Sexism in Sobatta Clinical Atlas of Human Anatomy
Anatomic detail for the clitoris, including nerves and vessels, is omitted.
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In the “Pelvis” chapter, there is a subsection for “Male Genitalia.” There is no subsection for female gentalia. The implication is male genitalia warrants it’s own subsection, but female genitalia does not.
Illustrations of vulvas show only women with an “innie,” where the labia minora do not protrude. But most women have labia minora that are visible when standing. According to the Gynodiversity Project, only 27% of women resemble the illustration.
All sagittal plane illustrations of the clitoris in Clinical Atlas of Anatomy are incorrect. They show the clitoris as if the glans and external segment of the clitoral body have been amputated. The glans and external segment of the descending clitoral body should be shown under the clitoral hood externally.
The tendency to portray the clitoris as smaller and more internal than it really is appears to come from a cultural suppression of female sexuality and fear of any sort of female phallus. However, such incorrect illustrations lead to ignorance among surgeons operating on and treating vulvas, putting female patients at risk of preventable harm.
Given how ignorance of clitoral anatomy undermines equitable female patient care, the following illustrations all require updates: 7.8, 7.16, 7.17, 7.18, 7.41, 7.52, 7.56, 7.107, 7.108, 7.118.
The clitoral body is approximately 1 cm in diameter on average and should be represented as such. In my study (Kelling et al.), the average length of the descending segment of the clitoral body was 3.7 cm. In Di Marino and Lepidi, it was 3.2 cm. Average reported glans lengths have ranged from 5–8 mm. The clitoral body and glans should be shown proportionately rather than minimized.
In both my study and Di Marino, most of the descending segment of the clitoral body was external under the clitoral hood. According to the Gynodiversity Project, the length of the clitoral hood is 34% of the length from the top of the clitoral hood to the forchette on average.
In contrast to sagittal plane illustrations featuring the clitoral body, transverse plane illustrations of the vulva, like Figures 7.42, 7.100, 7.101, 7.102, and 7.110, show excellent realistic proportions. It is important to recognize that the clitoris is external under the entire length of the clitoral hood.
The sagittal plane illustrations should simply be made consistent with the transverse plane illustrations, especially 7.102, showing most of the descending segment of the clitoral body external under the clitoral hood. An understanding of this anatomic relationship is critical so that surgeons do not cause damage to the clitoris in vulvar repairs, biopsies, and clitoral hood reductions.
The course of the dorsal nerves in the clitoris is missing from this schematic of the innervation of the female genitalia. The dorsal nerves enter the clitoral body where the crura come together and travel along the dorsum to the glans, as in the penis. The clitoris also has a cavernous nerve, which is essential for facilitating clitoral engorgement, yet it goes unmentioned. Female genital vascular engorgement is unacknowleged.
The course of nerves and vessels in the penis is shown. Equivalent details should be shown for the clitoris as well. The nerves in the clitoris are just as large and just as important to sexual response, which is a human right and important to overall health.
The “Structure/Function” of the penis is covered in detail. Equivalent details are not provided for the homologous female structures: the clitoris and labia minora. The arterial blood supply, venous blood supply, and innervation of the clitoris should be similarly described and shown. A cross-section of the clitoral body should be provided, showing all the same details for the clitoris.
Here is what a cross-section of a clitoral body looks like, for reference.
Though the course of nerves and vessels leading up to the clitoris is shown, the vessels and nerves in the clitoris itself are not.
Note the course of nerves and vessels in the clitoris.
In Figure 7.107, the clitoral body is shown smaller and more internal than it really is. The course of veins and arties in the clitoris are not shown.
In Figure 7.108, the clitoral body is again shown smaller and more internal than it really is. A woman with this little clitoral tissue protruding would necessarily be a victim of female genital mutilation. The course of the dorsal nerve in the clitoris is missing.
In Figures 7.114 and 7.115, by contrast, the course of nerves and vessels in the penis is shown. This same detail should be shown for the penis, especially given the nerves in the clitoris are just as large as the nerves in the penis, measuring 2.0–3.2 mm in diameter.
Helpful “Structure/Function” boxes are provided for a number of anatomical structures.
- The pelvic floor.
2. The anal canal.
3. The anal sphincter muscles.
4. The internal genitalia in women.
5. Peritoneal ligaments.
6. Tunnel of WERTHEIM.
7. Penis.
8. Innervation of male genitalia.
9. Deep perineal space in the female.
10. Deep perineal space in the male.
11. Nerves of the pelvis.
No “Structure/Function” boxes exist for female external genitalia. The following table suggests the authors are unaware the clitoris is involved in female orgasm. “Supports orgasm” under “superficial perineal nerves,” suggests the authors think women orgasm from their vaginas.
“Clitoris” is mentioned 36 times. “Vulva” is mentioned 5 times. “Penis” is mentioned 144 times. “Vagina” is mentioned 138 times.