Podcast

Making Peace With Your Pussy with Jessica Pin

This week’s guest on LaidOPEN Podcast is a woman on a mission, activist Jessica Pin. Jessica is a biomedical engineer whose life work is advocating for the inclusion of detailed clitoral anatomy in medical literature and curricula. Additionally, she believes there should be training standards for vulvar procedures and correction of medical misinformation about vulvas.

Together we discuss what contributes to the shame women feel about their larger vulva and the misinformation distributed by the medical field about the reality of how 50% of the population has “outties”. Jessica came to this cause because of her personal experience with a labiaplasty gone wrong, which resulted in her clitoral hood and entire inner lips being removed, and total loss of sensation in her clitoris.

Charna leads an exercise in becoming familiar with your vulva to reduce genital shame and lead to more ease and embracing of your body.

Show Notes

Welcome back to Laid Open podcast. This is your host Charna Casella and my guest today is Jessica Pin. She’s an activist and a biomedical engineer advocating for inclusion of detailed clitoral anatomy and medical literature and curricula, training standards for volver procedures and correction of medical misinformation of Elvis. I’ve been looking forward to having Jessica on the podcast because there’s a lot of misinformation and a lack of education that many people have, including doctors, the people that we may expect to know the most and we rely on to accurately inform the rest of us. Unfortunately, they only know what they’re taught in school hence how essential it is to have accurate texts available to future students in med school. Welcome Jessica.

I’m so glad to have you here today. Hi, thank you for having me. I really enjoy your posts on Instagram. And before my Podcast Producer, Sabrina offered an introduction I was just you know, really appreciative of the education that you were spreading.

And, so, I would like to start with what fueled your commitment to educating doctors and laypeople about female anatomy?

Well, so I had a labia plasti when I was barely 18 And my labia menorah were completely amputated and and clitoral hood reduction was done without my consent. And I lost clitoral sensation. And this was after I had been told there were no ribs to my sexual function. And I would later realize that what drove my surgery was actually medical misinformation. So I was driven to seek surgery by medical misinformation that I stumbled upon online. And then the surgery that I had was severely botched. And what I figured out was that surgeons doing these surgeries typically are not trained and they typically did not know the anatomy. I’ve been trying to get the anatomy taught to surgeons who operate on bolas. But this is still a problem where many surgeons are operating blind, they don’t know where nerves are. So that is what drove my advocacy. Yeah. And can you start by explaining to listeners who don’t know what a labia plasti is what that is.

So, labia plasti is a surgery to reduce the size of the labia Menara which are the inner lips of the vulva. So when you were doing that research online, what was the misinformation that you came across? What did you believe or think that had you have the surgery. So when I first got online, I was actually just trying to find out about the clitoris. I was 17 and I didn’t know what a clitoris was, and I didn’t know how to find it. So I got online and I was Googling like, where’s my clitoris. And then I ended up on the Wikipedia page for clitoris. And then I ended up on the Wikipedia page for boba. And I looked at the Bulevar on Wikipedia and I was like, That is not what I look like. So I was just looking at the different structures and I saw labia menorah. And so then I Googled like, Are my labia menorah normal or I just Googled labia menorah? And I did an image search and what what happened was it pulled up labia Busey advertisements, and it pulled up before and after photos of labia plastiques. And I saw that I looked like many of the before photos and so I thought that I had this embarrassing problem and that I was ugly. And what I read online in a peer reviewed medical literature was that protruding labia menorah are considered unseminary and embarrassing. I read that they’re caused by masturbation, sexual activity, excess androgens, which are male hormones, and aging. 

Right. None of those claims is supported by any evidence, but they all serve to stigmatize larger labia menorah

Right now, I didn’t know this when I was 17. But it turns out about half the female population has labia Menora that stick out. So it is actually very normal. But when I was 17, I got the impression that my labia menar were supposed to be completely hidden. And that wasn’t what I looked like. And so I thought I had this shameful embarrassing problem. And because I had been raised sort of, conservatively, I didn’t want anyone to look at my vulva and think that I masturbated, you know, so, I remember being horrified when I saw that. They said that it was caused by masturbation. I think saying that larger labia menarik caused by an observation of sexual activity. It’s sort of like feeds into this slut shaming. You know, I know that a lot of women become insecure when they see jokes about large labia manana being indicative of being quote unquote, use that. Right. And so the fact that there’s medical authority behind that, that repeatedly gets published to this day, is really disturbing. And it should be addressed. Absolutely. What what’s really frustrating is how professional medical organization haven’t done anything to address this pervasive misinformation about vulvas. I have asked them to do something. You know, right now, there’s a crisis of trust in medicine, people trust doctors less than less. And what we have are bullets. Our concern is just rampant misinformation published in medical journals published in medical textbooks published online, right, and no one is interested in setting the record straight. And so in my opinion, patterns like this are what cause the client to trust the medicine. And yet professional medical organizations never want to acknowledge it or do anything about it. It’s really frustrating. It’s, you know, when I was thinking about this, I was thinking about the parallels between growing up in an abusive household. And this tendency to have whether it’s like a narcissistic or abusive authority figure who’s denying their impact, minimizing gaslighting, and it really just can’t tolerate their own guilt that they could be doing something wrong. And so there’s just total dismissal, and thinking about how that parallels with the Western medicine medical model and response to you and in response to one of the things that I was reading was how when you did talk to doctors after your surgery, and say, like, I’ve lost all sensation, my clitoris, that that you were told that you were wrong about your own body, and that your experience was dismissed? Yeah, I was told that that couldn’t have happened. And that I just needed to relax and that I just needed to fall in love. It was really strange. I guess in the beginning, I wasn’t very clear. You know, I would just say, you know, I had lost sensation and I had trouble having an orgasm. I didn’t. I mean, I was not able to orgasm until I figured out how to use a vibrator. Yeah. And yeah, it’s just it’s still like kind of difficult because what I have to do TMI is I have to stimulate like the base of the clitoral body. So, you know, one thing a lot of women don’t recognize is that the clitoris is under the entire length of the clitoral hood. So, even externally, it’s not just the glands. In fact most of the external clitoris is the clitoral body and right under the clitoral hood. Right and so you I know that you were on The Daily Show and they presented you with an awesome Gold Award. That is basically a clitoris the full clitoris Yeah, in in, you know, in gold. Do you? Do you have a physical model handy? In case I do use this video that you can hold up so that you can show? Yeah, I do. I have my trophy. Yeah, go ahead and grab it.

All right. Yeah.

Yeah. And so describe because this is one of the things when I worked at Good Vibrations. That was one of my favorite pieces of information that I walked away with was this education. Because before I was 25 years old, I did not know that this that the clitoris was more than just a little tip. And that’s, you know, the extent of the erectile tissue and everything and so if you want to describe that, go for it.

Yeah, so the tip is the gland. And on this model, it’s not really differentiated from the body but it’s just the end and then this is the clitoral body and then the clitoral body splits into two crura and they’re inside the body. And then there are two bowls, and the bulbs around the vagina. Right and so for some people

They, it’s too sensitive to get stimulated right on the tip of their clitoris, which is what so many people are educated to think of as the clitoris. And instead if you rub on either side or as you were saying the base of the clitoris, like, you know, when when women’s vulva become more in gorge, just the way a penis will get encouraged with blood, then it’s like their stimulation. And so you could be the one side of the clitoris one clitoral leg is is, you know, more sensitive than the other. So it’s worth exploring that whole area. Yeah, I don’t think that the Karura are ever really stimulated. That’s one thing that people talk about. And I just, I don’t buy that anyone is actually getting to those, because that’s just not it’s not really possible.

In my opinion, having dissected the anatomy, yeah.

So what are the other thing? Go ahead. The other thing is, the penis has career too. And we haven’t seen any media articles about how the penis is bigger than men think it is, you know. So I think, you know, all the hype around the crura has been a bit silly. I do think the bulbs play a role because they’re just like right around the vagina. And I think the cuddle body is important and it tends to be under recognized, it tends to be minimized in pretty much all medical illustrations. It also gets described incorrectly, it gets described as smaller than a day.

But I do think the glands ultimately, you know, is, is the most important part of a clitoris. And I also think that the way the bola is designed, it is actually optimal for facilitating stimulation of the glands, like so for women, for whom stimulating the glands directly is too much. Just stimulating like the clitoral hood and the labia have an aura around it should actually help facilitate stimulation of the glands. And what’s interesting is some of the women that I’ve talked to who orgasm from penetration relatively easily, they will tell me that their glands and their clitoris is too sensitive. And I think that makes a lot of sense. Because I think that what’s actually happening is the glands is getting stimulated indirectly, during intercourse in a way that it is so sensitive, makes it very sensitive to like any kind of like movement of the vulva around it, you know, which is actually inevitable with penetration. So one thing that has never been properly studied, yeah, is the biomechanics of the robot. So actually, that was the first thing that I tried to look up when I was in college, which is sort of funny that I was in a biomechanics class in 2007.

So I got online and I was trying to find research on the biomechanics of the vulva, like no one has, no one has ever tried to, like, model it or analyze it in any way, despite the fact but it’s pretty clear, in my opinion, that, you know, any kind of traction on the labia menorah should be translating to some polling on the clitoral hood and some stimulation of the clitoris. It just seems obvious to me and, and I feel like you know, you can see this in, in porn, like,

TMI, but I have, like, you know, tried to look at like close ups to see. I know, it’s like weird of me, but it’s not. Yeah, you’re doing. You’re doing important research. It’s, you know, yeah, I mean, it’s not exactly research, but I think that the research should be done, and it hasn’t been. And it’s sort of annoying, because obviously they have done research on the biomechanics of peanuts, you know? And, you know, no one even thinks about the biomechanics of Ebola. And I remember in 2010, I was actually talking to a lady, a plastic surgeon about that. And he, he said, he didn’t think any doctors had considered the biomechanics of the bola. And so that was kind of obnoxious. Well, it’s, it sounds like an invitation for anyone out there who might be in this field to do this study. I mean, this would be a really interesting

research, it would be, it would be really interesting to know how different dimensions of the labia menorah and political it and clitoris relate to functionality. Oh, I was just gonna say, I mean, you know what you’re talking about? It’s like, especially during intercourse or manual play, when there’s movements, right, different parts are getting stimulated and you have to slow things down enough and pay enough attention to be able to parse these things out, right.

Yeah, I think a lot of women are not very aware of their bodies and they’re not very aware of what

it exactly is getting stimulated. And I think one thing that contributes to that is how, you know, we aren’t taught much about our bullets. And I think it also contributes the way that we call our bullets, vaginas. And we sort of just like, lump it all together. Right. And I think that I think this may contribute to a lesser ability to differentiate between different structures and figure out what exactly is getting stimulated? Yeah, I mean, it’s, it’s tricky, right? Because there’s a total setup. On one hand, there’s slight shaving and the other hand, there’s the request of like, tell me what you like. And so many women unless they’ve done a lot of inquiry, self stimulation, how do you then articulate and give feedback to a partner about what feels good to you? Right?

Yeah, so one thing really tricky is according to research, women who articulate what they want, Abed are perceived as more selfish and more promiscuous, and therefore less suitable for relationships, which is really frustrating. So I tend to get very upset about sexual double standard. Because that is at the root of all of these problems. It’s at the root of you know, why visible, female genitals are stigmatized, it’s at the root of why volver anatomy isn’t taught well enough. In medical education. It’s at the I mean, it’s at the root of pretty much everything that I try to address. Right? The notion that you’re that you’re used up and stretched out, right, that that’s something that’s, I think, commonly, commonly said, by by some Yeah, I think it’s also why female doctors won’t ever stand up for the clitoris, you know, it’s been so hard to get any doctors to speak up about how adequate anatomy isn’t taught. Like, nobody wants to advocate for the clitoris, because no one wants to, like be seen in any sort of negative way, or sexual way. Right, like being a female doctor, already, there are all these double standards or challenges that you’re that you may have to work within the medical field, and then to be a woman who’s standing up for that to then fear being sexualized in some way. So I don’t tend to think that female OBGYN aides are disadvantaged in any way. I think that that’s kind of like bullshit. And I really don’t like it when people make excuses. Because the fact is, that OBGYN is 65% women. And often when I’m trying to get these changed, I’m dealing with women. And so I actually don’t like it when people and especially the media, want to blame men for everything, because I actually think it makes it harder to hold the people who have the power to change these things responsible. Because if we just say that nothing is Women’s Hall, then it’s hard to get them to do anything, you know, yeah, we are urologists, part of the, the team of people that would have some capacity to talk about this. And to do yes, so I haven’t focused on urology as much because I was harmed by an OBGYN. And I have focused on plastic surgery but they also do a lot of female genital cosmetic surgery. So the way that I taught myself anatomy of the clitoris was by reading studies in urology journals, so urology most definitely ahead of plastic surgery and OB GYN where clitoral anatomy was concerned.

There is a perception that urology is mainly a field that focuses on male genitals. So I haven’t really focused on them as much there is Dr. Rachel Rubin, she has talked about how clitoral anatomy needs to be taught more. So she is one doctor who absolutely does stand up for the clitoris. But we really need more to do that. Right. The other thing that I’m remembering I mean this is from like decades ago, but vaginal rejuvenation surgery was something that I had heard about and I don’t know how common and what the like the age demographics of people who get labia plasti I mean, vaginal rejuvenation surgery is its own thing that sounded problematic to me that I think targeted women post pregnancy post birth. So they used to actually market labia plasti as vaginal rejuvenation needs to lump all of these procedures together as vaginal rejuvenation. And it was really misleading because you know, labia plasti involves neither vaginas nor rejuvenation, but actually there are still doctors who market labia plasti as vaginal rejuvenation to this day and in one study the average age of women seeking maybe a plasti was 23. According to another study, the most common age range that seeks labia plasti is 18 to 24. So it’s actually younger women who seek labia plasti. Right. But the irony is it is marketed as rejuvenation to younger women, which is saying, and and the, you know, the other thing I was curious about is, you know, you are going through this experience, and it’s so common, whether it’s about a physical thing or an emotional thing, this whole question of normality of like being seen as normal, because we, we want to belong, we’re inherently pack animals. And we want especially at that age, there’s so much vulnerability around being seen as normal and being accepted as, you know, being liked and desired. So thinking about a 17 or 18 year olds, when you talk to your parents, what was what was their response to? Were they in support of this? Or how did that conversation go? Well, my mom said, Oh, those Slappy thingies, they are supposed to be ugly. Oh, God, what a stupid thing to worry about. So that wasn’t particularly helpful. And she took me to her OB GYN and her OB GYN actually did tell me that I would normal. But she wouldn’t tell me how I compared to other women. And I wanted to know, I wanted to know how big my labia menar were relative to other women’s labia menorah. I wanted to know what percentile I was in. And she wouldn’t tell me. There wasn’t any modern data on that there was actually some data from the 19th century. But I don’t think it was particularly reliable because it’s not consistent with the studies that have been done since. So there. So 10 normative studies have been done now. And so now I know that the average life seminar are between like 1.5 and 2.2 centimeters long, there is a range and the averages and beach studies have gotten. So that would have been really helpful for me to know at the time. But I couldn’t find that information. And when I talked to my mom’s OBGYN, I asked her to tell me how many of the last 10 of her patients had had labia Menara bigger than mine. And she wouldn’t tell me. And so I perceived her refusal to tell me, I’ve heard keeping information from me, because she thought it would like hurt my feelings or something. So I thought that that actually meant that my views are bigger than everybody else’s. And she just didn’t want to tell me.

More likely she just hadn’t paid any attention to how big her patients labium not were. Yeah, because I think most overdue ions pay very little attention to boba at all, during exam.

The other problem was, it was hard for me to take our assurance that it was normal, you know, seriously, like, it didn’t really help me, because I had already read a recommendation. That OBGYN tell all patients that they are normal, regardless of how unusual they are, you know, and I was trying to figure out if my anatomy was unusual, so because I knew that there was like, you know, recommendations to tell everyone that normal no matter what, that wasn’t super helpful. Then what happened was, I was really desperate. And I told my dad that I paid when I rode my bike, which was not true. And which later made it really hard for me to stand up for myself because I blamed myself. Yeah, so what happened was my dad went to the hospital, and my dad is a plastic surgeon. So he talked to his friend to talk to other doctors at the hospital. They told him that people do leave your classes all the time, and it’s no big deal. And that was back in 2004. Yeah. And so and I remember thinking that I mean, that’s what I expected. I expected it to be no big deal. And my dad didn’t trust his plastic surgeon colleagues to do it. Because he knew what kind of training plastic surgeons were getting. And he didn’t think that these plastic surgeons do what they were doing. So he asked who the best OBGYN surgeon was at the hospital. And that too, I went to Yeah.

And a lot of the time people think that if a patient gets a really bad result, it’s because they saw a bad doctor. But my doctor is actually a doctor’s doctor. He has held multiple leadership positions. He has gotten awards, he has been in Time Magazine. And yet what he did to me was horrific. And not only did he do it, but he has never taken any responsibility for what he did. One of my doctors later called him and confirmed undid him. And, you know, told him like, You did this to her, you know? Yeah. And he, he said, he didn’t do it, that I must have had a second surgery.

And so then my dad confronted him. And he told my dad, maybe I did it to myself. What? So that’s insane, right? Yeah. And so that’s been really hard. And it’s been hard feeling like he’s still respected by his colleagues, despite when he digs me. Now, one thing that my dad did is he wrote an article, and he published it in the magazine for the hospital. And it basically tells my story, and it vaguely says that my doctor was a doctor at Baylor hospital.

And it made my doctor angry enough to call my dad’s office and threaten to sue him. So, you know, my dad thinks that that got to him. And I kind of hoped for that had been, I don’t know, I kind of hope that some of his colleagues believe what happened to me instead of just that I’m crazy and claiming that he did something that I did to myself, or that I, you know, had happened in the second surgery that I never had, which is insane. It really is, I think, you know, there can just be a lot of denial in cases where surgeons have harmed patients, I think they have a very hard time admitting it. By he knew that he had blocked off, because he never did it. Again, he never performed and never another lady of bossy after that. And in a letter that he wrote to me after I wrote him a letter, you know, asking him, basically, I wrote him a letter, telling him what he did to me, trying to paint it as not his fault, because he hadn’t adequately been trained. And then asking him to help me get OBGYN is better educated and me anatomy and trained to do the surgery. Right? You know, because what, what I had realized is that OB GYN ‘s were doing the surgery without training, and that they didn’t know the anatomy well. So I thought I could actually guilt him into helping me with that. And because he has so much status in the medical community, he would have been, you know, very powerful. But he didn’t want to do that. In his letter to me, he did say that he tells all his residents that labia plasti is just the bad surgery, and they shouldn’t be doing it. And so he he does know that he messed up, he just won’t acknowledge the full extent of it. Right, because he doesn’t want the litigation potentially. It’s not about litigation, that statute of limitations was up in 2006. And it is very hard to sue doctors in Texas, even if I had sued him within the statute of limitations, it is extremely unlikely that I would have one, I don’t know of a single case of botched slavery plasti where a patient have gone to court and one. I think it’s very difficult, because systemic negligence is actually a defense. Right? So the fact that Oh, would you answer not taught the anatomy would be something that they could bring up in court as like, yeah, you know, an excuse. And so that’s actually the problem with the medical liability system, is the only recourse patients have is to sue their doctor. And there’s no way it’s that I have found to address systemic negligence. You know, like, ideally, we would be able to sue professional medical organizations who have neglected to teach to address, you know, the lack of training standards, the lack of anatomy, education, they have the power to change that. And their efforts have been really inadequate. And it’s crazy, because they won’t even talk to me like the American Board of Plastic Surgery won’t talk to me. The executive director will email my dad, so he knows my dad personally. And he has said his duty is to protect the board, not for not to protect patients. His duty is to protect the board and that says everything that you need to know about professional medical organization. Yeah, absolutely. What has been the physical and emotional long term impact of the surgery on you? Well, that’s been very hard. I don’t tend to talk very much about that. You know, it is very difficult to have lost so much sensation and to just not be very responsive.

There was actually one guy I dated who told me that he thought that I was incapable of love, because I can’t connect to the same way other people can because I’m not responsive. That was a really fucked up thing for him to say because I still can enjoy sex with some guys. I’m just like, much more difficult. And you know, I need, I need toys and even finding toys that work for me is very challenging. Like recently I ordered like $800 worth of toys from love honey, by the way, they accept return, so I can just return them all. That’s amazing. What? They don’t work for me. I’m going to return them. Yeah, so but I made a mistake because I ordered another one from Sephora. And I really thought that Sephora top returns but like not for sex toys. Yeah. No, but that’s so weird.

Love honey. Yeah, money. No, no. Love, honey. That’s important. Because I mean, sex toys are really expensive. And yeah, just like shoes, you usually can’t return them. So knowing Nordstroms for shoes and love honey for sex toys. Yeah, they have like a 100 day satisfaction guarantee. That’s incredible. Yeah, the thing that guy said to you. So wrong, so shaming, and really about his own insecurity? Well, I guess the point that I was trying to say is that I do think that, you know, the ability to give and receive mutual pleasure in sexual encounters is extremely important and foundational to relationships. And I think that that is realistically harder for me. And that is, I mean, it is hard. Also, I think the hardest thing about what happened to me, isn’t even the damage that my doctor did. It’s the way that like, it’s a way that everybody responded to it as if it was nothing. And it’s knowing that the medical community doesn’t see what happened to me as worth preventing, just in general, you know, because it wouldn’t take much to make sure that it never happens. And yet, I continue to receive stories from other women who have been harmed. And it’s just, it’s so preventable. It’s so senseless. And that’s the hardest thing. Because I know that bad things happen to people, you know, like people get in accidents, they get paralyzed. And, you know, we go on living and we find workarounds. So we find ways to be happy. But knowing that someone hurt you, and it didn’t matter, is really, really hard. And that’s been the most challenging thing, psychologically. So for me, my trauma gotten much worse. When, you know, when I asked my doctor to help, and he didn’t want to help, it got much worse, when I really dug into the medical literature, and I saw just how much disregard there is for vulgar anatomy. And it was mind blowing to me, because I just assumed that of course, doctors would learn Bovard anatomy, just like anything out. Mm hmm. But they don’t know. When I work to good vibrations, I had a colleague who was the model for what we call pussy school. So she would go to Stanford and be the person whose, you know, ovaries were palpated. And that the students would practice on and I consider doing this. So I went and I got to, like palpate her ovaries and things. And I, I learned then and also, when I was in school for psychotherapy, how very little education there was around, you know, for sex, sex therapy for psychotherapists or experience that these doctors have hands on before they’re expected to go out into the world. And it’s insane to think that if there was an adequate education that they wouldn’t see that and take that into consideration and fold that into changing the curriculum. Right.

Yeah, it’s crazy how much resistance there is to change things. So the American Board of OBGYN didn’t make it so that a study of the nerves of the clitoris is now included in their maintenance of certification. Amazing It is required for their female pelvic medicine subspecialty but it is not required for general obedience. Yeah, so basically, you know, and they’ve chosen that so they’ve chosen to make it optional for general OBGYN which means the American Board of OB GYN does not believe that OB GYN need to know basic macroscopic anatomy of the clitoris. And that is just so unreasonable. Yeah, because they all they all know that anatomy have a penis and they don’t even treat penis. You know, that’s what’s crazy. Yeah, well, you know, it’s like who’s funding the studies the biases and, and who’s doing the studies and, and what studies get funded and it’s just, that’s very, very frustrating. I’ve had different gynecological health issues since I was a teenager, and autoimmune conditions that have that affect that area of my body. And there’s been very, very little awareness and education and over in my experience, and it’s really disappointing and frustrating to have to be such a strong advocate for yourself.

So what I’ve seen is that there’s systemic negligence across the board, we’re volver anatomy and female sexual function is concerned in medicine. And you can see this if you compare the literature on female sexual function with literature on male sexual function, and you can see it if you compare, you know, the anatomy covered for bullets versus penis, say, it’s just night and day. And the way that they approach male sexual function is like they approach the rest of the body, right? Like it’s very scientific. They cover detailed anatomy and physiology, they really try to understand how the penis works. And if the penis isn’t working, right, they really try to understand why. If you have a problem with your sexual function as a female, they don’t even consider what could be wrong with their clitoris, which is really just crazy. Right? It’s like going to a doctor with breathing problems and having them not consider what could be wrong with your lung, right.

And yet, you know, this continues, like as an example, in this one article and up to date on diagnosis and management of female sexual dysfunction. They mentioned relationship 26 times. And it’s funny because like, you don’t even need to be in a relationship for sexual function to be of concern. You don’t even need to be having sex with other people for your sexual function to be important. Right? She mentioned the clitoris only one time. She said you can put massage oil on the clitoris, which isn’t even good advice. Like you should use loot. Like, it’s just ridiculous. How little consideration there is for what could be wrong with with the boulder or with the clutter is if someone’s sexual function isn’t, isn’t working? Yeah, right. And it’s just irrational. And one of the textbooks that I got updated, it’s called Walter zero gynecology, there is an entire chapter on female sexual function and dysfunction, which is actually very rare, because normally, it just gets covered in chapters on emotional issues or psychosocial issues. Right. But in in this book commendably, they have a whole chapter on it. However, the chapter is offered by psychologists, and the authors of this chapter were actually told by the editors not to discuss anatomy or physiology of the clutter. So, you know, they focused on psychology more, because they were told to do that, because they’re psychologists, they’re not doctors, right. And

I really do think that there, there’s a lot more focus on the psychology of female sexual function, and there’s neglect of anatomy and physiology. And I really think that all goes back to sexual double standard, which cause a lot of women to just be fundamentally uncomfortable with their genitals. And there has been an expectation that female sexuality is supposed to be like romantic and emotional and not about like, just pleasure, you know. And there’s also this fundamental idea that female sexual pleasure isn’t as important because it’s not evolved in reproduction. So medical neglect of female sexual function tends to be based in that. And that’s also why the focus when it comes to female sexual dysfunction, the focus is generally on a lack of desire, and also on sexual pain. So generally, like there’s all this focus on desire, and the reason why, like, to me all that matters, is that women want to have sex.

So if you look at the medical literature tends to imply that all that matters is that women are willing and have like, holes. You know what I mean? That work? Totally, that’s a yes. Right? Yeah. And so there’s some focus on female sexual pain. But my memory is that there are multiple times as many studies on erectile dysfunction that there then there are all on sexual pain, so for women, so even that is neglected, but that gets far more attention than female sexual response and female orgasm. And there’s just this pervasive idea that female sexual pleasure is not medically irrelevant. And that’s what’s behind all the negligence surrounding mobile anatomy. It’s just not considered important. And so I think that we actually need to start recognizing the boba, and especially the clitoris as reproductive anatomy. Yeah. And I think that claiming that it’s not reproductive is fundamentally a denial of female sexual agency. So that’s what’s so disturbing is how medicine doesn’t really consider women as having any right to sexual pleasure. And it doesn’t consider that relevant to reproduction. In the top OBGYN surgery textbook, they said a lack of literal sensation didn’t seem to affect patients later sexual behavior after procedures that severed the dorsal nerves of the clitoris. So basically, they were severing the dorsal nerves and the clitoris in procedure done to reduce the size of the clitoris. And these procedures are done on infants. So that’s actually disturbing. And this was still recommended in the top OB GYN surgery textbook until 2019. And it didn’t change. I asked them to change it, which is disturbing this, even if hopefully they weren’t using that technique anymore. It’s just bizarre that no one would speak up, you know, no one said anything about it, right. And there’s definitely a pattern where doctors don’t want to speak up about, you know, their colleagues like doing things that are wrong or harmful to patients.

Yeah, they’re just all these patterns were medicine doesn’t seem to care about pleasure. And it’s fundamentally a denial of female sexual agency, because the number one reason human females have sex is for pleasure. So it’s funny because there’s all this focus on desire, but desire generally comes from pleasure, you know, like, it’s a feedback system. If you enjoy having sex, you will desire it more.

So can you specifically speak to the role that the clitoris plays in reproductive function? Well, I think it motivates reproductive activity, right. It’s the organ most responsible for motivating reproductive activity, because it’s where we get most of our pleasure from right. Another function that I think is very important is the pair bonding function. So oxytocin levels more than double and women who orgasm during sexual encounters, and they barely change at all and women who don’t. And oxytocin is the pair mounting hormone, it’s full of hormone. So I mean, I do think that being able to experience pleasure and orgasm is important for connecting. And it’s strange that we deny that I also think that, you know, for humans, pair bonding is fundamentally important for successful reproduction, because it keeps us with the same partner. And I, you know, there are a lot of ideas around that. I mean, you know, like some people argue that ancient humans were polyamorous, but at the very least, I think that, you know, forming these bonds was important for making sure that offspring were cared for. Right. Right. The other thing that came up, as you’re speaking earlier, is just, you know, some might make a distinction between female genital mutilation and an elective cosmetic genital surgery. But one of the things that you speak to that I would love to hear you speak more about is if there’s what it takes for there to be proper consent and this distinction.

Yeah, I mean, the reason why we think female genital cosmetic surgery is different from female genital mutilation is because we assume that there’s informed consent and a reasonable standard of care and I will argue that there is neither right so misinformed consent of non consent. And what I see happening is I see labia PLAs, the clitoral hood redactions marketed with misinformation. And, you know, surgeons misinformed patients about risks they miss inform patients about causes of hypertrophy, they even miss important patients about what is normal, right? There’s just one female OB GYN actually who said that most women have labium nor that are completely hidden when the legs are flows. And that’s just not validated by any research. So, you know, she shouldn’t be saying that. And she said that protruding lady women are caught distance in relationships. I mean, that’s just ridiculous. But you know, this type of language is totally, it’s totally unethical. You know, Stanford, said that protruding labia menorah were like a dark cloud over relationships, which is, it’s crazy. It’s just so derogatory, right? It’s, it’s so like Stanford called labia Busey rejuvenation. Right. So I kind of singled out Stanford and I made a post about him because, you know, like, we would expect Stanford plastic surgeons to not lie to patients.

And yet, that’s exactly what they were doing on their website. And that should be embarrassing. It should be shameful. You know, what’s so frustrating, right, is that there’s so much authority that people and agency they hand over to doctors. And the expectation is that they’re the ones who are going to be educating us about our bodies. And when they’re misinforming, of course, people believe what’s being said. That’s insane. So our healthcare system actually depends on the ability of patients to trust authors, right. And when it comes to female genital cosmetic surgery, doctors are blatantly misinforming patients. And there’s just this weird attitude that this particular misinformation doesn’t really matter. Which is crazy to me, because, you know, there needs to be integrity in medicine across the board, not just in certain areas. You know what I mean? Like we it’s not enough to just be honest about COVID. You know, like, It’s just strange, like, the lack of concern for pervasive misinformation in medical journals and in medical textbooks. Yeah. And what’s funny is the literature on female genital cosmetic surgery, proves that surgeons have been misinforming patients, that they have been operating wine to basic anatomy, and that they have you know, so they’ve been missing misinforming patients, both about risks of surgery, and about causes of hypertrophy. So, like, for me, the funny thing is, like if I had just watched porn, or just seeing what other roles look like, I never would have sought surgery. Yeah, I just I really had no idea. And so I was vulnerable to all this messaging that is just totally false.

And so, my, like everything, I was just misinformed in every way. And I also tried really hard to find out if there would be any risks to my sexual function. And I you know, I searched all over the internet, I read the peer reviewed medical literature published at the time, I tried really hard to find out if that was a risk and everywhere I looked, doctor said it was gonna risk so I thought it was an event. Well, and that’s the, that’s the beauty of what you’re doing. You know, in terms of educating I know that now there are a lot of people of all ages on Tik Tok, but I originally thought of it as like younger people on Tik Tok. Yeah, and that you’re providing information that is now recorded, right? If you Google, if you look up labia plasti, there’s probably information that you put out into the world that’s now available, versus, you know, what used to be the case?

I hope so. Yeah. I also, one thing I did is I got consent forms change. So the American Society of Plastic Surgery has standardized consent form. And they have changed them. I haven’t seen the updated consent forms. So I can’t actually say if they are accurate, but, you know, it seemed like they actually were motivated to address that and to change that. So that’s good. That’s amazing. Yeah, the American Society of Plastic Surgeons actually been the most cooperative of any of the professional metaphor agents that I’ve dealt with. But even with them, like when I first reached out, and I told them not to call labia plasti rejuvenation, because that’s fraud, you know, so 10 normative studies have been done and not one has found any positive correlation between age and labia Northside. So it’s just fraudulent to keep calling it rejuvenation. Like some doctor just made that up to make it sound good. And then they just like market it that way. It’s crazy. And I think a lot of it comes from the myth that labor human are get bigger with sexual activity. So if you believe that labor, human organ figure with sexual activity, then you also have to conclude they get bigger with age generally. Yeah, for women who aren’t having sex. Anyway, so I reached out, and I asked him to stop saying that, and they initially wouldn’t. And I explained to them that it was misinformation. But they said, you know, that’s the term that people know, which is not a reason. You know what I mean? Like, yeah, that’s absurd. People know, people know the term vaginal rejuvenation, because that’s how they’ve been marketing it for years. Right. That doesn’t make it okay for a professional medical organization to misinform things. Yeah. Anyway, so I had to get kind of antagonistic with them. But me and they seem pretty cooperative. You know, pretty much everybody else has just been terrible. And it’s, and it’s kind of shocking, because, you know, like, I’m bringing real problems to their attention. Yeah. And the way that they’re responding to me is to deny or to say that I’m a problem, right. So the executive director of the American Board of Plastic Surgery says that I hurt my cause by shaming people on social media. So apparently just telling the truth

About what doctors are doing is shaming. The other thing is this shouldn’t be my cause. I mean, this is literally their job. You know, the whole point of the American Board of Plastic Surgery is to provide a way for patients to know which doctors they can trust, right? It’s like, it’s supposed to be, you know, like, you’ve probably heard people say, to go see a board certified plastic surgeon, if ever you have cosmetic surgery, or, you know, like, they always say, make sure your surgeon or doctor is board certified. Right. It’s just like another level of protection for patients, or at least it’s what it’s supposed to be. But in the end, it’s a way for the American Board of Plastic Surgery and all the other medical board to make money. Right. Right. I don’t know if that’s entirely true. Because, you know, like, we, the American Board of OBGYN did update their maintenance of certification. So they do do things to keep doctors up to date. You know, and that’s really important. But I think a lot of it is sort of a racket, because they don’t seem they like willing to be responsible for what the doctors they certify. Actually, no, you know, they kind of just want to say it’s not a call, it’s not our business. And I think that that’s, that’s been the attitude of pretty much like, most doctors, most medical literate leadership, they’ll just say, it’s not our fault, not our business, you know, and so then you have to ask who is responsible then? Right, and everybody is pointing to somebody else. There’s no accountability. And there, there isn’t. There’s so many parallels between what you’re describing around these particular box surgeries, as well as, you know, accountability around sexual assault.

Yeah, I consider this a form of sexual trauma. I mean, this is, this is definitely, like, has long term impact around your sexuality.

Yeah, so people have been critical of the police, because the police are basically self regulating That is my understanding. So it’s medicine. Right. So there’s the same problem in medicine is just the doctors had been put on such a pedestal that no one’s gonna, like start rioting streets over it. But there’s the same fundamental problem where, you know, we’re expected to trust in medicine. But there are no consequences for systemic negligence. There are no consequences for professional medical organizations being untrustworthy. So, like, you can sue your individual doctor. But the irony is, if there is systemic negligence, that’s just the defense. So it doesn’t really help address systemic negligence.

When doctors published false information in medical journals and medical textbooks, there’s no, there are no consequences for them. And so we’re told we’re supposed to trust medicine. But generally, like, in order for systems to be trustworthy, then there needs to be mechanisms that punish untrustworthiness. You know, like, there needs to be Somrus feedback mechanism that helps guarantee trustworthiness and there isn’t. And so that’s what’s so crazy, like, we’re just supposed to have faith. And that faith isn’t actually based on anything. Except, you know, we just trust in the altruism of doctors, but altruism, it’s not enough. Because, you know, because people are biased, and they’re willfully blind. And, you know, if people aren’t making money doing a thing, then they generally don’t want to recognize if they’re doing something wrong. That’s one problem. And I think there’s a lot of ego in it, like doctors have so much ego tied to their education. So it’s hard for them to accept that there might be something wrong with their education, right? There are all these ways in which medicine is just not designed to learn from the state not designed to change. There aren’t adequate feedback mechanism. It really is kind of crazy.

But I think it’s funny because people need to be able to trust medical institution, and when their response to real problems is to deny or to blame the messenger. That’s exactly a reason why people aren’t trusting. And yet in every single article on declining trust in medicine, they never addressed this. They never acknowledged it, you know, they, they come up with every single reason why trust in doctors is declining except physician behavior, right, except the behavior of medical leadership. So they only ever talk about medical leadership as part of the solution. They never recognize that they can be part of the problem. Mm hmm.

Hmm. You know, and I would never wish trauma on anybody. And I’m so sorry that you had to go through this. And I’m also really grateful for the work that you’re doing in the world. And thank you, you know, I think it’s really essential and important for this education to happen. And it’s, it’s hard. I, you know, I just what I want for you, and I hope you have some of this is like a team of support that you have other people that are standing with you as allies. Because to be a lone voice, in, you know, up against these different boards that don’t want to change is really, really hard. Yeah, I mean, I do have all my followers, and I do have, you know, people like you like everyone who has had me on a podcast, I have thought about starting a nonprofit, because then I could be more of a team, I think, but I haven’t done that yet.

So when I got the idea that I needed to change all of these problems, I wanted a story where I was somehow better off because of what happened to me. In retrospect, I’m not sure if it’s worked out that way. But I told my psychiatrist in 2011, that I wanted what happened to me to vie for the best. Yeah. And he told me, it can’t be for the best. Or I told him, I needed to make it positive. And he told me, I couldn’t. But that is the whole point of my advocacy, you know, I have been trying to make my trauma, a positive thing, right. You know, like, what happened to me is horrible. But it also, you know, made me aware of this problem that I felt like maybe I was uniquely suited to solve. And so, you know, I guess, like, when I got this idea that I needed to do this, I was thinking about how other women would get hurt, if I didn’t do anything about it, and how, you know, like, problems like this has to happen to people like me in order for them to change. Right. And so I guess that was the idea I had, and maybe it’s like, a little egotistical. But that’s what’s been behind everything. And so it meant a lot to me, when the Daily Show said, I was like a superhero, the thing that I really struggled with it, you know, just feeling like, the way that the entire medical community, basically acts like what happened to me isn’t worth preventing, has been a fraud, an affront to my dignity, you know, it sort of used to make me feel worthless, like this idea, that would happen to me didn’t matter. You know, I guess I felt sort of, like disposable, like, there was this attitude that like, it’s okay, for what happened to me to happen, and that it didn’t matter. And that, you know, my lats, and my suffering didn’t matter. And so, if I can solve these problems, it’s an assertion that I do matter. And it feels like if I could solve these problems for future women and stop them from being con, that is justice for myself, because it’s an assertion, not what happened to me, never should have happened.

And I think a lot of it also has to do with how, you know, some people believe that, you know, people have suffered from traumas are diminished, and just, you know, like, permanently damaged.

And I guess I needed, I needed to find a way to stand up for myself as an assertion that like, I wasn’t just a victim. Yeah, so that’s what’s been behind it, even though, you know, it’s taken me a lot longer than I expected. And I ended up, you know, I ended up a lot more depressed, like, because of wanting to do this. So like, I was very depressed in my 20s. I think that what’s really important and again, you know, I wouldn’t wish my childhood on anybody, and the experiences that I went through, I also know have given me a particular kind of knowledge and wisdom. And my healing path has then allowed me to really intricately understand what other people are going through and help them out the other side. And, and it’s a lifelong process. Right. And, and it also, you know, it’s like as you are dealing with this, and each person who says no, or closes a door or refuses to help, you have to revisit that sense of powerlessness or worthlessness or all of that, you know, and, and so it takes a level of courage and conviction to keep coming back. And I really have this this sense of your tenacity and fierceness along with your privilege, right, the access that you have and your you know, whether it’s your education or your family background, it’s like you’ve really used that

To the best of your ability, and that’s an important thing.

Yeah, so I used to really struggle when people told me no, because it did make me feel like I was worthless, pretty much every time. And that was probably the hardest thing about my advocacy. It’s just like getting Retama ties, like every time, you know, yeah. But, you know, it’s been important for me to realize that people are just willfully blind, they’re just ignorant. They are limited, you know, they won’t know better. And even though, you know, a lot of these people may be very intelligent. They just have like, this mental block or this, you know? Well, no, I mean, I think what you’re, what you may be getting at, and you can tell me if this is not right, but as you were saying, like, doctors, egos are very much invested in what they’ve been taught. And they, you know, that’s, they don’t know what they don’t know. And just the way a kid will buy into and believe what their parents teach them, whether that’s about religion, or something else, and then they like, with his level of conviction and fear. They have to defend that and, and align with that. And that’s what they’re these doctors are doing. I think that there’s, you know, I don’t think that people are evil. I just think that denial is a very powerful thing that protects people from feeling guilt and shame. Yeah, exactly. And there’s a good dose of narcissism in there. But you know, yeah, like, I think maybe sometime, you know, they’re just trying to avoid feeling bad sometimes. I think, you know, like, yeah, my doctor wants me honest about what he did, because I think it would probably be too painful for him to fully recognize what he did. Yeah. You know, and, and it’s helped to figure out that that’s a reflection on him as a person and not a reflection on me. Good. Yeah. I think that’s essential. And I think it’s the same thing when you suffer from trauma inside your families as well. Right? It’s, it’s not about about you. It’s really took me it took me a long time to get there. And I just feel like that’s a really important lesson to learn.

Yeah, thank you so much. And I have one random question. That’s an outlier. Yeah. Okay. I’ve said I’m curious. That’s come up from watching your your social media stuff. Did you coined the term Audi?

No, I didn’t. Okay, it’s a it’s a really common term. I really like it. It’s like you know, people have any and outie belly buttons. Will you have any an Audi labia? Yeah, yeah, no, I didn’t know that. I hadn’t heard that before. So cheers to the Audi is up there.

Yeah, totally normal. Like half of women are Audi’s half of women are Eddie’s.

I also tend to think that thinner women are more often Audi hmm, just because the labia majora are just made up of fat. Yeah, Mmm hmm. Yeah, yeah. So and if you have small labia majora, There’s just nowhere for early viewing art to hide. There you go out and proud right here. Well, thank you and how can people find you if they want to follow you and find out more information? Where would they go? Well, I’m on Instagram @jessica_ann_pin and the same on Tik Tok and I’m on Twitter @MediClit M-E-D-I-C-L-I-T. Thank you so much.

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© 2022 By Charna Cassell, LMFT. Licensed Marriage and Family Therapist. MFC 51238.

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