Why does OB/GYN leadership insist anatomy absent from nearly all their literature is taught in residency programs?

I just got this extremely exasperating email from the Executive Director of the ACGME Review Comittee for OB/GYN. ACGME, Accreditation Council for Graduate Medical Education, has the ability to set standards for OB/GYN education. Unfortunately, though the nerves and vasculature of the clitoris are absent from all OB/GYN textbooks and journals (except in one article where incorrect and in Williams, where rudimentary, and only as of 2016), ACGME insists OB/GYNs learn this anatomy and refuses to acknowledge any problem.

I also previously exchanged emails with the director of ABOG, who ultimately responded the same way. He even made false assurances regarding the content of OB/GYN literature, which is very concerning, as most of the public does not have access to medical literature and has to simply trust their doctors to know what they claim to know.

There is some bizarre psychological phenomenon getting in the way of doctors acknowledging what they don’t learn. Ignorance of vulvar anatomy and sexual function in general is pervasive in their literature across the board. I previously wrote 200 pages analyzing every case, thinking if I built up enough evidence, they could not disagree. But no one wants to read 200 pages, and people seem to be impervious to even the most compelling evidence.

Now I’m just trying to focus on one blatant problem: the omission of clitoral nerves and vasculature from OB/GYN textbooks and journals. The biggest hurdle I’m facing isn’t getting them to acknowledge that clitoral anatomy is important; it’s getting them to acknowledge that clitoral anatomy isn’t already there. Imagine if only the internal course of nerves leading up to the penis were understood to constitute “neuroanatomy of the penis.” Imagine if textbook anatomy for hand surgeons ended at the wrist.

Really important, very large, nerves travel above the tunica along the descending segment of the clitoral bodies (shaft), leading up to the glans. They are only covered by a very thin layer of fascia, and the clitoral hood (which proximally is clitoral shaft skin). Injuries are possible, so GYNs doing repairs should know them. GYNs performing vulvectomies for treatment of vulvar cancer should know them. GYNs performing clitoral hood reductions should know them as well, as they are put unknowingly at risk.

Though the nerves of the clitoris are never shown in diagrams in GYN textbooks, sometimes they are mentioned. Te Linde, for example, leaves out the nerves and vasculature of the clitoris from the chapter on Surgical Anatomy of the Female Pelvis. Later, the authors write, “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.”

Are there any OB/GYNs who would be willing to email ABOG, ACOG, and ACGME regarding this problem? Is there any way GYNs could start speaking up to residency program directors where they were trained?