Allison Draper loved anatomy class. As a first-year medical student at the University of Miami, US, she found the language clear, precise, functional.
She could look up the Latin term for almost any body part and get an idea of where it was and what it did. The flexor carpi ulnaris, for instance, is a muscle in the forearm that bends the wrist — exactly as its name suggests.
Then one day she looked up the pudendal nerve, which provides sensation to the vagina and vulva, or outer female genitalia. The term derived from the Latin verb pudere: to be ashamed. The shame nerve, Draper noted: “I was like, What? Excuse me?”
Allison Draper NYTNS
It grew worse. When her teacher handed her a copy of the Terminologia Anatomica, the international dictionary of anatomical terms, she learned that the Latin term for the vulva — including the inner and outer labia, the clitoris and the pubic mound — was pudendum. Translation: the part to be ashamed of. There was no equivalent word for male genitals.
And that is when she really got fired up.
Anatomy as a science had its start in 16th-century Italy, as the purview of learned men. At the time it was a stretch to find a female corpse, let alone a female anatomist. Little wonder, then, that some words might sound a little off to modern ears. What surprised Draper was that this one had made it through 500 years of revisions and updates — and virtually no one knew what it meant.
That included her anatomy professor, Doug Broadfield, who had been showing the pudendal canal, nerve and artery to students for 14 years. “I never really gave it a second thought,” he said. “You just don’t really think about that kind of thing.”
Nor was the term limited to academia. Anyone who has gone to medical school has probably learned how to perform a pudendal block, a numbing injection at the site of the pudendal nerve. It is used to diagnose and treat certain forms of pelvic pain, perform vulval and vaginal surgeries and, though less common than the epidural, alleviate the pain of second-stage labour.
Dr Antje Barreveld, a pain management specialist at Newton-Wellesley Hospital in Massachusetts, US, performs around 250 pudendal blocks a year. “It’s incredible that this Latin term has really persisted,” she said. “What does that say about the medical establishment and their view of women?”
In 2019, with Broadfield’s support, Draper began research for a paper arguing that pudendum was inappropriate as a medical term and should be removed. “It was a project of fascination,” she said. “I just had to get to the bottom of it.”
In the beginning, shame knew no sex. First-century Roman writers used “pudendum” to mean the genitals of men, women and animals.
In 1895, anatomy officially recognised a pudendal region in both men and women. But 60 years later, only the “pudendum femininum” — the female shame part — was still listed. NYTNS
But it was women to whom the shame stuck.
In 1895, anatomy officially recognised a pudendal region in both men and women. But 60 years later, only the “pudendum femininum” — the female shame part — was still listed. It would later be simplified to “pudendum” and used as a slightly more formal synonym for vulva. Today, the word appears in almost every medical textbook, including recent editions of Gray’s Anatomy, Williams Obstetrics and Comprehensive Gynecology.
In 2014, Bernard Moxham, head of anatomy at Cardiff University in Wales, UK, collaborated with Susan Morgan from the same university to examine gender bias in anatomy teaching. Most medical textbooks, they found, showed the male body as standard and trotted out the female only when it came time to show the reproductive system, genitals and breasts.
In 2016, the pair asked hundreds of medical students and anatomists whether they had any concerns about the fact that the word “pudendal” stemmed from “to be ashamed.” Most did not.
This blasé attitude appalled Moxham.
Moxham knew that even established terms could be changed, and thought they should be, as part of efforts to weed out racial and gender bias in medicine.
He had just stepped down as president of the International Federation of Associations of Anatomists, which was working to release the newest edition of the Terminologia Anatomica.
In 2016, Moxham proposed that the federation’s terminology group — which was, at the time, all male and mostly European — remove “pudendum” and related words from its upcoming dictionary. After some grumbling, however, everyone agreed that “pudendum” had to go. NYTNS
In 2016, Moxham proposed that the federation’s terminology group — which was, at the time, all male and mostly European — remove “pudendum” and related words from its upcoming dictionary.
After some grumbling, however, everyone agreed that “pudendum” had to go. Then came time to change the related words: pudendal nerve, pudendal canal and pudendal artery.
To many members of the group, renaming a nerve that doctors referred to on a regular basis was a step too far. “There’s no way anatomists can maintain any credibility with surgeons and other biomedical people if we say they can’t use ‘pudendal’ anymore,” Dr Paul Neumann, a Canadian neuroscientist and member of the terminology group at the time, said.
For months, heated emails flew over what to do with the offending terms.
The decision came quietly. Draper learned about it in late 2019 from a paragraph at the bottom of a medical article: “pudendum” would no longer appear as an official term in the upcoming version of Terminologia Anatomica. However, the article noted, the pudendal artery, canal and nerve would remain relatively unchanged “because the use of the word pudendalis in terms for structures present in both sexes cannot be interpreted as sexist.”
In other words, if the shame was spread equally, maybe it wasn’t so bad.
NYTNS