Actually, maybe I should tell my story about why I don’t trust scientific “experts,” though I do trust science.

When I was 17, I trusted the peer-reviewed medical literature. It told me that protruding labia minora were “unfeminine,” “embarrassing,” “caused by excess androgens” (a false claim that arose from a hypothesis made in a case study being cited so many times it became a “fact”), and “caused by excess masturbation” (preposterous and unsupported). I read outcome studies which told me that there were “no serious complications.” I read, “no risk to sexual function.”

I went to an OB/GYN recommended as the best OB/GYN by the head of the department. He has won countless awards and been president of the Texas Medical Association. He completely removed my labia minora, performed a clitoral hood reduction without my consent, and cut the dorsal nerves of my clitoris, rendering the distal body and glans insensate. Though I have visible scars proving what he did, to this day, he insists I must have had a second surgery or done it to myself.

In the years after my surgery, I was very confused, as I had been a clueless virgin who could not find my clitoris. I knew I’d lost sensation, but I didn’t really understand what had happened. I thought it was my fault. I was repeatedly told by multiple OB/GYNs I expressed my concerns to that my surgery could not have affected my sexual function.

The way I figured out what happened was I did research myself. I realized that no, it does not look normal to have your labia minora completely amputated. I realized that I had scars reaching up into my clitoral hood, from a surgery to which I never consented. I realized I did not have sensation distal to those scars. I looked up studies of the distal course of the dorsal nerve — anatomy consistently omitted from OB/GYN journals and textbooks. I learned that, though the possibility had never been mentioned in peer-reviewed literature, the dorsal nerve is clearly put at risk during clitoral hood reductions. I went to a urogynecologist. I showed her my scars, and I explained to her what happened based on the research I had done. She told me she thought I was right.

To this day, 13 years later, the dorsal nerve has never been mentioned in peer-reviewed medical literature on vulvar cosmetic surgeries. Outcome studies still report that no one gets hurt. There are methodological problems and bias. The ACOG committee opinions contain factual errors. They approve these surgeries for women even under 18. They do not offer CME to help keep patients safe from untrained surgeons. ABOG refuses to add clitoral neurovascular anatomy to board exams. ABOG and ACGME certify OB/GYNs are qualified to do these surgeries based on residency training.

Clitoral neurovascular anatomy is omitted from nearly all OB/GYN textbooks (only barely shown but not described in Williams Gynecology and Williams Obstetrics). It is absent from all high impact OB/GYN journals. Yet the director of ABOG himself has reassured me it is in their “textbooks and atlases.” He is so ignorant he does not know what he does not know.

So tell me, at what point was trust in any expert warranted?

I am no one. But what I have to say is more correct than what the director of ABOG has to say. And why is he wrong? Hubris. Why is he so resistant to just add the anatomy to board exams? Financial reasons. And why does ABOG certify OB/GYNs can do surgeries they are not trained to do? Financial reasons.

And what incentives do I have for trying so hard to spread the actual truth? None but to protect others. So who is right? And how can people know I’m right? All they have to do is look at the medical literature.

But one problem is that most of the public does not have access to medical literature. How can I prove to the public that clitoral neurovascular anatomy isn’t in OB/GYN textbooks and journals when they don’t have access? I can show them it is incorrect, but posting examples of incorrect anatomy in textbooks has had little effect for some reason.

I’m nearly positive OB/GYNs make more money from female genital cosmetic surgeries than they do for any other procedure. But there is too much controversy around them for professional organizations to establish training standards. The public doesn’t know what’s going on. And this is key

Most of the public doesn’t know how medicine works. The public just sues their individual doctors when they get hurt. But the only way to have a decent case is to show that your doctor isn’t following the standard of care. If the standard of care is negligent, you don’t have a strong case. How trustworthy is a system without effective negative feedback? How trustworthy is a system where those responsible for the standard of care are not liable?

Fuck this pledge. The safety of countless women actually depends on people hopefully believing a “random blogger.” The truth is on my side.

I did quote an expert — arguably the biggest expert on vulvar anatomy in the U.S., but she told me to take down what she had said. Do you know why? She doesn’t want to be seen as saying anything negative about her colleagues.

The biggest regrets I have in my life are trusting doctors and trusting medical literature. I have looked back so many times and beat myself up for being naive and stupid. Even when I was clearly harmed, I trusted them beyond what reason would dictate. If people are no longer trusting scientific authorities, I think this is a good thing. At this point in time, they are not worthy of our trust. Information quality in medical literature is horrible, and when I email authors and editors of textbooks and journals about errors, they do nothing.

I also realize medicine depends on patient trust. So many things depend on trust in expertise, trust in authority. But just because it is necessary for systems to function optimally doesn’t mean it is deserved. If the public is no longer trusting of scientific authority, scientific authority needs to change. This pledge should not be to trust experts. What is needed is for experts to pledge to operate according to a higher standard. And for that, we need a complete overall of the entire healthcare system. Financial incentives need to be completely realigned.