She didn't want a hole punch near her genitals.
She hesitated when a gynecologist recommended a vulval biopsies to check for signs of cancer. The doctor suspected that the patch of skin next to her clitoris was a benign condition called lichen sclerosus. Taking a chunk out of a nurse's sensitive body part sounded extreme to her.
In the end, she agreed. She was a nurse, he was a doctor. She thought he was in charge of this part of the body. She asked to be identified by her first name to protect her privacy. I wasn't really clued up.
She was given a epidural and placed in stirrups for the procedure. The doctor pressed hard against her vulvar, the outer female genitalia, to stop the bleeding. She felt the pressure against her pubic bone during the anesthesia. She made a loud noise.
She realized that she couldn't orgasm when she was with her boyfriend. She could get aroused, but at the moment of no return she was done. That is how it is.
She said that her gynecologist thought that she was experiencing numbness caused by scarring and that it would go away in a few days. The thing didn't. After being alarmed, Gillian began to see specialists in order to find an explanation and a solution.
She found out that nobody wanted to talk about her clitoris.
She said that a urologist compared her to a rape victim after she heard about her injury. She was diagnosed with "perimenopause" and prescribed testosterone cream. An O shot is a vaginal rejuvenation procedure.
She was met with blank stares when she tried to return the conversation to her clit. They looked at me and thought I was crazy. It was like they did everything but acknowledge the clitoris when I said there was something wrong with them.
Some urologists think the vulvar is similar to a small town in the Midwest. Doctors don't look up on their way to the uterus or the cervix. That is where the real medical action takes place.
The clitoris is a local roadside bar that is not well known. Rubin is a urologist and sexual health specialist in Washington D.C. There is no medical community that is in control of the research or the diagnosis of the condition.
Rubin replied, "nothing that sticks out to me." It would be a side note if anyone mentioned it.
She learned how to look at the clitoris on a sexual-medicine fellowship. She learned that the clitoris is a deep structure made up of a lot of tissue from the sex organ.
Rubin has become Washington's premier clownologist. The joke is that few are vying for the title because of embarrassment, a lack of knowledge or fear. She said doctors like to focus on what they know. We don't like showing weakness because we don't know anything.
Patients are affected by this near-universal avoidance. Doctors overlook sexual health conditions when they don't examine the clitoris and vagina. When the hood of the clitoris sticks to the glans, it can cause irritation, pain and decreased sexual pleasure.
According to the authors, all health providers should check out the clitoris. It was difficult as most providers don't know how to examine or feel comfortable examining the clitoris.
Women, trans men, and other people with vulvas could be harmed by this oversight. Pelvic mesh surgeries, episiotomies, and hip surgeries have been documented to cause injuries to the clitoris. A labiaplasty, a procedure to reduce the size of the labia minora, can also damage nerves, leading to genital pain and loss of sexual sensation.
Rubin said that doctors should spend more time getting to know the clitoris in order to prevent many of these injuries. She made this point to a roomful of mostly male doctors at the annual convention of military urologists in Palm Springs, Calif. She was the best lecturer at the conference.
She insists that this is just biology and not magic. In her office in Rockville, Md., in early July, she talked about the mythical area that is supposed to give her orgasms. You should be aware of what is happening.
We don't know why. The clitoris is involved in female pleasure and orgasm. In the past, those themes have not been considered appropriate areas of medical pursuit.
In fields like urology, where male sexual pleasure and orgasm are considered important, women's sexual health is seen as hysteria, according to the education chair of the International Society for the Study. Quality of life and sexual health are not priorities for women. Viagra has brought in tens of billions of dollars to Pfizer since its introduction in 1998.
Fertility and preventing disease are the main focuses of gyno. Dr. Grimstad is a gynecologist at Boston Children's Hospital. From a preventative standpoint, we talk about it. We are trying to prevent STDs. Unless you are trying to get pregnant, we are trying to prevent pregnancies. We don't discuss sex.
Dr. Helen O'Connell was Australia's first female urologist. In the 1985 edition of the medical textbook, a cross-section of the female pelvis was not used, and parts of the female genitals were described as poor. The penises were described for pages. Her peers worked to preserve nerves in the penis during urology surgeries but not during surgery on women.
Magnetic resonance and microdissection were used to investigate the clitoris. In 2005, she published a study showing that the head of the penis is just the tip of a much larger clitoris. The organ consisted of two bulbs, two arms and a shaft.
She warned that surgeons working in this region risked damaging the nerves that carry pleasure and orgasm. Things are potentially in the crossfire in certain surgeries. You have to be thinking of what is underneath and what is hidden from view.
Women are talking about injuries they sustained during procedures. The other is Julie, a 44-year-old office manager in Essex, who lost her ability to orgasm in 2012 after having a hip operation. She used her first name only to share her story in The Telegraph.
During a call in January, Julie said she woke up from anesthesia with a pain in her clitoris. She was told by her surgeon that it was just a bruise. She didn't orgasm for a few months. She said it was like someone had pulled a plug out of the sockets. Everything ceased to exist.
It took two years for the internet to discover that a post placed between her legs during the operation had crushed her clitoral nerves. The perineal post is known to cause nerve damage, but it wasn't mentioned on her consent form.
When Julie lost her sense of taste and smell, she compared it to being injured and not having a sense of taste or smell. She still can't believe it's been 10 years. I haven't come to grips with it.
She is still trying to figure out what happened to her. Was it the procedure to remove a body part? Her gynecologist applied a lot of pressure afterwards. She resigned herself to the fact that she might never recover from that sensation. She said that this changed her entire life. You can't fix the damage from this. It has never been done ever.
The nerves of the clitoris are about three millimeters in diameter, and Dr. Blair Peters was surprised to see how big they were. The sensory nerve of the index finger is small.
When I attended medical school, we didn't learn much about the clitoris beyond the fact that it exists. He said that he developed a bias that it wouldn't be a superapparent structure. However, it is.
Dr. Rubin is helping expand medicine's map of this terrain by ensuring that what happened to Julie and Gillian doesn't happen again As part of his efforts to improve sexual sensation for phalloplasty patients, Dr. Peters recently magnified clitoral nerves. It was embargoed until he presents his findings at a conference later this month, but the number he found was more than 8,000.
Victoria Gordon, a medical student at the Kansas City University of Medicine and Biosciences, led a study that sought to define a "danger zone" for plastic surgeons to avoid. She noticed that clitoral nerves sometimes branch out into fine tendrils, which were not previously described in the literature.
The finding was published in a plastic surgery journal and she hoped that other plastic surgeons would follow it up. She said that she didn't think she should have to do the project. No other person is.
The clitoris is not the only part of the body that needs to be seen by doctors. When she came across a Medium post by a woman in Dallas, Jessica Pin, that sounded eerily similar to hers, she searched online to understand her injury. Ms. Pin had a labiaplasty at the age of 18.
A key oversight that Ms. Pin believed left the clitoris at risk in a number of procedures was the lack of representation of the clitoris' nerves. She wrote that the omission was caused by a lack of regard for female sexual response.
The person was interested. She said that she was the only one talking about it. The woman received a message.
Ms. Pin started a social media campaign to get updated training standards for OB- GYN. After helping build her followers, she joined Ms. Pin on the social media platform. She received hundreds of queries from all over the world from people who had lost their sexual sensation as a result of medical procedures.
She said that she couldn't give the medical advice that many of them wanted. She closed her account after 6 months. She goes to doctors' offices to drop off posters of clitoral anatomy. She pays close attention to the genitals in her work with older patients.
Ms. Pin kept pressing. She has been trying to get the diagrams of the clitoris and its nerves updated. She racked up over 160,000 followers on TikTok and was invited to be a guest on The Daily Show withTrevor Noah. She and her father published a study on clitoral nerves.
Her methods are controversial. She has been accused of harassment because of her attempts to reach gynecologists and anatomy textbook authors.
She said she wants to be done after four years of campaigning. If doctors started talking about this, it would be amazing. She said that the fact that a few medical professionals have is significant.
Every patient in Dr. Rubin's office is given a tour of their own vagina. The white sheet draped over a patient's legs is a convention that Dr. Rubin believes helps keep women's "private parts" out of the public eye. Rubin starts by showing her patient the mirror that she will be using to examine her body.
Dr. Rubin points out the labia minora, labia majora and vaginal opening to her patient as they follow her. She uses the clitoral hood to check for skin conditions. The exam takes less than 5 minutes. She told the 62-year-old woman that they were going at her pace. You are the leader of this show.
Rubin and her colleagues believe that their field is in a good position to promote clitoris and female pleasure. According to Barbara Chubak, a urologist at the Icahn School of Medicine at Mount Sinai hospital in New York, "urologists are all about the phallus."
By definition, clitoral anatomy should be a urologic thing.
urologists are comfortable waxing poetic about things that other providers aren't willing to discuss. Urology is all about sex and urinating. urologists want to talk about things that people are embarrassed to talk about. Clitoral medicine should be with the urologist.
It will take more than penis doctors to understand and map the vagina. Female sexual pleasure needs to be recognized as essential and worth preserving in other fields.
Rubin believes that we are several decades behind on the female side. We have to do it. People need to be interested in doing the work.
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