OB/GYNs, please help improve education in clitoral anatomy
The clitoris is important to women’s sexual health, and women’s sexual health is important to OB/GYNs. This is why we all would expect to see detailed clitoral anatomy in OB/GYN textbooks and journals. Unfortunately, there seems to be a legacy of omission, no doubt leftover from when OB/GYN was male-dominated and talk of female orgasms was taboo. But it’s 2018! So let’s change this!
My father and I are doing a dissection study, with the help of his plastic surgery residents, which we can hopefully publish in a plastic surgery journal soon. We are hoping to get clitoral anatomy disseminated in plastic surgery literature this way.
It would really be great if OB/GYNs would take an interest in getting detailed clitoral anatomy disseminated in OB/GYN literature. Maybe publishing a study in an OB/GYN journal would help.
Currently, typical OB/GYN textbook illustrations show the dorsal nerves of the clitoris incorrectly terminating prior to entry to the clitoral body. In reality, according to the most detailed study of the clitoris to date, these nerves, which are about 1–4 mm in diameter (hard to believe but this is what we measured in our 7 dissections), travel for about 3 more cm in the clitoral body, above the tunica, until termination at the glans. The omission of the neural anatomy of the clitoris itself appears to indicate a gap in OB/GYN education.
Knowledge of this anatomy is important for the informed treatment of sexual dysfunction, and for safe surgical practice, including safe repairs. Ignorance of this anatomy is a threat to patient safety.
Please consider that my clitoris was denervated in a clitoral hood reduction, thanks to ignorance of the distal course of the dorsal nerves. In the wake of my surgery, I was repeatedly told my surgery could not have affected my sexual function so I had to turn to studies of the dorsal nerves in the urology literature to know I was not crazy. My friend’s dorsal nerves were also injured, leaving her with chronic pain and anorgasmia. Her surgery was only supposed to be a repair after injury sustained during sexual assault. We are trying to find more victims like us to show there is a systemic problem.
Iatrogenic dorsal nerve injuries can be prevented with better education. Consider that even general anatomy textbooks show more detailed anatomy of the clitoris than can be found in OB/GYN literature. At the very least, shouldn’t OB/GYN surgery textbooks be on par with Netter? The innervation of the clitoris is highlighted in blue for clarification.
Maybe shouldn’t they show as much detail as a urology textbook (Smith and Tanagho)?
I have tried contacting at least 20 authors and editors for a number of OB/GYN textbooks — Williams, Te Linde, De Chearney, Lentz, Baggish, Hacker, etc. Unfortunately, because I am not a doctor, I rarely get a response. The most receptive current author, was Dr. Marlene Corton, who writes for Te Linde and Williams. Unfortunately, she insisted the nerves get too small and difficult to dissect once they enter the clitoral body. They really are actually quite large and easy to dissect.
Look how large they are going into the clitoral body. Is this where you would stop dissecting? We have taken much better photos for our study that show the course of both nerves, viewed from above, all the way to the glans (with some branching).
The following photos don’t seem to show the nerves as large or as dorsal as they were in the clitorises I have dissected. But you can see how they extend along the clitoral body.
Also, wouldn’t it be great if there were illustrations of the clitoris showing a cross-section, like this? We actually got a few awesome photos of cross-sections where you can see just how big the nerves are relative to the clitoral body.
Here are some prettier ones.
I think it would really help if OB/GYNs could please email textbook authors to request this anatomy be covered. It would also be really great if it could be added to board exams as well. Previously I emailed the executive director, president, and multiple other directors at ABOG about this but was unsuccessful. I also have emailed the president and other leadership at ACOG, as well as the OB/GYN committee director for ACGME. It would really help if OB/GYNs could help contact leadership as well.
If you still are not convinced, please consider also that a knowledge of anatomy is considered fundamental to understanding the function and dysfunction of any organ.
Why is it that detailed anatomy of the penis is always shown in literature on male sexual dysfunction but detailed vulvar anatomy is not shown in literature on female sexual dysfunction?
How equipped are OB/GYNs to diagnose and treat physical causes of female sexual dysfunction when their literature is lacking coverage of detailed anatomy, physiology, and biomechanics?
Is it right that female sexual response is typically only discussed in OB/GYN textbook chapters on “emotional aspects” and “psychosocial issues”?
I hope that some OB/GYNs can agree there is a problem here.