The clitoris should be viewed as reproductive anatomy and given comparable coverage as the penis.

Currently 77 words on Medscape describe the clitoris. 3,425 describe the penis.

There is a pattern throughout medical literature of minimizing the clitoris and omitting any anatomical detail. This extends to other vulvar structures as well, as they are not seen as reproductive, and what’s not reproductive isn’t seen as medically important.

OB/GYN textbooks and journals give very little attention to vulvar anatomy and the physiology of female sexual function. Detailed clitoral anatomy was published in 2 OB/GYN textbooks for the first time this year, and it was a fight to get it included.

I’ve been trying to figure out how to change this for years. In the beginning, I was a coward about it. Having a UTSW medical student tell me “Detailed vulvar anatomy isn’t included in our curriculum because female orgasm isn’t medically relevant” really got me down. My own mother told me “Sexual function isn’t an OB/GYN’s business.” This was after an OB/GYN had cut the nerves of my clitoris in a surgery to which I did not consent. Clearly I was getting too emotional, so I paid a therapist several hundred dollars to read a paper I wrote showing that OB/GYN ignorance of vulvar anatomy and sexual function is pervasive. She asked, “What is the point of this?”

A lot of people seem to accept that the clitoris isn’t particularly important to reproductive health and that this is why OB/GYNs shouldn’t have to know it. I even had an OB/GYN friend of a friend from college tell me, “We shouldn’t have to know that because it isn’t relevant to what we do and we already have to know so much.” It isn’t relevant to what they do?

Female sexual pleasure functions to motivate human females to engage in sexual activity, aka reproductive activity. Pleasure is actually the number one reason female humans have sex. Reproduction, meanwhile, doesn’t even make it into the top 3. Reproduction, realistically, is a side effect of the human drive to have sex.

How do women end up reproducing when they don’t enjoy sex? The answer, of course, is that they reproduce only via sex they do not want to be having, that they do not enjoy. The denial that the clitoris is reproductive anatomy is a denial of female sexual agency. The only way humans would be reproducing in the absence of female sexual pleasure, which is experienced via the clitoris (both internal and external) is through rape or through some kind of social coercion effectively equivalent to rape. Thus, the clitoris and rest of the sensitive structures of the vulva should be seen as just as important to reproductive anatomy as any other anatomy.

If women had to choose between sexual pleasure and having children, what would most women choose? I think they would choose the former. So why is the vulva so neglected? Why are women content to seek care for their reproductive health from doctors who do not study detailed clitoral anatomy?

In this age of social media, patients have the ability to change this. ACOG, ABOG, and ACGME all have the ability to change OB/GYN training standards nationally. I’ve seen the pieces journalists have written about textbooks not containing accurate clitoral anatomy. But they consistently get their facts wrong and they never actually call out anyone responsible with the power to change it.

I wish I could get more people on board with the need for better coverage of vulvar anatomy. Instead, most people insist it is already covered well when it isn’t or that it doesn’t need to be.

I got 2 OB/GYN textbooks changed. But I want to see ALL OB/GYN textbooks changed, I want to see better coverage in general anatomy textbooks as well.

I’ll send emails to Medscape editors tomorrow. I can probably get through to them, but it feels frustrating making one tiny change at a time, not getting any credit, and having there still be a pervasive pattern of inequality.