I’ve written about this in some of my other articles. This is challenging for me too. The answer is clear in the arguments I get from people about why it shouldn’t be covered and in how much I get dismissed or ignored when bringing it up.

1. The clitoris doesn’t play any known role in conception. Doctors have just begun taking female sexual response seriously pretty recently. But anatomy and physiology are still neglected.
2. Pervasive ignorance in the lay population. I have brought this to the attention of journalists, and I have posted it on Facebook. Even with cadaver dissections to show what is missing, people are thinking its fake news.
3. Pervasive ignorance among doctors. Some doctors opposing what I have to say have demonstrated an inability to differentiate between the glans and the body of the clitoris.
4. Due to pervasive ignorance, they think they already know it. One discredited me on Twitter. A number of doctors chimed in insisting they know it. It’s hard because some do. But this can’t be very common given the exclusion from the literature. That’s why I changed the title of my main article from saying they don’t know it to that it is simply omitted from their literature.
5. People don’t see what isn’t there. This has been very hard to understand, as to me, the omission has been obvious since I first started looking for the anatomy. I became so angry at residents and medical students for not seeing the obvious back in 2012 that I quit for a while. I couldn’t understand how they weren’t noticing and speaking up about this problem. One textbook author said he just didn’t realize he left anything out.
6. O’Connell thinks there was a conscious deletion that occurred in the early 20th century. This was likely due to Freud’s theory of vaginal orgasm.
7. There is an analysis of medical textbook content over the course of the 20th century that shows rises and falls of coverage with feminism and subsequent backlash.
8. Lack of interest. This is hard to explain, but doctors just are not interested, likely for the other reasons I’m saying. One 4th year going into OB/GYN explained that female sexual function just isn’t as “intellectually intriguing.” He’s just not interested.
9. Discomfort with ideas of active female sexuality. Female sexuality is framed as passive. The clitoris is understood as a passive organ when it isn’t, and it seems to be a reflection of that.
10. Discomfort with female external genitalia due to conception of female genitalia as an absence.
11. Men have historically not liked what the external clitoris says about the role of their penis in giving sexual pleasure. But if they were smart, they’d research the biomechanics of the vulva to prove that penetration does result in indirect stimulation of the external clitoris and internal clitoris.
12. Unwillingness to acknowledge there is any problem. Doctors are effectively trained to defend the status quo at all costs. They will say they already know it, and upon getting convinced they don’t, they will come up with reasons why they shouldn’t have to know it.
13. They think they already know too much and shouldn’t have to know more.
14. They don’t believe this anatomy is relevant to their practice. I wish I’d taken a hidden mic or hidden camera to the ACOG convention for this reason.
15. The approach to female sexual function focuses on psychology. Physiology and anatomy are neglected. This goes with perceptions that women are emotional and not sexual. Research on female sexual function tends to be very bad due to the conflation of physical and psychological barriers. As an example, my clitoral glans and some of the shaft (external body) was denervated — a result equivalent to FGM involving the clitoris. No man will ever be able to give me an orgasm, I cannot feel cunnilingus, I need a vibrator to orgasm because my clitoris is only sensitive at the base of the shaft. But I score a 31 on the female sexual function index. A 26.5 (or so) or less is necessary for a diagnosis of sexual dysfunction.
16. Medicine is set up so that it changes extremely slowly. Changing even the smallest thing takes a lot of effort.
17. OB/GYNs at the ACOG convention basically all told me they can’t do anything about it. They are too busy.
18. They claim they don’t have room for it in their textbooks.
19. One response to an another article said thinking about clitoral action potentials was a “boner killer.” This is likely part of the cause.
20. Historical male domination of medicine, though it is certainly difficult to understand why men would choose to actively delete this part of a woman’s body during the 20th century.
21. Puritanism. I started trying to change this in 2010 but struggled to talk about it. My mom asked why I was “so obsessed with sex.”
22. Mary Roach talks about obstacles to research in female sexual function in Bonk. Basically if you study it, people think you’re a pervert, more so than with men.
23. Apathy. There is this idea that it’s no one’s problem or responsibility to change. You see that with Claire Yang, though she is an expert and well aware of this gap. She didn’t want me quoting her email that said female genital anatomy was of low interest to OB/GYNs.
24. Due to ignorance in the lay population, patients seeking help for female sexual dysfunction and/or seeking surgery do not demand their doctors to know this. This may be the cause on some level.
25. It is generally assumed that injuries do not happen to the clitoris. This is false. If you crunch the numbers, even if clitoral tears happen in only 0.1% of live births, that would mean 4,000 women per year in the US. I have not done much research on this.
26. People think the clitoris is not involved in any health issues. This is false.
27. Female sexual pleasure and orgasm is seen as a bonus rather than requirement. Women do not feel entitled to sexual pleasure. This could be part of it.
28. The belief that the clitoris was essential for female sexual response was relatively controversial until recent years. Even the most recent edition of Te Linde, the “bible” of GYN surgery, says that “sexual function seems satisfactory” after cutting the nerve supply to the glans. They say, “a lack of glans innervation does not seem to affect sexual behavior.”
29. There is a focus on penetrative sex. Sexual function is often defined in the literature as meaning the ability to be penetrated. For example, I previously found instances where doctors described patients returning to “normal sexual function” after radical vulvectomy. Can you imagine doctors saying that men can return to “normal sexual function” after their dicks are cut off?
30. There is a focus on “satisfaction,” which is a psychological variable. The safety and efficacy of genital surgeries is judged based on satisfaction. OB/GYN textbooks say, “orgasm may not be important to female sexual function.”
31. There is a motion that anorgasmia is “normal” and “not clinically relevant unless the patient is distressed. So again, we are focusing on psychology. Often psychological issues are the culprit, largely due to slut shaming and to pervasive ignorance about female anatomy and sexual function.
32. People want to see victims for anything to be considered important. But when it comes to female genital cosmetic surgeries, for example, there aren’t even numbers for how many are done much less how many people are harmed. Outcome studies are biased because they are done by experts evaluating their own results. One plaintiffs attorney said getting a jury to understand would be too difficult, due to ignorance in the lay population. Pervasive ignorance means harmed patients get gaslighted, told it couldn’t have happened, etc. An expert witness would not likely know the anatomy well. There is significant financial incentive to prevent people from knowing about cases where people are harmed.
33. Unquestioning faith in doctors. The public will automatically ignore what I have to say because they assume it can’t be true.
34. Try sharing my articles with your friends and see what they say. You will get answers in how they respond.