Review: Hacker and Moore’s Obstetrics and Gynecology, 6e
I wrote to the authors of this textbook. One responded:
“Jessica, let me review some of this material. We sill be starting the 7th edition soon and I am totally open to any improvement that we can make for the better education of students, residents and practicing OB/GYNs. Regards, Joe.”
I get really discouraged trying to contact OB/GYN textbook authors and leadership because I get so few responses. This just shows it is possible to make a difference by reaching out to people.
Unfortunately, the other main author for this textbook explained he does not think clitoral neurovascular anatomy should be included in a general OB/GYN textbook. He did not comment on his choice to devote more space to male response than female sexual response. Apparently he thinks male sexual response is more important to include in an OB/GYN textbook than detailed, accurate clitoral anatomy. His name is Neville Hacker. His email is public and can be found in affiliation with articles he has published.
Allegedly this is the “#1 choice of OB/GYN residents and medical students.” This review is of the most recent edition (2015).
1. Contains more about male sexual response than female sexual response.
This book devotes more space to the male sexual response cycle than to the female sexual response cycle. This section is viewable in Google books.
2. Illustrations of the female sexual response cycle depict the clitoral body incorrectly.
There is a consistent failure to recognize how much of the clitoral body is actually external. This appears to come from a general fear of female external genitalia and possibly a fear of how much the clitoris resembles a penis. Any owner of a clitoris can check this by feeling its protrusion under the clitoral hood. Also, the angle of the clitoral body is acute, and while the angle increases with arousal, it should not increase this much. If there is any case where this has been shown to happen, someone please provide evidence. Regardless, significantly more of the clitoral body is external than these diagrams imply. Diagrams that show the clitoral body as primarily internal minimize the degree to which the nerve supply to the glans is at risk.
3. Illustrations of the clitoris are incorrect
The body of the clitoris has two parts: an ascending segment, and a descending segment. OB/GYN textbooks often get this wrong despite the fact that this can clearly be seen in MRIs and cadaver dissections. As usual, the size of the clitoral body is minimized and the size of the vaginal opening is exaggerated.
4. The course of the dorsal nerve of the clitoris in the clitoris itself is not shown nor described.
Note again that the course of the dorsal nerve in the penis is always shown, even in patient education materials and on walls in clinics. Note also that anyone who believes that the glans of the clitoris has as many nerve endings as the glans of the penis must also, by logical deduction, believe the dorsal nerves are equal in size to that of the penis.
5. Function of the labia minora not discussed.
The consistent failure to address functions of the labia minora contributes to careless approaches to female genital cosmetic surgeries. Also, as a consequence, OB/GYNs commonly publish (and inform patients) that the labia minora play no role in sexual function. This leads to violations of ethical principles of informed consent.
6. No discussion of how injuries can affect sexual function.
This is a consistent pattern in OB/GYN textbooks. It becomes especially senseless when one considers the degree of physical trauma women go through with childbirth. It is also injudicious to not discuss iatrogenic causes of sexual dysfunction in textbooks where genital surgeries are described. Furthermore, according to this textbook, 40% of female victims of sexual assault sustain injuries. Are we to believe these injuries never involve genitalia and never affect sexual function?
6. There is tons about how emotional women are.
As is typical, emotional considerations seem to trump physiological and anatomic considerations, especially when it comes to female sexual function.
Honestly, these reviews are exhausting and depressing. People keep insisting OB/GYNs do know detailed clitoral anatomy, but this is not supported by the content of their textbooks or journals.