Doctors ignore the clitoris. Women pay the price
October 19, 2022 12:45 PM Subscribe
Content warning: painful procedures, reference to sexual assault in the following New York Times Magazine feature by Rachel E. Gross (archived version). After hearing about her injury, she said, one urologist compared her to a rape victim and said she must be having a trauma reaction to her biopsy. Next, according to her medical charts, a women’s health specialist diagnosed her with “perimenopause” and prescribed testosterone cream. Another gynecologist recommended an “O shot,” or vaginal rejuvenation procedure.
When she tried to direct the conversation back to her clitoris, she was met with blank stares. “They looked at me like I was completely insane,” Gillian said. “I just kept on saying there’s something wrong with my clitoris, and they were, like — it was like they did everything but acknowledge the clitoris.”
Some urologists compare the vulva to “a small town in the Midwest,” said Dr. Irwin Goldstein, a urologist and pioneer in the field of sexual medicine. Doctors tend to pass through it, barely looking up, on their way to their destination, the cervix and uterus. That’s where the real medical action happens: ultrasounds, Pap smears, IUD insertion, childbirth.
If the vulva as a whole is an underappreciated city, the clitoris is a local roadside bar: little known, seldom considered, probably best avoided. “It’s completely ignored by pretty much everyone,” said Dr. Rachel Rubin, a urologist and sexual health specialist outside Washington, D.C. “There is no medical community that has taken ownership in the research, in the management, in the diagnosis of vulva-related conditions.”
... This near-universal avoidance has consequences for patients. In a 2018 study in the journal Sexual Medicine, Dr. Rubin, Dr. Goldstein and colleagues found that a failure to examine the vulva and clitoris led doctors to regularly overlook sexual health conditions. Among women visiting Dr. Goldstein’s clinic, nearly 1 in 4 had clitoral adhesions, which occur when the hood of the clitoris sticks to the glans and can lead to irritation, pain and decreased sexual pleasure.
The authors concluded that all health providers for women should routinely examine the clitoris. But that was easier said than done, they wrote, as most providers “neither know how to examine nor feel comfortable examining the clitoris.”
When she tried to direct the conversation back to her clitoris, she was met with blank stares. “They looked at me like I was completely insane,” Gillian said. “I just kept on saying there’s something wrong with my clitoris, and they were, like — it was like they did everything but acknowledge the clitoris.”
Some urologists compare the vulva to “a small town in the Midwest,” said Dr. Irwin Goldstein, a urologist and pioneer in the field of sexual medicine. Doctors tend to pass through it, barely looking up, on their way to their destination, the cervix and uterus. That’s where the real medical action happens: ultrasounds, Pap smears, IUD insertion, childbirth.
If the vulva as a whole is an underappreciated city, the clitoris is a local roadside bar: little known, seldom considered, probably best avoided. “It’s completely ignored by pretty much everyone,” said Dr. Rachel Rubin, a urologist and sexual health specialist outside Washington, D.C. “There is no medical community that has taken ownership in the research, in the management, in the diagnosis of vulva-related conditions.”
... This near-universal avoidance has consequences for patients. In a 2018 study in the journal Sexual Medicine, Dr. Rubin, Dr. Goldstein and colleagues found that a failure to examine the vulva and clitoris led doctors to regularly overlook sexual health conditions. Among women visiting Dr. Goldstein’s clinic, nearly 1 in 4 had clitoral adhesions, which occur when the hood of the clitoris sticks to the glans and can lead to irritation, pain and decreased sexual pleasure.
The authors concluded that all health providers for women should routinely examine the clitoris. But that was easier said than done, they wrote, as most providers “neither know how to examine nor feel comfortable examining the clitoris.”
Bella Donna, thank you for posting to main. As I said in your ask, this article reveals an absolutely wild (and yet totally normalized!) state of affairs.
My mom and I talk semi-regularly about living in our cis female bodies and how the lack of research really contributes to an unacceptably low standard of care for us. While I've been lucky in my health and generally speaking in my medical care, I've definitely had some non-standard OB/GYN experiences, at least one of which, looking back, amounts to sexual assault as far as I'm concerned.
I'm intrigued by the idea that urology might be the logical home for clitoral care. I've never thought about going to a urologist. I think many of us default to OB/GYN care for a LOT of our health questions, almost to the point of using them as primary care providers, and the default assumptions about reproductive goals (that you have any, for one!) in that environment are maybe not the optimal approach for everyone.
posted by Lawn Beaver at 12:57 PM on October 19, 2022 [15 favorites]
My mom and I talk semi-regularly about living in our cis female bodies and how the lack of research really contributes to an unacceptably low standard of care for us. While I've been lucky in my health and generally speaking in my medical care, I've definitely had some non-standard OB/GYN experiences, at least one of which, looking back, amounts to sexual assault as far as I'm concerned.
I'm intrigued by the idea that urology might be the logical home for clitoral care. I've never thought about going to a urologist. I think many of us default to OB/GYN care for a LOT of our health questions, almost to the point of using them as primary care providers, and the default assumptions about reproductive goals (that you have any, for one!) in that environment are maybe not the optimal approach for everyone.
posted by Lawn Beaver at 12:57 PM on October 19, 2022 [15 favorites]
I've had some scared and clueless doctors (mostly urologists, though a couple gynaecologists as well) when I had some issues a while back, but I kinda just figured they were puzzled and freaked out because I'm trans and my genitals are the result of reconstructive surgery. That it is similarly bad for cis women is shocking and appalling.
posted by Dysk at 1:40 PM on October 19, 2022 [12 favorites]
posted by Dysk at 1:40 PM on October 19, 2022 [12 favorites]
The lack of scientific and medical curiosity about the female body is astounding and bizarre. And horrifying.
posted by Saxon Kane at 1:54 PM on October 19, 2022 [15 favorites]
posted by Saxon Kane at 1:54 PM on October 19, 2022 [15 favorites]
That thank-you card saying "You're cliterally the best" is amazing.
posted by biogeo at 1:55 PM on October 19, 2022 [9 favorites]
posted by biogeo at 1:55 PM on October 19, 2022 [9 favorites]
Thanks very much for posting this. It's telling that I saw the NYT headline a few days ago, but for some reason, was oddly reluctant to click on it. I guess I'm not past everything we women and girls are taught about their bodies, i.e. that they are shameful and only worthy of attention when somebody else is interested in them.
Or on preview, "The lack of scientific and medical curiosity about the female body is astounding and bizarre. And horrifying," puts it much better, but I'd also add "personal curiosity" to that list.
posted by rpfields at 2:05 PM on October 19, 2022 [5 favorites]
Or on preview, "The lack of scientific and medical curiosity about the female body is astounding and bizarre. And horrifying," puts it much better, but I'd also add "personal curiosity" to that list.
posted by rpfields at 2:05 PM on October 19, 2022 [5 favorites]
I had a hysterectomy in 1998, back when I had to go to a library and look at books to get access to some of the info I wanted to know. And at the time, the topic of "possible sexual side effects" was, well, not quite a footnote but not a lot more than a footnote. I'm glad the state of the clitorological art has improved since, but I'm distressed and depressed that it's still not great.
posted by rmd1023 at 2:09 PM on October 19, 2022 [5 favorites]
posted by rmd1023 at 2:09 PM on October 19, 2022 [5 favorites]
This was an amazing article, a terribly sad article. Almost as sad as an article I read last year which detailed the one physician, a woman, who was studying the human uterus; the only person who was doing this. The clitoris is still being treated as an inconvenient myth, foisted off on people who can't be bothered by it's existence; or even worse, those who are bothered by it's existence and have it removed from their children.
posted by Oyéah at 3:36 PM on October 19, 2022 [5 favorites]
posted by Oyéah at 3:36 PM on October 19, 2022 [5 favorites]
Thanks for posting this. Parts of the article were upsetting to read, but I think it is good that the NYTimes made it a prominent feature rather than hiding it away as something shameful.
That it is similarly bad for cis women is shocking and appalling.
That it has repeated required me (a cisgendered man) to tag along to doctor's appointments in order to get my partner's health concerns taken seriously is one of the most angering things ever. Like, we have had doctors listen to her, then turn to me and ask if what she is saying is true, or simply not believe what she is saying until I repeat it back to them word for word.
posted by Dip Flash at 4:15 PM on October 19, 2022 [20 favorites]
That it is similarly bad for cis women is shocking and appalling.
That it has repeated required me (a cisgendered man) to tag along to doctor's appointments in order to get my partner's health concerns taken seriously is one of the most angering things ever. Like, we have had doctors listen to her, then turn to me and ask if what she is saying is true, or simply not believe what she is saying until I repeat it back to them word for word.
posted by Dip Flash at 4:15 PM on October 19, 2022 [20 favorites]
The lack of scientific and medical curiosity about the female body is astounding and bizarre. And horrifying.
Maybe the establishment could round up some men to study this issue in men? We'll just extrapolate from there.
posted by amanda at 5:01 PM on October 19, 2022 [8 favorites]
Maybe the establishment could round up some men to study this issue in men? We'll just extrapolate from there.
posted by amanda at 5:01 PM on October 19, 2022 [8 favorites]
How is it that every article I read about gynecological care (and adjacent stuff - it never occurred to me that hip surgery could destroy your ability to orgasm!) is simultaneously infuriating and also not surprising at all?! Of course the whole attitude to sexual pleasure for people with this equipment just runs the gamut from indifference to squeamishness. Just - every single paragraph of that article made me want to scream. Of course doctors don't care if they fuck your sexual function. Of course you'll be told it's all in your head. Of course no one has studied the clitoris properly (the people in the article should not be the first people doing this in 20. fucking. 22!)
I'm intrigued by the idea that urology might be the logical home for clitoral care. I've never thought about going to a urologist. I think many of us default to OB/GYN care for a LOT of our health questions, almost to the point of using them as primary care providers
Lawn Beaver, I read your comment before I read the article. So when I got to the part about gynecology being about preventing disease and protecting fertility, I realized: Train us to think of ourselves as transmission vectors or incubators, and sustain the feedback loop by making what is effectively a PCP someone who is trained to address us as either potential transmission vectors or incubators. That's why I've had so many lectures from OB-GYNs about how I'll suddenly want kids one day, you'll see and I can't possibly know when I'm ovulating and pelvic exams don't hurt and not one, not a single goddamn one, even when I was literally screaming with pain, ever stopped to ask me whether this means sex is also painful for me (it is!). And the last one always made me angry because it was so upsetting for someone to casually hurt me and deny it was happening as it was happening, but I now see another side of that casualness, which is that being able to access sexual pleasure is not considered relevant to my health as a whole-ass human being.
But Bella Donna, thank you for posting this. It's valuable information. I always like to know WHY I have flames on the side of my face.
posted by Fish, fish, are you doing your duty? at 5:48 PM on October 19, 2022 [30 favorites]
I'm intrigued by the idea that urology might be the logical home for clitoral care. I've never thought about going to a urologist. I think many of us default to OB/GYN care for a LOT of our health questions, almost to the point of using them as primary care providers
Lawn Beaver, I read your comment before I read the article. So when I got to the part about gynecology being about preventing disease and protecting fertility, I realized: Train us to think of ourselves as transmission vectors or incubators, and sustain the feedback loop by making what is effectively a PCP someone who is trained to address us as either potential transmission vectors or incubators. That's why I've had so many lectures from OB-GYNs about how I'll suddenly want kids one day, you'll see and I can't possibly know when I'm ovulating and pelvic exams don't hurt and not one, not a single goddamn one, even when I was literally screaming with pain, ever stopped to ask me whether this means sex is also painful for me (it is!). And the last one always made me angry because it was so upsetting for someone to casually hurt me and deny it was happening as it was happening, but I now see another side of that casualness, which is that being able to access sexual pleasure is not considered relevant to my health as a whole-ass human being.
But Bella Donna, thank you for posting this. It's valuable information. I always like to know WHY I have flames on the side of my face.
posted by Fish, fish, are you doing your duty? at 5:48 PM on October 19, 2022 [30 favorites]
I am not a (medical) doctor; I'm a sociologist. But as an intersex advocate, I periodically give talks to medical audiences on best practices when interacting with intersex patients. And every single time, I have to start with remedial anatomy, to show the people with medical degrees how we all start out as embryos with intermediate phalloclitoral genital structures, how the components of those intermediate genitals are expected to differentiate into idealized female and male forms, and what the genital sex spectrum looks like, including the full range of intermediate forms.
It always amazes me how many people with medical degrees are unaware of the clitoral crura, let alone that they are the same tissues that in the idealized male anatomy form the shaft of the phallus. Not knowing that makes encountering intersex people with intermediate phalloclitoral structures incomprehensible, "clearly disordered" and "requiring correction," instead of totally understandable and structurally predictable. It's mind-boggling to what degree having a penis is treated as the only normal genital form by 21st century medical practitioners.
posted by DrMew at 8:08 PM on October 19, 2022 [39 favorites]
It always amazes me how many people with medical degrees are unaware of the clitoral crura, let alone that they are the same tissues that in the idealized male anatomy form the shaft of the phallus. Not knowing that makes encountering intersex people with intermediate phalloclitoral structures incomprehensible, "clearly disordered" and "requiring correction," instead of totally understandable and structurally predictable. It's mind-boggling to what degree having a penis is treated as the only normal genital form by 21st century medical practitioners.
posted by DrMew at 8:08 PM on October 19, 2022 [39 favorites]
That it has repeated required me (a cisgendered man) to tag along to doctor's appointments in order to get my partner's health concerns taken seriously is one of the most angering things ever.
This has been my and my partner's experience, as well, and female doctors are only slightly better about this than male, if at all. In our case, I often don't even need to really say anything; just being there means my wife's concerns are taken more seriously. It's infuriating.
I think a lot of doctors would be better off if the super-hard course they had to pass in undergrad was developmental biology instead of organic chemistry.
posted by biogeo at 8:30 PM on October 19, 2022 [18 favorites]
Huge recommendation for Dr. Fenwa Milhouse (TikTok, Instagram, and YouTube) aka Your Favorite Urologist. Milhouse is a black woman who is a certified urologist and urogynecologist and her tiktok is fantastic. She's got gems like The Clitoris Exam, The One Thing I Want You to Know About Vulvas, Wanting Vulva Owners to Embrace Their Vulvas. "She uses social media to destigmatize pelvic floor & sexual conditions, as well as demonstrate the importance of representation in Urology" (quoted from her website).
posted by carrioncomfort at 7:10 AM on October 20, 2022 [11 favorites]
posted by carrioncomfort at 7:10 AM on October 20, 2022 [11 favorites]
Seconding that recommendation for Dr. Fenwa Milhouse, who I learned about during her facscinating (and entertaining!) interview on Alie Ward's Ologies podcast.
posted by pixiecrinkle at 7:57 AM on October 20, 2022 [3 favorites]
posted by pixiecrinkle at 7:57 AM on October 20, 2022 [3 favorites]
Pretty good article. I do wish that someone writing about women and trans people’s sexual anatomy would have thought to spend some time discussing post-op trans women’s clitoral experiences though. A significant % of female genital surgery is undergone by trans women.
posted by Summers at 7:50 AM on October 22, 2022 [3 favorites]
posted by Summers at 7:50 AM on October 22, 2022 [3 favorites]
« Older Hand-Drawn Miracle | Single link bird Newer »
This thread has been archived and is closed to new comments
posted by Bella Donna at 12:47 PM on October 19, 2022 [2 favorites]