Health

The needless omission of clitoral anatomy from medical textbooks

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Jessica Pin

All the following pictures make my blood boil.

From Gray’s Anatomy: Anatomical Basis for Clinical Practice, in which the neurovascular anatomy of the clitoris (in the clitoris, not just leading up to it) is not covered, but microscopic anatomy of the penis is:

From Te Linde’s Operative Gynecology:

From Haram and Baggish Atlas of Gynecologic Surgery:

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In all the above illustrations, and throughout OB/GYN literature, the innervation and vasculature of the clitoris are omitted. There are many more just like these. If you’re thinking detailed anatomy must be included elsewhere in these texts, you are mistaken. It is simply missing.

Pervasive ignorance of this anatomy among doctors, especially OB/GYNs, didn’t just lead to the denervation of my clitoris in a clitoral hood reduction performed without my consent. It also led to multiple OB/GYNs and even urologists telling me, “That couldn’t have happened”, when I explained I had lost sensation. I had to explain to the biggest sexual medicine expert in the country how it could.

You’ll see that nerves and vasculature leading up to the clitoris are shown. But would you consider this comprehensive anatomy of the penis? As you can see, the course of nerves and vasculature leading up to the penis is shown here. Would you consider that sufficient?

No, you wouldn’t. And why is that? It’s because you recognize that the anatomy of the penis itself is important. Well so is the anatomy of the clitoris.

Even when the anatomy of the clitoris is shown, it is incorrect. This is something I didn’t personally realize until I got to dissect clitorises myself. The clitoral body is far longer (3.5 cm on average) than these illustrations from Netter imply. The nerves, which are 2–3 mm in diameter inside the clitoris travel along the entire length of the clitoral body about half the time. Other times, they begin terminally branching before reaching the glans.

Also, note how the vagina is exaggerated and the clitoris is minimized in these illustrations. This speaks volumes about what parts of female genital anatomy are considered important and why (delivering babies and pleasing men). This is where you are much better off looking to porn for what vulvas and vaginas really look like.

Here are my illustrations which show what is missing. Pardon my novice artistic skills. I made the clitoris brown and the clitoral hood and labia minora pink. The yellow lines are the nerves. The red and blue lines are vessels. I made a point to draw the vagina very small, as it is not my focus, and my vagina personally does not gape open. My goal is not to draw someone who has just been fisted:

Here is also a cross-section I drew. You will find nothing like it for the clitoris in medical literature (except maybe in a couple of urology journal articles about GRS, where it is incorrect).

For those who don’t believe me, here are the nerves shown dissected out from their course inside the clitoral body. I made it into a cartoon so it would be less disturbing to people who don’t like looking at dissected body parts.

Again, these nerves are omitted from OB/GYN textbooks. While all doctors learn the homologous anatomy of the penis in medical school, they will be reticent to upvote this answer because they feel too “out of their element”. Nearly all doctors are “out of their element” when it comes to vulvar anatomy, including those doing surgery on it. That is exactly my point.

Here is one graphic presented at a sexual medicine conference, which somewhat illustrates what’s going on:

The good news is some doctors I contacted last year are finally speaking up about this.

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