We’ve always had vaginas, but it’s taken a long time to really get to know them — especially in medicine.

The number of words for the vagina is, frankly, amazing.

From the cutesy “lady bits” to the friendly “vajayjay” to hoohas, lady business, and far too many insulting terms to name — the English language is a veritable smorgasbord of vagirific slang. We can be quite creative, apparently, when we don’t want to come out and say “vagina.”

And that’s telling.

For much of human history, the vagina has been to some extent a taboo subject — if not entirely unspeakable, then certainly not something to discuss openly.

In fact, there wasn’t even a medical term for the female sexual passage until around the 1680s. Before then, the Latin word “vagina” referred to a scabbard or sheath for a sword. So it shouldn’t be surprising that in the medical realm, the vagina and other female reproductive parts were long viewed as mysterious — and even treacherous — bits of anatomy.

The ancient Greek physician Aretaeus believed that the uterus wandered about the female body like an “animal within an animal,” causing illness as it banged into the spleen or liver. He also believed that it was drawn to fragrant smells, such that a physician could lure it back into place by presenting the vagina with pleasant scents.

As historian Thomas Laqueur has written, it was common belief at the time that men and women literally shared the same sexual organs.

And so it has gone for the vagina — its history is rife with myth, misunderstanding, and mistreatment.

After all, how do you care for the health of something you can barely even mention?

“Women’s genitals are so sacred or so taboo that we can’t even talk about them at all, or if we do talk about them, they’re a dirty joke,” says Christine Labuski, a former gynecology nurse practitioner and now a cultural anthropologist at Virginia Tech and author of “It Hurts Down There,” a book about vulvar pain.

Oprah is widely credited with popularizing the “vajayjay,” but it’s not clear we’re all talking about the same body part. Is Oprah’s vajayjay her vagina — the channel from her cervix to the outside of her body — or is it her vulva, which includes all the external parts that I imagine when someone says “lady bits” — the labia, clitoris, and pubic mound?

Often today, we just use the word vagina as a catch-all — maybe because if there’s a word we’re less comfortable saying than vagina, it’s vulva.

And if modern-day women are often unclear about their own anatomy, you can imagine what ancient men made of it.

It wasn’t until 1994 that the NIH mandated that most clinical trials include women.

Galen, who was considered the premiere medical researcher of the Roman Empire, rejected the wandering uterus but saw the vagina as literally an inside-out penis. In the second century A.D., he wrote this to help readers visualize:

“Think first, please, of the man’s [genitals] turned in and extending inward between the rectum and the bladder. If this should happen, the scrotum would necessarily take the place of the uteri, with the testes lying outside, next to it on either side.”

So there you have it — Galen’s saying that if you imagine shoving all the man bits up into a man’s body, the scrotum would be the uterus, the penis would be the vagina, and the testicles would be the ovaries.

To be clear, this wasn’t just an analogy. As historian Thomas Laqueur has written, it was common belief at the time that men and women literally shared the same sexual organs.

Why a scrotum can’t bear children — not to mention where exactly the clitoris fits into this scheme — wasn’t so clear, but Galen wasn’t concerned with those questions. He had a point to make: That a woman was merely an imperfect form of a man.

It might sound silly today, but the assumption of a male as the standard for the human body was persistent.

It wasn’t until 1994 that the U.S. National Institutes of Health (NIH) mandated that most clinical trials include women (the last was first passed in 1993, but took effect after the NIH revised the guidelines).

Before then, many drugs were never tested on women at all, on the assumption that they would work the same in both sexes. That assumption proved incorrect. From 1997 to 2001, 8 out of 10 prescriptions drugs that were pulled from the market posed greater risks for women, often because women metabolize them differently.

Galen’s ideas about women rested on his shaky understanding of female anatomy, which was perhaps understandable since he hadn’t been allowed to dissect human corpses.

It wasn’t until the 1500s, during the Renaissance, that anatomists were able to peer inside the body and began to publish drawings of genitalia along with other organs. However, their images of the reproductive system were considered scandalous by the church, so many books of the time hid the genitals under flaps of paper or omitted them entirely.

Even Andreas Vesalius, a Flemish physician who was considered the father of anatomy, wasn’t always sure what he was looking at. He viewed the clitoris as an abnormal part that didn’t occur in healthy women, for instance, sticking instead to the view that the vagina was the female equivalent of the penis.

But during the Enlightenment period from 1685 to 1815, the sciences, including anatomy, flourished. And thanks to the printing press, more people started learning about sex and the female body.

“Thanks to the new print culture,” writes Raymond Stephanson and Darren Wagner in an overview of the era, “sexual advice literature, midwifery manuals, popular sexologies, erotica… medical treatises in the vernacular, even the novel… became publicly available for an unprecedented number of readers.”

“That book (“Our Bodies, Ourselves” 1970) was transformative,” Rodriguez says, “because it gave women knowledge about their bodies.”

What’s more, with the rise of modern medicine in the 1800s, far more people began to see doctors.

Childbirth, which had been seen as a normal life event to be carried out at home, began to move into hospitals, says Sarah Rodriguez, PhD, a medical historian at Northwestern University.

James Marion Sims was a young Alabama doctor in the 1840s when he took an interest in performing surgeries on women — then a fairly new undertaking. To do so, he basically invented the field of gynecology as we know it today.

First, he invented the vaginal speculum, which gynecologists still use to open and see inside the vagina, and then he pioneered the first surgery to repair vesicovaginal fistulas, a complication of childbirth in which a hole opens between the vagina and the bladder.

The surgery was a breakthrough, but the advance came at a great cost. Even at the time, Rodriguez says, Sims’ methods were seen as ethically questionable.

That’s because Sims developed the surgery by experimenting on enslaved African American women. In his own accounts, he discusses three women in particular, named Betsey, Anarcha, and Lucy. He performed 30 operations — all without anesthesia — on Anarcha alone, starting when she was 17 years old.

“I don’t think you should talk about his creation of these surgeries without mentioning those women,” Rodriguez says. “Fistula repair has benefited many women since then, but this came about with three women who couldn’t say no.”

In April of 2018, a statue of Sims in New York City’s Central Park was taken down, to be replaced by a plaque that will give the names of the three women who Sims experimented upon.

And while women today can find more information about their bodies than ever before, that also means they’re bombarded with more negative and inaccurate messages.

To many women, the statue’s removal was an important acknowledgement of the harm and neglect women suffered for years at the hands of the medical establishment. It really wasn’t until the 1970s, Rodriguez says, that women’s healthcare came into its own.

The book “Our Bodies, Ourselves“ was a major force in that change.

In 1970, Judy Norsigian and other women in the Boston Women’s Health Book Collective published the first edition of the book, which spoke directly and frankly to women about everything from anatomy to sexual health and menopause.

“That book was transformative,” Rodriguez says, “because it gave women knowledge about their bodies.”

And that knowledge empowered women to become their own health experts — the book has since sold more than four million copies, and women still tell stories of passing dog-eared copies around until they literally fell apart.

Clearly, there was a thirst for knowledge, Judy Norsigian says as she reflects back on that time. “Back in the late 60s and 70s we knew very little about our bodies, but we knew how little we knew,” she says today. “That’s what made women get together and do the research.”

Over the years, Norsigian says, the need for the book hasn’t disappeared, but it has transformed.

“There’s so much misinformation on the internet,” she says. She describes women approaching her at events and asking questions that show a lack of basic knowledge about the female body.

“They don’t understand about menstrual health and urinary tract infections,” she says, “or they don’t even know they have two different orifices!”

And while women today can find more information about their bodies than ever before, that also means they’re bombarded with more negative and inaccurate messages.

“Women today get the idea that you have to look like they do in porn, so they’re shaving and altering the vaginal area,” Norsigian says. “Vaginal rejuvenation is a hot surgery now.”

That’s why the last edition of the book — there’s no longer funding to keep updating it — has a section on how to find accurate information on the internet, and avoiding sales pitches disguised as education.

And after that long history, it’s going to take a lot of vagina talk to make up for lost time.

Here’s just one example: the Kotex company planned a TV commercial for its pads and tampons that mentioned the word “vagina.” After all, that’s where their products are used.

After three broadcast networks told the company it couldn’t use that word, Kotex filmed the ad with the actress using the phrase “down there.”

Nope. Two of the three networks rejected even that.

This wasn’t in the 1960s — this ad ran in 2010.

In the end, it was still an important advance. The company poked fun at its own past advertising, which featured blue liquid and women dancing gleefully, riding horses, and jumping around in white pants — presumably all while menstruating. Yet even in 2010, Kotex could make no mention, even euphemistically, of an actual vagina.

So yes, we’ve come a long way, baby. It’s been centuries since anyone tried to tempt a wandering uterus with a vaginal potpourri. But history continues to shape us.

As a result, many people still don’t know the difference between the vagina and vulva — much less how to care for either one.

Women’s magazines and many health-oriented websites don’t help, promoting nonsensical ideas like “how to get your best summer vagina ever” and promoting cosmetic procedures and surgeries that serve to shame women into thinking their perfectly normal vulvas aren’t attractive enough.

In 2013, a survey at a U.S. university found that only 38 percent of college women could correctly label the vagina on an anatomical diagram (beating out the 20 percent of college men who could find it). And fewer than half of all women in an international survey said they’re comfortable discussing vagina-related issues with their healthcare provider.

“Even though many of us live in this ‘vag’ world, and people send selfies of their genitals and it feels like this very open moment, I think [these attitudes are] still really new relative to the long history,” Labuski says.

And after that “long” history, it’s going to take a lot of vagina talk to make up for lost time.

Erika Engelhaupt is a science journalist and editor. She writes the column Gory Details at National Geographic, and her work has appeared in newspapers, magazines, and radio including Science News, The Philadelphia Inquirer, and NPR.