Dear OB/GYN Residency Program Directors,
We are writing to request that your residency curriculum include detailed clitoral anatomy, including internal structure, nerves, and vasculature. Included is our study of the innervation of the clitoris to help clarify what we are referring to.
Hopefully, you have seen the study by Jackson et al., published in the AJOG last year.1 Since this was the first representation of detailed anatomy of the clitoris in OB/GYN literature, we are concerned this material may not yet be included in your residency program curriculum.
Until last year, detailed clitoral anatomy was not in OB/GYN textbooks or journals. It is now in new editions of Te Linde and Williams. Our hope is that this inclusion can become standard in OB/GYN literature and curricula moving forward.
There has honestly been insistence from some OB/GYNs that this anatomic detail is not essential, but we would argue otherwise. The clitoris is the primary somatosensory organ in female sexual response. As such, it is extremely important to women’s sexual health, which should be important to all OB/GYNs.
Knowledge of clitoral anatomy is imperative for preservation of female sexual function in a number of procedures OB/GYNs perform. It is relevant to the treatment of genital infections, cysts, vulvar neoplasia, and complications with piercings. It is also relevant to biopsies and clitoral hood reductions, often performed with labiaplasty, in treatment for hypertrophy.
Additionally, injuries to the vulva do occur in surgery, during childbirth, and in straddle accidents. OB/GYN’s need to be able to recognize such injuries, repair them safely, and/or refer patients to physicians more qualified. Given the size of the dorsal nerves in the clitoris, repairs are possible if injured.
It is imperative that residency training empowers OB/GYNs to perform all surgeries they are considered qualified to do safely. Currently, OB/GYNs are considered qualified to do all female genital cosmetic surgeries according to the American Board of Obstetrics and Gynecology’s recommendations to ambulatory care providers. As such, even if your program does not fully endorse this type of surgery, the residents should at least be versed in the surgical anatomy.
Clitoral anatomy should be taught to all physicians who treat vulvas just like penile anatomy is taught to all physicians who treat penises. According to anatomical research and testimony from plastic surgeons who operate on genitals of both males and females, the dorsal nerves in the clitoris are at least as large as the dorsal nerves in penis. It would seem inequitable for clitoral nerves to be excluded while penile nerves are ubiquitous.
We hope we have respectfully persuaded you to include detailed clitoral anatomy in your residency curriculum. Please let us know if we can provide further information.
Sincerely,
Dr. Paul Pin and Jessica Pin
1. Jackson LA, Hare AM, Carrick KS, Ramirez DMO, Hamner JJ, Corton MM. Anatomy, Histology, and Nerve Density of Clitoris and Associated Structures: Clinical Applications to Vulvar Surgery. Am J Obstet Gynecol. 2019.