#157 | Labiaplasty Gone Wrong: The Collateral Damage of Ignorant Doctors

April 20, 2022

When Jessica Pin was a teenager, she became convinced her labia minora were unusually large and unattractive. Within days of her 18th birthday, she underwent vaginal labiaplasty with a prominent and trusted OB/GYN. Without her consent or knowledge, her surgeon severed the dorsal nerve of her clitoris, resulting in a loss of clitoral sensation. In the face of clear evidence, her doctor denied wrongdoing.

Jessica has since discovered labiaplasty is regularly performed by OBs even though (a) it's not taught in medical schools, (b) there's no regulatory board offering policies or best practices, and (c) there isn't even a procedure code for the surgery, which makes damage particularly difficult to prove in litigation. Through her online platform, Jessica has attracted countless women who've shared their stories of losing clitoral sensation during the same surgery.

Jessica is here to tell her personal story - including how her parents reluctantly supported her surgery - and to share the achievements and challenges of her activism.  Jessica has already succeeded in have some medical texts and journals corrected, and she's on a tireless mission to warn women that surgeons know little to nothing about clitoral anatomy.

Jessica Pin

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View Episode Transcript

In my opinion, this is a fake beauty standard that has been created for profit and that largely women are getting stigmatized with false medical information. My surgery was done within days my 18th birthday. I was still in high school. He completely amputated my labia minora and did a clitoral hood reduction without my consent. I lost clitoral sensation. He has since been the president of the Texas Medical Association and the president of the Dallas County Medical Society. This is someone with a lot of status in medicine surgeons are misinforming patients, and they are doing surgeries. They're not trained to do on anatomy they do not know.

I'm Cynthia Overgard, owner of HypnoBirthing of Connecticut, childbirth advocate and postpartum support specialist. And I'm Trisha Ludwig, certified nurse midwife and international board certified lactation consultant. And this is the Down To Birth Podcast. Childbirth is something we're made to do. But how do we have our safest and most satisfying experience in today's medical culture? Let's dispel the myths and get down to birth.

I am Jessica pin and I advocate for better medical education in clitoral anatomy. I have been getting more detailed clitoral anatomy into various medical textbooks, and I've changed board certification for OB GYN ones. The reason I do this is because when I was 18 I saw a labia plasti and in my labiaplasty my labia minora were completely removed and my clitoris was damaged in a clitoral hood reduction done without my consent. After my surgery, OBGYN told me that my loss of clitoral sensation could not have happened. So I taught myself the anatomy and I realized that it was not getting taught. So I tried to get detailed clitoral anatomy taught to OBGYNs, it's basically the nerves in the clitoris, were not in OB GYN literature until 2019. It is important for OBGYN to know where they are, if they're doing any procedures on the vulva especially on the clitoral hood. So I've been trying to get that changed.

Why would you have had a clitoral hood reduction? Why would they do that? I mean, obviously that wasn't what you went in for.

I've never gotten an answer to that question. My doctor claims he didn't do it. Just yesterday, I actually got a message from a woman who is trying to sue her doctor right now. And she says the lawyers are saying that she can't prove that that a clitoral hood reduction was done. It's really crazy. You know how much ignorance there is. And like, for me, I had another doctor examined me and examine my scars. And so I've encouraged this other woman, you know, just get it, get it in writing while your scars are still visible, you know, there should be clear evidence.

And so for you, you went into this procedure with a totally normal, healthy functioning clitoris and came out with loss of sensation. Is that correct?

Well, it's tricky, saying all sensation may not be entirely accurate. Maybe it's not, but I don't have glands sensation. So the clitoral glands is the most sensitive part of the clitoris. And if you cut the dorsal nerves of the clitoris, you're cutting the nerve supply to the glans. So that's what happened.

Jessica, when did you know something was wrong? And what happened for you? You were so young, and you had to go through recovery I'm imagining and you expected things to feel very uncomfortable during the recovery. When did you start to realize something was wrong? And what was the next couple of years of your life like?

So it's really embarrassing, but at 18 I really did not understand my anatomy at all. I think that ignorance of over anatomy is very, very common among women. You know, I grew up in Dallas, Texas. I never learned about the clitoris and sex ed. I assumed that the way that women got sexual pleasure was mainly from the vagina. So though I knew that I lost sensation, I didn't understand the significance of that loss. And I also thought it was my fault and I did not understand a separate surgery had been done without my consent, because I didn't fundamentally understand the difference between the labia minora and the clitoral hood. And I think that may actually be common. Because, you know, I've seen you know, I've seen posts on real self like I've seen a woman say that she got a labiaplasty and then post photos that clearly show she got a clitoral hood reduction and there's no mention of a clitoral hood reduction. And I also, you know, I've seen I've just seen posts that indicate some confusion about what the clitoral hood is. I think even some doctors think that you know, only the free end of the clitoral hood is the clitoral hood. And so then they count most of the clitoral hood as labia minora, which is which sounds sort of crazy like, you know, people often describe the clitoral hood as only the skin that covers the glans. And if you define it that way, then you have to account for the rest of the skin that they're operating on. And so I'm not sure what doctors want to call that.

Educate us a little bit here. First of all, specifically, what is the labiaplasty and why do women get labiaplasty? Typically, and then, if the clitoral hood isn't specifically the tissue that covers the glands, what is the clitoral hood specifically?

Sure. So, labiaplasty is a surgical procedure that reduces the size of the labia minora. So basically they just trim the labia minora. And most women get labiaplasty for cosmetic reasons. 13% of women get them for physical problems. However, I tend to question how often those physical problems are really due to the size of the labia minora. For example, there was a recent study that found that most physical complaints about labia minoras are sexual complaints, their complaints of discomfort during sex, and those complaints are not correlated with labia minora size. And so if those complaints are not correlated with labia minora size, it's quite difficult to say that they're actually being caused by larger size. Do you see what I'm saying? And so I think that there's an arousal problem going on right and lubrication issue rather than that there's a problem with the tissue itself.

That is my opinion what the plastic surgeon who did the study concluded was that labor you have an aura can be a problem at any size and therefore, they should not have any objective standard for what they call hypertrophy, which means hypertrophy means excessive growth and large and so, in the literature they define hypertrophy. As you know, they define it variably there is no objective standard, but sometimes they define it as labia minora that are equal to or longer than the labia majora which includes, you know, at least half of women sometimes they say it applies to all labia minora that protrudes how often is labiaplasty done how many women are seeking this procedure? There are no numbers for how many labiaplasties are done in the US. So every time you see a journalist write about labiaplasty and claim that you know there's some certain number done per year they are reporting only on the number that plastic surgeons are doing. Nobody is keeping track of how many labiaplasties OBGYN s are doing.

No. In my opinion, most labia placees are done by OB GYN. My surgeon was an OB GYN. They are not trained to do them in residency. Last I checked there was no continuing medical education for labiaplasty other than an online module, which was added in 2019 I believe or 2020 It was after I had started my activism. One of the things that I have done is pointed to how there are no training standards for labiaplasty and how there should be continuing medical education for labiaplasty. The online module is a step. Generally, an online module is not the best way to learn how to do surgery.

For sure. Wait Is Is this something that OB GYN are offering to women recommending to women or is it generally women coming to them and saying this is what I want? I think most of the time it's women coming to OBGYN. However, labiaplasty surgeons advertised labiaplasty aggressively personally, I had no insight charities at all about my labia menorah prior to seeking labiaplasty. What happened was when I was 17 I got online to try and figure out what the clitoris was. So I had no idea what a clitoris was. People at school had mentioned the clitoris. And I was embarrassed that I had no idea what it was. So I got online, and I was Googling to learn. And I couldn't find it. Of course, it's funny, but so I ended up on the Wikipedia page for clitoris. And then I ended up on the Wikipedia page for vulva. And I was just very confused. So I was like, what, like, I had no idea that any of that stuff because I had only learned about the vagina. I had never looked at myself. So you know, I got in front of the mirror. And I was like, what it is, it is funny to think about how in the dark I was about my anatomy, and how alarmed I was when I started learning about it. And how I had just conceptualized my anatomy as basically a whole because of how we call female genitals, vaginas, and vaginas are fundamentally cavities. So this left me with this impression that everything external was was maybe abnormal. And so I, you know, okay, can I jump in? I think I'm understanding what you're saying. Most girls are taught to refer to that area of their body as their vagina, but that's always been wrong. It should be the vulva. And the vagina is exclusively interior. So when you recognized that the vagina was interior, you said then what's all this other stuff? And that's when you thought there was something wrong?

Yes, that is how I felt. I mean, I had never paid attention to my vulva. Really, I didn't think much of it. I just sort of assumed as a default that I must be normal. However, once I started Googling and seeing photos of other vulvas, I started to question if I was normal or not, I remember the vulva on Wikipedia had very tiny labia minora. I don't think it's on Wikipedia anymore. But it definitely looked nothing like me. And it looked nothing like most of it was that I've seen, but I don't think that I don't really think that this is getting driven by men's preferences or by porn. I think it's getting driven by profit motive. So I ended up on the Wikipedia page for vulva and that's when I first learned the term labia minora. And I saw that the photo of a vulva on Wikipedia only showed very tiny labia minora. So then I Googled labia minoras to see what other labia minora looked like. And I stumbled upon labiaplasty advertisements and before and after photos for labiaplasty. And my memory is that before and after photos for labiaplasty actually came up in the search results for labia minora. I think it's gotten a little bit better now. But I'm sure you can still see information about labiaplasty when you google labia minora, or do an image search. And so when I was 17, I, you know, I read that protruding labia minora are considered unfeminine and embarrassing. I read that they're caused by excess androgens that they're caused by masturbation aging, that they're caused by sexual activity. These claims continue to be published in peer reviewed medical literature and a major medical textbooks to this day. So one problem was at 17 I actually read the peer reviewed medical literature on labiaplasty. And I did not think that information in medical journals was inaccurate. I believed that it was true. And I you know, I really just had so much trust in medical authority at that age. And I also read that the labia minora were not involved in sexual function. I read that there were no risks to sexual function. And so I really didn't think that there was anything to lose and having a labiaplasty so now 10 normative studies have been done not one has shown a positive correlation between age and labia minora size. Despite that until very recently, the American Society of Plastic Surgery called labiaplasty rejuvenation. So that is one thing that I got changed.

Well, it's a great selling point, isn't it? It's a great selling point youth. It's all about right the youth and it's false. It's not it's not even true. Exactly. This is unbelievable that honestly that you've uncovered all of this misinformation and basically glow medical journals about our very basic anatomy. It's one thing to grow up in a state where they don't teach proper sex education. There's always pockets of culture, shaming around sexuality, but this is these are medical journals. So the quote experts out there, don't know anything about it.

Jessica, I'm sure you are in a lot of communication with other women who have had labiaplasty. And I'm sure other women have had a similar experience as you. How common is it for the clitoral nerves to be damaged? And in answering that, can you kind of go back to helping us understand how a labia of how a labiaplasty affects the clitoral hood?

Yes, so I have no idea how common it is. I you know, I wish I could tell you. Yeah, I wish I could tell you how common my injury is? I don't know the answer to that question. I don't even know how many labiaplasties or clitoral hood reductions are done. There are no procedure codes, no one is keeping track of how many are being done. No one is keeping track of outcomes. The outcome studies that have been done have been published by experts who are essentially reporting on their own results. So that is one problem. You know, the the evidence basis in cosmetic surgery is is very biased. And in this case, it's worse, I think, because there are no training standards. So there is high variance in quality.

There's not even a procedure code. It's like it completely flies under the radar. Is that typical of cosmetic surgeries Is that why? Because it's considered cosmetic and not medical or other cosmetic surgeries have procedure codes. Other major cosmetic surgeries also have minimum procedure numbers for how many are performed during residency, at least for board certified plastic surgeons, OBGYN 's are different in that they are considered qualified to do a large number of procedures that they are not required to have any minimum procedure numbers for. So that is actually a broader issue in OBGYN. Personally, I think it's a problem that the least trained surgeons are operating only on women. I think that represents an issue in in medicine. But the thing is that they are operating without knowledge of where nerves are, that are, you know, right in the vicinity of where they are cutting. And it is not believable that this isn't leading to harm. And also, even if only a few women are getting harmed the way that I was, this is so preventable. And it's just irresponsible to operate without knowledge of anatomy. And you don't see that with any other surgeries. You know, I've asked my dad, are there any other surgeries?

Your dad is a doctor, we should mention.

I'm sorry, my dad is a plastic surgeon and he has told me that they learn more detailed anatomy of the outer ear than of the vulva.

Well, because the ear is important. This is I mean, I feel like this is I feel like this is just such a sexism issue. But even even so, if the doctor is male or female, you'd think because of their own personal experience in having sex lives, you think they would all be acutely aware of how many nerves are important around the clitoris? I mean, you would think that this is a common you would think they would be extraordinarily careful and think, oh gosh, I don't want to cause any harm here. So that'll that alone I feel like should have been another barrier to harm.

I know and it's really crazy because ignorance is every bit is common among women. Female OBGYN and plastic surgeons are not more receptive to learning anatomy, which has been something that I did not expect. It may not be a coincidence that the first plastic surgeon to consider the dorsal nerves of the clitoris was Dr. Christine memori. She's a woman so maybe that's not a coincidence. However, in the first paper where she mentioned them, which I believe was in 2015. So two decades after they started doing labiaplasties and clitoral hood reductions for cosmetic reasons, she said, painful sex.

She said dyspareunia is a unlikely because of the dorsal nerves are deep. So that was all that she had to say about it. However, she did acknowledge that there were there. Yeah, they're deep, but they're also completely on the surface.

The thing that is strange is that she was concerned about pain with sex, but not not sensation. Exactly.

And you see that pattern throughout literature on female sexual dysfunction, because sex is from a man's perspective all about penetration and the clitoris is left out.

Yeah. One of the most alarming things was how in the top OB GYN surgery textbook, which is called tailwinds operative gynecology, they recommended a clitoralplasty technique that involves severing the dorsal nerves on purpose. And they said a lack of clitoral sensation does not seem to affect patients later sexual behavior.

Oh my god, I cannot even believe this. And by behavior, they don't they didn't say satisfaction, by the way. They said behavior. What does that supposed to mean?

They said sexual function seems satisfactory in patients after procedures that separate the dorsal nerves of the clitoris sexual function, meaning that they could still have sex without pain.

That is my understanding. One time I analyzed the meeting of sexual function in every single article in the top two OBGYN journals. And most of the time sexual function is mentioned in OB GYN letter literature. It means the ability to be penetrated without pain, that is the primary meaning. Right? Wait, so you had mentioned I'm just gonna go back to this because in the beginning, you sort of had mentioned that you didn't necessarily think this was coming from a man's perspective or this wasn't a male issue. But to me, the fact that this is the way sex is viewed as penetration and sex is simply about the act of that and the clitoris is completely left out of it feels like a male issue.

Yeah, that may come from men, because I think you know, the way that men conceptualize sex is based on how they get pleasure. So in that sense, yes, it does come from men. I also think that the cultural suppression of female sexuality may primarily come from men however, there are different theories for how that arises. The labia minora are the inner lives of the vulva, they surround the vagina and they attach to the clitoral hood. They also attached to the clitoral frenulum So, basically, I like to conceptualize the labia minora as extensions of the clitoris. That's how I think they should be conceptualized because they are homologous to p&l shaft skin. And they have the same types of nerve endings as the clitoris and I really also think that they play a mechanical role in facilitating clitoral stimulation during intercourse because they must affect the hood they move they retract the skin during intercourse.

Exactly. I mean they pull on both the part of the clitoral hood that is basically shaft skin and foreskin of the clitoris. So that is fundamentally what the clitoral hood is. It is most of it is actually skin of the clitoral body. And then the end of it is basically like a foreskin and it covers the glands and it can be retracted.

So put differently we could potentially say the clitoral hood is where the labia minora meet at the top. Yes, yes. And they have a protective it has a protective function as well. Sure.

Yeah, the lady have no I do have a protective function. What is very strange is when I was 17 years old, and I first was talking to my doctor, or I may have been 18 at this time. My surgery was done within days and my 18th birthday. I was still in high school. I asked him what the labia menorah were for. And he just shrugged. He had no answer.

So you felt they weren't important?

Because I think a lot of surgeons are so ignorant of overt anatomy, that they don't realize when they're going when they're completely amputating the labia minora because they're counting some of the vestibule as labia minora. In one of the top OBGYN surgery textbooks, it's called Atlas of pelvic anatomy and gynecologic surgery, they show an illustration where they mark the labia minora while they're under tension and then they show in the illustration the labia minora are being completely removed. And I asked them to please take that out and to please update that illustration. And they wouldn't and they said I was misunderstanding the illustration and I didn't know what I was talking about and they threatened to sue me if I continue to talk about it is the intent is the intention with the labiaplasty to completely remove the labia minora? Are we just talking? Typically people want a reduction in size? Or is it ultimately, it's definitely a goal. complete removal is definitely not the goal and certainly should not be the goal. There is one OBGYN Dr. Reid Allen sod who promotes a procedure called the Barbie where he does basically completely remove the labia minora. Oh, my God, I what I think is that, you know, this is tiny, labia minora standard is a fake beauty standard. You know, I don't think that it's real. I think that what they're doing is they're saying that half the female population has ugly genitals. And I think that that is ridiculous. You know, and they're doing this to make money. You know, and I don't think that it's supported. For example, if you look at Reddit, the most popular vulva photo on Reddit has very large labia minora. So I just I don't even think that this beauty standard is real, I think that it has been something that has arisen due to cultural suppression of female sexuality, which has caused taboo around female external genitals, because they are involved in pleasure and not directly involved in reproduction. That's where this comes from. It is very normal to care about what you look like. Now, I think it should be emphasized that how things work is magnitudes more important than what they look like. And especially when it comes to the vulva. How it works is so incredibly important to female health and quality of life. And, you know, your ability to have fulfilling sexual experiences with your partners. And so in that sense, it's incredibly fucked up. That volver aesthetics are prioritized over function in medicine, and that if you choose to do something aesthetically related to the vulva and vagina, you're at risk of losing that function. I mean, that is astonishing. Yeah, it's scary.

And I know that there are some women who feel that they are willing to take that risk. However, I question what is leading them to be willing to take that risk. And also, even you know, for women who believe the risk is acceptable. What I want people to realize is that in seeking these procedures, they are financially supporting a field that has chosen to disregard female sexual function. So I think when female genital cosmetic surgery is held to the same standard as cosmetic surgery, on other body parts, like noses and breasts, then a decision to seek labiaplasty will be a personal decision. But now, I think that, you know, what it means is fundamentally funding this systemic negligence. And it's like, it's similar to how it's not ethical to purchase products from a company that uses slave labor. You know, that's how I see it, because what's going on is totally unethical. You know, because surgeons are misinforming patients, and they are doing surgeries. They're not trained to do on anatomy, they do not know. That's what's going on and professional medical organizations are complicit in this. The American Society of Plastic Surgery used to misinform the American College of OB GYN continues to misinform. What I say a lot is that misinformed consent is not consent.

That's really well put. Let's go back to your story. Okay, so you're in high school it was within days of your birthday. What exactly was going on? And did your parents know?

Yeah, um, so my mom so I actually went to my mom first and I hate to throw my mom under the bus but what she said is, that is such a stupid thing to worry about. Those flappy things are supposed to be ugly. And so for me at 17 That was not helpful. I think that what is helpful is to recognize the beauty of olbas like they really like now when I see vulvas. I think that their beauty before but I think that's because I'm used to looking at them. And I see the beauty in them. And so instead of just seeing these wrinkly foreign things I never expected to be there, I see something normal and beautiful, and I understand the connection to pleasure. And I, you know, I understand the connection to first fertility, you know, like one thing is, is the the labia minora developed during puberty, right, and so they are a sign of healthy hormones are a sign of maturity. And so now there's not this negative association with them. And I also understand that they come in all different colors. So I remember when I was 17, I was sort of alarmed that my labia minora were dark, you know, and I was like, what is that you?

And I because you were under the impression they should have been like, well, that's another thing that plastic surgeons say is that darker labia minora are considered less attractive. This is kind of crazy and it's also like slightly racist, I think because, you know, women who are darker and complexion have darker labia minora, you know, so, you know, even if, like if you're a darker complexion and white woman, it is more likely that your labia minora will be like, you know, more dark you have more melanin in your skin. Right?

Yeah, there was a doctor on Tik Tok who made a video about this and I thought it was really interesting. She explained all the factors that contribute to the color of the labia minora. There's also a project called the gyno diversity project that broke down like all the different colors that the labia minora come in, in different colors in you know, among different ethnicities. And I thought that was very interesting, interesting. And so for me, like I have all of skin I'm half Italian, like it made sense that my labia minora were a little darker. And there's nothing wrong with that. I also changed throughout the lifetime, they change in a woman's lifetime, from puberty, through pregnancy, through menopause, the change significantly in color in size and shape.

So I tend to question then, the narrative about how they change in size, I guess they may change in size in different ways. However, I really, you know, I because there there has been this pattern of associating bigger labia minora with older age. And that just hasn't been supported by 10 normative studies that have been done.

They actually get smaller in older age, because the vagina atrophies. But they do they can get bigger in pregnancy. So that that might be where some of that comes from pregnancy can alter the color can alter the size and then they are influenced by hormones. And then when you hit menopause, they tend to shrink.

I see. Well, I guess my main point was that now I see labia minora as beautiful. Oh, yeah. So my mom took me to her OBGYN. And her OBGYN told me that I was normal. However, at that point, I had read recommendations that doctors tell all patients that they are normal.

Oh, no, you came across that on your own. And you thought he's just saying that?

Yeah. So it was a woman we were supposed to say. So what they will say is that all labia minora are normal. But some lady women are unusual and unattractive, you know, so. So saying that they're all normal is not necessarily helpful, unless you define what that means. And you didn't want to be normal and unattractive, which is really where the focus had to be for you to feel better.

Yeah, yeah. And I think, you know, part of the issue was I was very vain. And my father was a plastic surgeon. And I sort of grew up with this idea that if there's something wrong with your appearance, you fix it. Which, you know, I disagree with now. But I think that, you know, I think that a lot of people who have high expectations for what they look like are vulnerable to this messaging. And that's why I think that it's important to emphasize that, in my opinion, this is a fake beauty standard that has been created for profit, and that largely women are getting stigmatized with false medical information. So I think that's where this is coming from. And I also think it comes from cultural suppression of female sexuality, which leads to all this ignorance and taboo around vulvas. And that's why we want them to be invisible because we're not comfortable with female sexuality. I wanted to know what percentile I was in. You were like good nor I'm all are bad, normal, right? I wanted to know how I compared to other women. And she wouldn't tell me. And so then I asked her how many of the last 10 patients that you've seen had larger labia minora than I have? And she wouldn't tell me. And so I thought that she was hiding information for me. In retrospect, it's likely that she just had not paid any attention. Yeah, so that did not make me feel better. I left feeling like she had deliberately hidden information from me. And I was even more concerned. And so then what happened was, I went to my dad. And this was where I did something that really impacted my ability to stand up for myself later. Because what I did is I said that my labia menar hurt me when I rode my bike. And that was a lie. And so that lie, made it so that I blamed myself. And so that I was afraid to speak up because I was afraid other people would blame me. But what was going on is I was 17 years old. And I had read all this false information. And I was really desperate to correct what I thought was a really embarrassing and shameful problem. And so I said that they hurt me when I rode my bike. And so my dad, you know, he asked around at the hospital. And he was told that people do these all the time, and it's no big deal. And he got the impression that it was just extra skin, that they were just going to be removing extra skin and it was no big deal. And that is what a lot that is how a lot of surgeons refer to it as excess skin. So it really the seriousness of the procedure gets minimized. There's one plastic surgeon who runs Facebook ads saying that it is a hair like a hair cut for your genitals.


Starting four years ago, I really expected I expected to find OB GYN who wanted to help advocate I hoped that popular OBGYN on social media would want to talk about this issue and use their platforms to help and when they didn't, I was very frustrated. And so I have made mistakes. You know very early on. I wrote an article explaining that the nerves and vessels in the clitoris were omitted from OB GYN literature. I made a mistake in that I titled the article OBGYN is don't learn the nerves and vessels with a clitoris, which is a fact. It is a fact. However, it is not a fact that OB GYN is except the problem is that they think that if they have learned the course of nerves and vessels leading up to the clitoris, that they've learned everything they need to know.

Or they think that if they've learned what was in the textbook, they learned everything they need to know that it's exactly what was there.

That's what was there. However, what's interesting is there was actually more in some general anatomy textbooks. So it is possible that some of them learned it, but it's bizarre is that they couldn't tell the difference letter is one of the top anatomy textbooks in the world. I think it is the one that most plastic surgeons rely on the course of the dorsal nerves is incorrect in Nether so the dorsal nerves are the nerves that innervate the clitoris. And what most doctors don't understand is that they are very large and easy to dissect and in the clitoris itself, and they are they travel on top of the clitoral body. So basically the clitoris has a clitoral body which really resembles a shaft and you can feel it by you know, rubbing your finger back and forth over the clitoral hood you can feel a little shaft and the dorsal nerves travel basically on top of that shaft just under the skin of the clitoral hood. And it's actually very, very similar to in the penis in the penis. You also have two main dorsal nerves and they travel on the top of the p&l shaft under the skin of the penis, and that anatomy is always shown. But the nerves in the clitoris are typically omitted. netters atlas of human anatomy is one of the top types anatomy textbooks in the world. And they show the course of the dorsal nerves incorrectly and yet doctors accept it as real imagine the anatomy of the penis in the dorsal nerve in the penis is highly detailed. Yes, in we're talking about the same nerve, right? In both sections Hmm, similar anatomy, but it's never taught. Yeah. So, what is important to understand is most of the clitoral hood is basically clitoral shaft skin. And so operating on the clitoral hood is, you know, operating most of the clitoral hood is like operating on the shaft skin of the penis. So you have to imagine if doctors operated on the shaft skin of the penis without considering where nerves in the penis are. And that's what we have going on here.

You Your dad asked around, he heard it wasn't a big deal.

Oh, my dad asked around. And he got the impression that his plastic surgeon colleagues who were doing labiaplasties didn't really know what they're doing. So it's frustrating is that a medicine doctors don't speak up if they believe that their colleagues don't know what they're doing. There's a culture of just respecting the professional judgment of your colleagues and not saying anything, when you know that they're doing something fucked up. And so my dad chose an OBGYN to do my surgery. And he chose my OBGYN based on asking around at the hospital. My OB GYN was recommended by the head of the OBGYN department as the best OB GYN surgeon at the hospital. Now my dad didn't ask who specialized labiaplasty you know, or you know who would be good in that specifically. And my doctor had only done two labiaplasties before mine. So it was pretty frustrating to find that out later. However, both women he operated on before me were also doctors family members. So basically this is a man who is very trusted by other physicians. Now I think that one reason he is so highly esteemed among physicians is because he has lobbied to get physicians paid more by insurance companies. I think that is why he's popular. I think that a lot of things come down to money, you know, when things don't make sense. Look at the money. And so that is who operated on me. He has since been the president of the Texas Medical Association and the president of the Dallas County Medical Society. This is someone with a lot of status in medicine. He completely amputated my labia minora and did a clitoral hood reduction without my consent. I lost clitoral sensation, when did you realize something was wrong?

So I knew that I had lost sensation after my surgery, I didn't fully understand what it meant. Because I thought that, you know, I didn't understand that the clitoris is the primary organ, a female sexual response. I thought that, you know, I would, I thought that there would be fireworks when I had intercourse. And so shortly after my surgery, I had intercourse because I thought that that was the solution. And when that was not enjoyable for me, I broke up with my boyfriend and I got a new one. You know, I didn't, I wasn't really, I was quite resistant to acknowledging that I had been harmed in a significant way. And when I did acknowledge it, I thought it was my fault. So eventually, I remember telling a boyfriend that I didn't think, you know, I didn't think that I could orgasm because of a surgery that I had. So I had an awareness of how it affected me. And yet, it took a very long time for me to realize that there was negligence, and that it was not my fault. So it it took almost four years for me to say this happened, and I need justice. And by then, you know, I was well past the statute of limitations. And also people, you know, like, my dad initially didn't believe me. And my mom said, she told me not to do that. And it was it was hard for me to say that it wasn't my fault. It was hard for me to say that something bad was done to me and it wasn't what I signed up for. The you know, I had not signed up for any risk of what had happened. You know, and again, misinformed consent is not consent. If you have a surgery and an outcome happens that you are not told could happen. It is not your fault. That is not informed consent. And I've had you know, I've had doctors tell me that all surgery has this and that I should have known. There was no way for me to know If I believed peer reviewed medical literature on the wrist, I was not told any risks other than all surgery carries risks.

Yeah, that implies that like something inadvertent could go wrong, there might be something with the necessary anesthesia going wrong. But it does not mean that a risk is that the doctor willingly due to negligence or not amputates something extra, we can call that the same kind of risk, like it might be that your doctor goes robe, that should not be considered a regular medical risk.

Yeah, I mean, he did surgery on a separate body part. And also, this is a very complete amputation is a very common adverse outcome of labia plasti. It's very common. That's why, you know, when I consulted with a plastic surgeon in 2010, he said, I see this all the time, most surgeons don't know what they're doing. Before that I had no way to explain my loss of clitoral sensation. And I was really confused about everything. I think one thing that may be common is that when women are harmed by these procedures, they have very limited ability to explain the harm. And I think they're getting told by doctors that it's not possible.

But this is because they don't understand the they have no knowledge of the anatomy. So they're in their minds. They're saying this is not this is not possible, because I have no knowledge.

She told me that my surgery could not have impacted my sexual function. But then later, I went back to her and I said, Next time, please examine the patient carefully. And don't just don't just say that they need to fall in love. And I said, Please tell other patients like me that they can report that they can report their doctors because I have no idea that that was an option. And the statute of limitations on reporting is seven years. The most important thing to understand is that ignorance of anatomy is pervasive among OB GYN and plastic surgeons who are considered qualified to operate on vulvas. And they don't realize they don't know what they don't know. And in order to really change this professional medical organizations need to do something. They need to change their maintenance of certification more than they have. They need to change their core curricula. They need to issue committee opinions. You know, I've emailed the executive director of the American Board of Plastic Surgery, and he will not engage with me because he doesn't want me saying anything about the board on social media. And he said, he has an obligation to protect the board. So it's really important to recognize that medical organizations are most responsible to their members, rather than to patients. And there's no one really representing patient's interests, because professional medical organizations claim to represent patient interests but really they represent physician interests.

Thank you for joining us at the Down To Birth Show. You can reach us @downtobirthshow on Instagram or email us at Contact@DownToBirthShow.com. All of Cynthia’s classes and Trisha’s breastfeeding services are offered live online, serving women and couples everywhere. Please remember this information is made available to you for educational and informational purposes only. It is in no way a substitute for medical advice. For our full disclaimer visit downtobirthshow.com/disclaimer. Thanks for tuning in, and as always, hear everyone and listen to yourself.

My own mom told me I was making mountains out of molehills, it's really hard to not be able to receive pleasure from a partner. And so when I hear it's just for pleasure, it's and I know that other women who have been harmed similarly feel the same as I do. Like it is so fundamentally trivializing to what we're experiencing as far as the loss. Yeah. And people need to ask why OBGYN don't help speak up. And, you know, when I pass out fires the ACOG annual meeting in 2018. I had female OBGYN tell me to my face, that women just shouldn't be getting those surgeries. So there's a lot of victim blaming. There's a lot of dismissal of the importance of clinical function.

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About Cynthia Overgard

Cynthia is a published writer, advocate, childbirth educator and postpartum support specialist in prenatal/postpartum healthcare and has served thousands of clients since 2007. 

About Trisha Ludwig

Trisha is a Yale-educated Certified Nurse Midwife and International Board Certified Lactation Counselor. She has worked in women's health for more than 15 years.

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