Labiaplasty & Medical Misogyny with Jessica Pin
Labiaplasty has been one of the fastest-growing medical procedures for about two decades now. Despite the abundance of surgeons performing this procedure, detailed clitoral anatomy has been missing from most medical textbooks. My guest today, Jessica Pin is an activist for the inclusion of detailed clitoral anatomy and medical literature and curriculum. Jessica has successfully convinced nine major medical textbooks to update their content and 11 more to consider updates. She has also published a cadaveric study with plastic surgeons, convinced OBGYNSs to publish a cadaveric study and effected changes in the OBGYN's board certification and residency curriculum in the States.
In today's episode, we explore the medical misogyny and the ambivalence of medical institutions regarding vulva anatomy, specifically, the absence of detailed clitoral anatomy in the medical literature. For anyone listening who may have been considering labiaplasty, I hope this episode provides you with a new perspective; this is not to convince you otherwise but rather to offer you insight.
If you, or anyone you know has had some shame or discomfort around their vulva. I highly recommend checking out my friends website: www.comfortableinmyskincom.au
In this episode, you'll learn:
Jessica’s story and what brought her into this type of work
Why labiaplasty is one of the fastest growing procedures
How removing parts of the labia can cause danger to your sexual function
How Jessica has successfully convinced nine major medical textbooks to update their content and 11 more to consider updates.
This podcast is for YOU, so if you ever have any questions you’d like me to answer on the show, or topics you’d like me to cover – reach out to me on email here or over on instagram @eleanorhadley
Links & Resources
Join the Embodied Course waitlist here
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Follow Jessica on instagram here
The Sensuality Academy Podcast is edited and produced with thanks to Lucy Arellano. You can find her work at @lucy_podcastva
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Episode Transcript
Hello and welcome to another episode of The Sensuality Academy podcast. I have always been so wildly passionate about empowering people to love their bodies as they are, especially women and vulva owners.
We know how toxic our society can be when it comes to unrealistic beauty standards and the expectations that are placed on women to meet an ever changing goal post of perceived perfection. so pervasive is the cultural addiction of profiting off women's insecurities which are mostly manufactured quite intentionally, that it seems no part of our body is spared scrutiny. Today we're talking all things vulva labia and particularly the clitoris.
Yeah, even our most sensitive organs come under criticism, because of course they do. I will never cease to be exhausted by systems patriarchy. Did you know that labiaplasty has been the fastest growing medical procedure for the past two decades. We'll be diving into this topic deeply with our guest today, but for those of you who may not have heard the term before, I know I only came across it within the past couple of years. A labiaplasty is a surgical procedure which reduces the length of the Labia minora, the inner lips of the vulva. Sometimes labiaplasty is performed for legitimate medical reasons due to things like discomfort. However, the rise in popularity of labiaplasty can be attributed to plastic surgeons spruiking what they call a vaginal rejuvenations while claiming that protruding labia minora is unfeminine and due to an excess in male hormones, or even excessive masturbation or sexual activity, all of which is absolutely untrue. In today's episode, we're going to explore the medical misogyny and the ambivalence of medical institutions when it comes to vulva anatomy, specifically, the absence of detailed clitoral anatomy in medical literature. That's right, detailed clitoral anatomy has been straight up missing from most medical textbooks. Despite the abundance of surgeons performing procedures on vulva owners.
Our guest today is Jessica Pin, an activist for inclusion of detailed clitoral anatomy and medical literature and curriculum. She's been successful in convincing nine major medical textbooks to update their content, and 11 more to consider updates. She's also published a cadaveric study with plastic surgeons convinced OBGYN to publish a cadaveric study and effected changes in the OBGYN board certification and residency curricula in the States. As she shares with us in this episode. She was inspired to do this after her own botched labiaplasty which robbed her of clitoral sensation at the age of 18. After her surgery, she taught herself the cause of the dorsal nerves in the clitoris and she realized that it was missing from obstetric and gynecological literature, and any literature on female genital cosmetic surgery. She holds a degree in Biomedical Engineering from Washington University in St. Louis, this chat with Jessica today was at once fascinating and deeply infuriating. I think many of us who identify as women have had personal experiences of our own medical misogyny, and it's so heartbreaking to hear how deep this runs and how little time and thought has been given to Volvo owners. Particularly in regards to our experience of sexual pleasure. Jessica is doing such important work and I hope that you enjoy listening to this episode. And for anyone listening who may have been considering labiaplasty, I hope that this episode provides you with a new perspective. This is not to convince you otherwise, but rather to offer you an insight.
If you or anyone you know, be at friends, family or lovers have had some shame or discomfort around your vulva. I highly recommend checking out my friend's website, www.comfortableinmyskin.com.au. Ellie is a dear friend and a vulva photographer with an online gallery called Flip through my Flaps. And this is a gallery of hundreds of followers that she's photographed. It's a really great way to see the diversity involved.And to potentially see that yours is in fact completely normal. I hope that you enjoyed this episode. And if you do, I would love your support by leaving a review on the Apple podcast app. Thank you so much. And now enjoy the episode. Here's Jessica.
ELEANOR: All right, thank you so much, Jessica for coming to the Sensuality Academy podcast. It's such a pleasure to have you here today.
JESSICA: Thank you.
ELEANOR: So today we're talking all about the clitoris, labiaplasty and the absence of detailed clitoral anatomy and medical literature. So I would love to start off by just hearing a little bit more about your story and what got you into this work.
JESSICA: So basically, I had a labiaplasty when I was barely eighteen, and my doctor completely amputated my labia minora and performed a clitoral hood reduction without my consent. In the clitoral hood reduction, he damaged my clitoris and I lost sensation. And after my surgery, I went to doctors and I told them that I had lost sensation. And they told me that wasn't possible. So I ended up teaching myself the anatomy and I ended up realizing that it wasn't getting taught to OBGYN or plastic surgeons who operate on vulvas. And so I've been trying to change their training so that they know the anatomy better and so that they're safer in surgery and also so that they don't gaslight patients who are harmed because one of the hardest things I dealt with was getting told it was all in my head.
ELEANOR: Thank you so much for sharing. It's horrifying. What happened to you? And I know that this is something that a lot of other women have been through as well. A lot of other vulva owners with the rise in labiaplasty. So for those of my listeners who might not know what a labiaplasty is, would you be able to explore that a little bit more?
JESSICA: Yeah, so a labiaplasty is a surgery that reduces the size of the labia minora. The labia minora, the inner lips of the vulva, it is the fastest growing cosmetic procedure it has been for I think about two decades now. It is extremely common, especially among young women. And while my story sounds a bit crazy, I hear from other women similar stories. I've been hearing more and more of them as I get more popular. And it is really shocking what goes on. And it is extremely difficult to sue in these cases. So there's not a lot of there's not a lot of feedback or justice when things go wrong. A lot of surgeons are really just operating blind and without adequate training.
ELEANOR: Yeah, it's ridiculous. I've been watching and reading a lot of your content and your story and what you're advocating for. And it's just mind blowing that so many people who are actually performing labiaplasties don't actually have the proper medical training. And we're gonna get into that. But first of all, I want to ask, why do you think labiaplasty is growing so much? You said it's the most popular surgery that is kind of growing in the past two decades. What do you think is contributing to that? S
JESSICA: I see it as the exploitation of ignorance and I see the demand for labiaplasty is acting as somewhat of a positive feedback system, because basically, the doctors create the demand. And there's not much to cancel that out because it's such a taboo topic. And so the way I see it, doctors are advertising these surgeries aggressively. One of my friends got an advertisement on her Facebook that said, like a haircut for your genitals.
ELEANOR: Oh my god.
JESSICA: Personally, I think that the reason demand for these surgeries is growing is because there is a lot of money to be made. And so more and more surgeons want to be making that money. And so they're advertising these surgeries, and they are often advertising them with misinformation. And so through the proliferation of that misinformation, women become more insecure about their vulvas and seek these procedures. That is at least my opinion. So for example, they call these procedures rejuvenation. That is very misleading because no positive correlation between age and labia minora size after puberty has ever been shown. They actually decrease in size with menopause and decreasing estrogen levels.
However, when they say that when they call it rejuvenation it implies that large labia minora “ look old” until a lot of women get the impression that they look old, and they look ugly based on that misinformation. They also say that they're caused by excess androgens; that's another claim that has never been proven. It comes from a hypothesis made in the case study. But it has been claimed at least 50 times in medical literature and major medical journals and in medical textbooks. So, in my opinion, when this misinformation gets more and more common, it gets taken for granted as fact. And it gets disseminated among the lay population. So, you know, I've talked to a lot of women who said that they were influenced by claims like largely women are caused by aging, excess androgens, which are male hormones, and also sexual activity and masturbation. That's another thing that gets said. And it's not supported by any evidence, but it has a function of stigmatizing labia minora. And when doctors are participating in spreading this misinformation, you know, these claims gain credibility, and they influence women's feelings about their bodies and their decisions to seek surgery.I've kind of a different perspective, because I don't think it has anything to do with like, waxing or porn or anything like that. I think that it stems a lot from stigma around the vulvas in general, and stigma around female sexuality in general. I see societal taboo around vulva’s getting exploited for profit. And I think that's what this fundamentally is about.
ELEANOR: Yeah, absolutely. I guess the fact that we don't talk about vulvas nearly as much as we talk about penises. It's just, I think, actually read something that you wrote about how, in medical textbooks penises were talked about so much more than the clitoris or the vulva. And it's just not as common, which is kind of ridiculous because we need the same level of care for and understanding of our genitals as you know, people with penises do.
JESSICA: Yeah, definitely. So detailed penile anatomy is always covered right to the course of nerves and vessels in the penis is always shown and described in anatomy textbooks. And they typically show a cross section with the internal structure, and they go into very in-depth descriptions. But with the clitoris that typically is not covered, how much gets covered really varies. So sometimes they will just completely leave out the nerves and vessels in the clitoris, which is crazy because the nerves and clitoris are actually just as large as the nerves in the penis, and they are extremely important to female sexual function. But they get left out sometimes they get left out because doctors and anatomists are genuinely ignorant and sometimes they get left out intentionally. So, for example, with surgical anatomy, detailed anatomy of the clitoris was omitted intentionally, about 50 times as many words were devoted to describing the penis as the clitoris. And they didn't show any detail for the clitoris. And the chief editor defended that on Twitter.
ELEANOR: How, how do you defend that?
JESSICA: Some male urologist came to his defense, which was really nuts because it's like they pretty much treat penises for a living and you would think that given how much they know about penises, they would understand the clitoris, which is the female homologue is similarly important. So that's something that I've been working on getting changed. Basically, I get textbooks to update their content. Until 2019, the course of nerves in the clitoris was not in any OBGYN textbooks. And so I've gotten three major OBGYN textbooks updated. I've also gotten a number of other textbooks in OBGYN urology, plastic surgery and general anatomy to agree to update their content. Some of the biggest wins are Moir Grant and Netter because those are really major anatomy textbooks used in medical training. And they have already created new illustrations. They are going to be showing basically equivalent anatomy for the clitoral as it is for the penis, which is awesome.
ELEANOR: Yeah, that's so fabulous. It's such an incredible task that you are doing. I can imagine that it's been very difficult the entire journey, let alone trying to convince textbooks and yet the publishers to actually include something that seems, to me, obvious. Of course, that should be in there as part of our body. And I think I remember you saying something that along the lines of the nerves of the clitoris are the only major nerves in the human body that are not considered worth teaching. Why do you think that is?
JESSICA: The clitoris is not seen as having any direct reproductive role. And so, its function is not considered as important as other functions. So there's that element. I actually had a female orthopedic surgeon argue that it wasn't important enough to include in general anatomy textbooks. That was kind of crazy, because it's like, Hey, can you care about your own body?
ELEANOR: What about pleasure, why are we just so dismissive of pleasure?
JESSICA: Basically, people just don't think that pleasure is as important as reproductive function or other functions, which is kind of crazy, because in reality, pleasure is so important, and most sex is not reproductive. You know, the biggest reason we have sex is for pleasure. So that particular function is extremely important.
ELEANOR: And in a roundabout way, it feels like the medical industry, admitting clitoral anatomy and not recognizing that pleasure is important. It's kind of this roundabout way of saying, well, your only purpose is to reproduce you don't you're not worth feeling pleasure. But Oh, yes, penis says yes. Like they get they experience amazing pleasure and orgasm. And we want to make sure that they experienced that I think, actually, I read something else that you wrote about on consent forms for pelvic surgery that there was nothing about the potential side effects for penis owners as opposed to no side effects or no inflammation for any side effects of the clitoris or the vulva.
JESSICA: Yeah, it was actually my dad's idea, my dad's kind of awesome, he brought home all the consent forms for pelvic surgeries that they had at the hospital where he works. And so it was just this whole stack of pelvic surgery, consent forms. And, he showed me that they did not discuss risk to female sexual function, they always discuss risk to male sexual function. And that was around 2013. So it may have changed. But there is that general pattern, and you can see it in the way that female bodies are approached versus male bodies. Female sexual function is basically an afterthought. In medicine, there's no specialty that's really considered responsible for it. Like generally it falls under OBGYN, but the OBGYNs tend to feel like it's not really their responsibility, because they're focused on reproduction. And so a lot of the time female sexual function will get discussed in a chapter on emotional issues and in OBGYN textbooks, and will be sandwiched between domestic violence and eating disorders. And it tends to be approached as an issue of psychology and hormones. And this, you know, a lot of the time people like to blame men for these problems. But I promise it's not just men behind this, there's a lot of women behind this pattern. For example, the author of an article on Up-to-date, so Up-to-date, is supposed to keep doctors up to date, and it basically, it's a medical decision support resource for doctors. And even my dad thinks it's up-to-date. And he's like, you know, I was talking to him about some medical issue recently. And he was like, Oh, let me check up to date. I'm like, that Up-to-date is bullshit. But it may not be with other subjects. However, with female sexual dysfunction, it is extremely out of date, in my opinion, because it pretty much neglects the clitoris. So there's this whole article on the evaluation and management of female sexual dysfunction. And they mentioned relationships 26 times.
And they mentioned clitoris one time, all they say is you can put massage oil on the clitoris, like, wow, god, if it was that simple. Do you think we'd be going to the doctor? I don't know. What's funny is the author of that article is a woman. She's a female OBGYN professor at Harvard Medical School.
ELEANOR: That's just screaming internalised misogyny. To me. I think that it's really sad, I suppose when we see women who are in fields that are meant to be championing empowerment of women, just not really caring that much and having this intense internalised misogyny. I know you've spoken a lot about some very famous plastic surgeons in the US who seem to be bankrolling from supporting labiaplasties and trying to convince people to have them.
JESSICA: Yeah, I definitely think it's very complicated. And I hesitate to say, people don't care. And I hesitate to even call it internalised misogyny. Because it's not like they don't think it's important, but they're just not thinking about it right. And it's really strange, people, including women, will tend to approach female sexual function as something that occurs above the waist. And there's just that pattern. And you know, even when pharmaceutical companies went to create a female Viagra, they created a drug that works on our brains, not our genitals. And I don't know exactly how that came about, but it seems, you know, a little funny, because it's just so typical. And another example, is there's a major Euro gynecology textbook. It's, I think it's just Walters Euro Gynecology, and in it, there's a whole chapter on female sexual function and dysfunction, which is a big deal that they devoted a whole chapter to it. And the chapter is written by women. It's written by a female Euro gynecologist, and a female psychologist. And in the chapter they mentioned the clitoris only one time. And I forget how many words a chapter is, but it's like a generous chapter. They mentioned the clitoris only once and all they say is it engorges. And it's just bizarre, because one thing that I say is the clitoris is the only organ whose anatomy and physiology is considered irrelevant to its function. Imagine going to a pulmonologist because you have breathing problems and having them just be like, Oh, do you think you're stressed? You know, imagine them not even considering what could be wrong with your lungs. And I've even had OBGYNs say, clitoral anatomy isn't relevant to treating female sexual dysfunction, because female sexual dysfunction is caused by low libido. And it's strange, because I'm like, What do you think causes low libido? Because I would suspect that if a woman had any sort of issue with her clitoris, maybe we wouldn’t want sex very much because it wouldn't be fun.
ELEANOR: Yeah, absolutely. I know that our female sexuality is very nuanced and there are a lot of factors at play. But of course, the actual physical anatomy should not be overlooked. It seems quite ridiculous.
JESSICA: Yeah, I don't want to discount psychological factors. There is this dichotomy in the way male and female sexual function are approached in that female sexual function is considered a psychological issue and male sexual function is considered very much a physiological issue. So if you look at literature on male sexual function and dysfunction, it's all very much like how the penis works. And it's almost to the point of excluding their very real and valid psychological issues that may impact men, you know, because there's going to detailed anatomy and physiology and biomechanics, and it's all very analytical.
ELEANOR: That's such an interesting view. I really, really appreciate that point that it's not necessarily about them not caring and pure misogyny, but just maybe a lack of awareness and a lack of scope, let's look at this from every angle. And so, I want to ask you more about the actual clitoris itself, because something that you wrote recently, you were talking about how often we have this fact kind of thrown around in sexology, and sex education about how there are 8000 nerve endings in the clitoris. But you've been saying that that's actually not quite right. Can you speak a little bit more about that?
JESSICA: From what I can tell, it comes from a study of cows. I always like to know where claims come from, I place a lot of value on evidence and proof. So I dug into where that claim came from and I traced it back to this book called “The Clitoris” by Thomas Lowery which was published in 1976. It talks about a study of bovine genitals. They also studied sheep. So both sheep cows have double the nerve endings in their clitoris’ as their male counterparts. What they did is they counted the nerve fibers in the dorsal nerves of the clitoris and the penis. So they didn't actually count the nerve endings. They counted the axons that lead to the nerve endings.
ELEANOR: It's so interesting.
JESSICA: That has not been done on humans.And so I was sort of exasperated because it's just like one of those things that's just sort of lazy and careless science in my opinion. And I think that claims about humans should be based on studies of humans.
ELEANOR: Yeah. It surely isn't that difficult to actually do that study on humans instead of adults, sure there's some similarities but it would be great to actually know. And so are you saying that we don't actually know how many nerve endings are in the human clitoris?
JESSICA: There was one study in the Journal of Sexual Medicine that looked at nerve density in the clitoral glands versus the penile glands. I did not like the results. So I'm not really interested in repeating that study.
ELEANOR: OK, gotcha.
JESSICA: I’m kidding. It would imply that the clitoral glands has less nerve endings in the penal glands. I am not sure about that. So one thing is I've dissected the dorsal nerves of the clitoris and they are quite large. And I have not dissected the dorsal nerves of the penis. But I did look up a study where they measured the dorsal nerves of the penis, and it really seems like the dorsal nerves in the clitoris are just as large. And I also discussed this with some anatomists, basically with the chief editors of Moir and Grant's anatomy. I talked to them about this, and they agreed the nerves and clitoris are about the same size. They've dissected both. And a gender reassignment surgeon told me he thinks the nerves in the clitoris are actually bigger. So who knows how big they are, but they're definitely quite large. And in theory, the diameter of the nerve would be proportional to the number of nerve endings that it leads to. Right.
ELEANOR: Yeah, definitely. So can you tell us a little bit more about the nerves that we do know are involved in the clitoris. I also know from my own sort of study that the structure I suppose, of the penis and the clitoral, are quite similar essentially, our genitals are all the same, but just organized differently. I'd love to hear a little bit more about those nerves and how they play a part in our sexual function?
JESSICA: Both the penis and the clitoris have two main dorsal nerves that travel either on the top of the clitoris body or the top of the penile shaft. Those are homologous structures that are both made of corpora cavernosa, which is erectile tissue. And so the nerves travel on the tops of those structures, and lead to the glands and the glands is the most sensitive part. So, in my study, the nerves were 3.2 millimeters in diameter at the angle of the clitoral body; you could conceptualize that sort of as the base of the clitoral body like before it becomes external under the hood. And then they were two millimeters in diameter towards the glands, like within a couple millimeters of the glands on average, which is where they begin to spread out, they branch off so much that you can no longer dissect them. So I've done the math before, and I forget, but what that implies is that about half of the nerve endings go to the glands and about half of the nerve endings lead to other things on the way to the glands. But the glands definitely have the greatest nerve density. I suspect it works about the same in the penis, I know that the dorsal nerves of the penis have more visible branching. But I don't have too much experience with penile anatomy. Maybe I lack interest. I'm like a little doctor not paying attention to the clitoris, except the other way around.
ELEANOR: But you're also not performing surgery on people.
JESSICA: Exactly. So, we both have dorsal nerves. And the one thing is, a lot of people don't understand what nerves are. I've explained it a couple times. Nerves are bundles of axons. Every neuron has nerve endings that it leads to. And as far as sensory neurons are the clitoris, they have nerve endings that end in the skin of a clitoris. And they have an axon that travels in a nerve, and that's how it gets from your spinal cord to your clitoris, you know, it has to get there. And so they're all so all the axons are bundled together in a nerve. That's how signals get sent from the nerve endings to your spinal cord, and then they get passed on to a different nerve that takes it from your spinal cord to your brain. So, if you damage the nerve, you cut off that signal.
ELEANOR: And so in terms of damaging the nerve, so in your case, you know you had the clitoral hood removed. Is that right?
JESSICA: Clitoral hood production was done without my consent, which is crazy. And I've heard of this happening to other women as well. And it's just bizarre because it's like the surgeons are just like, Oh, it's all just that skin down there. It's all the same thing. It's like no, it’s not, the clitoral hood is literally the skin of the clitoris. And so you can actually damage the clitoris and a clitoral hood production. So basically the nerves travel very superficially, they're pretty much right under the skin of a clitoral hood. And this is what goes misunderstood. And you can see experts in female general cosmetic surgery describing this incorrectly online. You can see them in real self - reassuring patients. Oh, no, don't worry about it, clitoral nerve damage can't happen. Because those nerves are “very deep”. But they are not. They're not very deep. So that's the fundamental thing that's happening.
ELEANOR: For people who are getting labiaplasties, they're getting parts of their labia menorah, the inner lips removed. And can you talk a little bit about the danger, especially to the sexual function of removing parts of our labia.
JESSICA: So the labia minora are not sexually sensitive tissue actually involved in female sexual response. I don't know as much about them as the clitoris. However, they have the same types of nerve endings as the clitoris, they engorge with arousal. They tend to be sensitive and most women, and in my opinion, they also mechanically facilitate clitoral stimulation. So I'm sure you've heard of Masters and Johnson. Right? They were like pioneering sex researchers. And they made that show on Showtime called Masters of Sex about them.
ELEANOR: I've never seen that. I mean, I'm Aussie though, so I'm sure my US listeners will have heard.
JESSICA: So their whole theory for how women had orgasms during penetration was by the labia minora, basically getting pulled a little bit during penetration and then pulling on the frenulum and the clitoral hood, which would sort of basically make the clutter stack itself off. That's the best way to explain.
ELEANOR: Yeah, yeah.
JESSICA: I really think that that mechanism exists, but it hasn't really been explored. You know, in my opinion, it's kind of obvious. So I think the labia plays a mechanical role, as well, in addition to themselves being sensitive, they also protect the vestibule and the vagina. So, you know, TMI, but those of us who have had too much like labia minora removed, we have our vestibules to expose, and it can be kind of annoying, like this one woman yesterday was telling me, she feels like she's like spread open all the time. And I've gotten to the point where I just ignore it. I've just accepted it. But I'm like, yeah, this is super fucked up that we live like this, and that doctors thought that this was appropriate. And one thing really crazy is that over the years, when I go to the doctor, like for an annual exam, no one ever says anything to me about it, you know, unless I bring it up, but no one is ever like, Hey, are you okay? It is sort of bizarre, because in my opinion, when this happens to women,if doctors see a patient who's had their labia minora completely removed, they should say, hey, like, are you okay? What's the appropriate response, in my opinion, but there's just so much ignorance around vulvas, the biggest reason why labiaplasty is dangerous is because there are no training standards. And because ignorance of anatomy is so pervasive among surgeons.
ELEANOR: In terms of someone who is considering getting labiaplasty or has heard of it and thinks, Oh, I should get that it's most often because they are feeling that they're labia minora are too long. Now, is this a thing that they can be too long? I know that some people actually feel uncomfortable physically. But I know I think from what I understand more often than not, the discomfort is with just this assumption that I should be all tucked in. And this difference between what people say is an innie versus an outie and more of that cosmetic ideal.
JESSICA: I think there was one study that showed only 13% of women seeking labiaplasty are doing so for physical reasons. However, some women really do have discomfort, their labia minora and pull on things and may even cause pain. So sometimes it really bothers them, but that does not mean that they deserve to be butchered. So that's one reason why I'm not against these procedures because some women actually need them.
ELEANOR: Yeah.
JESSICA: And I don't want to get in the way of those women having a solution that helps them be happier in their lives and more comfortable. And so my main critique is of the lack of training standards, the lack of informed consent, and the ignorance among surgeons. It's also important to recognize, at least here in the US, when these procedures go wrong, there is no recourse. So, people always ask me if I sued, and I didn't, because I didn't really understand what had been done, I didn't understand that what had been done was negligent. And I blamed myself, but I think, back then it probably would have been, it would have been harder to win back then than it is now. And now, when I talk to women who are trying to find a lawyer to represent them, they can't, so they're getting turned away. And one thing to recognize is just how traumatic it is to go to a law firm and say, hey, this terrible thing happened to me, and have that law firm say, hey, like, we can't, this is too hard to litigate. Okay, because let's just sort of devastating, I mean, it's like going to the police after you've been raped and having them be like, we can't do anything about it. Because it's so invalidating to the trauma that you've suffered. So I feel like one thing that goes on is there's only so much of this that women can take. And so they go, they try to contact lawyers and give up after a while. Until I try to, like, support people in doing this, but I don't know a single case that is litigated successfully. There's one woman who filed her lawsuit, I think, three years ago, and her case, I thought would definitely win because she was harmed to repair after a sexual assault. And so, you know, in a case like that, the jury would be a lot more sympathetic than in a cosmetic case, which is sad, but that's the way it works. And she still hasn't gotten to court. And she might lose.
I was just recently talking to this 23 year old who had her labia minora completely removed. And she said she went to an all female law firm, and they said they couldn't represent her. And one of the things that she mentioned is that the harm would be too hard to prove.
ELEANOR: Wow.
JESSICA: And it's so crazy. Because if you had your breasts entirely removed in a breast reduction, that would be an easy case any lawyer would take that in a heartbeat. And so I called my dad and I talked to my dad, so my dad's a plastic surgeon. And he said, Yeah, the problem is these plaintiffs' attorneys are lazy, and they want easy cases and they don't want to deal with anything that's taboo.
ELEANOR: Yeah.
JESSICA: So, dealing with a botched breast reduction, that's much easier than a botched labiaplasty. And so I think, basically, there are a lot of issues that are sort of enabling a very low standard of care. It's hard because nobody is trying to cause any harm. But that's what's happening because there are no consequences. So there are no consequences for the professional medical organizations for neglecting their duties to ensure a reasonable standard of care. So, for example, the American Society of Plastic Surgeons has their inservice exam, which is one way that they ensure the plastic surgeons know what they're doing. And it's taken by residents. And it's also taken by practicing plastic surgeons as a way to get continuing medical education credits. So basically, my dad takes the in-service exam. And so he told me that as of 2021, there's still or maybe 2020, the last time he took it, there was nothing about vulva anatomy or female genital cosmetic surgery on the in-service exam. And that's supposed to cover everything that they need to know.And so, things like that. It's just a way in which systemic negligence
is institutionalized, and so you think, how can that be like, That's not right.How can they do that? Well, there's no, they're not liable for not ensuring the plastic surgeons are trained to do what we think they're trained to do. So that's the crazy thing.
ELEANOR: Yeah, definitely. It should be just part of the curriculum embedded in their basic training, not like an optional extra that they have to seek out.
JESSICA: One of the biggest victories I’ve gotten is the course of the dorsal nerves in the clitoris is now included in Board certification for OBGYNs. It is included in their maintenance certification. Which is how practicing OBGYNs stay board certified but it’s optional. It’s a big victory but it’s optional learning for them. Now, if you are an OBGYN you have to get a certain number of maintenance certification credits and they have made it so that if you read a study of the dorsal nerves of the clitoris, which I convinced some OBGYNs to do. Then, they get double the maintenance certification credits. They have to read it and answer questions. But they don’t have to, it’s optional. Is required for Euro gynecologists. Euro gynecologists are a speciality of OBGYN and they have made it a requirement for them but not for general OBGYNs which is annoying. Why can’t you just make it that OBGYNs need to know about the clitoris? This is not complicated, this is pretty basic.
ELEANOR: It does feel so basic, if that is your speciality. You are in gynecology. It seems so bizarre, like to not know about certain membranes of the nostrils, it seems so ridiculous that it’s not included. I heard that you have got a petition going as well, can you tell us a little about your petition?
JESSICA: I started that in December and got a bunch of signatures, it really took off. It was a petition to get the nerve in the clitoris taught to OBGYNs. It’s a petition to the council on graduate medical education and obstetrics gynaecology to specify the nerves in the clitoris be taught. The reason they need to specify is because historically it hasn’t been getting included. So, in 2019, every time OBGYNs went to cover the nerve supply of the vulva they didn’t cover the nerve in the clitoris and it’s really nuts. So, you can’t just say hey, teach the nerves of the vulva and expect the nerves in the clitoris to be taught because that’s never happened. So, currently all they do is specify the nerve supply to the vulva should be taught and in my opinion, that is not enough because that is not going to make it get taught. The Council on Graduate Education and Obstetrics and Gynecology is basically the entity with the most authority to dictate what type of standard the OBGYN curriculum is. So, if I can get them to do this it will solve the problem, add scale, everywhere. It will dictate what OBGYNs have to learn in every residency program across the country. It’s so simple and they won't do it. I started my petition after I got an email that said this specific anatomy doesn’t fit in the curriculum and so I created the petition and I got a phone call with the Education chair of Creog and it was me and two of them on the phone. That was around the time I got Covid so I keep going back to it and thinking that I wasn’t on my game and I didn’t handle that well, I didn’t negotiate properly. One problem, I was trying to be nice because I didn’t criticise for being too aggressive, I tried to take a different approach and tried to get them to understand that there is a problem with ignorance in this anatomy with OBGYNs and they were telling me they were not going to specify that, they explained to me that they don’t specify that level of detail in their core curriculum and they said of course the information of the clitoris would be included in nerve supply of the vulva. I said, the problem is not of course because never was. It was only included in textbooks as of 2019, so how can you expect it to be taught regularly? When they said I should send them a list of the textbooks that I got updated and I hoped that would open up a dialogue and that dialogue would continue however when I got off the phone I never heard from them again. I really regretted how I handled that situation because I think I could have been pushier but I was trying not to be too pushy and ultimately I didn’t succeed. However, there is still an opportunity for them to change their core curriculum. I did check with the American Urological Association, they do dictate that the nerves in the penis be taught to the Urologists so why can’t ACOG do the same? PREOG is under ACOG, ACOG IS American College of Obstetricians and Gynecologists and PREOG, their council on graduates of OBGYN and all they have to do is add a line, it’s such a small thing.
ELEANOR: I would be so interested, I will do this afterwards, to see what systems are in play in Australia or other countries in terms of labiaplasty and the popularity of it, the regulation of it, obviously I'm not going to be able to do as deep research as you’ve done in the States but it will be interesting to see more about the rise of it here as well.
JESSICA: because there is so much lack of transparency you have to judge what doctors know and don’t know based on the literature. At least that's been my approach because it’s so hard to get a good answer as to what they are getting taught but you can see what they know based on what they publish. When you see the anatomy is missing it’s a pretty clear indication that they are not getting taught about anatomy. The other thing that is comical, is you see the clitoris gets mislabelled. It’s really funny when that happens. There’s some Euro Gynecologists that publish multiple papers where they have labelled the clitorol body as the glands, in major medical journals. Medical Journal Editors have had to sign off on this and doctors have to polish it to begin with and it’s so ridiculous. I’ve taken a photo or illustration of a penis and I labelled the shaft of the glands as a joke. I was trying to troll the chief editor of the Journal of Sexual Medicine, he didn’t respond. I think it’s hilarious but he probably didn’t. I emailed him , he said the professional thing to do is to write a letter to the editor. If I do that, would that work for me? I'm over here doing free work, is this actually going to make a difference? So I asked him, what are you going to do if I write a letter to the editor?'' He said, these errors aren’t serious enough to get a retraction or review, so what’s the point? This is ridiculous. Let’s mislabel the arm from a hand, that's how ridiculous that is. I have to laugh. Sometimes, I might be a bit of an asshole but doctors are supposed to be smart. When you see really smart people doing really dumb things it’s kind of hard to be super understanding about it because they are better than that. It also means there's something going on where psychological discomfort seems to cause people to act dumb. When they are unable to apply a normal level of cognitive ability to this particular topic. I made the word clitoris may cause doctors brain to turn to mush, that’s kind of a rude thing to say.
ELEANOR: Oh gosh. This has been so fascinating to learn about. I am so behind your mission, I think it's incredible the work that you have done so far and continued to do so. Thank you so much for sharing more about this topic, this issue. I will be very interested to see what textbooks will be like in other countries but my US audience this will be important for you to know as well as a lot of things that come out of the US as well. Thank you for sharing today.
JESSICA: I have talked to doctors internationally and there is a textbook that is very commonly used in the UK that I haven't checked yet. However, a lot of the textbooks used in the US are also used elsewhere. Grey’s Anatomy came out of the United Kingdom and Moir & Grant came out of Canada. I’ve gotten Moir and Grant to get them to change it but I was unsuccessful. I got them to sight study the dorsal nerves but they didn’t cover the anatomy so it’s really bizarre. It’s an international issue. When I checked medical journals it’s not in International medical journals either. The british journal of OBGYN has never published the nerves of the clitoris. At least the last time I checked. I know there’s Dr Helen O’Connell who has made quite a name for herself. She is in Australia, she has published a few studies of the clitoris and she got the media’s attention by claiming she discovered parts of the clitoris, those parts are shown in anatomy textbooks in the 80s, 70s, before she discovered them in 1998. So, she didn’t really discover anything but she is well known for published studies of the clitoris, she did dissect the dorsal nerves and did comment on how large they were in the study that she published in 1998. She didn't photograph them, she also has also talked about how clitoris anatomy isn't completely covered and she is Australian. Those same issues are impacting doctors in Australia. There was also a Guardian article, Guardian Australia, they talked about the Royal College RANZCOG - The Royal Australian New Zealand College of Obstetrics and Gynecology. They would quote this article in the Guardian and they were some doctors in Australia and also Dr Helen O’Connell who is a neurologist, they were quoted in this article. They were discussing whether doctors in Australia and New Zealand are getting taught adequate clitoris anatomy.
ELEANOR: As suspected, it’s a worldwide thing.
JESSICA: They also talked about a lack of interest. One thing that’s really bizarre, it’s a topic that makes everyone uncomfortable. Which I guess makes sense because I used to be afraid to talk about it, but for me it was always scary because it was connected to a trauma and I was so afraid to discuss what happened to me and it’s kind of awkward to talk about my vulva on the internet. It’s ridiculous. I remember just talking about vulva’s generally used to be embarrassing. Now, it’s like, guess what, I have a clitoris trophy. I’m proud of it.
ELEANOR: Same with me, I have a clitoris around my neck. So I'm like, let’s talk about it.
JESSICA: I’ve got a clitoris necklace and earrings.
ELEANOR: I was going to ask about where you got your clitoris model from because that’s epic.
JESSICA: It is from Stephanie Crumball, she is in Austria.
ELEANOR: Thank you so much for coming on the Sensuality Academy Podcast, this honestly has been such an eye opening, fascinating conversation one that I think a lot of my listeners have never heard about, I know a lot of people don’t know what labiaplasty is in general let alone the lack of awareness and information of the clitoris anatomy in Medical literature. Thank you so much for joining us, thank you for your work. It's incredibly impressive and I wish you all the best in continuing to change medical gynecological history.
JESSICA: Thank you.
ELEANOR: Thank you so much.
