Women and Women Medical Professionals
Let’s talk about the vagina and clitoris stuff etc. Why do so many of us feel more comfortable with female rather than male gynecologists? It’s not that a male one can’t be as skilled. But only a biological female has the same plumbing as us, the same chromosome pattern, the same rough chemistry. She knows the pain of menstrual cramps or childbirth. A man can imagine some of these things, but he can never feel them.
But it’s not just pain or discomfort that female medical experts can help us with, but sexual pleasure as well. Men do not get aroused in the same way or at the same speed as women. Their biological gear is different, they cannot have multiple orgasms or recover within seconds. When you describe an orgasm, or even sexual arousal, a female doctor knows exactly what you mean, because she’s felt it herself.
And this is why it’s so important to acknowledge the founding women, the veritable mothers of modern female sexual medicine and reproduction, since these are the first human beings to study our biology not just from a clinical perspective—which is the limit of what a man can do—but from a personal one as well.
Australian Helen O’Connell is one such founder of female sexual biology, and her studies have revolutionized how we understand our wonderful lady bits. We recap her interview in the December 8, 2018 Sydney Morning Herald, which explains some of the importance of her work and career.
Female Genitalia and the Limits of Men:
Men had of course produced the earliest Western texts on sexuality and genitalia, but back in the 1980s O’Connell found these texts woefully inadequate. As regards to female genitalia, the medical books lacked any illustrations at all, and not even a correct description of the clitoris.
The books basically described female genitalia as a “failure to develop into the male version,” perhaps not incidentally implying that women were second-class people with second-class reproductive systems.
Later in that decade, more accurate, female-created books emerged with more precise and detailed illustrations of female genitalia. In 1989, the female-written A New View of a Woman’s Body was published.
The authors had not only performed vital studies on the external and internal structure of the clitoris, but in a truly hands-on work, had at one point stripped down, masturbated, and took notes on one another to discover the biological roots of female sexual pleasure. O’Connell still looks back with respect on these early sexual explorers, calling it “amazing methodology.”
On to Cadavers
The living can tell scientists a lot, but so can the dead, especially when it comes to internal structures, so O’Connell began to use the cadavers she could access in the dissection rooms of her university to gain deeper knowledge of the anatomy of female sexual organs.
In doing so, she could scientifically validate the above discoveries of the female researchers, while also disproving much of the common consensus on the shape and structure of female sex organs. Specifically, by 1998, through her work with cadavers she proved that:
· The button-shaped sensitive area of the vulva is not the entire clitoris, but just the glans, which is the only visible part of the organ.
· The clitoris itself extends several centimeters inside the body in a wishbone shape, most of it located beneath the pubic bone.
· The body of the clitoris has two legs—called crura—extending out from it, as well as two eggplant-shaped bulbs cradling the vaginal walls.
· All these tissues are soft and spongy, and get engorged with blood when stimulated, becoming erect as a penis does.
· The clitoris is supplied with well-developed nerves and plenty of blood supply, making it extremely sensitive.
The work was scientifically groundbreaking, because it would enable surgeons to take more care in preserving pleasure-generating genital parts during surgical procedures on the pelvic area, as they had long done with men’s genitalia. The work also accelerated research on the nature and types of female orgasms (i.e., vaginal vs. clitoral) and the contested design or even the existence of the celebrated G-spot.
Summing up all this, the British writer Jessica Berens said that “without a proper map of the female bits, it’s as if everyone’s been driving around for ages and still not found where they want to go.”
But O’Connell is not only a researcher. She is also Australia’s first female urologist, and still practices today as a surgeon, using some of the latest technologies and minimally invasive techniques. Interestingly enough, though, in her interview with the SMH, she also revealed herself as something of an historian and artist.
On the History of Clitoral Research
O’Connell provided a history of the study of the clitoris, beginning with the 16thcentury Realdo Colombo, an anatomist, who called the organ “the seat of (female) lust.” A Dutchman, Regnier de Graaf, took the work further in the 17thcentury, by describing the bulbs, among more comprehensive details.
A German in the field, Georg Kobelt, brought all of this together in anatomical drawings that still hold instructional and aesthetic value today. “His black-ink drawings are like a landscape of rivers, lakes and tree roots. Really beautiful,” said O’Connell.
But like all scientists before him, even Kobelt failed to show that the outward genitalia are linked to internal structures by a nerve complex and supply of blood, as well the connections between the vagina, clitoris, and urethra.
It hardly mattered, though, because science itself seemed to have given up on understanding the clitoris and related genitalia after that. By 1948, regressing to a time even before the 16th century, texts were omitting the clitoris completely.
A Woman Updates the Field
It was then up to O’Connell to bring the entire field forward into the 20th century. Through work on her aforementioned cadavers, she made cuts to reveal the internal clitoris. She and her team took photographs, carried out lab tests, and brought an exactitude to the research that had been missing earlier.
She proved that the bulbs engorge with blood during arousal, and located their precise anatomical position—which in earlier drawings had often been wrong. She disproved other consensus-based ideas about the bulbs. They were not, as believed at the time, connected to the inner parts of the vulva. Rather, they were connected to the clitoris body. Her research also proved that the clitoris did not rest flat against the pelvic bone but instead was set in three planes.
The 1995 edition of Grey’s Anatomy claimed that the clitoris blood supply was small, but even that was disproved by O’Connell, who showed that the supply was actually quite large. The large blood supply enables powerful sensations in the nerve endings, which is why female orgasms are so much more intense than men’s. As O’Connell put it, “There’s a lot going on in those nerves.”
As technology in her field advanced, O’Connell was able to discover more, as well as bring more evidence that validated her earlier theories. Magnetic Resource Imaging (MRI), for instance, proved O’Connell’s earlier ideas on blood flow and its connection to female arousal. MRI also showed that blood flow to the clitoris shrinks during times of stress, to the point where the device can hardly detect the clitoris at all.
O’Connell, the Clitoris and Art
The breakthroughs of O’Connell have not been confined solely to the medical world but have expanded into wider society, including the arts. Sophia Wallace, an NYC artist, for example, creates impressive sculptures based on anatomically correct designs of the clitoris.
Asked to describe one of her many pieces on the subject, she said, “The shadow it makes is sort of like a penguin. It’s like the inside of a very complex flower, maybe an orchid. But it is also robust and strong.” With her Cliteracy project and TED talk, Wallace is a woman bridging the science and art worlds.
Wallace warns against the still widespread abuse of women through Female Genital Mutilation (FGM)—the removal of the clitoris and other tissue for non-medical reasons in some cultures, most often to keep a woman “tame” and “loyal” to her husband—something suffered by 200 million girls yearly worldwide.
Beyond anything, though, Wallace credits O’Connell with giving her the anatomical blueprints for her artistic work, placing the surgeon on one of her cards as “the discoverer of the precise anatomy, function, complexity and external and internal scale of the clitoris.”
Anita Brown-Major, an occupational therapist, has also relied heavily on O’Connell’s research in her sex ed work with disabled people. Brown-Major uses puppets—based on O’Connell’s anatomically correct designs—to teach health professionals about basic genital anatomy. She also uses plasticine in exercises where learners have to create correct mockups of female genitalia.
Rise of a Genius
O’Connell came along perhaps an unlikely path to her current position. The nuns at her Catholic school offered her no sex education, so she turned to her mother, who told her nothing beyond sex being “a man planting a seed in a woman.”
But while she did not gain much sex education from her parents, she did see role models of equality, career, and education in them. Her father encouraged her to do what she wanted in life.
Her mother, although repeating the age-old belief that “a woman’s place is in the home,” actually worked as a bookkeeper herself. “We all knew that Mum was happiest when she was working,” said O’Connell.
Many years later, O’Connell felt the same way. After having each child, she returned to work within a matter of weeks. “It felt very strange to be full-time at home with healthy, perfect babies. I trained for 15 years to be a surgeon and none of that taught me how to be a mother.”
At school, O’Connell was hardly any kind of nerd. She remembers herself as being quite popular, enjoyed partying and even played in a rock band—whose lead guitarist she eventually married.
As she launched her medical studies in urology, O’Connell found plenty of discouragement —from colleagues and elders. Superiors cautioned that she would have few patients, if any, as men would be too shy to see her and women would doubt her skill. As it turned out, she quickly grew a large base of both male and female patients, particularly as her achievements piled up.
However, even as a breakthrough medical researcher and accomplished surgeon, O’Connell was disappointed to see that her work initially received very little public or scientific attention at all. She still had to deal with skepticism, cynicism, and censorship, both professionally and socially, because she had destroyed many of the myths that surrounded female arousal and satisfaction.
Not surprisingly, the Oxford Dictionaries still wrongly describe the clitoris as “a small, sensitive, erectile part of the female genitals at the anterior end of the vulva,” 20 years after O’Connell’s research.
Although she worked for many years essentially as the only woman in her field and among an abundance of male skeptics, O’Connell harbors no bitterness. She said that period was “lonely rather than sexist.” Her solution was to simply keep racking up achievements. Eventually her work was recognized internationally, and in 2007 she had earned a World Health Association for Sexual Health gold medal, its highest award.
O’Connell on corrective surgery for stress incontinence
In 1993, O’Connell went to Texas for advanced research under Dr. Edward McGuire, by that time a leading light in urology. There she learned minimally invasive techniques to correct stress incontinence (caused by sudden movement, such as coughing or lifting).
They worked on the development of a sling fashioned from abdominal tissue to support the urethra, but were overtaken by technology as even more advanced and easier-to-install synthetic mesh slings appeared.
Early on, O’Connell was skeptical of mesh slings and did not use them in her own practice. She proved to be prescient in this, as these devices have been responsible for infections, pain, and loss of sex lives for thousands of Australian women.
In 2014, the Australian government placed tight restrictions on the devices, and O’Connell herself has performed about 100 operations to have the synthetic meshes removed.
On the G-Spot
Debate and controversy continue to follow the concept of the G-Spot. Adam Ostrzenski, an American gynecological surgeon, insisted that he had found it, “a well-delineated sac” on the vaginal wall.
While his published article on the subject became immensely popular, another American, bioethicist Jeffrey Spike, dismissed the G-Spot as a fantasy. Through her own work on cadavers, O’Connell herself found no evidence for the existence of a G-spot.
By inference, it also means that vaginal orgasms do not exist—sort of. While the vagina itself may not produce orgasms, pressure, play, or toys can create sensations in the clitoris and its bulbs around the vagina, which in turn can lead to orgasms.
To quote O’Connell, “So presumably with intercourse or play, there will be movement of all that erectile tissue [around the vaginal wall]. The shape of people’s bulbs varies … but there are enough reasons why for some women, vaginal penetration will be associated with orgasm, particularly given the location of erectile tissue around the opening of the vagina.”
O’Connell’s work complements that of French gynecologists Odile Buisson and Pierre Foldès, who used ultrasound–even on a couple having sex–to eventually find that, as per a 2009 paper, the G-Spot could best be described as a “richly innervated clitoris.”
Sexologist Tanya Koens expresses gratitude to O’Connell for her pioneering work on the clitoris. Koens became committed to understanding the biology surrounding the clitoris, even to the point of getting a 10-centimeter 3D model of the organ.
Speaking of O’ Connell’s work, Koens calls it “really amazing.” She then continued, “And I take that theory and wrap it around clinical experience where I see things happening over and over again.”
Koens asserts that correct knowledge of the clitoris and related organs can lead to more satisfying sexual encounters. In her own studies and practice, she notes that it usually takes 45-60 minutes for an average woman to achieve full clitoral engorgement—and become most primed for penetrative acts.
Vaginal entry prior to that time could cause the woman pain and discomfort. Koens insists that a slow workup of foreplay is integral to any female orgasms. She laid out her ideal scenario, “Start with kissing, touching the outside of the body and working your way in so that the genitals are getting the idea that they are going to get touched, but you are going to tease us.”
She then goes into the importance of pressure. “Pressure can be applied (on the clitoral shaft right above the glans) via thumb pads or heel of hand…it can feel particularly delicious when a small amount of pressure and movement is applied.” She also pointed out that with enough arousal the bulbs push back against the vagina, making the entry of anything (a penis, a toy, a tongue, etc.) a snug fit.
This advice can be particularly helpful for men. As Koens puts it, “I get a lot of men going, ‘My girlfriend’s got a flabby vagina and I don’t like it.’ And I say, ‘Well, maybe you are not doing your job well of warming up your lovely lady’.”
On the orgasm gap:
O’Connell acknowledges the well-known orgasm gap, with only 66% of straight women regularly achieving orgasm, while 92% of men (gay or straight) do. Lesbians are not too far behind, at 86%. O’Connell says this is a product of women not being able to relax and let themselves go the way men do.
What will you do with your knowledge?
Now that you know all about how your internal plumbing works, what will you do? Remember that a woman’s pleasure will depend on a number of factors, including the time spent in foreplay, kissing, and cuddling, which result in the stimulation of organs and tissues that are internal and not visible to the naked eye.
Sex should kick off with plenty of foreplay to create enough time for the clitoris to get engorged before penetration. Share this knowledge with your boyfriend or husband so that he learns the biology behind female pleasure. Or if you are solo, you can use this same knowledge to explore, play, and find your own private satisfaction. Either way, drop us an email and let us help you start down that golden road.