1988.10.4 / USA / 173cm
Help improve female sexual medicine by getting attention drawn to omission of clitoral neural anatomy.
This really matters. Women have as much right to sexual health as men. Anatomy is very important for understanding function, avoiding harm during surgery, and treating dysfunction. Please retweet to help me raise awareness:
Why this matters and is relevant to this subreddit:
Even in this subreddit, I’ve seen women talk about issues with their clitorises. They have questions about loss of sensation, clitoral pain, etc. These questions cannot be answered adequately or truthfully by doctors who don’t know anatomy.
Lifetime prevalence of vulvodynia is 10–28% among reproductive-aged women in the general population. Meanwhile, among 430 patients with vulvodynia in one study, 15 had clitorodynia. This would indicate a lifetime prevalence of approximately 0.35-.98%. This may not sound very common, but this translates to 0.550–1.54 million women in the US. How can we expect doctors who don’t know basic neuroanatomy to treat this competently?
Sexual dysfunction is common among women. Many women have difficulty with arousal and orgasm. It is often assumed such difficulties, when present in young, healthy women, derive from psychological issues. But such assumptions are invalid when the physiology and anatomy is not adequately studied. Injuries to the dorsal nerve, including compressive injury from riding a bike, are possible. For every woman who has tried to talk about sexual problems with her OB/GYN, this should be relevant.
Though clitoral tears have been reported in childbirth, there is no literature on the subject of repairing such tears. Considering that about 4 million births occur per year, even if the risk of a clitoral tear is low, this would likely affect a significant number of women.
Similarly, 1 in 2000 women are born with ambiguous genitalia. This translates to about 2000 per year in the US. Treatment is normally done by urologists and/or plastic surgeons. However, urology education is certainly much better in this area, coverage is still not great. Plastic surgery education in this anatomy is definitely lacking.
Data on the number of women who undergo clitoral hood reductions is lacking. However, based on NHS data and considering the much larger population of the United States, as well as based on numbers performed by plastic surgeons (10k), and the number of OB/GYNs who say they would offer these surgeries (77% according to one study), I would bet around 50k of these are done per year in the US. I’d welcome any help getting access to real numbers, though this will be tricky due to a lack of a CPT code.
As transpeople gain wider acceptance, FtM gender-reassignment surgeries become more and more common. I’m not sure what the prevalence for these procedures is, but it seems like the people undergoing these procedures would want there to be detailed surgical anatomy and would want standards in place to keep them safe.
It is estimated that 200 million women alive today have undergone female genital mutilation. Most of these cases involve excision of the the glans and some of the distal body of the clitoris. In all cases involving the clitoris, some of the clitoral body remains intact. Reconstruction, which can help women regain some clitoral function, is possible but can only occur when doctors fully understand this anatomy.
Doctors are resistant to acknowledging and solving a problem. While I have some doctors on my side (Dr. Michael Goodman, Dr. Irwin Goldstein, Dr. Rachel Rubin, Dr. Paul Pin, and others who have followed me or retweeted me on Twitter), it takes a great deal of effort to change a systemic problem like this. When I crashed the ACOG convention (professional convention for gynecologists), many acknowledged a problem and commended my efforts but did not seem to think they could help. Textbook authors have been resistant to add the anatomy, and ABOG refused to add it to board exams.
There are many barriers to change in medicine, many of which are discussed in The Patient Will See You Now. In this book, the author talks about the power of patients to change medicine. With the rise of social media, patients have begun to impact medical education and the standard of care. While change in medicine is typically very inefficient, a demand for change, led by patients, could make this happen faster.
In this case, there is nothing unknown. Knowing this anatomy merely requires a dead body and a scalpel. Getting it included in textbooks should be easy. The barriers here are social and cultural. If we can all acknowledge how important sexual health is, beyond reproductive considerations, we can get this changed.
ariesangel0329: This is really fascinating. Why would so many professionals be so unwilling to address these issues or even add them to textbooks or exams? Like is the clitoris that scary?
All joking aside, thank you for this. This honestly looks like the beginning of a great research paper or even a book. Maybe that’ll help get the ball rolling.
I remember reading the book Virgin by Hanns Blank and she said that people were aware the clitoris existed well before the 1990s, but it was buried and not really paid any attention. I can’t remember what century she said it was, but I highly recommend that book, especially because it might help you in your research.
Kyrias: Hey! You made an alt! At least you seem more stable on this account.
rocketlaunchr: Since when does men have more “rights to sexual health”?