In my exam room, female anatomy comes up more than you'd expect in the ordinary course of a visit. I've learned to listen for how a woman describes her own body when the subject comes up naturally. Most can describe the vulva in general terms. Far fewer can locate the full 9 to 11 cm of the clitoris with any precision.
Most say that no one ever showed them where to look.
Last month it was a family physician, twenty years into her own practice, who paused. She had delivered hundreds of babies and could not locate, with confidence, the organ responsible for her own arousal. She’s a doctor but remember, the map of the clitoris and its nerves wasn’t published until March, 2026.
She is not unusual. I have watched the same pause cross the faces of nurses, lawyers, teachers, and professors. I wrote about it here and here. What medical school taught me about female anatomy was minimal. What thirty years of practice has taught me is that the gap she showed me is not rare. It is close to universal.
This is the sex education most of you did not get, not in fifth grade and not at fifteen, and for most of you, not since. Here is the anatomy, the orgasm physiology, the arousal science, and the sexspan research that should have come with adolescence and instead arrives, if it arrives, decades late.
A 2025 study of 2,880 women, average age thirty-two, found that roughly one in three could correctly name the clitoris and vulva on a diagram of her own body [1]. A separate study out of the UK found the real picture is worse than that number suggests. Only nine percent of participants could correctly label every external genital structure on a diagram, and the median woman correctly labeled just one structure out of several [2]. A third study found women answered only half the questions right on a basic clitoral knowledge quiz [3]. This is not a knowledge gap limited to the uneducated. This is the average, across income, across degree, across the exact women filling the comment section of this Substack and asking why no one taught them this.
Most women were taught what I was taught. A diagram that ends at the vagina, with the clitoris reduced to a small external button, if it appears on the page at all. The truth is stranger and more generous than that drawing ever suggested. The clitoris is a multiplanar structure nine to eleven centimeters long in total. The glans, the small visible part, is only the tip of it. The body, the root, and two pairs of internal structures, the crura and the vestibular bulbs, make up the rest, hidden beneath skin and connective tissue you were never shown [4,5]. What you were shown in tenth grade was the tip of an iceberg. Nobody told you there was an iceberg.
What I was taught in med school: the reproductive tract. Ovaries, fallopian tubes, uterus, cervix, vagina. What I now understand: the one organ whose sole function is pleasure was left out of my education entirely, and out of nearly every other clinician’s too. Researchers at an Irish maternity hospital showed fifty clinicians, consultants, doctors, midwives, and students, a three-dimensional model of the clitoris and asked them to label five basic parts. Not one of the fifty could label all five. Thirty-eight of them could not correctly name even a single part [6]. If the people trained to treat your body cannot find your clitoris on a model, you were never going to find it on a diagram in tenth grade.
Traditional sex education has focused almost entirely on reproduction: what makes a pregnancy, what prevents one, what transmits disease. The organ responsible for orgasm was treated as optional information, if it was mentioned at all [4,7]. The data show this omission has a direct, measurable cost. Clitoral knowledge predicts orgasm frequency and pleasure, and it does so by reducing a woman’s investment in scripts that tell her vaginal intercourse alone should be enough [3]. Knowing your own anatomy is not trivia. It changes what happens in your body.
I believe every woman deserves this information before she turns twenty, not after decades of wondering why intercourse alone left her unsatisfied and quietly concluding the problem was her.
Female orgasmic disorder affects an estimated ten to twenty-eight percent of women, and it remains one of the least discussed conditions in clinical medicine [8]. Orgasm is a normal psychophysiological function, available to nearly every woman’s body, with the clitoris as its primary anatomical driver [7,8]. The orgasm gap, the well-documented difference in orgasm frequency between men and women in heterosexual encounters, reflects biology intersecting with culture. It does not reflect a female design flaw [8,9]. Some women have orgasmed through masturbation for years without recognizing what happened as an orgasm, because no one ever described it to them accurately enough to know [10]. That is an education problem, not a biology problem. Combined clitoral and anterior vaginal wall stimulation produces stronger orgasms than either alone [7].
Desire does not always arrive first. The old model of female sexual response ran in a straight line: excitement, plateau, orgasm, resolution. The current model is circular, and arousal frequently precedes desire rather than following it [10]. Your brain processes a sexual cue, your body begins to respond, and desire builds from that response rather than announcing itself in advance. If you have spent years assuming something was wrong with you because you rarely feel spontaneous desire, sit with this finding. Responsive desire is not a lesser version of the correct kind. It is the more common pattern, and clinical medicine spent decades measuring women against a model built from male sexual response.
Most American sex education operates entirely within a risk-reduction frame: prevent pregnancy, prevent disease [11]. Pleasure is not mentioned, as though it were irrelevant to the subject or too dangerous to teach. ACOG now recommends comprehensive sexuality education that includes healthy relationships, communication, consent, and sexual expression, treating sexuality as more than a footnote to disease prevention [12,13]. One research-backed program, an online intervention called OMGYes, has shown large, measurable improvements in women’s knowledge of their own preferences, their confidence communicating those preferences, and the pleasure they experience, alone and with a partner [14].
I spent the first decade of my practice asking every patient about her period, her fertility, her contraception. I did not ask a single one of them about her pleasure. That was not modesty on my part. It was the direct output of the training I received, which never once suggested that pleasure was a clinical variable worth measuring.
Sexspan, sexual function tracked across your lifespan as a marker of your overall health, is not yet a formally codified clinical term. The data standing behind it are not preliminary. Sexual complaints in women rise from forty-two percent to eighty-eight percent between ages forty-five and fifty-five, over an eight-year window, tracking directly with declining estradiol [15]. Sexual dysfunction is associated with chronic disease, depression, cardiovascular risk, pelvic floor disorders, and the side effects of common medications, which makes it one of the earliest signals available that something else in your physiology needs attention [16]. In healthy aging women, psychosocial factors, relationship satisfaction, emotional support, self-esteem, and optimism, predict sexual function more strongly than hormone levels do [17]. Your hormones matter. Your relationships and your self-regard matter at least as much.
The World Health Organization, ACOG, and the International Society for the Study of Women’s Sexual Health all recommend universal screening for sexual concerns as a routine part of care [16,18-20]. Fewer than half of women with distressing sexual difficulties ever bring it up with a clinician, and most clinicians never ask [16,18-20]. I ask now. Every patient, every visit: sexual function is an important part of health, is there anything you want to discuss? Watch what happens to the room when I ask it.
This is not only about hormones or anatomy in isolation. Optimal sexual function requires a biopsychosocial view: body image, past trauma, the dynamics of your specific partnership, cultural conditioning, and medication effects all sit alongside the physiology [10,16,21].
A patient told me last year that she had faked orgasm with her husband for eleven years. She wept in my office describing the exhaustion of performing something her body had never learned to do honestly in partnered sex. She could orgasm with a vibrator, but she needed time.
Her experience is not unusual.
I wrote before about faking orgasms and the no-shame strategy to address the behavior. Nearly fifty-nine percent of women in a national U.S. sample report having faked orgasm at some point, most often out of embarrassment about discussing sex directly or a wish to protect a partner’s feelings [22]. Numbers range higher in other studies.
Faking orgasm predicts lower sexual, relationship, and life satisfaction across large European samples. It also correlates with a pattern researchers call sexual distancing, along with a perceived lack of care from a partner [23,24]. Women who eventually stop faking describe better communication and more comfort with an encounter that does not end in orgasm every time [23]. More than fifty-five percent of women have wanted to talk with a partner about sex and chosen silence instead, primarily out of embarrassment [22]. That silence is not a personality trait. It is what happens when nobody ever taught you the words.
Sexual self-esteem operates as more than a feeling. It is the mechanism connecting how a woman sees her body to how her body responds. Women with lower sexual self-esteem report poorer arousal, lubrication, orgasm, and satisfaction, and sexual self-esteem mediates the entire relationship between body image and sexual function [25]. Sexual self-efficacy, meaning confidence in navigating a sexual experience, predicts satisfaction directly and through the behaviors it makes possible [26].
Women who endorse the belief that vaginal intercourse alone should produce orgasm report significantly worse sexual functioning than women who do not carry that belief [27]. In qualitative interviews, women describe the absence of orgasm as damaging to their self-image. Not simply as a physiological gap, but as a perceived failure of femininity built entirely from male-centered norms [28]. Sexual shame, meaning shame connected to one’s sexual self, experiences, and desires, is independently associated with poorer mental health [29].
Purity culture, the strict sexual ethic common in evangelical Christian upbringing, independently predicts this same shame, even after controlling for a woman’s trauma history [30]. Sex guilt, not religiosity itself, is the mechanism: it fully explains the link between a religious upbringing and painful sex, and it separately explains reduced sexual desire [31]. If you were taught your body was dangerous before anyone taught you it was yours, the shame did not come from the body. It came from the curriculum.
The relationship between sexual dissatisfaction and mental health runs in both directions. Daily diary research in premenopausal women found that depressive symptoms predicted a drop in desire the following day. General psychological distress predicted orgasm difficulty on the same day it was felt [32]. At the population level, sexual dysfunction and dissatisfaction are strongly associated with mood disorders, anxiety disorders, and substance use disorders over a twelve-month period, even after researchers controlled for demographics, medical conditions, and childhood trauma [33]. Structural modeling suggests depression, anxiety, and female sexual dysfunction share a common underlying vulnerability, rather than simply co-occurring by chance [34].
DSM-5-TR recognizes distressing low desire as connected to depression, anxiety, thyroid disease, and urinary incontinence, and names sociocultural factors such as gender role expectations as genuine influences on orgasm difficulty [35].
Comprehensive sexuality education, received by only fifteen percent of young adults in one national sample, is associated with greater sexual satisfaction, better communication about sexually transmitted infections, and higher rates of testing, compared with no education or abstinence-only curricula [36].
In a controlled study of female college students, those who received **integrated, practical sexual education **scored significantly lower on interpersonal sensitivity, depression, anxiety, hostility, and obsessive-compulsive symptoms than students in the control group [37]. This is a measurable mental health intervention that our current curriculum ignores.
I want to point out the other side of this issue because not every woman wants her pleasure quantified, screened, or turned into a clinical metric, and she does not have to. The data above are tools for understanding your own body, not a new performance standard to fail or feel bad about. The point is that you deserve accurate information, instead of inheriting a diagram that stopped at the vagina where the rest of the conversation should have been.
Learning about your anatomy, asking for the pleasure you want, saying the names of your own anatomy out loud to a partner or a physician, is an act of sovereignty over your own body.
Nobody else gets to hold that information instead of you.
A few months ago, my daughters taught me a word I did not expect to hear used as praise: cunty. They use it to describe a woman running a boardroom, a woman ending a bad relationship without apology, a woman who knew exactly what she wanted and asked for it unapologetically. In their generation, the word has become shorthand for power, precision, and total ownership of yourself.
I sat with that for a long time. For most of my life, that word was the worst thing you could call a woman. Watching my daughters and their friends turn it into praise told me something about what their generation is asking for.
A generation that can reclaim the word for a woman’s anatomy as the highest compliment for her power is a generation asking, whether it describes it this way or not, for exactly what this post aims to provide.
Cunt literacy: knowing the real names for your own body, and saying them without flinching.
If the word can carry a compliment now, your education can carry the truth.
I want to hear from you. What word were you taught to be ashamed of that you, or your daughters, have since reclaimed? Of everything in this post… anatomy, shame, or the silence around asking for help, which one hit hardest?
Please tell me in the comments. I read every one.
Send this to the woman who was inadequately taught about her own anatomy. Send it to the one who wonders if the problem is her. It was never her, it’s a problem with our culture’s curriculum.
xo Dr. Sara
Notes
**[1] **Grosse-Rueschkamp MS, et al. What Knowledge Matters for Women’s Sexual Wellbeing? Validating a Questionnaire Measuring Sexual Knowledge Using Public and Patient Involvement. Journal of Sexual Medicine. 2025. PMID: 40974279.
**[2] **El-Hamamsy D, et al. Public Understanding of Female Genital Anatomy and Pelvic Organ Prolapse: A Questionnaire-Based Pilot Study. International Urogynecolo…
