The lack of medical research into female anatomy has caused a data gap and an ingrained taboo surrounding sexual pleasure
Defaulting Male Anatomy
Scientific study has been situated within a white, cis, male framework that has been used as a template for all medical practices. Those that fall outside of this norm, namely women, trans men and non-binary individuals are met with a large gap in data and in treatment.
British journalist and author, Caroline Criado-Perez’s book “Invisible Women: Exposing Data Bias in a World Designed for Men,” details how medical research, anatomy textbooks and drug trials typically operate under the assumption that male bodies are representative of all bodies.
Historically, female anatomy has often not been adequately explored or represented, but rather treated as a mere counterpart to the male norm, save for references to hormones and the sexual organs.
However, there is more nuance in how those with female anatomy respond to medication, express symptoms, and experience both pain and pleasure. Similarly, those on hormone replacement therapy (HRT) or those who have undergone gender-affirming surgery also face a lack of research and cultural recognition of the differences, sometimes subtle, in how they achieve pleasure.
It should be noted that female anatomy refers to the external genitalia, or vulva, and internal reproductive organs such as the ovaries and uterus. Not everyone with female anatomy is a woman and to suggest so is exclusionary of trans and non-binary people.
Because cis male bodies have been treated as a proxy for the rest of humanity, there is a data gap in the medical understanding of female anatomy and subsequently of pleasure among women, trans men and non-binary folks.
The Suppression of Female Sexual Pleasure
Through the 19th century, the female body was viewed as a deficient version of the male body with every assumed difference linked to the uterus and hormone differences. Hysteria became a catch-all diagnosis for any woman with a problem. It was thought to be caused by too much sex, not enough sex or excessive masturbation.
To treat epilepsy and hysteria, English gynecologist Isaac Baker Brown strongly advocated for and performed many clitoridectomies, a procedure that entails removing the clitoris. According to his obituary, Brown believed that masturbation was the cause of women’s ailments and took it upon himself to perform the procedure whenever possible.
Female genital mutilation occured in Europe and the United States well into the 1960s to treat sexual deviancy and hysteria and “cure” lesbianism. The practice is still found in some areas of Africa, Indonesia, and Yemen but has a long history within Western culture that goes largely ignored.
As psychiatry became increasingly medicalized in the early 20th century, women faced scrutiny for having too much or too little sexual desire. German psychoanalyst Sigmund Freud argued that a woman’s sexual focus should shift from the clitoris to the vagina over time. This was held as the benchmark for female sexual maturation.
Given the lack of understanding of its capacity for pleasure, The clitoris was treated as an unnecessary organ. Simultaneously, it was also viewed as the main culprit for ailments and any sex-related issues.
These theories were steeped in a heteronormative ideas of feminity and sexuality. Women who desired clitoral stimulation into adulthood were branded as denying their maternal obligations and behaving like men.
Society confined Sexual pleasure within the limits of marriage, heterosexuality, and motherhood. The lack of education that women received on their capacity to achieve pleasure caused many to live unhappily. Furthermore, social constraints encouraged the sexual voracity of men and subservience of women.
Even today, much of the dialogue surrounding both sexual pleasure and health privileges is centred on heterosexual, cisgender penetrative sex. Not only is research on female anatomy still lacking, but widespread information on the safest and most pleasurable sex practices for LGBTQ+ individuals remains scarce.
The History of the Clitoris
Australian urologist Helen O’Connell largely established the anatomical structure of the clitoris in 1998 through a series of MRI studies and cadaver dissections. Previously thought to just be a small nodule at the top of the labia minora, the clitoris is both an internal and external organ.
The external portion of the clitoris, the glans clitoris, roughly 2 centimeters in diameter, is indeed located above the urethra and partially covered by the clitorial hood of the labia minora. The glans clitoris is what many think of when they hear the word clitoris.
The internal structure of the clitoris, the body, crura and vestibular bulbs, resembles a wishbone with an extra pair of protruding structures. The clitoral body projects upward and is attached to the pelvic bones by ligaments while the crura, leg-like protrusions, and bulbs extend behind the labia, urethra, and vaginal canal.
In the 1840s, German anatomist Georg Ludwig Kobelt published a detailed account of female genitals, including the clitoris and its tissues and nerves. Although scientific study on the clitoris dates back two centuries, we can attribute much of the medical suppression of clitoral studies to Freud.
Famous for his theories on Oedipal complexes and sexual deviancy, Freud posited in 1905 that achieving orgasm through vaginal penetration rather than through clitoral stimulation was a greater sign of maturation.
Because the clitoris is homologous to the penis, in that they are both made up of erectile tissue and similarly respond when stimulated, Freud surmised that the clitoris was a more masculine organ and therefore a less feminine source of pleasure.
Freud’s two cents on the proper female sexual maturation indicated widespread cultural misogyny and ignorance about female anatomy in medicine.
Freud’s invalidation of the clitoris as a healthy way to achieve pleasure led to the stunting of research on the organ. There was greater interest in medical studies of female genitals in the 1970s, but O’Connell’s paper‘s marked the first accurate render of the clitoral anatomy.
Most people with vulvas need clitoral stimulation to achieve orgasm. There is, however, variation in people’s most sensitive erogenous zones and how they experience pleasure.
The taboo surrounding female anatomy has left gaps in understanding pleasure in both masturbation and parterned sex. This failure to grasp the mechanics of female anatomy indicates a cultural invalidation of women’s pleasure.
The erasure further extends to queer, trans and non-binary folks provided with even less sexual education and research on pleasure. What does exist most often centers straight cis people.
Going forward, not only is there a need for greater research into pleasure but greater commitments to widespread education of achieving pleasure across gender identities and sexualities.
The Need for Queer, Trans and Non-Binary Sex Education
The limited sex education that does exist in the United States is rarely inclusive of how queer, trans and non-binary folks experience and seek pleasure.
It is not enough to know how penises and vulvas function because there is a spectrum of experiences for those that take HRT, undergo gender-affirming surgeries, or experience gender dysphoria. It would be an oversimplification to suggest that penises and vulvas each have universal avenues for sexual pleasure.
Trans-inclusive sex education should teach how bodies change from HRT, how to adjust your sex life after gender-affirming surgery, and sex positions that meet trans and non-binary people’s specific needs related to comfort or dysphoria.
Trans people suffer disproportionately high rates of sexual violence compared to their cis counterparts. The suppression of pleasure of trans and non-binary folks is not just caused by a lack of education but by widespread transphobia. Because of the way that trans and non-binary people are also fetishized in sexual contexts, it is more difficult for them to find affirming and pleasurable sexual health practices that aren’t objectifying.
Sex education that extends to queer, trans and non-binary folks is an opportunity to divert from patriarchal modes of sex that often focus on domination and one-sided pleasure.