John: When it comes to medical
research and innovation, men's
health has long gotten more
attention than women's health.
It was only in 1993 that
congress mandated that women and
minorities be included in
clinical research.
But as Ali rogin reports, even
with improvements over the last
30 years, women's sexual health
remains vastly understudied.
>> Just about half the world's
population has one.
In the medical world, it's been
discovered, forgotten, and
declared rediscovered, but is
usually dismissed as an
afterthought.
And often, it's been seen as
shameful.
The clitoris is considered the
only organ that exists solely
for sexual pleasure, but it's
also a crucial part of female
anatomy.
Just as sexual health is
critical to overall well-being.
So why is the clitoris and the
sexual health of people who have
them still so understudied?
Joining me to discuss are
urologist and sexual health
expert Dr. Rachel Rubin and
Rachel gross, a science
journalist and the author of the
book "Vagina obscura."
Rachel gross, I'm going to start
with you.
Why do we, and when I say we, I
mean doctors, academics, and the
general public, why do we know
so little about the clitoris?
>> I think, as you said, there
is a long history behind this.
In general, we know far less
about female bodies than male
ones, and that's partially
because of who's been asking the
questions.
So, throughout medical history,
you ended up with a lot of male
anatomists who saw the world
from their perspective.
One way that they looked at
women was as sort of walking
wombs or baby machines, and that
meant a very different focus
than sexual pleasure, which is
what the clitoris is all about.
So, I think we are still
recovering from those attitudes
and a lot of stigma and shame
still exists today.
>> Dr. Rubin, based on what
Rachel has just told us, how
does that translate to the
medical field and how it thinks
about the sexual function of
these organs?
>> Well, it's a huge problem,
right?
So, in medical school, I didn't
learn about the clitoris.
I didn't learn anything about
women's sexual health.
I then went into a urology
residency where I'm a penis
doctor.
Right.
I take care of men and men.
And men's sexual health.
So, when I learned as a medical
student how to examine the
pelvis, they told us to stay
away from the clitoris.
That examining it might make our
patient feel uncomfortable.
Can you imagine me saying the
same thing to my male patients
if I were examining their
genitalia?
And there is a very small
community of us who do this
work, but it's extremely small,
extremely undervalued.
>> It seems like in recent
decades there have been lots and
lots of advancements in the
understanding of this critical
organ, including simply how it
looks and how big it is.
And a lot of that is
attributable to gender affirming
health care.
So, I want to ask you about the
role of that sort of care in
leading to a lot of advancements
in the understanding of the
clitoris.
>> I'd actually say that a lot
of different fields have
contributed to these
advancements.
A urologist in Australia, she
really kind of brought the world
this understanding that had
existed before but never went
mainstream that the head of the
clitoris is the part you can see
and touch and it's really just
the tip of the iceberg.
So, underneath, there's two
bulbs and two arms that kind of
flare out into the pelvis and
the bulbs hug the vagina and the
urethra and they're all made of
erectile tissue.
And, basically, 90% of this
organ is beneath the surface.
So, there have been several
fields that have been getting
advancements like this into
journals.
And what I saw was that they're
often kind of siloed.
So, they don't talk to each
other and they don't build off
each other's work.
So, we're sort of reinventing
the wheel each time.
But the rise of this kind of
care means that there's access
to parts of the body that
normally you wouldn't end up
with as a surgeon.
And there's an actual focus on
sexual sensation and making it
better for these patients.
So, for one of the first times,
we are prioritizing sexual
function instead of shying away
from it.
>> I know that you both actually
feel strongly that this should
not be viewed as a failing of
the field of gynecology, which
focuses on reproductive health.
But I do wonder if you think
there is one field, or a number
of fields, that should take more
ownership of the study in the
care of the clitoris.
>> So, I think it's unfair to
say that gynecologists are
supposed to do absolutely
everything for all women's
issues.
Right?
There are cancer doctors.
There are emergency room
doctors.
There are baby doctors.
There are breastfeeding doctors.
There are vulva doctors.
There are uterus doctors.
There is no way they can do it
all, and in a 10- minute visit
once a year.
It's totally unfair and kind of
misogynistic in and of itself
that we think that that's ok.
There is no doctor for men that
is responsible for all of men's
health issues.
And so, the clitoris is in the
pelvis.
The pelvis has lots of urologic
anatomy, colorectal anatomy,
gynecologic anatomy, and
actually a lot of
musculoskeletal orthopedic
anatomy.
And all of the nerves from the
spine are what innervate and let
the clitoris do its thing.
And the fact that we don't even
understand basic anatomy,
orthopedic surgeons don't
understand the basic anatomy and
the innervations of the clitoris
because it's not in the
textbooks is a huge problem
because there are consequences.
When you operate in a pelvis,
and a lot of us operate in the
pelvis, there can be harm to
pelvic organs, which can lead to
very intense sexual dysfunction,
which I see in my clinic every
day.
>> You're a urologist, but
you're also a sexual health
expert.
Why is this kind of practice so
rare?
>> So, after you do finish
urology training, which is five
years, you can do a subspecialty
fellowship.
We have 27 fellowships in men's
sexual health.
We have one that even
acknowledges women's sexual
health.
It's the fellowship that I did,
and I take care of all genders.
That's a huge problem.
But there's no funding, there's
no support, and there's no
ability for us to grow and train
people if we don't have the
fellowships in place and the
ability to train people.
There are a lot of clitorises in
the world that absolutely need
help and medical care because
sexual health is just health.
Right.
People's quality of life is
really important.
And we have to start talking
about it and demanding that
equal care.
>> That's why conversations like
this are so important.
Dr. Rachel Rubin, thank you for
joining us.
Rachel gross, we really
appreciate your time.
>> Thank you so much for having
us.
>> Thank you for having us.