Stacia Alexander was 25 and pregnant when her OB-GYN first recommended a hysterectomy. It was 1996, and an ultrasound had revealed fibroids growing in the walls of her uterus.But she knew what the procedure had done to her mother: After her ovaries and uterus were removed in her 40s, her mother faded into a sad, irritable shadow of herself.So after giving birth, Dr. Alexander opted for surgery to prune back the fibroids. Years later, when the growths returned, she was again able to avoid a hysterectomy by choosing a uterine ablation, in which the lining of the uterus is burned away to prevent bleeding caused by fibroids.But by the time she was 45, the fibroids were back, and her doctor informed her that she was “too old” for another uterus-sparing surgery.Dr. Alexander, a psychotherapist in Dallas, was already on the operating table when a surgeon came in and asked whether she wanted a “full” or “partial” hysterectomy.If she chose the second option, he warned, there would be no guarantee that she wouldn’t be back for another operation in two years. So Dr. Alexander agreed to a “full” hysterectomy.We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe.

One morning in 2012, eight weeks into her pregnancy, Shannon Withycombe woke up bleeding: She was having a miscarriage. In the emergency room, however, no doctor or nurse uttered that word. Instead, she had to wait to read her discharge papers, which read “incomplete abortion.”Dr. Withycombe, a medical historian at the University of New Mexico, knew the term from her research on 19th-century medical journals; it was doctorspeak for a miscarriage that had not fully exited the uterus. But it was jarring to see it on her own 21st-century medical notes.“I’ll admit, I was surprised,” she said. “Like most of us, I had been socialized to think that miscarriage and abortion were very different animals.”Physiologically, miscarriage and medication abortion are near-identical experiences. Both start with a decrease in the hormones that maintain pregnancy, followed by vaginal bleeding, and then the uterus squeezes like a fist to push out the tissues of pregnancy. Both are managed with the same tools and medications, which is why laws that restrict abortion care also affect women who miscarry.In the 21st-century United States, of course, the distinction matters. Dr. Withycombe’s odd-sounding diagnosis is a relic of a time when the word “abortion” had none of the legal, moral or political connotations that it does today — a time before doctors had medicalized miscarriage and legislators had moralized abortion.In medical circles during the 1800s, “abortion” was the preferred term for any form of early pregnancy loss, used interchangeably with the more colloquial “miscarriage.” It was often accompanied by a modifier like “spontaneous” (meaning it happened of its own accord), “missed” (tissues were retained in the uterus) or “habitual” (several miscarriages occurred consecutively).We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe.

The word “failure” is rampant in medicine. Hearts, livers, lungs, and kidneys all “fail,” which simply means they cease to do their job. But the failures that patients tend to remember are the ones that seem to indict not an organ but an entire person. Just ask anyone who has been told that they have “failed” vaginal delivery (meaning that labor was slow or the cervix didn’t dilate) or “failed” chemotherapy (meaning that the tumor didn’t respond to treatment).Worst among these phrases, many doctors say, is a common diagnosis for both infants and older adults: “failure to thrive.”In pediatrics, the term refers to infants who struggle to hit key milestones in size, weight and cognitive development. When Dr. Deborah Frank, a retired pediatrician, was in medical school in the 1970s, the diagnosis meant one of two things: “Either you had major congenital heart disease or cystic fibrosis, or you had a bad mother,” she said. “Or maybe you had both.”If the term sounds slightly accusatory, that’s because it is. It arose from the idea that struggling infants were ailing not because of any underlying disease or lack of nutrients but because of poor parenting.The first known appearance of “failure to thrive” was in the 1933 edition of a medical textbook, “The Diseases of Infancy and Childhood.” An explanation for the condition came near the end of World War II, when René Spitz, an Austrian psychoanalyst, observed that infants in a Mexican orphanage tended to be listless, scrawny and slow to develop.This concerning syndrome, Spitz surmised, resulted from a lack of “maternal affection, maternal care and maternal love.” Pediatrics took the idea and ran with it​ — “in the fine old tradition of mother-blaming,” Dr. Frank said. (A similar psychoanalytic idea that became popular around this time was “refrigerator mother theory,” which posited, incorrectly, that autism was caused by “cold mothering.”)We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe.

Since its inception, this murky term has straddled the dual role of disciplining and inspiring.When Joel Bervell thought about professionalism as an undergrad, he thought of “Grey’s Anatomy.” Specifically, he thought about how residents on the show were expected to be, although often were not: on time, prepared for their cases and respectful to everyone around them.“That was the only standard that I had of what it meant to be a doctor — especially someone like me, who doesn’t come from a family of doctors,” said Mr. Bervell, 28, a fourth-year medical student at Washington State University. Mr. Bervell, who is Ghanian American, is one of the first Black medical students at the medical college, which opened in 2017.From the moment students set foot in medical school, they are instilled with the concept of medical professionalism: their sacred responsibility to conduct themselves with the values of a profession that is granted automatic trust in society. “It is the first thing they tell you: You are now literally a medical professional,” Mr. Bervell said.The same metric can be used to determine whether or not a med student becomes a doctor at all.Starting in their third year, Mr. Bervell learned, he and his classmates would be regularly assessed on their professional behavior, along with other attributes like communication skills. Faculty, staff and other students could also report specific concerns about an individual’s professionalism, resulting in write-ups the contents of which could become attached to their permanent records, following them like scarlet letters.The problem, as many medical students have also learned, is that where “professional” is vague, “unprofessional” is even more so. Depending on who makes the call, unprofessional behavior can mean hugging your program director, letting a bra strap show, wearing braids, donning a swimsuit over the weekend or wearing a “Black Lives Matter” sweatshirt in the E.R.As a result, professionalism exists at two levels, as both a lofty standard of behavior and a (sometimes literal) list of dos and don’ts that blur ethics and appearance. That second meaning can prove particularly pernicious to residents of color, said Dr. Adaira Landry, an adviser at Harvard Medical School and co-author on a recent journal article on the “overpolicing” of Black residents.We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe.

The debate over aid in dying still rages in the language that medicine and the media use to describe the practice.In rural Iowa, Peg Sandeen recalls, living with AIDS meant living under the cloud of your neighbors’ judgment. After her husband, John, fell ill in 1992, the rumors began swirling. The couple had almost learned to live with the stigma when things took a turn for the worse.In 1993, ravaged by his disease and running out of options, John wanted to make one final decision: to die on his own terms, with the help of life-ending medication. But at the time, there was no way to convey to his doctors what he wanted. As the debate over assisted dying raged in far-off Oregon, the headlines offered up only loaded words: murder, euthanasia, suicide.John was adamant that what he wanted was not suicide. He loved his life: his wife, who had married him even though he had asked her to leave when he learned he was H.I.V. positive; their 2-year-old daughter, Hannah; and playing Neil Young songs on guitar, a pleasure that was rapidly being taken from him as his faculties slipped away.“This was not a man who wanted to commit suicide, at all,” said Ms. Sandeen, now the chief executive of Death With Dignity, a group that supports aid-in-dying laws across the country. To her, the word only added more judgment to the homophobia and AIDS phobia that they — and others who found themselves in a similar position — were facing.John had expressed to his wife his wish to die on his own terms. But, to her knowledge, he never spoke about it with his physicians. At the time, it felt impossible to bring it up as simply a medical question, not a moral one.“Even if the answer was, ‘No, we can’t offer that,’ that would have made such a difference,” she said. “We were just facing so much stigma that even to have the ability to have this end-of-life care conversation would have just been remarkable.”John succumbed to the virus on Dec. 9, 1993, less than a year before the Death With Dignity Act passed narrowly in Oregon. Since its enactment in 1997, more than 3,700 Oregonians have taken measures permitted by the law, which allows patients with a terminal illness and the approval of two doctors to receive life-ending medication. The practice is now legal in 10 U.S. states and Washington, D.C.With this shift has come new language. Like the Sandeens, many health advocates and medical professionals insist that a terminally ill patient taking medication to hasten the end is doing something fundamentally different from suicide. The term “medical aid in dying,” they say, is meant to emphasize that someone with a terminal diagnosis is not choosing whether but how to die.“There is a significant, a meaningful difference between someone seeking to end their life because they have a mental illness, and someone seeking to end their life who is going to die in the very near future anyway,” said Dr. Matthew Wynia, director of the University of Colorado’s Center for Bioethics and Humanities.In the 1990s, advocates were facing an uphill battle for support. Two assisted-dying bills, in California and Washington, had failed, and the advocates now faced an opposition campaign that mischaracterized the practice as doctor-prescribed death. “At the time, the issue very badly needed to be rebranded and repositioned,” said Eli Stutsman, a lawyer and a main author of the Death With Dignity Act. “And that’s what we did.”The text of the law, however, only defined the practice by what it was not: mercy killing, homicide, suicide or euthanasia. (In the United States, euthanasia means that a physician actively administers the life-ending substance. That practice has never been legal in the United States, although it is in Canada.)New terms soon became inevitable. Barbara Coombs Lee, an author of the law and president at the time of the advocacy group Compassion and Choices, remembers a meeting in 2004 where her group discussed which terminology to use going forward. The impetus “was probably another frustrated conversation about another interminable interview with a reporter who insisted on calling it suicide,” she said.A phrase like “medical aid in dying,” they concluded, would reassure patients that they were taking part in a process that was regulated and medically sanctioned. “Medicine has that legitimating power, like it or not,” says Anita Hannig, an anthropologist at Brandeis University and author of the book “The Day I Die: The Untold Story of Assisted Dying in America.” “That really removes a lot of the stigma.”By contrast, words like “suicide” could have a devastating effect on patients and their families, as Dr. Hannig learned in her research. Grieving relatives might be left feeling shamed, isolated or unsupported by strangers or acquaintances who assumed that the loved one had “suicided.” Dying patients often hid their true wishes from their doctors, because they feared judgment or struggled to reconcile their personal views on suicide.Unlike an older term, “physician aid in dying,” “medical aid in dying” also centered on the patient. “This is not a decision the physician’s making — this is not even a suggestion the physician is making,” said Ms. Coombs Lee, who has worked as an emergency-room nurse and a physician assistant. “The physician’s role is really secondary.”An equally important consideration was how the phrase would be taken up by the medical community. Doctors in Oregon were already practicing aid in dying and publishing research on it. But without agreed-upon terms, they either defaulted to “assisted suicide” (generally used by opponents of the law) or “death with dignity” (the term chosen by advocates for the name of the law). A more neutral phrase, one that doctors could use with each other and in their research, was needed.Not all organizations today agree that “medical aid in dying” is neutral. The Associated Press Stylebook still advises referring to “physician-assisted suicide,” noting that “aid in dying” is a term used by advocacy groups. The American Medical Association also uses this language: In 2019, a report from the association’s Council on Ethical and Judicial Affairs concluded that “despite its negative connotations, the term ‘physician assisted suicide’ describes the practice with the greatest precision. Most importantly, it clearly distinguishes the practice from euthanasia.”Medical language has long shaped — and reshaped — how we understand death. Dr. Hannig noted that the concept of brain death did not exist until 1968. Until then, a patient whose brain activity had ceased but whose heart was still beating was still legally alive. One consequence was that any doctor removing the patient’s organs for transplant would have been committing a crime — a serious concern for a profession that is notoriously fearful of lawsuits.In 1968, a Harvard Medical School committee came to the conclusion that “irreversible coma,” now known as brain death, should be considered a new criterion for death. This new definition — a legal one, rather than a biological one — has paved the way for organ transplantation around the world. “Before the definition of death was changed, those physicians would be called murderers,” Dr. Hannig said. “Now you have a totally new definition of death.”Of course, doctors have always assisted patients who sought a better end. But in the past, it was usually in secret and under the shroud of euphemism.“Back in the day, before the laws were passed, it was known as a wink and a nod,” said Dr. David Grube, a retired family physician in Oregon who began prescribing life-ending medications after one of his terminally ill patient violently took his own life. He knew doctors in the 1970s and ’80s who prescribed sleeping pills to terminally ill patients and let on that combining them with alcohol would lead to a peaceful death.For a brief time after the Death With Dignity law was passed, some doctors used the word “hastening” to emphasize that the patient was already dying and that the physician was merely nudging along an unavoidable fate. That term did not catch on, in part because hospices did not like to advertise that they were shortening lives, and patients did not like hearing that hospice care might lead to their “hastening.”In the absence of other language, the name of the law itself became the preferred term. The phrase allowed patients to open conversations with their physicians without feeling as though they were raising a taboo subject, and doctors understood immediately what was meant. The name has stuck: Even in his retirement, Dr. Grube gets calls from patients asking to talk about “death with dignity.”Yet in some ways, Dr. Grube believes the use of the word “dignity” was unfortunate. To him, the crucial point is not the kind of death a patient chooses, but that the patient has a choice. “You can have a dignified death when you pull out all the stops and it doesn’t work,” he said. “If that’s what you want, it’s dignified. Dignity is defined by the patient.”To him, that means avoiding language that heaps judgment on people who are already suffering. “There’s no place for shaming language in end-of-life,” Dr. Grube said. “It shouldn’t be there.”

Besides causing offense, the phrase may contribute to the underdiagnosing of treatable problems associated with menopause.When Heather Corinna started a Facebook support group in 2019 for people going through menopause and perimenopause, one phrase came up again and again. Members of the group had read about it online, heard it from their doctors and seen it in their medical notes. “Everybody had a bad reaction to it,” said Mx. Corinna, a queer sex educator and founder of the sex education site Scarleteen.The phrase? Vaginal atrophy.Amid the many unfamiliar terms and bodily changes that people were facing, “vaginal atrophy” seemed to encapsulate a host of fears around sexuality and aging. “I mean, atrophy,” said Mx. Corinna, 53, who is nonbinary. “Like, I’m getting older, bodies change. My elbows certainly don’t look or act like they used to, but you don’t hear anybody talking about my elbow atrophy.”Officially, the phrase was phased out years ago. In 2013, the Menopause Society and the International Society for the Study of Women’s Sexual Health convened a panel of medical experts to replace the term, which was increasingly seen as outdated. Atrophy “has negative connotations for midlife women,” they wrote. Also, they added, “vagina” was “not a generally accepted term for public discourse or the media.”But as Mx. Corinna has learned, the phrase continues to haunt the medical literature, as well as the health and medical care of people going through menopause. In medicine, “atrophy” commonly refers to a loss or thinning of tissue. In this case, it refers to tissues that rely on estrogen, and so become thin and lose elasticity in menopause, when levels of the hormone decline. But the vagina and vulva aren’t the only body parts affected by these hormonal changes; the urethra and bladder also require estrogen to function properly.To many patients, the focus on the vagina alone makes it seem as if all their genital symptoms are being sexualized. In reality, problems that are often associated with penetrative intercourse — dryness, irritation, thinning of tissue — also cause discomfort and pain with other everyday activities.Dr. Stephanie Faubion, director of the Mayo Clinic Center for Women’s Health, hears from patients who find it difficult to sit in the car, put on jeans or wipe after going to the bathroom. But because estrogen therapy is often marketed primarily for sexual pain, many patients don’t realize that these symptoms can also be addressed with vaginal estrogen.“It is weird that there just is a focus on the sex part of it,” said Dr. Faubion, who is also the medical director of the Menopause Society. “These are not lifestyle drugs, like Viagra. They’re treating many more symptoms other than having this just be about sex.”An over-focus on the vagina also obscures the fact that urinary problems — including incontinence, increased frequency of urination and urinary tract infections — are often related to menopause. For many, these symptoms can be just as bothersome as genital ones: U.T.I.s are responsible for 15 percent of hospitalizations of older adults, and can lead to delirium or even death.“I spent my 20s and early 30s in a nonstop urinary tract infection, I can’t go back to that,” said Mx. Corinna, who is the author of the book “What Fresh Hell Is This? Perimenopause, Menopause, Other Indignities, and You.” “If something changes with my vulva and I need to learn different ways to have sex or I need to sit on a donut, I can deal with that. But I can’t deal with having a U.T.I. all the time anymore.”In other words, the phrase “vaginal atrophy” wasn’t just potentially offensive, it was also clinically misleading. Millions of women and other people going through menopause go undiagnosed for treatable symptoms, said Dr. James Simon, a clinical professor of obstetrics and gynecology at George Washington University School of Medicine and Health Sciences and a member of the panel reconsidering the term. “We felt that one of the reasons was bad terminology,” he said.In 2014, the panel agreed on a new term incorporating these insights: genitourinary syndrome of menopause, or G.S.M. It wasn’t particularly catchy, but it brought the urinary system to the party, and unlike the term vaginal atrophy, it “didn’t have shame, wasn’t something that women did wrong or brought upon themselves,” Dr. Simon said. “It was just a natural process of aging that had a constellation of symptoms that could be lumped together as a syndrome.”There was precedent for rebranding a genital condition to make it more palatable to patients. In 1992, the National Institutes of Health replaced the term impotence with erectile dysfunction, or E.D. The reasoning was similar: Impotence was considered to be disparaging and imprecise, and was thought to imply that the condition was mainly psychological, adding to barriers in communication between patients and health care providers.Yet while E.D. has become firmly established in both the medical and popular lexicon, G.S.M. hasn’t had the same success. Vaginal atrophy is still the primary term used by most estrogen therapy companies, as well as many providers. “I don’t know that it’s commonly known,” said Dr. Faubion, who often finds herself having to explain the term to colleagues.Even doctors who don’t want to subject their patients to the term can find it difficult to avoid. Dr. Robin Noble, an obstetrician-gynecologist in Portland, Maine, tries to focus her conversations with patients on specific symptoms such as dryness and irritation. Yet when she prescribes vaginal estrogen, she still has to choose “vaginal atrophy” from a drop-down menu of diagnoses on her hospital computer system, and patients might end up seeing it in their medical notes. “I can’t avoid it entirely,” she said.Only a decade ago did gynecology shift from being a male-dominated field to one in which providers were primarily female. Given that history, it is perhaps unsurprising that much of the terminology feels archaic: Consider the phrases ovarian failure, incompetent cervix and senile uterus (really).In OB-GYN literature, women ages 15 to 49 are often categorized as “reproductive-aged” or “of reproductive age.” Going through menopause marks “the end of the childbearing phase of a woman’s life,” as the NAMS website puts it, and “the end of their reproductive years,” according to the World Health Organization. (Both are better than the choice of wording in one 2015 paper: “the end of reproductive competence.”)Besides being vague — there’s quite a difference between a 15-year-old and a 49-year-old — these phrases carry an implicit assumption that all women will, or should, reproduce. Such language can be jarring to people who can’t have children or choose not to, and to those who don’t want to be defined by their reproductive capacity. It has also caused some people to believe that they can’t get pregnant in perimenopause; they can.It may be more useful, and less presumptuous, to define menopause simply by what is happening inside your body, said Dr. Judith Joseph, a psychiatrist at NYU Langone Health who is on the medical board of Let’s Talk Menopause, a nonprofit organization. “Your ovaries are no longer ovulating,” Dr. Joseph said she tells her patients. “That has a totally different sound compared to ‘reproductive years,’” she said, adding, “You’re teaching people about what’s happening in their bodies, not what they’re capable of doing.”Of course, meanings change over time, and depend on who is holding the medical chart.Many people consider “vaginal atrophy” derogatory because there is no equivalent term for male genitals. While penises and testicles also shrink with age, medicine rarely describes them as atrophying, “and so no woman wants that diagnosis, either,” Dr. Faubion said. But testicular atrophy is not unheard-of; the term can describe genital shrinkage after steroid use, prostate cancer treatment or testosterone-blocking hormones for gender affirmation.For some doctors, atrophy is a neutral term that has no bearing on the value and dignity of the patient before them. Dr. Kathleen O’Banion, an OB-GYN and faculty member at Cooper University Hospital in New Jersey, remembers using the phrase in a lecture on estrogen loss and sexual function 30 years ago. During her talk, a sex therapist in the audience raised her hand and objected to the language.Dr. O’Banion was taken aback. “I saw that the term ‘atrophy’ upset her, but it had no such meaning for me,” she said in an email. In her view, “an atrophic labia is as wonderful and deserving of my concern and care” as any other.

The names of Nazi-era doctors are still found on diseases and body parts. By expunging them, will doctors forget lessons of the past?Edith Sheffer’s young son always disliked labels such Asperger’s syndrome. But in 2016, a psychiatrist told him that he should be proud: His condition was named after Dr. Hans Asperger, an Austrian scientist in the 1930s who used his position to help save children like him. By devising a diagnosis that emphasized the children’s intellectual abilities, the psychiatrist said, Dr. Asperger tried to spare them from the Nazi campaign to “euthanize” youths with cognitive disabilities.Dr. Sheffer, sitting next to her 12-year-old son, knew this wasn’t entirely true. Now a historian of 20th-century Europe at the University of California, Berkeley, she had spent years researching Dr. Asperger for her 2018 book, “Asperger’s Children.” Before he became known as a benevolent savior — “a psychiatric Oskar Schindler,” as Dr. Sheffer put it — Dr. Asperger marched in line with the Nazis’ medical framework.His diagnosis, which he later called autistic psychopathy, was part of the larger Nazi medical effort to divide lives into two categories: worthy or unworthy of living. And, Dr. Sheffer learned with horror, he had personally condemned dozens of children to the killing centers. “I don’t want my son to be named after someone who sent children like him to their deaths,” she told Vox in 2018.By the time her book was published, Asperger’s syndrome was no longer listed in the Diagnostic and Statistical Manual of Mental Disorders. In 2013 it was folded into autism spectrum disorder, in part because there was not solid evidence that it warranted its own diagnosis. But shortened versions of the term are still used widely in the autism community, many of whom refer to themselves with terms, such as “Aspie,” derived from the name Asperger’s.Dr. Sheffer has since been gratified to see that other medical organizations, including the American Psychiatry Association and the World Health Organization, which put out the 11th revision of the International Classification of Diseases, or ICD-11, have largely phased it out. “I think the message has reached the medical community,” she said.Asperger’s is (or was) a medical eponym, part of a hallowed tradition of naming body parts, diseases, disorders and tools after great medical figures. Its demise illustrates the risk inherent in idolizing anyone from another era, and adds support to a growing movement to end this tradition altogether. But some scholars contend that even “canceled” eponyms have a place, as stark reminders of the ethical breaches medicine should never repeat.An eponym was once considered medicine’s highest honor. Like monuments to great generals, they paid tribute to medicine’s most brilliant minds, ensuring their names would live on in perpetuity. The best-known example is the fallopian tubes, named after Gabriele Falloppio, an Italian priest and anatomist who is credited as being the first to describe them. Others include Alzheimer’s, Parkinson’s and Hodgkin’s diseases, all named for European medical men.So it was a shock when, in the early 2000s, dozens of eponyms were discovered to be linked to National Socialist doctors who had violated every value of medical consent and human dignity. These offenders could be found lingering in the lungs, attached to common diseases like arthritis and even on craters of the moon. There seemed to be only one possible response: purge the Nazis. These names were “not only a travesty but an affront to the profession,” two doctors wrote in 2007 in The Israel Medical Association Journal.“We owe it to our patients, we owe it to their loved ones, we owe it to the victims of these atrocities,” said Dr. Eric Matteson, a retired rheumatologist who helped rename a disease of inflamed blood vessels formerly known as Wegener’s granulomatosis. “You are doing them an injustice.”Beginning in 2000, after hearing a rumor that Dr. Friedrich Wegener had ties to National Socialism, Dr. Matteson and a colleague spent years combing through World War II archives around the world. They eventually learned that Dr. Wegener was a Nazi supporter who had worked three blocks from the ghetto in Lodz, Poland, and might have dissected victims of medical experimentation. In 2011, several major medical organizations moved to replace Wegener’s syndrome with “granulomatosis with polyangiitis” — a mouthful, admittedly. (“Wegener’s” can still be found in the ICD-11.)The hunt for Nazi names was on. Clara cells, a type of cell that lines the lungs and secretes mucus, were found to be named for a Nazi doctor who experimented on soon-to-be-executed prisoners. The cells were renamed club cells, reflecting their bulbous shape. Reiter’s syndrome, a form of arthritis caused by a bacterial infection, was renamed “reactive arthritis” after it was found to have been named for a doctor who performed deadly typhus experiments on prisoners of the Buchenwald concentration camp.In most cases, the name change fit with medicine’s growing preference for descriptive terms over honorific ones. “Many of us just don’t use eponyms because they’re not anatomically informative,” said Jason Organ, an anatomist at Indiana University. Rather than a fallopian tube, he said, “uterine tube just makes more sense — it tells you what it is.” In some cases, the inconsistent use of eponyms can even lead to medical errors, Dr. Organ added.Not all anatomists agree with this slash-and-burn approach. Dr. Sabine Hildebrandt, an anatomical educator at Harvard Medical School, trained in Germany a few years before the legacy of Nazi medicine began coming to light. To her, eponyms provide an opportunity to remind future doctors of the path medicine must never go down again. “I would like to see them not as badges of honor, necessarily, but as historical markers — as teaching moments,” she said.In the classroom, Dr. Hildebrandt highlights Frey’s syndrome, one of the rare medical eponyms that celebrates both a female researcher and a victim of the Holocaust. The syndrome, a neurological condition that can cause heavy facial sweating while eating, is named for Lucja Frey-Gottesman, a Polish neurologist who was murdered by the Nazis after being sent to the Lvov ghetto.Dr. Hildebrandt also draws attention to Dr. Charlotte Pommer, a name that her students probably have not encountered. In 1942 Dr. Pommer, a young German anatomist, walked into the laboratory of her department’s director, Dr. Hermann Stieve, only to be confronted with the executed bodies of five people she recognized, members of the resistance group Rote Kapelle. Horrified, she abandoned the field.Dr. Pommer gave up her bid for immortality. No part of the body is named after her; no papers list her as an author. Dr. Stieve gained renown for his contributions to medicine, including disputing the “rhythm method” of birth control and studying the effects of stress on the menstrual cycles of doomed female prisoners. By contrast, Dr. Pommer led a life of obscurity, treating victims of war in a nearby hospital.Dr. Hildebrandt uses this story to show that complicity was not the only choice available to doctors of that era, and that there are other ways to be remembered than by having something named after you. Her 2016 book, “The Anatomy of Murder: Ethical Transgressions and Anatomical Science during the Third Reich,” is dedicated to Dr. Pommer. “It really is about correcting history,” she said.Seen this way, eponyms might be compared to the modern German tradition of Stolpersteine, or “stumbling stones”— brass plaques, embedded in cobblestone streets across Europe, that commemorate Holocaust victims by listing their names and the date they were seized from their homes. They are meant to arrest passers-by, prompting them to contemplate past atrocities and the lives of those who were lost.Similarly, many scholars argue that medicine should discard Nazi eponyms but retain those related to victims and resisters, to honor their stories. But the “right” side of history doesn’t stay put; as norms and standards change, and as scholars like Dr. Sheffer and Dr. Matteson uncover damning new evidence, many more are sure to fall from grace.“If you pull enough of the threads here, a lot of this stuff’s going to come unraveled,” Dr. Organ said.Dr. Sheffer notes another strike against eponyms: They often don’t even honor the right person. The term Asperger’s first emerged in the 1980s, at the suggestion of a British psychiatrist named Dr. Lorna Wing. Yet Dr. Wing conducted far more extensive research into the condition that would bear Dr. Asperger’s name. “He doesn’t deserve the credit,” Dr. Sheffer said. “If anything, we should use the name Wing’s syndrome because we’re going by her definition, not his.”There is also a more fundamental reason to get rid of eponyms. Highlighting an individual obscures the reality that medicine moves forward through collaboration, debate and gradual consensus. But that’s a lesson that even doctors are still learning.“Trying to keep an eponym and strip it of its honorific meaning is probably really, really challenging,” said Jason Wasserman, a bioethicist at the Oakland University School of Medicine who writes about medical ethics in the Nazi era. “Built into medical culture is the glory of the discovery.”

To protect your sexual function, it’s vital to discuss your sex life, even if that feels awkward.Any medical procedure on the outer genitals carries some risk to sexual function. But so can other pelvic surgeries, including hysterectomies and surgeries to remove ovarian cysts or endometriosis tissue, in part because the clitoris is so interconnected with the nerve supply in that region.To understand the risks of pelvic surgery and protect your future sexual sensation, it’s vital to discuss your genitals and sexuality openly with your doctor first, even if doing so feels awkward. Here are four questions to ask during your surgical consultation.Can you show me the parts that will be affected?Your doctor should be able to walk you through the procedure using diagrams or three-dimensional computer models, or by showing you your own anatomy. You may want to ask how often the doctor performs this procedure; ideally, yours should not be a first. If your doctor is vague or appears uncomfortable talking about these topics, “get a new doctor,” said Dr. Rachel Rubin, a urologist and sexual health specialist outside Washington, D.C.What are the risks to my sexual sensation?It’s important to share your concerns about arousal, orgasm and pain, as well as your preferences, as specifically as possible. Dr. Rubin said, “If you never tell your doctor how you experience pleasure, how can they assess if the side effects are relevant to you?” This may include asking how the procedure could affect non-genital areas like the anus, nipples and cervix.Do your patients typically experience side effects?Make sure your doctor reviews with you the most common side effects, which should also be listed on your consent form or post-op document. If a medical term is confusing or unfamiliar — for example, dyspareunia (pain during intercourse) or anorgasmia (inability to achieve orgasm) — ask your doctor to slow down and put it into everyday language.If I do experience lasting sexual side effects, whom should I call?Side effects to look out for include numbness, scarring, difficulty with arousal, loss of sensation, hypersensitivity and pain that does not improve. “I usually tell patients, ‘Every day you should feel better,’” said Dr. Emily Von Bargen, a urogynecologist at Massachusetts General Hospital. If symptoms do not improve, ask your doctor to provide names of sexual health experts whom you can consult.

If there was one thing Gillian knew, it was that she did not want a hole punch anywhere near her genitals.So when, in 2018, a gynecologist recommended a vulval biopsy to check for signs of cancer, she hesitated. The doctor suspected that the whitish patch of skin that Gillian had found next to her clitoris was lichen sclerosus, a skin condition that is usually benign. To Gillian, a registered nurse, taking a chunk out of her most sensitive body part sounded a bit extreme.But in the end she consented. He was a doctor; she was a nurse. She assumed he was the authority on this part of the body. “I never worked in OB-GYN before,” said Gillian, who asked to be identified by her first name to protect her privacy. “I was pretty clueless.”For the biopsy, she was placed in stirrups and given a spinal epidural to numb the area. Afterward, to stem the bleeding, the doctor put one hand over the other and pressed hard against her vulva — the outer female genitalia, including the inner and outer labia, the opening to the vagina and the clitoris. Even through the anesthesia, she could feel the pressure against her pubic bone. She screamed.A month later, Gillian was in bed with her boyfriend when she realized that she could no longer reach orgasm. She could become aroused, but at the moment of no return, “it ended into nothing,” she recalled. “And that’s still how it is.”When she informed her gynecologist, she said, he speculated that she was experiencing numbness caused by scarring and that it would go away in time. It did not. Alarmed, Gillian began seeing one specialist after another in search of an explanation and, hopefully, a solution.That’s when she discovered that no one wanted to talk about her clitoris.Gillian at home. When she tried to inquire with medical professionals about her clitoris, “they looked at me like I was completely insane,” she said.Maddie McGarvey for The New York TimesAfter hearing about her injury, she said, one urologist compared her to a rape victim and said she must be having a trauma reaction to her biopsy. Next, according to her medical charts, a women’s health specialist diagnosed her with “perimenopause” and prescribed testosterone cream. Another gynecologist recommended an “O shot,” or vaginal rejuvenation procedure.When she tried to direct the conversation back to her clitoris, she was met with blank stares. “They looked at me like I was completely insane,” Gillian said. “I just kept on saying there’s something wrong with my clitoris, and they were, like — it was like they did everything but acknowledge the clitoris.”‘A side note at best’Some urologists compare the vulva to “a small town in the Midwest,” said Dr. Irwin Goldstein, a urologist and pioneer in the field of sexual medicine. Doctors tend to pass through it, barely looking up, on their way to their destination, the cervix and uterus. That’s where the real medical action happens: ultrasounds, Pap smears, IUD insertion, childbirth.If the vulva as a whole is an underappreciated city, the clitoris is a local roadside bar: little known, seldom considered, probably best avoided. “It’s completely ignored by pretty much everyone,” said Dr. Rachel Rubin, a urologist and sexual health specialist outside Washington, D.C. “There is no medical community that has taken ownership in the research, in the management, in the diagnosis of vulva-related conditions.”Asked what she learned in medical school about the clitoris, Dr. Rubin replied, “Nothing that sticks out to my memory. If it got any mention, it would be a side note at best.”Only years later, on a sexual-medicine fellowship with Dr. Goldstein, did she learn how to examine the vulva and the visible part of the clitoris, also known as the glans clitoris. The full clitoris, she learned, is a deep structure, made up largely of erectile tissue, that reaches into the pelvis and encircles the vagina.Today, Dr. Rubin has appointed herself Washington’s premier “clitorologist.” The joke, of course, is that few are vying for the title — out of embarrassment, a lack of knowledge or fear of breaching propriety with patients. “Doctors love to focus on what we know,” she said. “And we don’t like to show weakness, that we don’t know something.”Dr. Rachel Rubin, a urologist and sexual health specialist outside Washington, D.C., said doctors need to better understand the clitoris.Shuran Huang for The New York TimesA model of the pelvis in Dr. Rubin’s office. She was taught little about the clitoris in medical school, she said.Shuran Huang for The New York TimesThis near-universal avoidance has consequences for patients. In a 2018 study in the journal Sexual Medicine, Dr. Rubin, Dr. Goldstein and colleagues found that a failure to examine the vulva and clitoris led doctors to regularly overlook sexual health conditions. Among women visiting Dr. Goldstein’s clinic, nearly 1 in 4 had clitoral adhesions, which occur when the hood of the clitoris sticks to the glans and can lead to irritation, pain and decreased sexual pleasure.The authors concluded that all health providers for women should routinely examine the clitoris. But that was easier said than done, they wrote, as most providers “neither know how to examine nor feel comfortable examining the clitoris.”This oversight has the potential to harm women, as well as trans men and other people with vulvas. There have been documented injuries to the clitoris in procedures including pelvic mesh surgeries, episiotomies during childbirth and even hip surgeries. When performed poorly, a labiaplasty — a procedure to reduce the size of the labia minora, and one of the fastest-growing cosmetic surgeries worldwide — can also damage nerves, leading to genital pain and loss of sexual sensation.Many of these injuries could be prevented, Dr. Rubin said, if doctors just spent more time getting to know the clitoris. In January, she made this point to a roomful of mostly male doctors at the annual convention of military urologists in Palm Springs, Calif., during a lecture on female sexual health. Practical, animated and unflappable, she was voted as having the best lecture at the conference.This anatomy, she stresses, isn’t magic, just biology. “It’s not just this strange, mythical area that’s supposed to give you orgasms,” she said in her office in Rockville, Md., in early July, surrounded by penile prostheses, pelvis models and a large Hitachi wand. “You should know what is what and where things are coming from.”A tradition of neglectA thank-you card in Dr. Rubin’s office.Shuran Huang for The New York TimesSo why don’t we know? To Dr. Rubin, the reason is simple: The clitoris is intimately bound up in female pleasure and orgasm. And until very recently, those themes have not been high on medicine’s priority list, nor considered appropriate areas of medical pursuit.Even in fields like urology, where male sexual pleasure and orgasm are considered integral, women’s sexual health “is seen as hysteria, Pandora’s box, all psychosocial, not real medicine,” said Dr. Rubin, who is also the education chair of the International Society for the Study of Women’s Sexual Health. “Sexual health and quality of life is not something we focus on for women.” (In contrast, Viagra is one of the most lucrative pharmaceutical drugs in recent decades, bringing in tens of billions of dollars to Pfizer since being introduced in 1998.)Gynecology, for its part, is far more focused on fertility and preventing disease. “We don’t do a great job about talking about sex from a pleasure-based perspective,” said Dr. Frances Grimstad, a gynecologist at Boston Children’s Hospital. “We talk about it from a prevention standpoint. We’re trying to prevent S.T.I.s,” or sexually transmitted infections. “We’re trying to prevent pregnancy, unless you’re trying to get pregnant. We don’t talk about sexual pleasure.”Dr. Helen O’Connell, Australia’s first female urologist, recalled that in her own medical training, the clitoris barely made a cameo. In the 1985 edition of the medical textbook “Last’s Anatomy” that she studied, a cross-section of the female pelvis omitted the clitoris entirely, and aspects of the female genitals were described as “poorly developed” and a “failure” of male genital formation. Descriptions of the penis went on for pages. To her, this widespread medical disregard helped explain why her urology peers worked to preserve nerves in the penis during prostate surgeries but not during pelvic surgeries on women.Dr. O’Connell set out to investigate the full anatomy of the clitoris using microdissection and magnetic resonance imaging. In 2005, she published a comprehensive study showing that the outer nub of the clitoris — the part that can be seen and touched — was just the tip of the iceberg, equivalent to the head of the penis. The full organ extended far beneath the surface, comprising two teardrop-shaped bulbs, two arms and a shaft.By failing to appreciate this anatomy, she warned, surgeons working in this region risked damaging the sensitive nerves responsible for pleasure and orgasm, which run along the top of the shaft. In procedures like pelvic mesh surgeries or urethral surgeries, “things are potentially in the crossfire,” Dr. O’Connell said. “You always need to be thinking of what’s underneath, what’s hidden from view that you’re potentially altering.”Increasingly, women are speaking out about injuries they sustained to this area during routine procedures. One is Julie, a 44-year-old office manager in Essex, east of London, who lost her ability to orgasm in 2012 after a minimally invasive hip operation to address back pain. She shared her story publicly in The Telegraph last year, using only her first name to avoid discrimination by future employers.During a Zoom call in January, Julie described waking up from anesthesia to a searing pain around her clitoris. Her surgeon told her that it was just bruising and would fade. A few months later, she found that she could no longer orgasm. When she tried, “it was literally like someone had pulled a plug out of the socket,” she said. “Everything went dead.”It took two years of internet searching for her to realize that a cylindrical post placed between her legs during the operation had likely crushed her clitoral nerves. Use of the device, called a perineal post, is known to cause nerve damage, but this was not mentioned on her consent form.Julie compared her injury to losing the sense of taste or smell — a pleasure taken for granted but when lost changes everything. “It’s 10 years, and I still can’t believe it,” she said over Zoom. “And I haven’t come to terms with it.”Gillian is still trying to understand the cause of her own injury. Was it the biopsy? The crushing pressure her gynecologist applied afterward? Four years and 12 specialists later, she has resigned herself to the fact that she may never recover that sensation. “This changed my whole life,” she said. “The devastation from this is something you can never repair. Ever.”A new medical mapDr. Blair Peters, a plastic and reconstructive surgeon in Portland, Ore., is publishing a study on the clitoris.Leah Nash for The New York TimesJessica Pin, an activist, scoured OB/GYN textbooks to see what doctors were learning about the clitoris, only to discover little.Anastasiia Sapon for The New York TimesWhen Dr. Blair Peters, a 33-year-old plastic surgeon at Oregon Health & Science University, first began performing phalloplasties for trans men and nonbinary people, he was surprised to see how large the nerves of the clitoris were — about three millimeters in diameter, on average. (By comparison, the sensory nerve of the index finger is about one millimeter wide.)“When I went through medical school, we did not learn anything in particular about the clitoris beyond the fact that it exists, basically,” said Dr. Peters. As a result, he said, he developed “this subconscious bias that it’s not going to be this superapparent structure. But it is.”Dr. Peters is among a handful of young, social media-savvy doctors who, like Dr. Rubin, are helping expand medicine’s map of this terrain — and, in doing so, ensure that what happened to Julie and Gillian doesn’t happen again. As part of his efforts to improve sexual sensation for phalloplasty patients, Dr. Peters recently magnified clitoral nerves and counted up how many nerve fibers they contained. The number he found — embargoed until he presents his findings at a conference later this month — was “significantly more” than 8,000, the figure often cited, which is drawn from an outdated study on cows.In 2020, Victoria Gordon, a medical student at the Kansas City University of Medicine and Biosciences, led a study that sought to define a “danger zone” around the clitoris for plastic surgeons to avoid. During dissections of cadavers, she noticed that clitoral nerves sometimes branch out into fine tendrils, like roots, in ways that might be relevant to surgeons but were not previously described in the literature.She hoped that others in the plastic surgery field would follow up on this finding, which was published in a plastic surgery journal. “I’m just a fourth-year medical student, I don’t think I should have to tackle this project,” she said in late 2021. “But no one else is.”Doctors are not the only people urging medicine to recognize the full anatomy of the clitoris. In 2018, Gillian was searching online to make sense of her injury when she came across a Medium post by a woman in Dallas, Jessica Pin, whose situation sounded eerily like hers. Ms. Pin, now 36, had lost most of her clitoral sensation after undergoing a labiaplasty at age 18.After scouring the major obstetrical-gynecologicial textbooks, Ms. Pin learned that the nerves of the clitoris were rarely well represented, if at all — a key oversight that she believed left the clitoris at risk in a number of procedures. “This omission appears to be caused by sociocultural discomfort with the clitoris and a pervasive lack of regard for female sexual response,” she wrote on Medium.Gillian was intrigued. “She was the only one talking about this on the internet,” she said. She sent the woman a Facebook message.Ms. Pin eventually began a social media campaign to get OB-GYN textbooks and training standards updated to cover this anatomy. Gillian quietly helped her build followers, then joined Ms. Pin on Instagram, using the handle @nursevulvaadvocate. There, she found herself fielding hundreds of queries from around the world from people who had lost genital sensation as a result of medical procedures on or near the clitoris.Gillian tried to respond to everyone, she said, but could not offer the medical advice that many of them sought. After six months, she closed her account. Today her efforts are more local: She often drives to doctors’ offices to drop off posters of clitoral anatomy. In her work with older patients, she pays close attention to any genital concerns, from vulvar itching to pain after cancer surgery.Ms. Pin pressed on. In the past few years, she has lobbied several textbooks and anatomical resources to update their diagrams of the clitoris and its nerves. Her efforts have reached the front page of Reddit, racked up over 160,000 followers on TikTok and landed her a guest spot on the “The Daily Show with Trevor Noah.” In 2019, she copublished a dissection study with her father, a plastic surgeon, on clitoral nerves.Yet her tactics are not without controversy. She has been embroiled in numerous social media disputes, and has been accused of harassment for her persistent and sometimes inappropriate efforts to reach gynecologists and anatomy textbook authors.Now, after four years of advocating, “I want to be done,” she said. “It would be amazing if doctors start picking up the cause and start talking about this.” The fact that a few medical professionals have, including Dr. Rubin, is “a really big deal,” she added.Giving the vulva its dueDr. Rubin, at left, with a patient. She begins exams by handing the patient a mirror to see the same anatomy that she is examining. Shuran Huang for The New York TimesEvery patient who enters Dr. Rubin’s office, regardless of age, is taken on a tour of their own vulva. Banished is the white sheet draped over a patient’s legs for the pelvic exam — a convention that Dr. Rubin believes helps keep women’s “private parts” shameful and hidden. Instead, Dr. Rubin starts by handing her patient a long-handled mirror to see the same anatomy that she will be examining.With a Q-tip, Dr. Rubin probes each part of the vulva for pain, pointing out the labia minora, labia majora and vaginal opening as her patient follows along. Then, she checks under the clitoral hood for adhesions or other skin conditions. The entire exam usually takes under five minutes. “We go at your pace,” she said recently in an exam with a 62-year-old woman, who was experiencing pain after sex. “You’re the boss of this show.”Dr. Rubin and her colleagues believe that their field is uniquely positioned to champion the clitoris and female pleasure. After all, said Dr. Barbara Chubak, a urologist at the Icahn School of Medicine at Mount Sinai hospital in New York, “urologists are all about the phallus” — which the clitoris technically is, as it arises from the same embryological structures and is made up of the same erectile tissues as the penis.“So by definition, clitoral anatomy could, and should, also be a urologic thing,” Dr. Rubin added.Moreover, urologists are perfectly comfortable waxing poetic about things that other providers are too squeamish to discuss. “Urology is all about peeing and all about sex,” Dr. Chubak said. “The stuff that people are embarrassed to talk about, urologists want to talk about. Clitoral medicine belongs with the urologists.”Still, it will take more than passionate “penis doctors,” Dr. Rubin said, to give the vulva its due; there must be a concerted movement, one that transcends medicine’s traditionally siloed specialties, to understand and map this anatomy. And for that to happen, other fields need to recognize female sexual pleasure as essential and worth preserving.“I truly believe we are just several decades behind on the female side,” Dr. Rubin said. “But we have to do the work. And we have to have people interested in doing the work.”

Why do so many female body parts honor male scientists? “Pudendum” isn’t the only questionable term slinking around in the female pelvis. Pull out a map to this region and you face an array of unfamiliar landmarks: Alcock’s canal, the pouch of Douglas, Bartholin’s glands, the fallopian tubes. These are all body parts named in honor of the people thought to have “discovered” them. They are relics from a time when the female body was considered terra incognita for great minds of medicine to explore, stake out and claim.But such terms may be on their way out of medicine. Scientifically, anatomists frown on naming parts after people for several reasons. These terms are useless, offering little information about what any given body part actually does. They’re confusing: Surnames sometimes vie for the same part (for example, the bodies of Arantius are also known as the nodules of Morgagni), and some surnames adorn multiple parts (Gabriele Falloppio lays claim to a tube, a canal, a muscle and a valve, not to mention a flowering buckwheat plant). Finally, they give the unfortunate, off-putting impression that medicine (and the female pelvis) is still an old boys’ club.Such terms were officially banned from medicine in 1895. Unofficially, they are everywhere. A recent count found at least 700 in the human body, most of which take their names from men. (One of the few women on the body’s map is Raissa Nitabuch, a 19th-century Russian pathologist whose name is attached to a layer of the maturing placenta called the Nitabuch membrane.) They persist because they are memorable, recognizable and — for clinicians, at least — familiar. Here’s a guide to some of the better-known ones in the female pelvis, and what you can call them instead.