is also — almost blow by blow — as violent as the man. (Eminem: “Tell me I’ll be sorry that you pushed me into the coffee table last night so I can push you off me … You hit me twice, yeah, but who’s countin’ / I may have hit you three times.”)

Inherent in the above is some suggestion of perverse 21st century gender parity: Both partners are equally to blame, both partners are equally abusive; women are strong enough to punch, women are not — or no longer — the only victims. When we hear of a woman who hits, we hear rumblings that women are “becoming more violent,” that this is the dark price we pay for female empowerment. As in, hey, feminism, thanks a lot. But are women really becoming “as violent as men”? And is that even the question we should be asking in the first place?

People who support women’s rights, and who have worked for decades to get male-on-female domestic violence taken seriously, may find this conversation not just eye-rolling, but deeply troubling. As expert Jill Murray, author, most recently, of “But He Never Hit Me,” puts it: Equating the scope, incidence and danger of male vs. female domestic violence “stands to negate everything we’ve been trying to fight for, all the work we’ve done.”

How so? Because when not just played for man-bites-dog laughs, female violence against men — especially in cases of heterosexual domestic abuse — is invoked to diminish, even deny, the reality of male violence against women.

“We can’t ignore or deny that women can be violent to their partners, whether their partners are men or women,” says Jennifer L. Pozner, author of “Reality Bites Back: The Troubling Truth About Guilty Pleasure TV” and founder of Women in Media & News. “But by hyping inaccurate studies in news reports and creating salacious narratives on crime dramas, media have for decades tried to create a false equivalence, discussing the few women who have been violent and using those women’s stories as proof that A) there’s ‘just as much’ female-to-male domestic violence as male-to-female, and B) domestic violence isn’t a problem that women have to deal with as victims anymore.” (Men’s rights activists go even further, claiming that men are [as reporter Kathryn Joyce put it] “victims of an unrecognized epidemic of violence at the hands of abusive wives.”)

Let’s see what the stats really say, and what they mean in context. The DOJ’s numbers do contain this one perhaps surprising stat among many, many others: Males and females in violent relationships are “hit, slapped, or knocked down” by partners at almost exactly the same rate. Other research accumulating since at least 2000 suggests that, in fact, females are at least as likely as males to perpetrate intimate partner violence and that abusive relationships often involve mutual violence. So if you were cherry-picking, or very-broad-stroking, you could sort of call it even.

Except it’s not. Not at all. Experts say the raw, in-a-vacuum numbers don’t even start to tell the whole story of a given relationship, or of the complex dynamics of domestic violence. Other DOJ data shows men are more likely to be attacked with a knife or hit with a thrown object; women are more likely to be grabbed, held or tripped, raped, or sexually assaulted. Perhaps more to the point, females are more likely than males to sustain severe or injurious violence and to require medical treatment. “When you take the data out of context, in some cases, women come up as violent as men,” says Meda Chesney-Lind, Ph.D., a criminologist, professor of women’s studies at the University of Hawaii, and author, most recently, of “Fighting for Girls: New Perspectives on Gender and Violence.” “But men will often use the excuse ‘she hit me first’ to justify decking her or throwing her against a wall. She slaps him, and that’s used as a pretext to beat the crap out of her. She’s the one who winds up in the hospital.”

Research also shows that male victims do not take violence by their partners as seriously as females do and, conversely, that women are more likely to be frightened by future violence. Men, perhaps most significantly, are much more likely to commit the extended, continuing violence known as “battery.”

In other words, even where select data points appear to be equal, “shared rates are not shared problems,” says Jeff R. Temple, Ph.D., an assistant professor of obstetrics and gynecology at the University of Texas Medical Branch who specializes in intimate partner violence.

Temple also notes that — likely related to changing mandatory- and dual-arrest laws in cases of domestic violence — reporting of female domestic abuse has increased; that skews the numbers as well.

Another fallacy, says Chesney-Lind: the presumption that violent women are a new post-feminist breed, hitting because being “empowered” makes them more like men. In reality, male and female domestic violence tend to emerge from different places, and with different intentions. In the context of heterosexual domestic abuse, she says, “male violence is an expression of power and control over women; men are hitting to control and get things. Women’s violence is an expression of frustration and rage and exasperation.”

And that’s where we get to the bigger picture. Bottom line, says Chesney-Lind, “we are fascinated by girls’ and women’s violence.” For those who like to see women — Angelina Jolie, even Helen Mirren — wielding serious, even heretofore forbidden, power, it’s hot. For those who fear women in that role, it’s … not. “For all the increased tolerance, even celebration, of aggressive women in pop culture, in daily life there’s still a lot of disapproval of women even speaking up at meetings or asking for a raise, let alone committing a physically aggressive act,” says Maud Lavin, author of “Push Comes to Shove: New Images of Aggressive Women.”

Adds Chesney-Lind: “To take the longest possible view, one of the things you do when you want to discourage women from seeking social justice for their gender is show that there are terrible downsides to ‘mimicking maleness.’ That has been a motif since the first wave of feminism. If you demand to go into the public sphere you’re going to be corrupted, just like men — and the most recent version of that is that you’re going to get ‘out of control,’ even hyper violent.”

None of this is to say that domestic violence by women should be accepted, excused or cheered. But when it comes to pop culture and public discourse, it needs to be discussed on its own face and in its own context, with its own set of causes and implications, not as a game of one-upmanship — and certainly not as a consequence of liberation. “Once we became concerned about them, it was very easy to find violent girls, because they’d always been there,” says Chesney-Lind. That more enlightened, accurate conversation might be — among other things — one step toward “I Love the Way You Lie (Pt. III), in which both singers say, “… and that’s why I got out.”

Mr. and Mrs. Bird-Bee are actually “Neil and Karen,” who are actually two very funny deadpan actors in giant goofy costumes. They’re the stars of a series of five webisodes at the centerpiece of a new campaign designed to raise awareness about infertility, one that nails the experience so knowingly and wittily that it’s getting big love from the infertility community — which is especially notable considering that, in fact, it’s coming from big pharma. Sponsored, subtly (no, really), by EMD Serono — Massachusetts-based maker of fertility drugs used to stimulate ovulation — the “Increase Your Chances” campaign encourages couples to visit a specialist if they hit that fertility wall, and, more broadly, aims to change the way infertility is talked, or, more to the point, whispered about, in our culture. (Part of the campaign involves sending bird- and bee-clad actors onto the streets of small cities — two weeks ago, it was Austin — to “get couples talking about fertility issues.”) The Web spots also close with key facts about infertility: One in eight couples struggles with it; it’s about equally likely that fertility issues will stem from the male as the female partner; 85 to 90 percent of fertility issues are treatable; infertility — “just relax,” my ass — has no correlation with stress. While scattered dissenters find the humor trivializing, most bloggers and commenters became big fans on sight, sending the videos to each other and also (as one poster wrote) to “close (and fertile) friends who are trying to be supportive of me but who just don’t quite understand what living with infertility is like.”

“This ad campaign takes infertility out of the darkness,” says Barbara Collura, executive director of RESOLVE: the National Infertility Association, who has partnered with Serono as a resource for patients.

What’s it doing there in the first place? Thankfully, infertility is not like it was for my childless great-aunt Bess (for whom my daughter is named), born in 1898, who went through it even before it had a name (or books, or blogs, or support groups, or treatments). But for all the resources and help available, there somehow persists the old-fashioned, possibly sexist notion that women get pregnant because that’s what they do, that conceiving is the natural, default outcome — after all, we spent so many years trying not to, goddammit — such that failing to seems to mean there’s something wrong with you. Not your plumbing, you. Result: stigma, secrecy, shame. (For the, mercifully, relatively short time I subscribed to Conceive magazine, I felt like I had to slip it inside something respectable, like Us Weekly, when I read it on the subway.) The assumption persists that every (married) woman will have a child, even those who aren’t interested. So you can imagine how that might feel for those who are. But, then, articles about infertility online, for one, often elicit ungenerous commentary that basically boils down to “boo-fucking-hoo.” Our nation’s collective pop-culture “bump watch” being on permanent orange alert (what Rebecca Traister called “pregnancy porn”) doesn’t help, either.

Speaking of culture, it’s not overflowing with positive, nuanced or compassionate images of women struggling to conceive or seeking fertility treatment. (One word: “octo-mom.”) Also, if you totally forgot that there was a dramedy about a fertility clinic on NBC called “Inconceivable,” good. In “Increase Your Chances,” Neil and Karen do drift a bit toward the tired doofy-husband/testy wife (hey, it works in “Modern Family”), but they’re still pretty winning; they still ring real, right down to the rank wheat-grass snake oil and military-timed robosex (post-coital murmur: “Don’t forget the dry cleaning”). They’re tense, they’re tender: You root for them. “They’re note-perfect, an assessment that my commenters share,” says Julie Robichaux of ALittlePregnant.com. “They’re kind of Everyinfertile, in fact, stunningly typical. For people trying to conceive, that makes it easy to relate to the couple. For those not in that situation, it advances the notion that people who do seek fertility treatments aren’t quite as egomaniacal/selfish/not-like-us as they may previously have thought — a win for the infertile community. By humanizing the couple so unerringly, the ads make us receptive to the message.”

How did Serono (and mono, the agency they worked with) get it so right? Not rocket science: They talked to people. “What you see comes directly from conversations with patients,” confirms David Stern, executive vice president of endocrinology for EMD Serono. “We wanted to come up with an awareness campaign to help create less stigma around infertility. We looked at everything being done online by IVF clinics, patient advocacy groups, and competitors, and we saw very similar themes: flowers and soft colors and other warm, fuzzy things and babies. Lots of babies. It’s all done very softly. We said, ‘OK, a lot of people are doing this and there’s still this stigma. We want to do something different that will get a conversation started, in a way that’s humorous without making fun.” He adds: “We also want to get people to physicians who know how to treat them. If they use fertility drugs, that’s great, but we really want to motivate people to go in to see specialists because that’s the best route for them to become parents.”

That’s a welcome message, too, says Robichaux. “It undoubtedly serves the drug company, but it also serves anyone who’s been trying for a while with no success. Nothing frustrates me more than to hear a friend tell me, ‘Well my gynecologist said a year’s not that long, that we should just keep trying on our own.’ Lady. You’re 41. Your doctor has done you no favors.”

The ads, she notes, also don’t pander or patronize by promising success. “That’s huge,” she says. “Not only is it a truthful acknowledgment of the limitations of medicine — imagine that — it’s also a very respectful position to take with regard to the intended audience. Infertile people know that there’s no magic bullet, or silver needle, or pregnant rainbow Pegasus crop-dusting the world with glittery baby dust.” And now they also know that there are a few more people who understand.