In December 2018 I spoke at Glasgow University Medical Visualisation in Education conference, as you can see in the rather murky photograph below. I presented my Medical Visualisation and Human Anatomy Msc thesis project: anatomyofpleasure.org, on how we can best image and describe the female genitalia from the perspective of sexual pleasure.

Here is my take:

Glasgow University Medical Visualisation in Education Dec 2018

Firstly, appropriately show the external genitals.

We show the female genitals, vulva, inner and outer labia and the huge variety between different people, both in aesthetics and in experience, as not only normal but beautiful! This could help prevent the sharp rise and desire for, non-medical labiaplasty in women, which has increased five-fold between 2001–2010. In the UK between 2008 and 2012 there were 266 non-medical labial reductions were performed on girls under the age of 14, despite exposing them to medical risks (Barbara et al., 2015).

Honest and realistic photographs of vulvea are essential for reducing shame and busting myths about how the genitals ‘should’ look. One admirable example of positive vulvic imaging is Gynodiversity.com, they receive and catalogue photographic submissions of vulvea of every size shape and skin tone. This is an important stepping stone on the way to reducing the bodily shame that so many people experience that inhibits the every-day enjoyment of life as well as sexual pleasure!

http://gynodiversity.com/panels/

It saddens me to blur this screenshot of Gynodiversity, who recently had to leave their Tumblr page with the new Yahoo regulations, despite doing vital social and academic work. There is nothing harmful or distressing about the female vulva, there is only beauty. This censorship feels misplaced when we compare these vulva pictures to the violence shown frequently on news sites, often with no warnings. Having said that, I’m happy to be conscious to those of you who might be reading this at work. You’re welcome.

Appropriately image the full clitoris.

We make sure that the internal anatomy of pleasure is displayed properly, particularly the clitoris, who’s only known function is sexual pleasure (Puppo, 2013).

“The clitoris is possibly the most critical organ for female sexual health.”(Pauls, 2015)

We make sure the clitoris is displayed and labeled in its entirety, from at least two angles, in order to portray is 3D nature and internal relationship to the vagina and urethral sphincter, not only the external glans clitoris that we see in the vulva. These requirements are often not met in gynaecology textbooks, so no wonder there is confusion about the female body and sexuality (O’Connell et al., 2008). Anatomyofpleasure.org contains illustrations (imaged below) and 3D models of the clitoris, descriptions of the erectile tissue and diagrams that are accessible to all, whether you are a medic or a teenager finding out about the body for the first time.

Image courtesy of anatomyofpleasure.org. Illustrator: Alakina Mann
Image: The full clitoris and attachment to the pubic bone. Credit: Render and Texture Timea Kosa, 3D Model Alakina Mann.

Next, we discuss pleasure as a normal, nice function of the genitals.

Pleasure is still taboo and not present in most sex-education syllabuses, to the great detriment of the pupils. We rarely tell our girls and women, or anybody else, about the clitoris and how it is fundamental in female sexual pleasure. This is sets people up for confusion, self-doubt and possibly painful sex (Levin, 2018).

Sexual consent is gradually permeating common conversation, which is wonderful and an essential foundation for pleasurable sexual experiences, however it is possible to consent to things that are painful or harmful, mentally or physically. If we discuss and teach about pleasure then consent becomes explicit, if someone is enjoying something thoroughly, they are usually consenting to it, although consent should still be actively collected. Teaching pleasure sets up young people and adults alike for a mutually enjoyable experience, which at the end of the day, is kind of the point.

Image and discuss internal anatomy of pleasure, and common pleasure zones.

Image Credit: Alakina Mann

We can then start to discuss the different areas of the female body and genitalia that can create pleasure and orgasm, and how they work together as a whole. For example, the glans clitoris (the very sensitive tip of the clitoris you can see in the vulva), the clitoral complex (the relationship between the clitoris, distal/lower vagina and urethra), g-spot, and deep areas of the vagina, the anus and in some cases the nipples, throat, even earlobes… We can discuss the changes that happen in the body upon arousal and female ejaculation. I hope to go into more detail on this in a later article, watch this space.

“When the entire network is thoroughly engorged [aroused], a woman will tend to have the most fulfilling orgasmic response. It’s as if an entire orchestra was engaged in a symphony. Unfortunately, though, since they don’t know it’s all there, many women are only playing with part of their equipment, thus limiting their erotic adventures. “ (Winston, 2010)

Gently does it.

“Sex is the place where mind, body and emotions all meet.” (Mazanti and Lousada, 2017)

When pleasure anatomy is discussed it is important to emphasise that any bodily exploration is at that person’s own pace, there is no pressure to be or act a certain way, you don’t owe anyone an orgasm! We also start to bring in emotional and psychological elements and systems that relate to the body and sexuality.

Image Credit: Alakina Mann

Particularly when it comes to sexuality a gentle learning approach is always best, going at the individual’s own pace and allowing time to integrate what was learned. This is important in sex education as everyone will have a different starting point and slightly different assumptions about sexuality. Patience and listening are key here, never pushing anyone into the ‘panic zone’ as no learning happens here.

Address myths and assumptions about the body and sexuality

“As therapists, our view is that we don’t really have ‘sex education’ in the UK, only what might as well be called ‘reproduction education’.” (Mazanti and Lousada, 2017)

Typically sex information tends to focus on the vagina, generally because such information addresses reproduction or STIs, when this is just one aspect of a bigger beautiful picture. For example, only 18% of people with vaginas orgasm from vaginal stimulation, such as penetration, 36% orgasm solely from clitoral stimulation and 36% can orgasm from vaginal stimulation but combining it with clitoral stimulation greatly improves the experience (Herbenick et al., 2017).

I recognise that everybody is affected by a taboo on sexual pleasure, for example, pleasure and the male prostate is often under discussed or misunderstood, not to mention how intersex and trans bodies are underrepresented. However my scope here constrains me to the female body, which has experienced a particular bias in its imaging and discussion that we hope to correct going forward.

“…Although 19th Century Victorian-era doctors did not believe that women experienced sexual desire or anything approximating the pleasure of a ‘male’ orgasm during sex (since neither were viewed as a ‘requirement’ for reproduction in women)…Could women be taught to do this [self-pleasure] themselves? Evidently not, at least not openly.” (Pfaus et al., 2016)

A long standing assumption that the female body is somehow inherently ‘less sexual’ than the male stems from a Victorian bias, as they believed women didn’t have orgasms, instead having little fits called ‘paroxysms’. This, I should add is an anatomical impossibility, all humans have the capacity for sexual pleasure, whether or not they access it is a different matter (Pfaus, 2016). Paradoxically, the Victorians would also use clitoral and vaginal stimulation to trigger these ‘paroxysms’ (pleasuring the women to orgasm) as a treatment for ‘hysteria’ or a number of mental health issues. This was only socially acceptable because they believed the women did not feel sexual pleasure, which really begs the question, what is so bad about pleasure?

Which leads us to look at how this bias, or pleasure-taboo, affected how the clitoris, the seat of female sexual pleasure, was imaged in both medical and public spheres.

The clitoris was omitted from anatomical textbooks and then ‘rediscovered’ throughout medical history (O’connell, 1998), most recently the clitoris was left out of the 1948 Grey’s Anatomy. When we know that the clitoris shares an embryological origin with the penis (illustrated below), it is difficult to imagine the penis getting left out of the most commonly used anatomical textbook in Western medicine. This also helps us understand perhaps why it was thought that women were less sexual, as their primary sexual organ, was left out of medical and public understanding.

Image: Internal genitalia depicting homology (Carrellas, B. and Sprinkle, A., 2017).

As anatomical information was, and still is to a large extent, centralised around the medical industry, which was historically male dominated, which affects how the general public discusses and understands their bodies to this day.

One 2005 US study of college students found that 29% of women and 25% of men couldn’t identify the clitoris on a diagram of a vulva (Wade, Kremer and Brown, 2005). This is a high percentage of people unable to name a part of their own body, more men could identify something that the women had owned their entire lives. This sends a message to young people that the clitoris, and by extension female sexuality, is either so unimportant as its not worth mentioning, or that its too shameful to mention. Again as a comparison, it would be hard to find anyone who couldn’t identify a penis on a diagram in the West.

Image: External genitalia depicting homology (Carrellas, B. and Sprinkle, A., 2017).

Sexuality can be an uncomfortable topic to discuss, between adults, friends and even intimate partners, and can trigger strong emotions, no wonder sex education is difficult to address. However if we start the conversation amongst educators, doctors, therapists, and perhaps most importantly our own friends and loved ones, we can be well prepared to talk to young people without shame and embarrassment about their bodies and sexuality. This will enable us to live our own lives with a bit more ease, joy and connection, rather than feeling confused and fighting against our own bodies. This is energy we sorely need for the many challenges of daily life. We also gift this ease and reduction of shame on to the next generation, as the one before gave to us.

Thanks for reading, hopefully there will be more on the way so follow or subscribe at anatomyofpleasure.org.


Because references never hurt…

  • Barbara, G., Facchin, F., Meschia, M. and Vercellini, P., 2015. “The first cut is the deepest”: a psychological, sexological and gynecological perspective on female genital cosmetic surgery. Acta obstetricia et gynecologica Scandinavica, 94(9), pp.915–920.
  • Pfaus, J.G., Quintana, G.R., Mac Cionnaith, C. and Parada, M., 2016. The whole versus the sum of some of the parts: toward resolving the apparent controversy of clitoral versus vaginal orgasms. Socioaffective neuroscience & psychology, 6(1), p.32578.
  • Puppo, V., 2013. Anatomy and physiology of the clitoris, vestibular bulbs, and labia minora with a review of the female orgasm and the prevention of female sexual dysfunction. Clinical Anatomy, 26(1), pp.134–152.
  • Pauls, R.N. 2015, “Anatomy of the clitoris and the female sexual response: Clitoral Anatomy and Sexual Function”, Clinical Anatomy, vol. 28, no. 3, pp. 376–384.
  • O’connell, H.E., Eizenberg, N., Rahman, M. and Cleeve, J., 2008. The anatomy of the distal vagina: towards unity. The journal of sexual medicine, 5(8), pp.1883–1891.
  • Levin, R.J., 2018. The clitoral activation paradox — Claimed outcomes from different methods of its stimulation. Clinical Anatomy.
  • Lousada, M., 2017. Real Sex: Why Everything You Learned About Sex Is Wrong. Hay House UK.
  • Herbenick, D., Fu, T., Arter, J., Sanders, S. and Dodge, B. (2017). Women’s Experiences With Genital Touching, Sexual Pleasure, and Orgasm: Results From a U.S. Probability Sample of Women Ages 18 to 94. Journal of Sex & Marital Therapy, 44(2), pp.201–212.
  • O’connell, H.E., Hutson, J.M., Anderson, C.R. and Plenter, R.J., 1998. Anatomical relationship between urethra and clitoris. The Journal of urology, 159(6), pp.1892–1897.
  • Carrellas, B. and Sprinkle, A., 2017. Urban tantra: Sacred sex for the twenty-first century. Ten Speed Press.
  • Wade, L.D., Kremer, E.C. and Brown, J., 2005. The incidental orgasm: The presence of clitoral knowledge and the absence of orgasm for women. Women & health, 42(1), pp.117–138.
  • Winston, S., 2010. Women’s Anatomy of Arousal. Mango Garden Press.