Review of Te Linde’s Operative Gynecology, 11e

“A lack of clitoral sensation does not seem to significantly affect the later sexual behavior of patients treated by procedures that sever the dorsal nerves to the glans.”

This is considered the “bible” of gynecologic surgery. The latest edition was published in 2015.

1. No description or illustration of the course of nerves in the clitoris

The distal course of the dorsal nerves is neither shown nor described. These are large nerves that travel above the tunica, along the body, largely intact until termination at the glans. The former author of this chapter was very nice in that he explained he did not leave this anatomy out on purpose. He just did not realize it was missing. He connected me with the new author of this chapter, who hopefully will be including this in the next edition.

“This was not a purposeful omission, but rather the result of each of us over the years revising what has been in the chapter for many years and not looking for things that weren’t included that should be.” — Dr. John DeLancy.

2. Authors say cutting innervation to the glans of the clitoris is no big deal

As someone who has actually suffered a dorsal nerve injury, I can tell you this is an extremely big deal. It is also functionally equivalent to amputating the glans of the clitoris.

Note how the focus is on “sexual behavior,” as if all that really matters is whether a woman is sexually available to her partner. Note this is the only mention of the dorsal nerves of the clitoris in this entire textbook. They further note that “sexual function seems satisfactory” after intentional denervation of the glans.

3. As usual, sexual function is covered in a chapter on psychology

Sexual function is discussed in a chapter entitled, “Psychological Aspects of Pelvic Surgery.” This pattern of discussing sexual function only in chapters on psychology is consistently observed in OB/GYN textbooks. Note that this is never the case with male sexual function. This is sexist.

4. “Feminine role as givers of pleasure”

Hopefully it goes without saying that the view of women’s sexuality as being primarily about giving men pleasure is problematic. This view is echoed in women’s magazines and in orgasm gap statistics. This is a gender inequality issue. We cannot truly be equal in society when our pleasure is constantly of secondary importance.

5. Minimization of importance of the clitoris

I would very much like to hear from women who have had their external clitorises completely removed (with no residual stump) regarding whether they can still orgasm.

6. Female sexuality is all about receiving validation from others

What about her capacity to receive pleasure? Why is that not central?

7. Female sexuality is all about “ body image,” not about functionality

Consider this text in light of later notes about how denervating the clitoris is not big deal.

8. No discussion of innervation or function of labia minora

9. Themes of body image and penetrability being of primary importance.

Note how the very first consideration is “capacity for intercourse” not orgasm. Note how a “marked sense of disfigurement” comes before “reduction in genital sensitivity.”

For those unfamiliar with “radical vulvectomy,” this is what it entails. For all women out there, if this was done to you, would you be primarily concerned about whether you can still have intercouse with your fully intact vagina? Would you be more concerned with a feeling of disfigurement than with the objective loss of erectile tissue?