Written by Dr. Maria Uloko, MD
Dr. Maria Uloko, MD is a board-certified urologist specializing in comprehensive sexual health, reconstruction, and prosthesis.
“ As a “Sexual Health Sherlock,” I specialize in diagnosing and treating conditions that many clinicians find too complex, such as pelvic pain or recurrent UTIs. What sets my approach apart? A deep understanding of the vulva—its anatomy, function, and its historical neglect in medical education. ”
Let’s start with a simple fact: every human body has a vulva, a penis, or some combination of both.
Now here’s the problem: society and a majority of medicine still act as if the vulva doesn’t exist.
When Gillian Anderson wore a vulva-embroidered dress to the Golden Globes in 2024, the internet exploded, calling it a “vagina dress.” But it wasn’t a vagina—it was a vulva. The fact that the distinction was lost on the general public? Not surprising. What is shocking, though, is that most doctors wouldn’t get it right either.
As one of seven board-certified urologists trained in the medical and surgical management of sexual dysfunction for all genders, I have witnessed firsthand the stark disparities in sexual healthcare access. I treat everything from erectile dysfunction to complex pelvic pain, menopause, and orgasm dysfunction. I built one of the first vulvar sexual health and UTI clinics in the U.S. that accepted insurance, treating over 2,000 patients with vulvovaginal conditions.
My work has always centered on one critical question: why can’t people get care? As a "Sexual Health Sherlock," I specialize in diagnosing and treating conditions that many clinicians find too complex, such as pelvic pain or recurrent UTIs. What sets my approach apart? A deep understanding of the vulva—its anatomy, function, and its historical neglect in medical education. Through years of research and clinical experience, I discovered a systemic failure: the widespread lack of vulvar training, the absence of research, and the deeply ingrained societal biases that have resulted in a crisis in care. This isn’t just a gap—it’s a full-blown public health emergency.
What is the Vulva?
The vulva encompasses the external female genitalia, including several distinct anatomical structures critical for urinary, reproductive, and sexual health:
Mons pubis: Fatty tissue covering the pubic bone.
Labia majora and labia minora: Outer and inner folds that protect the vaginal and urethral openings.
Clitoris: A highly innervated organ essential for sexual pleasure.
Vestibule: The area surrounding the vaginal and urethral openings.
Skene’s glands: Analogous to the male prostate, contributing to lubrication and ejaculation.
Bartholin’s glands: Secrete mucus for vaginal lubrication.
Perineum: The tissue between the vulva and anus.
Each part plays a crucial role in maintaining overall genital function, yet these structures are often overlooked in medical education and research.
A Body Part Without a Medical Specialty
Every major organ and body system has a designated medical specialty.
The heart? Cardiology.
The brain? Neurology.
The bladder? Urology.
The uterus, vagina, and ovaries? Gynecology.
And the vulva? Nowhere to be found.
This means that when someone presents with burning, pain, itching, recurrent UTIs, or discomfort during sex, they bounce between urologists, gynecologists, dermatologists, and primary care doctors—none of whom have been trained to evaluate the vulva.
The Numbers Don’t Lie:
🔹 1 in 4 people will suffer from chronic pelvic pain at any given time.
🔹 It takes an average of 7 years and 3+ specialists before a patient with chronic vulvar pain receives a diagnosis.
🔹 50% of patients with recurrent UTIs, chronic pelvic pain, or interstitial cystitis are misdiagnosed at least once.
🔹 The healthcare system spends ~ $100 billion annually on mismanaged vulvovaginal conditions.
🔹Patients pay on average 17K dollars to get a diagnosis for pelvic pain
If you’re thinking, Wait, but aren’t OB/GYNs experts in this?—think again. First and foremost, it’s not just a gynecologist’s job to know about the vulva—it’s every doctor’s job. The vulva is a human body part and should be studied like all others. Yet, preliminary data from our IRB-approved study found that up to 75% of current training physicians have never been trained to perform a basic vulvar exam.
Even the materials used to teach about the vulva are not standardized. Research shows that vulvar education is deeply flawed and inconsistent:
🔹 A study found 486 different anatomical terms used to describe vulvar and pelvic anatomy, yet the gold standard medical reference, Terminologia Anatomica, only includes 186 of them—illustrating the lack of standardization in medical education.
🔹 A review of 30 anatomy textbooks revealed that none provided standardized measurements for the labia minora or majora, and most included only a single, vague illustration of the vulva.
This lack of standardization in medical education leaves clinicians without a clear framework for diagnosis and treatment—directly leading to patient suffering, misdiagnoses, and wasted healthcare resources. For most people suffering from pelvic issues, the specialists they turn to are gynecologists or urologists. But most gynecologists focus on the vagina, uterus, and ovaries, while urologists focus on the bladder. The vulva? It falls through the cracks.
Because of this knowledge gap, doctors miss critical diagnoses. Patients with pelvic disorders like recurrent UTIs, chronic pelvic pain, vaginal infections, and painful bladder symptoms are routinely misdiagnosed—totaling roughly 85 million people—and they pay the price.
How We Got Here: A Look at History
To understand how we arrived at this crisis, we have to look at history. Before the 1920s, obstetrics and gynecology were separate specialties. Obstetrics focused on pregnancy and childbirth, while gynecology focused on conditions of the female reproductive system, including the vulva. But when the American Board of Obstetrics and Gynecology (ABOG) was established in 1927, the two fields merged into a single specialty: OB/GYN.
The problem? The training was never extended to accommodate two distinct fields within one specialty. Over time, obstetrics—the field that deals with life-or-death emergencies—took precedence. Obstetric procedures pay more, litigation is higher, and hospitals prioritize labor and delivery over gynecological care. Meanwhile, gynecology, which deals primarily with quality-of-life issues, fell by the wayside.
As a result, many OB/GYNs graduate with little to no training in vulvar health. This systemic oversight has left a massive gap in care, disproportionately impacting patients suffering from chronic pelvic pain, recurrent infections, and sexual dysfunction.
The Research Gap
On top of the lack of training or standardized curriculum, there exists a significant lack of research and innovation in vulvar health. No other structure depicts this as well as the clitoris. Research dedicated to the glans penis is 20 times greater than research focused on the clitoris, highlighting a stark disparity. For centuries, the penis has been dissected, mapped, and studied in exhaustive detail. You can not graduate from urology residency or become board certified urologist without knowing the ins and outs of the penis. Meanwhile, the clitoris wasn’t fully mapped until 2005 by a urologist, Dr. Helen O'Connell—nearly 40 years after MRI technology existed to do so. But here’s the real kicker:
Until 2023, no one had ever published the number of nerves in the human clitoris.
It took my team—Dr. Paige Isabey, Dr. Blair Peters, and myself—to finally fix this. And what did we find? The clitoris has over 10,000 nerve endings, more than any other human structure. To this day, accurate depictions of the clitoris are not well documented or discussed in medical and surgical textbooks. This lack of research directly impacts clinical care, as many vulvar conditions go undiagnosed, untreated, or are dismissed as psychological rather than physiological. Without a strong scientific foundation, clinicians lack the knowledge to accurately diagnose and treat vulvar disorders, perpetuating medical neglect and leading to patient suffering.
If science ignored something as basic as nerve count for centuries, what else have we failed to study? Although the anatomy and innervation of the clitoris have now been defined, major gaps remain in our understanding of its physiology, including its hormonal response, and function in sexual health. This extends to much of the vulvar structures as well.
VULVAi: Bridging the Gaps in Care with Technology
How do we train an entire medical workforce that is actively practicing and still in training? This is where technology comes in. AI and digital tools can help bridge the vast educational gaps in vulvar health, providing clinicians with the real-time knowledge they were never taught in medical school. Right now, the medical field remains woefully deficient in understanding vulvar and vulvovaginal conditions, leading to persistent misdiagnoses and inadequate treatment.
As a urologist, I am aware of how men’s health has long benefited from cutting-edge technology—prostate imaging, erectile dysfunction medications, and testosterone therapies. Meanwhile, vulvar health has been left in the dark.
This is why I founded VULVAi—an AI-driven platform designed to:
✅ Train doctors in real-time on vulvar conditions
✅ Provide diagnostic support for conditions like vestibulodynia, recurrent UTIs, and vulvar pain
✅ Empower patients with evidence-based knowledge and advocacy tools
We are building the future of vulvar healthcare, ensuring that both doctors and patients have the knowledge they need to advocate for better care. But right now? Medicine is still 100 years behind. It’s time to catch up.
Conclusion
Despite its critical role in urinary, sexual, and reproductive health, the vulva remains one of the most overlooked and understudied organs in medicine. This neglect is deeply rooted in historical biases, the outdated structuring of medical specialties, and systemic failures in research funding. The result? Widespread misdiagnoses, inadequate treatment, and unnecessary suffering for millions. Addressing this knowledge gap isn't just about improving medical education—it's about rectifying a century of neglect and ensuring that every patient receives informed, effective, and compassionate care.
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