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.”
‘A side note at best’
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.”
Asked what she learned in medical school about the clitoris, Dr. Rubin replied, “Nothing that sticks out to my memory. If it got any mention, it would be a side note at best.”
Only years later, on a sexual-medicine fellowship with Dr. Goldstein, did she learn how to examine the vulva and the visible part of the clitoris, also known as the glans clitoris. The full clitoris, she learned, is a deep structure, made up largely of erectile tissue, that reaches into the pelvis and encircles the vagina.
Today, Dr. Rubin has appointed herself Washington’s premier “clitorologist.” The joke, of course, is that few are vying for the title — out of embarrassment, a lack of knowledge or fear of breaching propriety with patients. “Doctors love to focus on what we know,” she said. “And we don’t like to show weakness, that we don’t know something.”