There's a nerve called the pudendal nerve,
and one of its branches is the clitoral nerve.
It conducts sensory information.
The summary of these signals allows the brain to react in a
way that results in this very interesting,
erotic mix of impulses and sensations that once you feel it,
you realize that, you know, this is, you know,
this is really an incredible feeling. You know,
why have we been so afraid to talk about it?
So our patient from tomorrow, she was cut at a very early age,
four or five years old,
and then sewn closed through a practice known as infibulation.
She can feel things, there is some residual sensation, but it's very, very deep,
as she describes it.
It's like pulling up seven covers up over yourself and then trying to be
sexual through that.
Well, the first time I learned about the surgery and Dr. Bowers,
I was newly married and it was our honeymoon.
After a few days of having sexual relationship with my
husband, I started to question myself.
This is not the experience that
I'm supposed to have.
"J" is one of at least 200 million girls and women alive today who have
undergone genital cutting,
which is also sometimes called female genital mutilation, or FGM.
She requested that we conceal her identity to protect her privacy.
It was a crucial issue with my husband that we
always think about how to have a pleasure
without suffering for me.
We were open and honest
about it, so we Googled it together.
What I've learned after I, you know, continuously searched about it,
it's not just in my home country or in my community.
It's all over the world.
Shame and stigma surrounding female sexuality extends to western science.
While genital cutting has been shown to cause severe pain, bleeding, infections,
urinary problems, and childbirth complications,
very little research has investigated its impact on sexual function and
solutions. As late as the mid-20th century,
genital cutting was routinely practiced in the U.S. And the UK.
Until very recently,
female sexual anatomy was outright ignored in medical textbooks.
You know,
I was aware of FGM going all the way back to my residency 35
years ago, I think it was now. And, uh,
where we would see these patients and people would just kind of shrug their
shoulders and go, you know, nothing could be done. Even back then,
I thought to myself, you know,
this just doesn't make any sense that we're so dismissive of her own sense of
self.
So it was really interesting when I began interviewing patients who had
undergone FGM.
And their primary motivation for getting the surgery was not sex or sexual
feeling, even. It was the sense that their identity had been taken from them.
But I would say relative to other, uh, problems of this magnitude,
you know, when you think that this affects 200 million women worldwide, uh,
it's, it's an embarrassingly small amount of attention.
In the 1990s and early 2000s,
a French surgeon named Pierre Foldès pioneered a technique to restore sexual
sensation to survivors of genital cutting.
In a study by Foldès and his colleagues published in 2012,
out of more than 800 patients who attended a one-year follow up,
about 98 percent reported an improvement, or at least no worsening,
in pain and clitoral pleasure.
About 51 percent had experienced orgasms.
A meta-review in 2021 similarly reflects improved sexual sensation,
but more data are needed.
Bowers first learned the technique from Foldès about 15 years ago.
She has now performed more than 500 such surgeries and trains local surgeons in
regions where genital cutting is most common.
When that infibulation is divided, we,
in about a third of cases, we will see that the clitoris is completely intact.
Uh, so we don't, we don't know that yet, but we are
optimistic at this point. So we'll see what we, we can find.
In this work,
Bowers draws from her experience performing close to 4,000 gender-affirming
surgeries-and receiving one as a patient.
So literally,
I deconstruct and reconstruct the genitalia.
And how that has informed me is to realizing that, uh,
that really everything that a man has,
a woman has anatomically and everything that, uh,
a woman has a man has.
So I think we think historically about the clitoris as being a very small focal
area in women's anatomy, that once it's gone, that's the end of it,
reducing the clitoris to really this little anatomical speck of just a couple of
millimeters. But in fact, uh,
because it has been mapped out and because we understand just dissection-wise
and even what I do in my own work every day, uh,
we realize the clitoris is much larger.
Below the surface, the clitoris is typically more than four inches in length,
and new research suggests it has more than 10,000 nerve fibers.
The tip here would correspond to the clitoral glans. And then the,
uh, the clitoral body is composed of two paired structures, uh,
again, very similar in the male, called the corpora.
And they have erectile tissue in them, they extend down,
and then this is called the crura. And then these are the clitoral bulbs.
Really what we see is the glans; we don't see the clitoral body.
If you summarize both of those structures,
you realize that less than 5 percent of the clitoris is taken,
even in the worst case of FGM.
But that's only been common knowledge in the past couple of decades.
I mean,
like the general story of the clitoris is that it appears to have been lost and
found throughout history, which is very odd.
Science journalist Rachel E.
Gross wrote a book about how early anatomists mapped the female body and how a
new generation of women and LGBTQI scientists are rethinking everything.
Galen, for instance,
once said that the female reproductive organs were like the eyes of a mole;
they exist, but they're kind of inferior and messed up,
and they don't really do anything very well.
I don't know if he asked any women about that.
This attitude is also where you get words for female genitalia like "pudendum,"
which means "the part to be ashamed of" in Latin. Similarly,
"vagina" translates to "sheath" in Latin.
The implication is that its main purpose is to house a penis,
even though "penis" apparently comes from "tail." So I think that gives you
a window into how these male anatomists were viewing the female body.
"How does this help me, the male?" Like,
"How is a woman's body made to interact with and
pleasure and benefit a male body?" because that was the body that was centered.
Even the "father of anatomy," Andreas Vesalius,
called the clitoris a "new and useless part" that could not be found in any
healthy woman.
Also,
it should be noted that he probably dissected two women out of the thousands of
dissections he did. After him, you get two more Italian anatomists, uh,
Colombo and Fallopio, which is where we get the name for our fallopian tubes.
It was very popular to name organs after yourself. As a result,
we have a dozen white men in our pelvises.
These two men fought over who had found the clitoris. Meanwhile, again,
no women's voices going on, not in this debate, anyways.
In the 17th century Dutch anatomist Reinier de Graaf comprehensively described
the clitoris.
And in the 1840s German anatomist Georg Kobelt used dye to trace its nerves
and blood vessels.
He has some of the most beautiful pen-and-ink drawings that really just look
like these expansive landscapes.
But things went sideways again at the turn of the 20th century with Sigmund
Freud.
People were freaking out about the sexuality of women and children,
and they had all these ideas that masturbation would lead to insanity and
epilepsy and moral decay.
And Freud kind of capitalized on that.
And he said that the clitoris in women was an
infantile organ,
and it was destined to eventually give up its pleasure
and power to the vagina, which was the adult, mature female organ.
The concept of shame being centered in genitals,
especially for women and people with vaginas and clitorises, uh,
it really is rampant.
Even today,
some women opt for cosmetic surgery to get their labia reduced in size.
This can lead to pain or reduced sensation if the provider isn't familiar with
female sexual anatomy. And that is still very much a possibility.
This is how urologist Helen O'Connell put it in a TEDx talk in 2020.
When I was studying to be a surgeon,
the textbook we used had a lot to say about the penis. The clitoris,
which as a young woman I was very aware of from the inside,
was actually almost completely omitted from the book.
In the late 1990s and early 2000s O'Connell went on to comprehensively
map the clitoris for the first time using microdissection and magnetic resonance
imaging. Twenty years later,
clitoral anatomy is still making its way into textbooks,
largely through the advocacy of one patient named Jessica Pin,
who lost clitoral sensation after undergoing plastic surgery on her labia.
You know, we don't talk about it like fruits and vegetables, you know.
It should be just a little more matter of fact, I think. Uh,
and then it wouldn't be so mystified and, and frankly, so, um,
so shrouded in this kind of mix of guilt and shame.
People are really suffering. But at the same time,
there is barely information enough
for people to be educated about it and to speak up
and say something about it. Why it's not important, that is the question.
Why it's not important, why we are just ignoring it?