When Jessica was 17, she stumbled upon marketing for labiaplasty, a surgery done to reduce the size of the labia minora. She read claims that protruding labia minora were "hypertrophic," or excessively developed. She read false claims that "hypertrophy" was caused by sex, masturbation, aging and male hormones. These claims were and still are online on surgeons' websites and in peer-reviewed medical journals. She read that labiaplasty was recommended and that there were no risks to sexual function and no serious complications. 

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Overwhelmed by shame and not seeing a downside, Jessica sought a labiaplasty. She went to a renowned OB/GYN recommended as the best OB/GYN surgeon at Baylor in Dallas. He did not tell her any risks of labiaplasty. When she asked him what her labia minora were for, he shrugged. Within days of her 18th birthday, she went in for surgery. She consented to "excision of redundant labia minora" on a fill in the blank consent form that merely said all surgery carried risks.

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The surgeon amputated her labia minora as well as her frenulum and severed the dorsal nerves of her clitoris in a clitoral hood reduction done without her consent. After her surgery, Jessica could no longer get pleasure from external touching or oral sex. She hoped it wouldn't be a big deal because sex, she thought, was about penetration. One month after her surgery, she had sex for the first time. Nothing. 

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In the years following, Jessica struggled to find answers, but she blamed herself and found it hard to speak about this to anyone. At 19, she finally told a boyfriend that she thought her surgery had made it so she would never be able to orgasm. At 21, she tried to get help from her OB/GYN. She was told she looked normal, despite completely amputated labia minora, that her surgery could not have caused her dysfunction, and that she just needed to relax and see a sex therapist. At 22, a new OB/GYN told her she just needed to fall in love. Again, she was told her surgery couldn't have caused the dysfunction.

 

She tried consulting with a plastic surgeon about a repair. He told her, "I see this all the time. Most surgeons don't know what they are doing." Too much of her clitoral hood had been removed to create new labia minora, he said. But he had no answers regarding her loss of sensation.

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Frustrated with the lack of a functional explanation for her symptoms, Jessica decided to teach herself anatomy. The dorsal nerves of the clitoris traveled along the clitoral body. She couldn't find any information on how deep below the skin they were, so she looked it up for the penis and figured out her surgeon had operated right where nerves were. These nerves were entirely missing from OB/GYN literature and from all literature on female genital cosmetic surgery. She realized surgeons were operating blind. This was not about one surgeon. It was not some random mistake. The horrifying ignorance was systemic. She knew she had to be one of many.

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Justice, she decided, was solving the problem. If she could solve this for other women, that would be justice for herself. She also wanted acknowledgment. So, she wrote to her original doctor, explaining what he had done, explaining how it was because there were no training standards and the anatomy was not taught. She asked for his help making change.

 

He took 6 months to respond. He blamed her. He said he had been surprised that her labia minora "atrophied" instead of acknowledging that he had completely removed them in surgery. He denied the clitoral hood reduction. How could she prove what had happened if no doctor would confirm it?  ​

At 24, Jessica sent the research she had found on the clitoris to a urogynecologist and had her injury confirmed. While she finally received the acknowledgement she desired, it was not going to help others. Jessica pushed forward with her goal of systemic change to medical literature.

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In December 2017, she got the courage to begin meeting with medical leadership. The head of patient safety said it was very difficult to make sure surgeons were trained to do what they were given privileges to do. The Chief Medical Officer suggested she start a #metoo movement for women genitally mutilated by surgeons. She reached out to professional medical organizations, journalists, leadership at residency programs, anatomy professors and countless doctors and surgeons.

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The Executive Director of the American Board of OB/GYN told Jessica she was mistaken regarding nerves in the clitoris missing from OB/GYN literature. The best response she received from a gynecologic surgery textbook author was, "I don't think I have room," and "The problem is those nerves are very thin and difficult to dissect, unlike the nerves in the penis." Eventually, a urologist responded, "Information gets disseminated based on interest. OB/GYN journals are not interested in research on female external genitals. I don't know how to get this widespread." So, Jessica took to social media. If the problem was interest, she would create interest. 

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She wrote a Medium article about how the nerves in the clitoris were missing from OB/GYN journals and textbooks, a clear indication that they weren't known by OB/GYNs. She shared her story online, which helped get traction. Still, a prominent OB/GYN on Twitter tweeted that Jessica, “didn't know what she was talking about.”

 

Jessica needed credibility, so she asked for her dad’s (Chief of Plastic surgery at Baylor Medical College) help doing a study. Talking to her father about clitorises, much less actually dissecting them, was the last thing she wanted to do.  But, to her surpise, she found they were large and easy to dissect, about 2-3mm in diameter. She also found they had first been documented in 1672, yet they were largely ignored and censored from medical diagrams. 

 

Jessica helped to create the first detailed illustrations of the clitoris, including a transverse cross section like the ones always shown for the penis. Similar illustrations have since been published in Netter, Moore, Te Linde, Williams Gynecology, Williams Obstetrics, and multiple other medical textbooks, journals, anatomy apps, anatomy posters, and online resources.

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​​ Her study was covered in The New Scientist. Detailed anatomy of the clitoris had been shared and liked over 100,000 times before it was published in OB/GYN literature. Jessica believes the interests of patients can drive medicine to change.

 

In 2021, ABOG, who had previously denied any problem, added the course of the nerves in the clitoris to Maintenance of Certification, a requirement for all female pelvic and reconstructive surgery subspecialists. It is only optional for general OB/GYNs. 

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One weakness in Jessica’s method was that it was too often referred to as "her cause," often with attacks on character. It is not just her cause, it is a cause for women. SHE Project embodies that cause.

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Women deserve a better world where sexuality and genitals have equal dignity. They deserve a healthcare system that takes female sexual function seriously. Where sexual function is defined by the ability to achieve pleasure and not on the ability to receive penetration.

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