Closing the Anatomy Gap

1. 77% of OB/GYNs say they would offer labiaplasties and clitoral hood reductions, despite no residency training in techniques or anatomy involved.

2. ACOG approves these procedures even for women under 18.

3. Knowing the anatomy of the penis is considered integral to understanding sexual function, so why should the clitoris be approached differently?

4. I’ve addressed other reasons for needing to know this anatomy, such as treating clitoral tears and cysts. Also 7% of cases of vulvodynia involve the clitoris.

This doctor believes the following illustration covers the innervation of the clitoris. As you can clearly see, it doesn’t get close to covering nerves in the clitoris, which are ~1 mm and travel about 3 mm in the clitoral body.

I am trying to spread awareness about the omission of clitoral neural anatomy from OB/GYN literature. The goal is to leverage social pressure in order to get it added to textbooks and board exams. The effect of this change would be improving female sexual medicine and protecting patients from preventable harm caused by ignorance of this anatomy.

Please reblog 🙏🏻

The most efficient solution would be to get the American Board of Obstetrics and Gynecology to add this anatomy to board exams. This would force OB/GYN textbooks to add it and OB/GYN residency programs to teach it. ABOG refuses. Textbook authors are resistant or unresponsive. Enough social pressure would force them to acknowledge and remedy this problem.

If anyone wants to sign up for Medium and clap for my article that would be awesome. If anyone wants to share this on Facebook, twitter, or Instagram, that’s awesome too. I posted it on Twitter here:

I have tried contacting at least 200 OB/GYNs on Twitter and via email. I have contacted 20+ textbook authors. I have contacted countless OB/GYNs in leadership positions at ACOG, ABOG, and ACGME.

In my article, I quote a urologist who says vulvar anatomy is of “low interest to OB/GYNs.” In order to make it higher interest, I think female patients need to demand it. This is why I need to ask for claps and support. If you click on my article, you can read it and give me claps. I really think this will help.

I want to inspire doctors to want to be part of the solution rather than part of the problem. I think the more they become aware that I am educating patients, and the more I can get patients to believe me, the more inclined they will be to speak up. I need to inspire them to care more about patient safety and female sexual health than about politics or risk of offending colleagues.

For some reason even female OB/GYNs either deny or defend the omission. One said, “We already have to know so much so we shouldn’t have to know this too.” One said, “These nerves get to small and difficult to dissect as they enter the clitoris.” This is not true.

You’ve all heard about how the clitoral glans (the head - the part you can see) has many nerve endings. What this means is that the nerves leading up to it are quite large (at least - mm in diameter!). The descending body of the clitoris, which you can feel under the clitoral hood reaching from the glans up to the pubic bone, is 3.24 cm long on average, not including the glans. That means OB/GYN textbooks are leaving out 3 cm each of the two nerves that innervate the glans of the clitoris.

I personally had the innervation of my clitoris cut in a clitoral hood reduction performed without my consent during a labiaplasty - a minor procedure that was supposed to be safe in the hands of a very reputable OB/GYN surgeon. Consider also that one woman who contacted me had the dorsal nerves of her clitoris damaged in a repair she needed due to injuries sustained from sexual assault.

Vulvas can get injuries. There can be physical problems with the clitoris. In fact, it is possible that far more female sexual dysfunction is attributable to physical cause than we think. When “little is known” (which is in the intro of many a study of female sexual physiology), it is easy to dismiss nearly everything as in our heads. We are so emotional, after all (saracasm).

Content warning for genital mutilation, medical trauma

When Jessica Pin got a labiaplasty at age 18, her consent form read, “excision of redundant labia.” Instead, the doctor cut off the entirety of her labia minora and performed a clitoral hood reduction she never agreed to.

Afterward, when she touched her clitoris, there was no sensation. Since then, she hasn’t been able to orgasm, or feel much of anything at all, without a vibrator—something therapists and doctors dismissed as normal or a consequence of her “not being in love.”

When she wrote to her surgeon about what happened, he said he’d given her what she asked for. But an examination from his colleague confirmed that the dorsal nerve of her clitoris had been cut, leaving scars.

She wanted to report her surgeon, but her psychiatrist warned her that the board would defend him and attack her. Plus, the loss of her sexual functioning combined with the backlash she’d received for talking about it had left her suicidal. By the time she felt mentally healthy enough to speak out, the statute of limitations had passed. The doctor went on to win awards and become president of the state medical association. And even after she got yet another examination from his colleague, her surgeon said the scars must have been from a different surgery (which she never got) or that she must have done it herself (which she didn’t).

When another woman, who wishes to remain anonymous until her case goes to trial, got surgery to repair a tear to her labia after a sexual assault, she told the doctor not to go anywhere near her clitoris. “The doctor decided they needed to remodel my entire vulva, without discussing with me or asking for my consent, thinking this was best and would improve the ‘appearance,’” she remembers.

Instead of the minor repair she requested, her inner labia were completely cut off, and the skin of her outer labia and clitoral hood were pulled inward, causing nerve damage. In addition to losing all sexual sensation and ability to orgasm, she developed “extreme burning sensations, sharp pains in my clitoris glans, shaft, up the inguinal nerves and into my cervix.” She now finds it difficult to walk due to the pain. She had several consultations with doctors who do reconstructive surgery for botched labiaplasties. “They told me it looks like FGM,” she says.

A study she conducted that is currently awaiting publication has identified hundreds of women who have been victims of botched labiaplasties. Their complaints include complete amputation of the labia, inability to orgasm, clitoral injuries, and labia minora stitched to their labia majora, clitoral hood, or vagina.

People who compare male circumcision with FGM and say that if we ban FGM, we should ban male circumcision because they are the same drive me mental. 

I can’t feel cunnilingus. I know what this is like. 

Women who have had their clitorises and labia minora removed suffer from this same loss of ability to experience sexual pleasure. 

70% of women need external clitoral stimulation to orgasm. This is taken away by FGM.

How many circumcised men have  you met who cannot feel  a blowjob?