“The anatomy and innervation of the penis has been clearly documented in the medical literature, but similar details are lacking for the clitoris.” — Van Anh Ginger, Christopher Cold, Claire Yang

It’s coming to my attention that the lack of vulvar anatomy is not meaningful without contrast. One example is Rohen’s Anatomy: A Photographic (Color Atlas of Anatomy). There are pages and pages of penis penis penis penis penis penis penis penis penis penis penis penis penis (37 images). “What about the clitoris?” you might ask. Well, some part is shown in 14 images, but there is never any detail. Who cares? It is small and not necessary for reproduction!

Campbell Walsh Urology

A fundamental comprehension of male genital anatomy is necessary for understanding normal reproduction as well as pathology and treatment options.

Well there we go — an explanation for why the anatomy of the penis is important. This is the justification behind studying all anatomy of functional organs. “What about the clitoris?” you might ask. Nah — women are emotional.

Here are all the pictures and photos in Campbell-Walsh, to hopefully serve in contrast to OB/GYN textbook content. Keep in mind that there is simply no reason the same level of detail can’t be provided for the clitoris. The size of the clitoris is not a reasonable limiting factor when the nerves are about 1 mm in diameter. Plus, it’s not like we don’t have microscopes. It’s not like there aren’t detailed photographs of this anatomy in texts that rarely get cited. It’s not like this anatomy wasn’t illustrated in better detail in 1844. Also, the clitoris is so similar to the penis that we could use the existing diagrams for the penis and just tweak them a bit.

A cross-section of the descending clitoral body (shaft proximal to glans and palpable under hood)) would look almost identical to this. The dorsal nerves would be slightly more lateral and larger in relative scale. There woud be no urethra and the frenulum would attach to the labia minora ventrally.

Erectile dysfunction (ED) management has evolved into a mature clinical discipline in the past few decades, owing to steady, considerable progress made in the basic science, epidemiology, clinical investigation, and health services research within this dynamic field.

Basically, according to this table, management of female sexual dyfunction is 4 decades behind management of male sexual dysfunction.

These are the tests available for evaluation of erectile dysfunction. Note that all of these could be used to evaluate female sexual dysfunction, but none are discussed in OB/GYN textbooks or journals (unless journal content has recently changed) because everyone knows women are emotional. Why would we want to use fancy science to female bodies?! Women aren’t good enough at science to notice anyway.

Models of female sexual function and dysfunction are dominated by psychological aspects. Note how models of male sexual dysfunctions completely ignore that emotions affect male sexual function at all. The dichotomy in approach is hilarious.

From Campbell-Walsh

From Comprehensive Gynecology

In Campbell-Walsh, a large volume of text is devoted to penis issues. There is a very detailed understanding of penile physiology and anatomy. The course of the dorsal nerve of the penis is described and/or shown in detail in all the following chapters, as it relates to sexual function:

Disorders of Male Orgasm and Ejaculation. Campbell-Walsh Urology, 29, pages 692–708.e5

Evaluation and Management of Erectile Dysfunction. Campbell-Walsh Urology, 27, pages 643–668.e7

Surgical, Radiographic, and Endoscopic Anatomy of the Male Reproductive System. Campbell-Walsh Urology, 21, pages 498–515.e2

Physiology of Penile Erection and Pathophysiology of Erectile Dysfunction Campbell-Walsh Urology, 26, pages 612–642.e9

Surgery of the Penis and Urethra Campbell-Walsh Urology, 40, pages 907–945.e4

The idea of genital sensation being important to sexual response is much more prevalent.

“Traveling ventral to the main pudendal trunk above the internal obturator and under the levator ani, the dorsal nerves perforate the transverse perinei muscles to arrive on the dorsum of the penis and continue distally along the respective dorsolateral penile surface lateral to the dorsal artery. On the shaft, their fascicles fan out to supply proprioceptive and sensory nerve terminals in the tunica of the corpora cavernosa and sensory terminals in the skin. These nerves terminate in the glans penis.”

Granted clitoral amputation is not really a common thing in the West. But if it did happen, maybe we should know how to fix it? Dorsal nerve injuries to the clitoris do happen. Maybe we should know how to fix them?

Smith and Tanagho’s General Urology

Here is the volume in Chapter 39. Male Sexual Dysfunction. As can be observed everywhere, there is about 10 times as much coverage of male sexual function and anatomy than female. This is why I previously said it would be huge if we could simply establish that female genital anatomy and sexual function is half as important.

Penn Clinical Manual of Urology

Under the section entitled, “Physiology of sexual function,” the following illustrations are provided. Why don’t we see any anatomy of sexual function in OB/GYN textbooks?

Look! Fancy science is important for understanding how penises work!

By contrast, even this textbook on Urogynecology and Reconstructive Pelvic Surgery completely omits the neurovascular anatomy of the clitoris, despite describing techniques for surgeries where it is put at risk. The authors note:

“The physiologic pathway of arousal in women is an intricate neurobiologic process that is not fully understood.”

Is anyone trying to understand it? What I see going on is that research on female sexual function and anatomy simply gets ignored and forgotten. This is how coverage of clitoral anatomy today is worse than in the 1800s!

People have all sorts of reasons why female sexual function can’t be properly studied. In the words of one OB/GYN textbook:

“Female sexual function is less easily quantifiable, as satisfaction is qualitative rather than the more quantitative measurements of male sexual function.”

How exactly is female sexual satisfaction less quantative than male satisfaction? How exactly is it more difficult to obtain quantitative measurements of female sexual function than male? This is complete bullshit. Female orgasm consists of a series of contractions. This is a perceivable, measureable, recordable phenomenon. Physiological arousal is also a measurable phenomenon. Engorgement and erection of female genital structures is just as measurable as in male genital structures.