Article

Clitoral Size and Location in Relation to Sexual Function Using Pelvic MRI

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Abstract

Introduction: The female sexual response is dynamic; anatomic mechanisms may ease or enhance the intensity of orgasm. Aim: The aim of this study is to evaluate the clitoral size and location with regard to female sexual function. Methods: This cross-sectional TriHealth Institutional Board Review approved study compared 10 sexually active women with anorgasmia to 20 orgasmic women matched by age and body mass index (BMI). Data included demographics, sexual history, serum hormone levels, Prolapse/Incontinence Sexual Questionnaire-12 (PISQ-12), Female Sexual Function Index (FSFI), Body Exposure during Sexual Activity Questionnaire (BESAQ), and Short Form Health Survey-12. All subjects underwent pelvic magnetic resonance imaging (MRI) without contrast; measurements of the clitoris were calculated. Main outcome measures: Our primary outcomes were clitoral size and location as measured by noncontrast MRI imaging in sagittal, coronal, and axial planes. Results: Thirty premenopausal women completed the study. The mean age was 32 years (standard deviation [SD] 7), mean BMI 25 (SD 4). The majority was white (90%) and married (61%). Total PISQ-12 (P < 0.001) and total FSFI (P < 0.001) were higher for orgasmic subjects, indicating better sexual function. On MRI, the area of the clitoral glans in coronal view was significantly smaller for the anorgasmic group (P = 0.005). A larger distance from the clitoral glans (51 vs. 45 mm, P = 0.049) and body (29 vs. 21 mm, P = 0.008) to the vaginal lumen was found in the anorgasmic subjects. For the entire sample, larger distance between the clitoris and the vagina correlated with poorer scores on the PISQ-12 (r = -0.44, P = 0.02), FSFI (r = -0.43, P = 0.02), and BESAQ (r = -0.37, P = 0.04). Conclusion: Women with anorgasmia possessed a smaller clitoral glans and clitoral components farther from the vaginal lumen than women with normal orgasmic function.

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... 44 Although the urethrovagi nal septum is to be considered an approximate representation of the size of the CUV, the distance between the external clitoris and the vagina could also influence the ability to experience orgasm. A cross-sectional study 45 obtained detailed clitoral measurements using non contrast MRI of the pelvis to assess whether differences were evident in women with anorgasmia compared with women with normal orgasmic function. The findings of this study indicated that closer proximity of the clitoral glans to the vagina might be critical for enhanced sexual sensation, assessed using sexual health questionnaires. ...
... The findings of this study indicated that closer proximity of the clitoral glans to the vagina might be critical for enhanced sexual sensation, assessed using sexual health questionnaires. 45 A greater distance of the clitoris from the vagina and a smaller clitoral glans were noted in women with anorgasmia, suggesting that clitoral size and location could be key influences on sexual function, specifically orgasm. 45 These findings might be compatible with the importance of the CUV complex to VAO, in that factors that would increase the interactions during coitus (larger clitoral tissues and closer proximity between the components of the complex) seem to be associated with the ability to attain this type of orgasm. ...
... 45 A greater distance of the clitoris from the vagina and a smaller clitoral glans were noted in women with anorgasmia, suggesting that clitoral size and location could be key influences on sexual function, specifically orgasm. 45 These findings might be compatible with the importance of the CUV complex to VAO, in that factors that would increase the interactions during coitus (larger clitoral tissues and closer proximity between the components of the complex) seem to be associated with the ability to attain this type of orgasm. ...
Article
The search for the legendary, highly erogenous vaginal region, the Gräfenberg spot (G-spot), has produced important data, substantially improving understanding of the complex anatomy and physiology of sexual responses in women. Modern imaging techniques have enabled visualization of dynamic interactions of female genitals during self-sexual stimulation or coitus. Although no single structure consistent with a distinct G-spot has been identified, the vagina is not a passive organ but a highly dynamic structure with an active role in sexual arousal and intercourse. The anatomical relationships and dynamic interactions between the clitoris, urethra, and anterior vaginal wall have led to the concept of a clitourethrovaginal (CUV) complex, defining a variable, multifaceted morphofunctional area that, when properly stimulated during penetration, could induce orgasmic responses. Knowledge of the anatomy and physiology of the CUV complex might help to avoid damage to its neural, muscular, and vascular components during urological and gynaecological surgical procedures.
... For some researchers the clitoris is also an "internal/inner" organ: "except for the labia, glans clitoris and vaginal introitus, the female urogenital tissues are internal" (O'Connell et al., 1998); "the internal clitoris may have individual differences bigger than 100%" (Gravina et al., 2008); "the internal clitoris is, in fact, involved and stimulated during penetration" ; "The G-spot (or area) is composed of individually different amounts of cavernosal tissue from the inner clitoris" ; "contact of the internal clitoris and the AVW. . . stimulation of the external or internal clitoris" (Jannini et al., 2012); "sexual pleasure from vaginal penetra-tion, leading to orgasm, could result from indirect stimulation of the inner clitoris" (Jannini et al., 2014); "the internal portion of the clitoris" ; "the external component of the clitoral complex is the glans" (Oakley et al., 2014). ...
... Some researchers have stated: "the clitoris is composed of two arcs, the first consisting of two corpora cavernosa along the right and left ischiopubic ramus; they join on the summit of the vulva to form a bend 90 degrees forward: the raphe; the raphe ends in the glans clitoris, the visible part of the clitoris. The second arc consists of two bulbs that surround the lateral walls of the vagina" "the bulbs and cavernous bodies forming the erectile root of the clitoris" "the double arch of the cavernous bodies and bulbs of the clitoris" (Buisson, 2010;Buisson et al., 2010;Jannini et al., 2012Jannini et al., , 2014; "the bulbs of the clitoris" (O'Connell et al., 1998(O'Connell et al., , 2005(O'Connell et al., , 2008Gravina et al., 2008;Jannini et al., 2010Jannini et al., , 2012Jannini et al., , 2014; "the components of the clitoris, including the glans, body, crura, bulb, and root" (Oakley et al., 2014). ...
... The distal vagina is a structure that is so interrelated with the clitoris that it is a matter of some debate whether the two are truly separate structures. . . the distal vagina, the site of the female sexual response. . . the Clitoro-Urethro-Vaginal Complex. . . The clitoral complex, composed of the distal vagina, urethra, and clitoris, is the location of female sexual activity, analogous to the penis in men" (O'Connell et al., 2008); "clitoral complex. . . the clitoris-urethro-vaginal (CUV) complex" (Gravina et al., 2008;Buisson et al., 2010;Jannini et al., 2010Jannini et al., , 2012Jannini et al., , 2014Oakley et al., 2014;Vaccaro, 2014;Vaccaro et al., 2014); "clitoral complex is analogous to the male penis" (Vaccaro, 2014); "Beyond the G-spot. . . the CUV complex a definition that more accurately and scientifically describes the true nature of the G-spot" (Jannini et al., 2014). ...
Article
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Article selected to feature in Wiley's News Round-Up (it is a biweekly mailing sent to over 1,800 subscribing journalists). October 06, 2014 Wiley Press Release: http://eu.wiley.com/WileyCDA/PressRelease/pressReleaseId-112610.html Sexual medicine experts and sexologists must spread certainties on the biological basis of the female orgasm to all women, not hypotheses or personal opinions. Therefore, they must use scientific anatomical terminology. The anatomy of the clitoris and the female orgasm are described in textbooks, but some researchers have proposed a new anatomical terminology for the sexual response in women. The internal/inner clitoris does not exist: the entire clitoris is an external organ. The clitoris is not composed of two arcs but of the glans, body, and crura or roots. “Clitoral bulbs” is an incorrect term from an embryological and anatomical viewpoint: the correct term is “vestibular bulbs.” The bulbocavernosus muscles are implicated in inferior vaginismus, while the pubovaginal muscle is responsible for superior vaginismus. The clitoral or clitoris-urethro-vaginal complex has no embryological, anatomical and physiological support: the vagina has no anatomical relationship with the clitoris, and the clitoris is a perineal organ while the supposed G-spot is in the pelvic urethra. G-spot/vaginal/clitoral orgasm, vaginally activated orgasm, and clitorally activated orgasm, are incorrect terms: like “male orgasm,” “female orgasm” is the correct term. The “vaginal” orgasm that some women report is always caused by the surrounding erectile organs (triggers of female orgasm). The male penis cannot come in contact with the venous plexus of Kobelt or with the clitoris during vaginal intercourse. Also, female ejaculation, premature ejaculation, persistent genital arousal disorder (PGAD), periurethral glans, vaginal–cervical genitosensory component of the vagus nerve, and G-spot amplification, are terms without scientific basis. Female sexual satisfaction is based on orgasm and resolution: in all women, orgasm is always possible if the female erectile organs, i.e. the female penis, are effectively stimulated during masturbation, cunnilingus, partner masturbation, or during vaginal/anal intercourse if the clitoris is simply stimulated with a finger. Clin. Anat., 2014. © 2014 Wiley Periodicals, Inc. The claims by Emmanuele Jannini, Odile Buisson, Helen O’Connell, Beverly Whipple, Adam Ostrzenski, Stuart Brody, Irwin Goldstein (The Journal of Sexual Medicine), Chiara Simonelli and others, have no scientific basis.
... However, no conclusions have been drawn owing to small samples. 23,25,26 Some studies have reported that smaller erectile structures are associated with normal orgasmic function because of greater innervation density. 26 In contrast, others have found that a smaller clitoral glans is associated with anorgasmia. ...
... 26 In contrast, others have found that a smaller clitoral glans is associated with anorgasmia. 25 The authors question whether a difference in clitoral size at a resting or an engorged state can actually be responsible for differences in sexual sensitivity or function. ...
... Nonetheless, previous studies on clitoral anatomy using MRI have used similar sample sizes. 25 Another limitation is the comparison of women with and without FGM who were from different ethnicities and sociocultural backgrounds. Religious and cultural differences were evident for masturbation (only two women with FGM replied to this question). ...
Article
Introduction: Female genital mutilation (FGM), the partial or total removal of the external genitalia for non-medical reasons, can affect female sexuality. However, only few studies are available, and these have significant methodologic limitations. Aim: To understand the impact of FGM on the anatomy of the clitoris and bulbs using magnetic resonance imaging and on sexuality using psychometric instruments and to study whether differences in anatomy after FGM correlate with differences in sexual function, desire, and body image. Methods: A cross-sectional study on sexual function and sexual anatomy was performed in women with and without FGM. Fifteen women with FGM involving cutting of the clitoris and 15 uncut women as a control group matched by age and parity were prospectively recruited. Participants underwent pelvic magnetic resonance imaging with vaginal opacification by ultrasound gel and completed validated questionnaires on desire (Sexual Desire Inventory), body image (Questionnaire d'Image Corporelle [Body Image Satisfaction Scale]), and sexual function (Female Sexual Function Index). Main outcome measures: Primary outcomes were clitoral and bulbar measurements on magnetic resonance images. Secondary outcomes were sexual function, desire, and body image scores. Results: Women with FGM did not have significantly decreased clitoral glans width and body length but did have significantly smaller volume of the clitoris plus bulbs. They scored significantly lower on sexual function and desire than women without FGM. They did not score lower on Female Sexual Function Index sub-scores for orgasm, desire, and satisfaction and on the Questionnaire d'Image Corporelle but did report significantly more dyspareunia. A larger total volume of clitoris and bulbs did not correlate with higher Female Sexual Function Index and Sexual Desire Inventory scores in women with FGM compared with uncut women who had larger total volume that correlated with higher scores. Conclusion: Women with FGM have sexual erectile tissues for sexual arousal, orgasm, and pleasure. Women with sexual dysfunction should be appropriately counseled and treated.
... Oakley et al. [1], in the figure 1 (i.e. "MRI of the female pelvis in sagittal view demonstrating the boomerang appearance of the clitoris") show the clitoral glans, body and bulbs, but for "clitoral glans" in this figure, the body and glans of the clitoris are the correct scientific terms; for "clitoral body" in this figure, the root or crus of the clitoris is the correct scientific term; for "clitoral bulbs" in this figure, the vestibular bulb is the correct scientific term [2][3][4][5]. ...
... Dr. Vincenzo Puppo Buisson and Jannini stated "visualizing the movements of the clitorourethrovaginal (CUV) complex … the different parts of the clitoris (external and internal) … the components of the clitoris (glans, raphe, bodies) … the inner clitoris is also involved during internal stimulation … so called G-spot is a complex anatomic area … the functional unit of the clitoris and the vagina". 1 In anatomy textbooks there is a separation between the embryological development of the internal and external genital organs in males and females. It is important to know this because it is related to the function of these organs, that is, the internal genitals have a reproductive function while the external ones have the function of giving pleasure. ...
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FREE full text (with 30 figures) of: G-spot does not exist: the claims published by Beverly Whipple, Emmanuele Jannini, Odile Buisson, Helen O’Connell et al. have no scientific basis. Journal sexual medicine and Irwin Goldstein vs women sexual health. G-spot is only a business: is it a scientific fraud?
... Those thoughts will drive the attention from the sexual pleasure during sexual acts to sexual anxiety, leading to dissatisfaction and, in some cases, sexual avoidance or sexual dysfunction. More precisely, the more a woman is concentrated on how her body parts look (including genitalia), the higher is the risk of sexual concerns and lack of satisfaction [31,32]. However, our study only partially confirms these observations -state body image did not predict sexual performance. ...
... Secondly, it might be speculated that other factors than state body image might have a greater impact on sexual performance [16,23,24]. Thirdly, some cultural difference cannot be excluded [31]. That needs further investigation. ...
Article
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Introduction: Recently it has been shown that body image during sexual activities is a better predictor of the diversity of sexual experience than body image as a psychological trait. To measure contextual body image (as a state) the Body Exposure During Sexual Activity Questionnaire (BESAQ) was developed. Material and methods: 845 women aged 18-55 years were included in the study. The original model was first translated into Polish and consulted to create the version to be further validated. The original model was tested using confirmatory factor analysis (CFA). The population was divided in two equal groups - group 1 was used for exploratory factor analysis. Discriminant and convergent validity were checked. Sexual function was assessed by the Changes in Sexual Function Questionnaire. Results: The Polish model of BESAQ (BESAQ-PL) consisted of 28 items with 2 lower-order factors. It had a satisfactory goodness of fit - comparative fit index (CFI) = 0.93, Tucker-Lewis index (TLI) = 0.94, root-mean-square error of approximation (RMSEA) = 0.06 and χ2 = 1360.0, df = 337, p< 0.001, excellent internal consistency measured by Cronbach's α = 0.88 and satisfactory discriminate validity. State body image (BESAQ-PL) did not predict sexual functioning. Face was the most important for self-consciousness during sexual contact in the population of Polish women. Conclusions: State body image correlates with sexual functions but is not a major factor influencing sexual performance. Women in Poland are not anxious about body exposure during sexual activity. The BESAQ-PL may be used in the population of Polish women between 18 and 55 years of age.
... There are reports of a negative correlation between birth weight and clitoral length [49] but not with gestational age [50]. Women with anorgasmia were reported to have a smaller clitoral glans and clitoral components farther from the vaginal lumen than women with orgasmic function [51]. ...
Chapter
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The clitoris and the clito‐urethro‐vaginal complex are responsive to ovarian hormones and are the main peripheral structures that, with significant individual differences, provide the genital peripheral afferent component of female sexual pleasure. In the central nervous system during orgasm, essentially all of the major brain systems are activated, including the brainstem, limbic system, cerebellum, and cortex. In a symphony of integration, these peripheral and central systems mediate the sensory, cognitive, autonomic, and motor events of orgasm.
... From an anatomic standpoint a series of detailed dissections performed on fresh and fixed cadavers by O'Connell et al. 14 imply that the majority of current descriptions of female human urethral and genital anatomy are inaccurate and that there are major shortcomings in the published literature. Further research in the same group demonstrated the integral relationships and dynamic interactions between the clitoris, urethra and anterior vaginal wall, 15 whereby MRI imaging favourably complemented the conclusions drawn from the dissectional studies by providing multiplanar depictions in the live state; this was also confirmed by the MRI studies of the clitoral complex by Vaccaro et al. and Oakley et al. 16,17 In particular, MRI helped to demonstrate that the distal vagina and urethra are clearly related, forming a midline core to the clitoris. 15 Histologically, this tissue cluster might be a locus of female sexual function and orgasm, as micro-dissections and immunohistochemical studies have shown differences in innervations of various regions of the vagina, especially in 1/5 partition of the distal anterior wall. ...
Article
Objectives: To identify a G-spot complex (GSC) in vivo in MRI examinations at 1.5 Tesla field strength. Design: Observational study. Setting: Single centre. Population: Twenty-one consecutive patients (January-March 2014). Methods: Imaging analysis of routine imaging protocols for usual medical indications with and without concomitant opacification of the vaginal cavity with inert ultrasound gel. The gel distends the otherwise collapsed vaginal walls, allowing for an improved discrimination of anatomic features. The macroscopic and histological results recently derived from the dissections of fresh cadavers by Ostrzenski et al. were translated into imaging characteristics to be expected in the respective MRI sequences (e.g. T1- and T2-weighted) in search of an in vivo correlate of the GSC. Age, menopause status, medical indication and diagnosis were co-variables. Main outcome measures: To analyse primarily whether MRI imaging is able to depict a distinct morphological entity in vivo matching the GSC, based on anatomical descriptions published recently. The elaboration of an appropriate MRI-imaging protocol was a secondary aim. Results: A total of 21 studies were obtained. A GSC was identified within the anterior vaginal wall in 13/21 patients (62%). In all, 10/21 (48%) had vaginal gel opacification. We identified a GSC in 10/10 patients (100%) with opacification in all three planes of the T2 images. This was only true for 3/11 cases (27%) without opacification. Conclusions: There is evidence for an in vivo morphological correlate to the postmortem anatomical findings of a GSC described by Ostrzenski et al.; its visibility in MRI imaging can be significantly improved with vaginal opacification by ultrasound gel. Tweetable abstract: Identification of G-spot by MRI with vaginal gel-opacification in 13/21 patients.
... It is not merely the hooded clitoral glans visible to the naked eye but includes the paired bulbs and corpora in an interconnected neural network (O'Connell, Sanjeevan, and Huston 2005). Other MRI studies have indicated that clito-ral size, as well as distance of the clitoris from the urethral meatus (referred to as the CUMD), influence orgasmic potential ( Wallen and Lloyd 2011;Oakely et al. 2014), while sexual science studies have indicated that women report higher rates of orgasm when oral and manual stimulation of the external genitalia are involved compared to vaginal intercourse alone (Freder- ick et al. 2017). Other physiological studies have shown an integral sensory relationship between the clitoris, the distal urethra, and the vaginal wall (Bag- gish, Steele, and Karram 1999). ...
Chapter
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We began our history by noting the particular difficulty that arises when one attempts to write the biography of a concept that is now often dismissed as redundant, old-fashioned and silly. And we have ended our long history with the work of Marie Bonaparte, perhaps the first and last woman to take frigidity with entire seriousness both as a theoretical concern in psychoanalytic knowledge, and as an explanation of her own sexual and social frustrations. That frigidity was a difficult concept for women to engage with was fully apparent as Bonaparte struggled to reconcile her sense that clitoral pleasure was unavoidable and necessary with Freudian suspicion of it as a phallic sign of regressive pleasure, one that women needed to abandon for the sake of sexual maturity and social belonging. That is a logical place to conclude our book. It was the moment in history when the idea of frigidity was brought to bear on the new social expectations of women, and it was the moment when frigidity failed to prove its usefulness. For most feminist thinkers after the Second World War who deigned to consider frigidity as a concept, it was clear that the matter had been settled. Women’s pleasure followed patterns different from those that medicine, psychiatry and psychoanalysis had imagined, and frigidity was one of the sites at which misapprehension of the feminine ‘dark continent’, to use Freud’s expression, was now most clearly apparent.
... Body image and sexual well-being exist at the intersection of feelings, thoughts, and behaviors relevant to the body (Cook-Cottone, 2019; Gillen & Markey, 2018). Body image can encompass sexual well-being insofar as it denotes the subjective (e.g., sexual satisfaction) and objective (e.g., sexual dysfunction and behaviors) connections to people's sex lives (Alatartseva & Barysheva, 2015;Cash, Maikkula, & Yamamiya, 2004;Oakley et al., 2014;Tylka & Piran, 2019;Vaillancourt-Morel et al., 2017;Yamamiya, Cash, & Thompson, 2006). Further, sexual self-concept, a subjective sense of self as a sexual being, includes feelings and perceptions about the body within the context of sex. ...
Article
Body image is a critical component of an individual’s sexual experiences. This makes it critical to identify demographic and sociocultural correlates of sexuality-related body image: the subjective feelings, cognitions, and evaluations related to one’s body in the context of sexual experience. We examined how sexuality-related body image differed by gender, sexual orientation, race, age, and BMI. Four items assessing sexuality-related body image were completed by 11,620 U.S. adults: self-perceived sex appeal of their body, nude appearance satisfaction, and the extent to which they believed that body image positively or negatively affected their sexual enjoyment and feelings of sexual acceptability as a partner. Men reported slightly less nude appearance dissatisfaction and fewer negative effects of body image on sexual enjoyment and sexual acceptability than women, but did not differ in reported sex appeal. Poorer sexuality-related body image was reported by people with higher BMIs, not in relationships, who had sex less frequently, among White compared to Black women and men, and among gay compared to heterosexual men. Data also revealed a subgroup of respondents who reported that their body image had a positive impact on their sex lives. The findings highlight a need for interventions addressing sexuality-related body image.
... 21 Also, anorgasmic women typically have a smaller glans clitoris. 22 Clitoral body volume also grows largest during the peri-ovulatory phase 23 of the cycle, probably reflecting higher estradiol levels. These individual anatomic differences could be important if, for example, some women experience orgasm during penetration from clitoral stimulation, whereas others experience orgasm during penetration from vaginal stimulation. ...
Article
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Introduction: Most women report that clitoral stimulation is an integral aspect of their orgasm experience. Thus, recent claims that vaginal stimulation and vaginally generated orgasms are superior to clitoral stimulation and clitorally generated orgasms pathologize most women and maintain a clitoral vs vaginal dichotomy that might not accurately reflect the complexity of women's sexual experience. Aim: To have women report on their experienced source of orgasm, including combinations of vaginal and clitoral stimulation, the solo or partnered context of the stimulation, and the intensity of the orgasms from different sources and to predict indicators of mental health and sexual health using the orgasm source. Methods: Eighty-eight women 18 to 53 years old answered detailed questions about their usual and recent orgasm experiences, sexual history, depression, and anxiety. Then, they viewed a series of neutral and sexual films. They were instructed to increase or decrease their sexual arousal or respond "as usual" to the sexual films. They reported their sexual arousal after each film. Main outcome measures: Outcomes assessed included mental health (depression and anxiety) and sexual health (orgasm quality, ability to regulate sexual response to sex films). Reported sexual arousal was analyzed for the regulation task. Results: Most women (64%) reported that clitoral and vaginal stimulation contributed to their usual method of reaching orgasm. Women who reported that clitoral stimulation was primarily responsible for their orgasm reported a higher desire to self-stimulate and demonstrated greater control over their self-reported sexual arousal. The primary stimulation site for orgasm was unrelated to measurements of depression or anxiety despite sufficient statistical power. Conclusion: Most women reported that clitoral and vaginal stimulation is important in orgasm. Women experience orgasms in many varied patterns, a complexity that is often ignored by current methods of assessing orgasm source. The reported source of orgasm was unrelated to orgasm intensity, overall sex-life satisfaction, sexual distress, depression, or anxiety. Women who reported primarily stimulating their clitoris to reach orgasm reported higher trait sexual drive and higher sexual arousal to visual sexual stimulation and were better able to increase their sexual arousal to visual sexual stimulation when instructed than women who reported orgasms primarily from vaginal sources.
... It is not merely the hooded clitoral glans visible to the naked eye but includes the paired bulbs and corpora in an interconnected neural network (O'Connell, Sanjeevan, and Huston 2005). Other MRI studies have indicated that clito-S I G N S Autumn 2018 y ral size, as well as distance of the clitoris from the urethral meatus (referred to as the CUMD), influence orgasmic potential (Wallen and Lloyd 2011;Oakely et al. 2014), while sexual science studies have indicated that women report higher rates of orgasm when oral and manual stimulation of the external genitalia are involved compared to vaginal intercourse alone (Frederick et al. 2017). Other physiological studies have shown an integral sensory relationship between the clitoris, the distal urethra, and the vaginal wall (Baggish, Steele, and Karram 1999). ...
Article
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Current narratives about female sexual pleasure frequently make recourse to teleological views of the historical development of sexuality, positing the present as more liberated than past repressive attitudes. This usually takes the form of recognising early modern accounts of the clitoris (though in a reductive fashion), and then denying the profoundly holistic views of female pleasure that can be found in nineteenth-century medical texts. In spite of Foucault’s famous ridicule of the myth of “Victorian repression” in the 1974 first volume of the History of Sexuality, both popular feminist writers and physiology researchers continue to blame nineteenth-century medicine for the notion of the vagina as the only legitimate locus of female pleasure. This paper suggests an alternative account of how the clitoris became maligned in largely a twentieth-century confluence of anti-masturbation thought and interwar gender discourses. In doing so it proposes a corrective to Thomas Laqueur’s notion of a dominant homologous model of male and female genitalia from ancient times that was replaced in the nineteenth-century by an insistence on the idea that women were radically different to men. Instead I propose that two distinct strands of thought about female genitalia (the Galenic and the Hippocratic) have been consistently present, and in tension, in Western medical and anatomical texts across time, our own time being no exception. The final section of the paper considers what is now understood scientifically about female genitalia and how these new understandings might inform feminist thinking about women’s pleasure in ways that do not trade upon historical myths about Victorian repression.
... The clitoris tends to be sensitive to a wide variety of stimuli (Vardi et al., 2000). Finally, the precise location of genital structures varies from woman to woman, and this variation has been related to differences in sexual responsiveness (Oakley et al., 2014). ...
... In a self-assessment study by 749 Belgium women (aged 18-69) sexual pleasure and orgasm were found to be the strongest and the effort to attain the orgasm was the lowest when the clitoris and its sides were stimulated while the vaginal sensitivity for orgasm was lower (Bronselaer et al., 2013). In another study, Oakley et al. (2014) reported that women with anorgasmia (n 5 10) possessed smaller clitoral glans and clitoral components that were further from the vaginal lumen than women (n 5 20) with normal orgasmic function; their data supports some of the conclusions of Wallen and Lloyd (2011). ...
Article
This article reviews clitoral structures, their functions and how they are activated during the stages of female life. The paradox that occurs is that different procedures of activation are claimed by some to favour ‘noxious outcomes' to the physical and psychic health of women who use it to achieve sexual arousal/orgasm with or without penile vaginal intercourse. A number of the difficulties and inconsistencies in relation to these claims are explored. The proposed justification for the ‘noxious outcomes' is that ‘evolution' punishes sexual arousals other than by coitus because it is the only one that leads to gene propagation. In this context, however, the new, evolutionary interpretation of clitoral function in the fertile years as a fundamental proximate mechanism for facilitating female reproductive fitness makes such a justification improbable. The role of coital alignment technique (CAT) in the treatment of female orgasmic disorder is discussed in relation to its features of introital, clitoral and periurethral glans stimulation. Attempts to control female sexuality through various ‘clitoridectomies' are examined and unanswered questions about clitoral stimulation are listed. This article is protected by copyright. All rights reserved.
... The key to female orgasm are the female erectile organs, i.e. the clitoris, vestibular bulbs and pars intermedia, labia minora, and corpus spongiosum of the female urethra. Vaginal orgasm, Gspot, G-spot amplification, clitoral bulbs, clitoral or clitoris-urethra-vaginal complex, internal clitoris and female ejaculation (O'Connell et al., 2005(O'Connell et al., , 2008Rubio-Casillas and Jannini, 2011;Jannini et al., 2012;Buisson and Jannini 2013;Jannini et al., 2014;Oakley et al., 2014;Vaccaro et al., 2014;Graziottin and Gambini, 2015;Herold et al., 2015;Levin, 2015;Pan et al., 2015;Pauls, 2015;Vaccaro, 2015) are terms without scientific basis and should not be used by urologists, gynecologists, sexologists, sexual medicine experts, women, or the mass media (Puppo, 2013;Puppo and Puppo, 2015b). ...
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Article selected to feature in Wiley's News Round-Up (it is a biweekly mailing sent to over 1,800 subscribing journalists). Wiley Press Release November 02, 2015 http://eu.wiley.com/WileyCDA/PressRelease/pressReleaseId-121651.html Human semen contains spermatozoa secreted by the testes and a mixture of components produced by the bulbo-urethral and Littre (paraurethral) glands, prostate, seminal vesicles, ampulla and epididymis. Ejaculation is used as a synonym for the external ejection of semen, but it comprises two phases: emission and expulsion. As semen collects in the prostatic urethra, the rapid preorgasmic distension of the urethral bulb is pathognomonic of impeding orgasm, and the man experiences a sensation that ejaculation is inevitable (in women, emission is the only phase of orgasm). The semen is propelled along the penile urethra mainly by the bulbocavernosus muscle. With Kegel exercises, it is possible to train the perineal muscles. Immediately after the expulsion phase the male enters a refractory period, a recovery time during which further orgasm or ejaculation is physiologically impossible. Age affects the recovery time: as a man grows older, the refractory period increases. Sexual medicine experts consider premature ejaculation only in the case of vaginal intercourse, but vaginal orgasm has no scientific basis, so the duration of intercourse is not important for a woman's orgasm. The key to female orgasm are the female erectile organs; vaginal orgasm, G-spot, G-spot amplification, clitoral bulbs, clitoris-urethra-vaginal complex, internal clitoris and female ejaculation are terms without scientific basis. Female sexual dysfunctions are popular because they are based on something that does not exist, i.e. the vaginal orgasm. The physiology of ejaculation and orgasm is not impaired in premature ejaculation: it is not a disease, and non-coital sexual acts after male ejaculation can be used to produce orgasm in women. Teenagers and men can understand their sexual responses by masturbation and learn ejaculatory control with the stop-start method and the squeeze technique. Premature ejaculation must not be classified as a male sexual dysfunction. It has become the center of a multimillion dollar business: is premature ejaculation - and female sexual dysfunction - an illness constructed by sexual medicine experts under the influence of drug companies? This article is protected by copyright. All rights reserved.
... The clitoris tends to be sensitive to a wide variety of stimuli ( Vardi et al., 2000). Finally, the precise location of genital structures varies from woman to woman, and this variation has been related to differences in sexual responsiveness ( Oakley et al., 2014). ...
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PROLOGUE The first reports of the measurement of physiological responses during sexual activity date back to the late 1800s. For example, Mendelsohn (1896) described “pulse curves” (EKGs) during sexual intercourse. Such early explorations were followed by more systematic attempts to understand the physiology of sexual response, as exemplified by the writings of Van de Velde (1926), Dickinson (1933), and Kinsey and colleagues (Kinsey, Pomeroy, Martin, & Gebhard, 1953). The work of Masters and Johnson (1966), who observed sexual responses in over 650 individuals, served as a foundation for the field of sexual psychophysiology and continues to be the stimulus for much research. Initially, researchers relied on direct observation and the use of non-genital measures such as heart rate, respiration, and sweat gland activity to index sexual arousal. Zuckerman (1971) concluded that extragenital measures were not specific to sexual arousal. Coupled with Masters and Johnson’s (1966) report that genital vasocongestion is the most reliable indicator of sexual response, Zuckerman’s review accounts for the trend in the field toward the development and use of genital response measures. ANATOMY AND PHYSIOLOGY Anatomy Women The external female genital area is known as the vulva, which is rich in nerve endings and heavily vascularized. The labia majora, also known as the outer lips, surround the labia minora, or inner lips, which enclose an area called the vestibule. The labia minora fuse above the vestibule to form the clitoral prepuce and under the vaginal opening form the frenulum. The clitoris is composed of the clitoral head (glans), the clitoral shaft (corpus), and the clitoral legs (crura). The clitoral body consists of two corpora cavernosa. The vestibular bulbs of the crura, also referred to as the clitoral bulbs, appear homologous to the corpus spongiosum in men (O’Connell, Hutson, Anderson, & Plenter, 1998; however, see Puppo & Puppo, 2015). The clitoral shaft becomes engorged with blood during sexual arousal. However, it does not have a subalbugineal layer that would constrict venous outflow. Due to this, the clitoris can become engorged but does not reach levels of rigidity similar to that of the penis. The organ that has been the focus of genital response measurement in women is the vagina. The vagina is a collapsed canal that consists of two layers (Levin, 2003). The innermost layer is made of many transverse folds or “rugae” that provide accordion-like distensibility.
... Although studies on female sexual response have predominantly focused on vaginal blood flow in humans [39] and vaginocervical stimulation in rats [40], there is a growing recognition of the importance of the clitoris for female sexual function and behavior in both humans and rats [41][42][43]. Stroking the external clitoris at 5 s intervals with a lubricated paintbrush is rewarding to sexually naïve female rats [44,45], as is the orgasm that results from clitoral stimulation in humans [43,46,47]. Clitoral stimulation given to rats at 5 s intervals induces a distinct pattern of Fos expression in the medial preoptic area [45], leads to fewer solicitation behaviors directed toward the male, and increases the rate of pregnancy [48]. ...
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The present study tested the effects of lidocaine anesthetic ointment applied to the vaginocervical (Experiment 1) or clitoral-vaginocervical (Experiment 2) areas on the display of paced mating behavior over the course of five weekly tests in ovariectomized, hormone-primed, Long-Evans rats. Experiment 3 tested whether rats that acquired sexual experience without ointment application would exhibit altered paced mating behavior on a fifth test under clitoral-vaginocervical lidocaine or vehicle application. Although rats in Experiment 1 and Experiment 2 exhibited shorter contact-return latencies after intromission and reduced likelihood of leaving the male compartment following mounts and intromissions after gaining sexual experience, only rats that received clitoral-vaginocervical lidocaine exhibited altered paced mating behavior relative to vehicle. Specifically, clitoral-vaginocervical lidocaine resulted in shorter contact-return latency to ejaculation and greater percentage of time with the male. Paced mating behavior of sexually experienced rats in Experiment 3 was not disrupted when tested after clitoral-vaginocervical lidocaine treatment. Together, these studies suggest that the sensory input during repeated mating encounters affects the pattern of paced mating behavior that develops with sexual experience. Copyright © 2014. Published by Elsevier Inc.
... Most of the studies that reported their measuring tool state using a flexible measuring tape. Several other studies did not report the measuring tool employed, or used a different tool altogether, such as calipers or a digital imaging machine [11,16]. ...
Conference Paper
An accurate understanding of anatomy allows designers and scientists to create medical devices that work well for their market. However, reliable descriptions of vulva vaginal dimensions are not currently available for reference. This literature review attempts to survey the existing data collected on vulva vaginal dimensions and report the findings. We located scholarly journal articles and cross-sectional studies via academic databases and online search engines. To pinpoint the data that would be helpful in dimensional analysis of vulva vaginal measurements, key search terms included: “vulva dimensions”, “vulva measurements”, “vaginal dimensions”, “vaginal measurements”, “labia dimensions”, “labia measurements”, “clitoral dimensions”, “clitoral measurements”, and “vulva cross-sectional study”.
... In our study, 39.4% of the patients were identified as having FSD, as defined in the literature. Clitoral measurements were taken via magnetic resonance, and the clitoral measurements of anorgasmic subjects were found to be significantly smaller in a study by Oakley et al. (24) Clitoral glans length measurements were between 1 and 2 cm and glans width was between 0.5 and 1 cm and no differences between clitoral dimensions according to age or weight were detected, whereas parity was found to increase the size of the clitoris in another study by Verkauf et al. (25). In our study, clitoral measurements were consistent with the literature; however, although parity did not change the glans size, it was associated with an increase in the size of the prepuce. ...
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Objective: To provide baseline data for the anatomy of the external female genitalia and to investigate the correlation between those measurements and sexual function and genital perception. Materials and methods: This prospective cohort study consisted of 208 healthy premenopausal women. The Female Sexual Function index (FSFI) and the Female Genital Self-image scale (FGSIS) questionnaires were administered. Participants were divided into two groups according to their female sexual dysfunction (FSD) status. External genital measurements and anterior and posterior vaginal length were measured. Results: The external female genital measurements were (cm, mean ± standard deviation): clitoral prepuce length 2.05±0.48; clitoral glans length 0.87±0.21; clitoral glans width 0.60±0.15; clitoris to urethra 2.24±0.55; anterior fornix depth 7.75±0.92; posterior fornix depth 9.25±0.75; labia minora width, right 2.12±0.86, left 2.20±0.96. A weak negative correlation was found between total FGSIS scores and clitoral prepuce length (p=0.01, r=-0.17), whereas a weak positive correlation was seen between total FGSIS scores and anterior-posterior vaginal lengths (p=0.04, r=0.13; p=0.02, r=0.15, respectively). No statistically significant difference was found between the genital measurements of participants with FSD (n=82, 39.4%) and those without FSD (n=126, 60.6%), and the total FSFI scores and orgasm subdomain scores. Conclusion: The female genital measurements were found to be distributed over a wide range. Although the relationship between genital measurements and genital perception varied, no significant relationship was found between genital measurements and sexual functions or orgasm. These findings suggest that a more cautious approach should be taken towards genital surgeries for cosmetic purposes.
... In regard to the latter feature, two studies have investigated the relationship between the clitoris and its anatomical location. The most recent, by Oakley et al. (2014), used MRI to compare the size and the location of the clitoris in a small sample of 10 women with anorgasmia and 20 controls. They found that the former had smaller clitorises (glans) with clitoral components (body) further from the vaginal lumen than women with normal orgasmic function. ...
Article
This review deals critically with many aspects of the functional genital anatomy of the human female in relation to inducing sexual arousal and its relevance to procreation and recreation. Various controversial problems are discussed including: the roles of clitorally versus coitally induced arousal and orgasm in relation to the health of women, the various sites of induction of orgasm and the difficulty women find in specifically identifying them because of “'ambiguity problems” and “genital site pareidolia,” the cervix and sexual arousal, why there are so many sites for arousal, why multiple orgasms occur, genital reflexes and coitus, the sites of arousal and their representation in the brain, and identifying aspects and functions of the genitalia with appropriate new nomenclature. Clin. Anat., 2014. © 2014 Wiley Periodicals, Inc.
... Namely, better scores were associated with smaller clitoral structures, while larger clitoral anatomy was surprisingly associated with declining sexual function in women with greater BMI. Different results were achieved by other authors, who showed that worse sexual function was correlated with smaller clitoral glans, again farther from the vaginal lumen than women with normal orgasmic function [41][42][43], possibly because the distance from the urethra and vagina to the clitoris is shorter. Indeed, during arousal, it is reported that all the structure is engorged with blood and this process could bring the clitoral tissue closer to the vaginal lumen [44], which could aid in stimulation and sensation. ...
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In the field of female sexuality, the existence of the so-called “G-spot” represents a topic still anchored to anecdotes and opinions and explained using non-scientific points, as well as being overused for commercial and mediatic purposes. Purpose of Review The scope of this review is to give an update on the current state of information regarding the G-spot and suggesting potential future directions in the research field of this interesting, albeit controversial, aspect of human sexual physiology. Recent Findings From evolutionary, anatomical, and functional points of view, new evidence has rebutted the original conceptualization of the G-spot, abandoning the idea of a specific anatomical point able to produce exceptional orgasmic experiences through the stimulation of the anterior vaginal wall, the site where the G-spot is assumed to be. From a psychological perspective, only few findings to date are able to describe the psychological, behavioral, and social correlates of the pleasure experience by G-spot-induced or, better, vaginally induced orgasm (VAO). Summary Recent literature suggests the existence of a G-spot but specifies that, since it is not a spot, neither anatomically nor functionally, it cannot be called G, nor spot, anymore. It is indeed a functional, dynamic, and hormone-dependent area (called clitorourethrovaginal, CUV, complex), extremely individual in its development and action due to the combined influence of biological and psychological aspects, which may trigger VAO and in some particular cases also female ejaculation (FE).
... Women 18 to 55 years old were eligible if sexually active (defined as at least four sexual encounters in the month before enrollment), were in a monogamous relationship, and had a documented diagnosis of HSDD as the primary cause of FSD (defined as a non-adjusted score 6 in the desire domain [range ¼ 0e10] of the Female Sexual Function Index [FSFI] questionnaire). 12 Exclusion criteria included postmenopausal women (defined as absence of menstruation in the prior 12 months), pelvic pain or dyspareunia as the primary cause of FSD (defined as a non-adjusted score 6 in the pain domain [range ¼ 0e10] of the FSFI), prior hysterectomy and/or oophorectomy, history of chemotherapy and/or pelvic irradiation, use of hormonal contraception or hormone replacement therapy, active skin infection or disease preventing insertion of acupuncture needles, known allergy to acupuncture needles, or blood dyscrasia. Potential participants were identified by recruitment posters in the local clinic and by referral from their primary gynecologist or after consultation with an urogynecologist. ...
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Introduction: Female sexual dysfunction affects up to 43% of women in the United States and hypoactive sexual desire disorder (HSDD) is the most common type; however, we lack treatment options showing improvement for this condition. Aims: To investigate whether acupuncture therapy could improve HSDD. Methods: Premenopausal women with a primary diagnosis of HSDD were included in a single-arm prospective pilot study that was approved by the institutional review board. After providing informed consent, subjects completed validated questionnaires. Participants underwent 25-minute twice-weekly acupuncture sessions for 5 weeks with one certified acupuncturist. Questionnaires were completed again 6 weeks after onset of treatment. Main outcome measures: Based on a statistically significant change in the desire domain of the Female Sexual Function Index from 2.0 (at baseline) to 2.4 (after intervention with a specialist) in our population of patients diagnosed with HSDD, a sample of 13 was determined, with 90% power and α 0.05. Results: Fifteen women were enrolled and 13 completed the study. Mean age was 36.9 ± 11.4 years. Most were white (n = 9, 60%), heterosexual (n = 15, 100%), and non-smokers (n = 14, 93%). Most were sexually active more than four times per month (n = 8, 53%) and none had a history of sexual abuse (n = 15, 100%). Participants received a mean acupuncture needle application of 17 ± 2 at each session. Sexual function improved after intervention, particularly desire (2.1 ± 0.6 to 3.3 ± 1.2, P < .0001), arousal (P < .0001), lubrication (P = .03), and orgasm (P = .005). Conclusion: In this cohort of premenopausal women with HSDD, 5 weeks of acupuncture therapy was associated with significant improvements in sexual function, particularly desire. This supports a role for acupuncture as a therapeutic option for women with low desire.
Article
The clitoris may be the most pivotal structure for female sexual pleasure. While its significance has been reported for hundreds of years, no complete anatomical description was available until recently. Most of the components of the clitoris are buried under the skin and connective tissues of the vulva. It comprises an external glans and hood, and an internal body, root, crura, and bulbs; its overall size is 9-11 cm. Clitoral somatic innervation is via the dorsal nerve of the clitoris, a branch of the pudendal nerve, while other neuronal networks within the structure are complex. The clitoris is the center for orgasmic response and is embryologically homologous to the male penis. While the source of vaginal eroticism might or might not be exclusively clitoral stimulation, it is necessary to understand the intricate anatomy of the organ to assess the data in this regard. Ultimately, sexual enjoyment entails a balance of physical and emotional factors and should be encouraged. Clin. Anat., 2015. © 2015 Wiley Periodicals, Inc. © 2015 Wiley Periodicals, Inc.
Article
Many would agree that there are two quintessential sexual organs in the female: the clitoris and the brain. Using non-invasive techniques of magnetic resonance imaging (MRI), investigators have gained insight into the mental and physical factors involved in female sexual function. Since only the external clitoral glans is easily accessible for direct measurement, the complete anatomy of the clitoris (including the internal components-paired corpora, crura, and bulbs) has only recently been described, with MRI providing the most sensitive way of distinguishing among the various soft tissue planes. Average sizes of clitoral structures and average distances between the clitoral complex and other pelvic landmarks have been measured. These measurements have been correlated with female sexual function: a longer distance between the clitoral complex and the vaginal lumen correlates with poorer sexual function, consistent with prior imaging studies. However, whether clitoral size influences function is debatable, so further studies are needed. Physiological investigations have demonstrated that female arousal disorder is unlikely to be due to inadequate genital engorgement. Some consider the brain to be the ultimate sexual organ, and several recent studies have used functional MRI (fMRI) to reveal sexual excitability in the brain. The normal sexual response requires deactivation of the frontal lobe and activation of the instinctual limbic system of the midbrain. As MR technology continues to improve, the mysteries of female sexuality will be further unraveled. Clin. Anat., 2015. © 2015 Wiley Periodicals, Inc. © 2015 Wiley Periodicals, Inc.
Article
Accurate and comprehensive measurements of the external genitalia in female adults are of great significance in surgery designs and for aesthetic evaluation in genital plastic surgeries. The authors carried out a 319-case study and provided baseline data and morphometric reference for plastic surgery involving the genital deformity caused by trauma or burns and male-to-female transsexual operations. Our study design recruited 319 women referred to the out-patient clinic from August 2010 to August 2013. From each individual we measured 16 parameters and assessed the significance of variations in age, height, weight, BMI, and marital status (as a proxy for parity). We tried to establish a female external genitalia database of the population presenting for cosmetic surgery and define the general proportions of female genitalia in Chinese adults from the data we obtained. A wide range of values was noted in female genital measurements especially in labia minora parameters. Four parameters, including clitoral prepuce length, clitoris to urethra, labial length, and perineal body length had a proportional relationship to some extent. The position of the clitoris and urethral orifice was found to be regular in female adults. Compared with unmarried women, perineal body length decreased (P = 0.048), while the apex to perineum (bilateral) and labial length increased (P = 0.005, 0.006, <0.0001) in those who were married. Several parameters were statistically significantly associated with age, height, weight, BMI, and marital status. We presented an external genitalia database of Chinese female adults asking for cosmetic surgery. Although the ranges of genital measurements vary, there is a proportional relationship in female genital appearance, which should be heeded in surgical designs and genital aesthetic evaluation.
Article
Introduction and hypothesis: We present a 3D computational approach for automated clitoral measurements. We hypothesized that computationally derived measurements would be comparable and less variable than reported manual measures. Methods: In this retrospective study, MRIs of 22 nulliparous women age 20-49 years with normal vaginal and clitoral anatomy were collected. Manual segmentations were performed to reconstruct 3D models of the whole clitoris (glans, body, crura, and bulbs) and vagina. The length, width, and volume of the clitoral structures and the distance between the vagina and clitoral structures were calculated. Computed clitoral morphometrics (length, width) were compared to median [range] values from a previously published cadaver study (N = 22) using the median test and Moses extreme reaction test. Calculated distances were compared to mean (± SD) reported by a 2D MRI study (N = 20) using independent t-test and Levene's test. Results: Overall, computed clitoral morphometrics were similar to manual cadaver measurements, where the majority of length and width measures had ~1-2 mm difference and had less variability (smaller range). All calculated distances were significantly smaller and had smaller SDs than manual 2D MRI values, with two-fold differences in the means and SDs. Large variation was observed in clitoral volumetric measures in our cohort. Conclusions: The proposed 3D computational method improves the standardization and consistency of clitoral measurements compared to traditional manual approaches. The use of this approach in radiographic studies will give better insight into how clitoral anatomy relates to sexual function and how both are impacted by gynecologic surgery, where outcomes can assist treatment planning.
Article
IntroductionThe clitoris is often considered the female version of the penis and less studied compared to its male counterpart. Nonetheless, it carries the same importance in sexual functioning. While it has more recently been allocated the appreciation it deserves, the clitoris should be examined as a separate and unique entity.AimTo review clitoral anatomy, its role in sexual functioning, the controversies of vaginal eroticism and the female prostate, as well as address potential impacts of pelvic surgery on its function.Methods We examined available evidence (from 1950 until 2015) relating to clitoral anatomy, the clitoral role in sexual functioning, vaginal eroticism, female prostate, female genital mutilation/cutting, and surgical implications for the clitoris.Main Outcome MeasuresMain outcomes included an historical review of the clitoral anatomy and its role in sexual functioning, the controversies regarding vaginal sources of sexual function, and the impact of both reconstructive and nonmedical procedures on the clitoris.ResultsThe intricate neurovasculature and multiplanar design of the clitoris contribute to its role in female sexual pleasure. Debate still remains over the exclusive role of the clitoris in orgasmic functioning. Normal sexual function may remain intact, however, after surgical procedures involving the clitoris and surrounding structures.Conclusions The clitoris is possibly the most critical organ for female sexual health. Its importance is highlighted by the fact that the practice of female genital cutting is often used to attenuate the female sexual response. While its significance may have been overshadowed in reports supporting vaginal eroticism, it remains pivotal to orgasmic functioning of most women. Donna Mazloomdoost and Rachel N. Pauls. A comprehensive review of the clitoris and its role in female sexual function. Sex Med Rev **;**:**–**.
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The female vulva is an intricate structure comprising several components. Each structure has been described separately, but the interplay among them and physiologic significance remain controversial. The structures extend inferiorly from the pubic arch and include the mons pubis, labia majora, labia minora, vestibule, and clitoris. The clitoris is widely accepted as the most critical anatomic structure to female sexual arousal and orgasm. The female sexual response cycle is also very complex, requiring emotional and mental stimulation in addition to end organ stimulation.
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Though the public consciousness is typically focused on factors such as psychology, penis size, and the presence of the "G-spot," there are other anatomical and neuro-anatomic differences that could play an equal, or more important, role in the frequency and intensity of orgasms. Discovering these variations could direct further medical or procedural management to improve sexual satisfaction. The aim of this study is to review the available literature of anatomical sexual variation and to explain why this variation may predispose some patients toward a particular sexual experience. In this review, we explored the available literature on sexual anatomy and neuro-anatomy. We used PubMed and OVID Medline for search terms, including orgasm, penile size variation, clitoral variation, Grafenberg spot, and benefits of orgasm. First we review the basic anatomy and innervation of the reproductive organs. Then we describe several anatomical variations that likely play a superior role to popular known variation (penis size, presence of g-spot, etc). For males, the delicate play between the parasympathetic and sympathetic nervous systems is vital to achieve orgasm. For females, the autonomic component is more complex. The clitoris is the primary anatomical feature for female orgasm, including its migration toward the anterior vaginal wall. In conclusions, orgasms are complex phenomena involving psychological, physiological, and anatomic variation. While these variations predispose people to certain sexual function, future research should explore how to surgically or medically alter these.
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Introduction Female genital mutilation (FGM) includes all procedures that involve partial or total removal of the female external genitalia or any other injury of the female genitalia that is performed for nonmedical reasons. FGM is classified into 4 types. Surgical clitoral reconstruction was first described by Thabet and Thabet in Egypt and subsequently by Foldès in France. The technique was then modified by different authors. Aim This article aims to provide a detailed description of clitoral surgical reconstruction and the modifications which have been made over time to improve the procedure while recalling current knowledge in the anatomy of the clitoris. Methods We performed a broad systematic search in PubMed/Medline and EMBASE bibliographic databases for studies that report the surgical technique of clitoral reconstruction. From the anatomical point of view, we examined available evidence (from 1950 until 2020) related to clitoral anatomy, the clitoral role in sexual functioning, female genital mutilation/cutting, and surgical implications for the clitoris. Main Outcomes A review of the surgical techniques for clitoral reconstruction after female genital mutilation/cutting Results We described the current anatomical knowledge about the clitoris, and the procedures based on the surgical technique by Pierre Foldès, We included the technical modifications and contributions described in articles published subsequently. Conclusion Surgical repair of the clitoris for FGM offers anatomical and functional results although they still have to be evaluated. However, it should not be the only therapeutic solution offered to women with FGM. Botter C, Sawan D, SidAhmed-Mezi M, et al. Clitoral Reconstructive Surgery After Female Genital Mutilation/Cutting: Anatomy, Technical Innovations and Updates of the Initial Technique. J Sex Med 2021;XX:XXX–XXX.
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Ženský orgasmus je komplexní psychosomatický proces. Přestože existuje celá řada definic ženského orgasmu, většina z nich se shoduje, že se skládá ze dvou komponent: z tělesné složky, kdy dochází k uvolnění neuromuskulárního napětí v těle ženy v reakci na tělesné dráždění, a z psychologické složky, kdy ženy pociťují sexuální naplnění a uspokojení. Výskyt ženského orgasmu je velmi variabilní a závisí na mnoha faktorech. V rámci tohoto textu představujeme některé z těchto faktorů, které ovlivňují orgastickou schopnost žen a to s důrazem na partnerskou a sexuální perspektivu.
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Introduction: Female sexual dysfunction affects up to 43% of women in the United States and hypoactive sexual desire disorder (HSDD) is the most common type; however, we lack treatment options showing improvement for this condition. Aims: To investigate whether acupuncture therapy could improve HSDD. Methods: Premenopausal women with a primary diagnosis of HSDD were included in a single-arm prospective pilot study that was approved by the institutional review board. After providing informed consent, subjects completed validated questionnaires. Participants underwent 25-minute twice-weekly acupuncture sessions for 5 weeks with one certified acupuncturist. Questionnaires were completed again 6 weeks after onset of treatment. Main Outcome Measures: Based on a statistically significant change in the desire domain of the Female Sexual Function Index from 2.0 (at baseline) to 2.4 (after intervention with a specialist) in our population of patients diagnosed with HSDD, a sample of 13 was determined, with 90% power and α 0.05. Results: Fifteen women were enrolled and 13 completed the study. Mean age was 36.9 ± 11.4 years. Most were white (n = 9, 60%), heterosexual (n = 15, 100%), and non-smokers (n = 14, 93%). Most were sexually active more than four times per month (n = 8, 53%) and none had a history of sexual abuse (n = 15, 100%). Participants received a mean acupuncture needle application of 17 ± 2 at each session. Sexual function improved after intervention, particularly desire (2.1 ± 0.6 to 3.3 ± 1.2, P < .0001), arousal (P < .0001), lubrication (P = .03), and orgasm (P = .005). Conclusion: In this cohort of premenopausal women with HSDD, 5 weeks of acupuncture therapy was associated with significant improvements in sexual function, particularly desire. This supports a role for acupuncture as a therapeutic option for women with low desire.
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Regression methods were used to select and score 12 items from the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36) to reproduce the Physical Component Summary and Mental Component Summary scales in the general US population (n = 2,333). The resulting 12-item short-form (SF-12) achieved multiple R squares of 0.911 and 0.918 in predictions of the SF-36 Physical Component Summary and SF-36 Mental Component Summary scores, respectively. Scoring algorithms from the general population used to score 12-item versions of the two components (Physical Component Summary and Mental Component Summary) achieved R squares of 0.905 with the SF-36 Physical Component Summary and 0.938 with the SF-36 Mental Component Summary when cross-validated in the Medical Outcomes Study. Test-retest (2-week) correlations of 0.89 and 0.76 were observed for the 12-item Physical Component Summary and the 12-item Mental Component Summary, respectively, in the general US population (n = 232). Twenty cross-sectional and longitudinal tests of empirical validity previously published for the 36-item short-form scales and summary measures were replicated for the 12-item Physical Component Summary and the 12-item Mental Component Summary, including comparisons between patient groups known to differ or to change in terms of the presence and seriousness of physical and mental conditions, acute symptoms, age and aging, self-reported 1-year changes in health, and recovery from depression. In 14 validity tests involving physical criteria, relative validity estimates for the 12-item Physical Component Summary ranged from 0.43 to 0.93 (median = 0.67) in comparison with the best 36-item short-form scale. Relative validity estimates for the 12-item Mental Component Summary in 6 tests involving mental criteria ranged from 0.60 to 1.07 (median = 0.97) in relation to the best 36-item short-form scale. Average scores for the 2 summary measures, and those for most scales in the 8-scale profile based on the 12-item short-form, closely mirrored those for the 36-item short-form, although standard errors were nearly always larger for the 12-item short-form.
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Context While recent pharmacological advances have generated increased public interest and demand for clinical services regarding erectile dysfunction, epidemiologic data on sexual dysfunction are relatively scant for both women and men. Objective To assess the prevalence and risk of experiencing sexual dysfunction across various social groups and examine the determinants and health consequences of these disorders. Design Analysis of data from the National Health and Social Life Survey, a probability sample study of sexual behavior in a demographically representative, 1992 cohort of US adults. Participants A national probability sample of 1749 women and 1410 men aged 18 to 59 years at the time of the survey. Main Outcome Measures Risk of experiencing sexual dysfunction as well as negative concomitant outcomes. Results Sexual dysfunction is more prevalent for women (43%) than men (31%) and is associated with various demographic characteristics, including age and educational attainment. Women of different racial groups demonstrate different patterns of sexual dysfunction. Differences among men are not as marked but generally consistent with women. Experience of sexual dysfunction is more likely among women and men with poor physical and emotional health. Moreover, sexual dysfunction is highly associated with negative experiences in sexual relationships and overall wellbeing. Conclusions The results indicate that sexual dysfunction is an important public health concern, and emotional problems likely contribute to the experience of these problems.
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There is general agreement that it is possible to have an orgasm thru the direct simulation of the external clitoris. In contrast, the possibility of achieving climax during penetration has been controversial. Six scientists with different experimental evidence debate the existence of the vaginally activated orgasm (VAO). To give reader of The Journal of Sexual Medicine sufficient data to form her/his own opinion on an important topic of female sexuality. Expert #1, the Controversy's section Editor, together with Expert #2, reviewed data from the literature demonstrating the anatomical possibility for the VAO. Expert #3 presents validating women's reports of pleasurable sexual responses and adaptive significance of the VAO. Echographic dynamic evidence induced Expert # 4 to describe one single orgasm, obtained from stimulation of either the external or internal clitoris, during penetration. Expert #5 reviewed his elegant experiments showing the uniquely different sensory responses to clitoral, vaginal, and cervical stimulation. Finally, the last Expert presented findings on the psychological scenario behind VAO. The assumption that women may experience only the clitoral, external orgasm is not based on the best available scientific evidence.
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In men and women sexual arousal culminates in orgasm, with female orgasm solely from sexual intercourse often regarded as a unique feature of human sexuality. However, orgasm from sexual intercourse occurs more reliably in men than in women, likely reflecting the different types of physical stimulation men and women require for orgasm. In men, orgasms are under strong selective pressure as orgasms are coupled with ejaculation and thus contribute to male reproductive success. By contrast, women's orgasms in intercourse are highly variable and are under little selective pressure as they are not a reproductive necessity. The proximal mechanisms producing variability in women's orgasms are little understood. In 1924 Marie Bonaparte proposed that a shorter distance between a woman's clitoris and her urethral meatus (CUMD) increased her likelihood of experiencing orgasm in intercourse. She based this on her published data that were never statistically analyzed. In 1940 Landis and colleagues published similar data suggesting the same relationship, but these data too were never fully analyzed. We analyzed raw data from these two studies and found that both demonstrate a strong inverse relationship between CUMD and orgasm during intercourse. Unresolved is whether this increased likelihood of orgasm with shorter CUMD reflects increased penile-clitoral contact during sexual intercourse or increased penile stimulation of internal aspects of the clitoris. CUMD likely reflects prenatal androgen exposure, with higher androgen levels producing larger distances. Thus these results suggest that women exposed to lower levels of prenatal androgens are more likely to experience orgasm during sexual intercourse.
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Regression methods were used to select and score 12 items from the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36) to reproduce the Physical Component Summary and Mental Component Summary scales in the general US population (n=2,333). The resulting 12-item short-form (SF-12) achieved multiple R squares of 0.911 and 0.918 in predictions of the SF-36 Physical Component Summary and SF-36 Mental Component Summary scores, respectively. Scoring algorithms from the general population used to score 12-item versions of the two components (Physical Components Summary and Mental Component Summary) achieved R squares of 0.905 with the SF-36 Physical Component Summary and 0.938 with SF-36 Mental Component Summary when cross-validated in the Medical Outcomes Study. Test-retest (2-week)correlations of 0.89 and 0.76 were observed for the 12-item Physical Component Summary and the 12-item Mental Component Summary, respectively, in the general US population (n=232). Twenty cross-sectional and longitudinal tests of empirical validity previously published for the 36-item short-form scales and summary measures were replicated for the 12-item Physical Component Summary and the 12-item Mental Component Summary, including comparisons between patient groups known to differ or to change in terms of the presence and seriousness of physical and mental conditions, acute symptoms, age and aging, self-reported 1-year changes in health, and recovery for depression. In 14 validity tests involving physical criteria, relative validity estimates for the 12-item Physical Component Summary ranged from 0.43 to 0.93 (median=0.67) in comparison with the best 36-item short-form scale. Relative validity estimates for the 12-item Mental Component Summary in 6 tests involving mental criteria ranged from 0.60 to 107 (median=0.97) in relation to the best 36-item short-form scale. Average scores for the 2 summary measures, and those for most scales in the 8-scale profile based on the 12-item short-form, closely mirrored those for the 36-item short-form, although standard errors were nearly always larger for the 12-item short-form.
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While recent pharmacological advances have generated increased public interest and demand for clinical services regarding erectile dysfunction, epidemiologic data on sexual dysfunction are relatively scant for both women and men. To assess the prevalence and risk of experiencing sexual dysfunction across various social groups and examine the determinants and health consequences of these disorders. Analysis of data from the National Health and Social Life Survey, a probability sample study of sexual behavior in a demographically representative, 1992 cohort of US adults. A national probability sample of 1749 women and 1410 men aged 18 to 59 years at the time of the survey. Risk of experiencing sexual dysfunction as well as negative concomitant outcomes. Sexual dysfunction is more prevalent for women (43%) than men (31%) and is associated with various demographic characteristics, including age and educational attainment. Women of different racial groups demonstrate different patterns of sexual dysfunction. Differences among men are not as marked but generally consistent with women. Experience of sexual dysfunction is more likely among women and men with poor physical and emotional health. Moreover, sexual dysfunction is highly associated with negative experiences in sexual relationships and overall well-being. The results indicate that sexual dysfunction is an important public health concern, and emotional problems likely contribute to the experience of these problems.
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This article presents the development of a brief, self-report measure of female sexual function. Initial face validity testing of questionnaire items, identified by an expert panel, was followed by a study aimed at further refining the questionnaire. It was administered to 131 normal controls and 128 age-matched subjects with female sexual arousal disorder (FSAD) at five research centers. Based on clinical interpretations of a principal components analysis, a 6-domain structure was identified, which included desire, subjective arousal, lubrication, orgasm, satisfaction, and pain. Overall test-retest reliability coefficients were high for each of the individual domains (r = 0.79 to 0.86) and a high degree of internal consistency was observed (Cronbach's alpha values of 0.82 and higher) Good construct validity was demonstrated by highly significant mean difference scores between the FSAD and control groups for each of the domains (p < or = 0.001). Additionally, divergent validity with a scale of marital satisfaction was observed. These results support the reliability and psychometric (as well as clinical) validity of the Female Sexual Function Index (FSFI) in the assessment of key dimensions of female sexual function in clinical and nonclinical samples. Our findings also suggest important gender differences in the patterning of female sexual function in comparison with similar questionnaire studies in males.
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The aim of this study was to develop the short form of a condition-specific, reliable, validated and self-administered instrument to evaluate sexual function in women with pelvic organ prolapse and/or urinary incontinence. The Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire -12 (PISQ-12) was developed from the data of 99 of 182 women surveyed to create the long form (PISQ-31). An additional 46 patients were recruited for further validation. All subsets regression analysis identified 12 items likely to predict PISQ-31 scores. Short form scores underwent correlation analysis with long form, Incontinence Impact Questionnaire - 7 (IIQ-7), Sexual History Form -12 (SHF-12) and Symptom Questionnaire (SQ) scores. Test-retest reliability was checked with a subset of 20 patients. All subsets regression analysis with R>0.92 identified 12 items that predicted PISQ-31 scores. Short form scores were highly correlated with long form scores ( R=0.75-0.95). Correlations of the PISQ-12 with SHF-12 ( R=-0.66 and -0.68) and IIQ-7 ( R=-0.38 and -0.54) scores were similar to correlation of the PISQ-31 with these other measures. Reliability was moderate to high, with weighted kappa values from 0.56 to 0.93. PISQ-12 scores were lower in patients with low sexual function as measured on the SHF-12 ( P <0.001), and lower in women with depression as measured on the SQ ( P <0.001). The PISQ-12 is a validated and reliable short form that evaluates sexual function in women with urinary incontinence and/or pelvic organ prolapse and predicts PISQ-31 scores. It is able to distinguish women with poor sexual function as measured on the SHF-12.
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Androgen insufficiency has been associated with decreased libido and arousal in postmenopausal women, but rarely has been evaluated in healthy premenopausal women. In all, 32 healthy premenopausal women were enrolled in this study, 18 with one or more complaints of sexual dysfunction and 14 without. Assays of ovarian and adrenal androgens were measured before and after ACTH stimulation. The women with complaints of sexual dysfunction had significantly lower adrenal androgens than did the control women. There were no differences in the basal ovarian androgens or cortisol levels. After ACTH, both groups stimulated cortisol as well as adrenal and ovarian androgens. In conclusion, premenopausal women with complaints of sexual dysfunction had lower adrenal androgen precursors and testosterone than age-matched control women without such complaints. Further study is required to determine how lower adrenal androgens contribute to female sexual dysfunction.
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The Female Sexual Function Index (FSFI) is a brief multidimensional scale for assessing sexual function in women. The scale has received initial psychometric evaluation, including studies of reliability, convergent validity, and discriminant validity (Meston, 2003; Rosen et al., 2000). The present study was designed to crossvalidate the FSFI in several samples of women with mixed sexual dysfunctions (N = 568) and to develop diagnostic cut-off scores for potential classification of women's sexual dysfunction. Some of these samples were drawn from our previous validation studies (N = 414), and some were added for purposes of the present study (N = 154). The combined data set consisted of multiple samples of women with sexual dysfunction diagnoses (N = 307), including female sexual arousal disorder (FSAD), hypoactive sexual desire disorder (HSDD), female sexual orgasm disorder (FSOD), dyspareunia/vaginismus (pain), and multiple sexual dysfunctions, in addition to a large sample of nondysfunctional controls (n = 261). We conducted analyses on the individual and combined samples, including replicating the original factor structure using principal components analysis with varimax rotation. We assessed Cronbach's alpha (internal reliability) and interdomain correlations and tested discriminant validity by means of a MANOVA (multivariate analysis of variance; dysfunction diagnosis x FSFI domain), with Bonferroni-corrected post hoc comparisons. We developed diagnostic cut off scores by means of standard receiver operating characteristics-curves and the CART (Classification and Regression Trees) procedure. Principal components analysis replicated the original five-factor structure, including desire/arousal, lubrication, orgasm, pain, and satisfaction. We found the internal reliability for the total FSFI and six domain scores to be good to excellent, with Cronbach alpha's >0.9 for the combined sample and above 0.8 for the sexually dysfunctional and nondysfunctional samples, independently. Discriminant validity testing confirmed the ability of both total and domain scores to differentiate between functional and nondysfunctional women. On the basis of sensitivity and specificity analyses and the CART procedure, we found an FSFI total score of 26.55 to be the optimal cut score for differentiating women with and without sexual dysfunction. On the basis of this cut-off we found 70.7% of women with sexual dysfunction and 88.1% of the sexually functional women in the cross-validation sample to be correctly classified. Addition of the lubrication score in the model resulted in slightly improved specificity (from .707 to .772) at a slight cost of sensitivity (from .881 to .854) for identifying women without sexual dysfunction. We discuss the results in terms of potential strengths and weaknesses of the FSFI, as well in terms of further clinical and research implications.
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We determined the magnetic resonance imaging (MRI) characteristics of normal clitoral anatomy. A series of MRI studies of 10 healthy, nulliparous volunteers with no prior surgery and normal pelvic examination was studied and the key characteristics of clitoral anatomy were determined. A range of different magnetic resonance sequences was used without any contrast agent. The axial plane best revealed the clitoral body and its proximal continuation as the paired crura. The glans was seen more caudal than the body of the clitoris. The bulbs of the clitoris had the same signal as the rest of the clitoris in the axial plane and they related consistently to the other erectile structures. The bulbs, body and crura formed an erectile tissue cluster, namely the clitoris. In turn, the clitoris partially surrounded the urethra and vagina, forming a consistently observed tissue complex. Midline sagittal section revealed the shape of the body, although in this plane the rest of the clitoris was poorly displayed. The coronal plane revealed the relationship between the clitoral body and labia. The axial section cephalad to the clitoral body best revealed the vascular component of the neurovascular bundle to the clitoris. The fat saturation sequence particularly highlighted clitoral anatomy in healthy, premenopausal, nulliparous women. Normal clitoral anatomy has been clearly demonstrated using noncontrast pelvic MRI.
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Androgen insufficiency is a recognized cause of sexual dysfunction in men and women. Age-related decrements in adrenal and gonadal androgen levels also occur naturally in both sexes. At present, it is unclear if a woman's low serum androgen level is a reflection of the expected normal age-related decline or indicative of an underlying androgen-deficient state. We studied premenopausal women with no complaints of sexual dysfunction to help define a normal female androgen profile. In all, 60 healthy, normally menstruating women, ages 20-49 y, were studied. The Abbreviated Sexual Function Questionnaire was administered along with a detailed interview. Radioimmunoassay measurements of morning serum testosterone (T), free testosterone (fT), dehydroepiandrosterone-sulfate (DHEAS), sex hormone-binding globulin (SHBG), and free androgen index (FAI) were measured during days 8-15 of the menstrual cycle. In women 20-49 y old without complaints of sexual dysfunction, serum androgen levels exhibit a progressive stepwise decline. Comparing values obtained in women age 20-29 y to those obtained in women 40-49 y, specific hormone decrements were DHEAS 195.6-140.4 microg/dl, serum T 51.5-33.7 ng/dl, fT 1.51-1.03 pg/ml. SHBG did not change significantly in women in this age group. The FAI reflected the age-related decrease in female androgen levels. The framework for the development of a female androgen profile in women with no complaints of sexual dysfunction has been established, and an age-related decrease in testosterone and its adrenal precursor, DHEAS, has been demonstrated. The FAI mirrors these decreases and its usefulness in clinical practice is confirmed. A precipitous decline in all androgens occurs after the decade of the 20s, yet SHBG does not show a significant change throughout the premenopausal years.
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Factual presentations of sexual anatomy are required for educational purposes, for clinical and more general communication about sexual matters. To date, unambiguous, accurate and objective images with appropriate labeling to enhance specificity in communication have been lacking. The aim of this presentation is to provide a comprehensive overview of anatomy of the distal vagina. We aim to simplify the anatomy to reduce the confusion of historical descriptions. In doing so, we aim to avoid sacrificing any of the specific detail. This would aid communication between clinicians, researchers, and the nonclinician regarding this anatomy. OUTCOME MEASURES AND METHODS: This article reviews the historical and current anatomical literature. Systematic dissection and photography, histological study, and magnetic resonance imaging have been used as the basis for this presentation. Digital technology has been used to label, color, and highlight photography to provide clarity and permit diagramatization of photography. No distortion has otherwise been used in presenting images from cadavers or anatomical research. The anatomy of the distal vagina and surrounding structures is shown and described in detailed. The distal vagina, clitoris, and urethra form an integrated entity covered superficially by the vulval skin and its epithelial features. These parts have a shared vasculature and nerve supply and during sexual stimulation respond as a unit though the responses are not uniform. Significant progress has been made in the field of female sexual anatomy and its pictorial representation. This may facilitate further progress in the related fields of female sexual health and education.
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A growing literature points to the role of body-image attitudes in human sexual functioning. Specifically, body dissatisfaction and excessive psychological investment in one's physical appearance may lead to physical self-consciousness and body exposure avoidance during sexual relations, which in turn may impair sexual desire, enjoyment, and performance. The present research with 145 college women and 118 college men evaluated a contextual body-image measure, the Body Exposure during Sexual Activities Questionnaire (BESAQ), which assesses anxious/avoidant body focus during sex. Findings supported the BESAQ's reliability and validity. Associations with sexual functioning were stronger for the BESAQ than for trait body-image measures. For both sexes, better sexual functioning was related to less anxious/avoidant body focus and stronger sexual self-schemas. Physical self-consciousness during sexual relations focused substantially on weight and gender-relevant attributes. Clinical and research implications of the findings are considered.
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Women who have undergone female genital mutilation rarely have access to the reconstructive surgery that is now available. Our objective was to assess the immediate and long-term outcomes of this surgery. Between 1998 and 2009, we included consecutive patients with female genital mutilation aged 18 years or older who had consulted a urologist at Poissy-St Germain Hospital, France. We used the WHO classification to prospectively include patients with type II or type III mutilation. The skin covering the stump was resected to reveal the clitoris. The suspensory ligament was then sectioned to mobilise the stump, the scar tissue was removed from the exposed portion and the glans was brought into a normal position. All patients answered a questionnaire at entry about their characteristics, expectations, and preoperative clitoris pleasure and pain, measured on a 5-point scale. Those patients who returned at 1 year for follow-up were questioned about clitoris pain and functionality. We compared data from the 1-year group with the total group of patients who had surgery. We operated on 2938 women with a mean age of 29·2 (SD 7·77 years; age at excision 6·1, SD 3·5 years). Mali, Senegal, and Ivory Coast were the main countries of origin, but 564 patients had undergone female genital mutilation in France. The 1-year follow-up visit was attended by 866 patients (29%). Expectations before surgery were identity recovery for 2933 patients (99%), improved sex life for 2378 patients (81%), and pain reduction for 847 patients (29%). At 1-year follow-up, 363 women (42%) had a hoodless glans, 239 (28%) had a normal clitoris, 210 (24%) had a visible projection, 51 (6%) had a palpable projection, and three (0·4%) had no change. Most patients reported an improvement, or at least no worsening, in pain (821 of 840 patients) and clitoral pleasure (815 of 834 patients). At 1 year, 430 (51%) of 841 women experienced orgasms. Immediate complications after surgery (haematoma, suture failure, moderate fever) were noted in 155 (5%) of the 2938 patients, and 108 (4%) were briefly re-admitted to hospital. Reconstructive surgery after female genital mutilation seems to be associated with reduced pain and restored pleasure. It needs to be made more readily available in developed countries by training surgeons. French Urological Association.
Article
Oral contraceptives (OCs) induce mood and libido changes. The aim of this study was to evaluate in young, eumenorrheic, healthy women the sexual behavior and the genital vascular effects of an OC containing 30 µg ethinylestradiol (EE) and 3 mg drospirenone (DRSP). The main outcome measures are McCoy Female Sexuality Questionnaire (MFSQ), the labia minora thickness and vaginal introitus area, the pulsatility index (PI) of clitoral and labia minora arteries, and hormonal and biochemical assays. Twenty-two adult, eumenorrheic, healthy women were administered the two-factor Italian MFSQ. The labia minora thickness was studied by two-dimensional ultrasonographic, and the clitoral and labia minora arteries were evaluated by color Doppler; three-dimensional static volumes of the vulvar area were calculated. Hormonal (estradiol, androstenedione, and testosterone) and biohumoral (sex hormone binding globulin) parameters were assayed. Subjects were studied in baseline conditions and after 3 months of therapy with an OC (Yasmin®, Bayer-Schering Italia, Milan, Italy; -30 µg EE + 3 mg DRSP). After 3-month treatment, the labia minora thickness and the vaginal introitus area significantly decreased in comparison with the baseline values, whereas the PI of the dorsal clitoral artery and the posterior labial artery significantly increased. The OC use induced a significant decrease of the two-factor Italian MFSQ score, a reduction of the number of intercourse/week, and a reduction of the frequency of orgasm during intercourse. The item 18 (pain during intercourse) worsened after OC. The treatment with Yasmin® (Bayer-Schering Italia) is associated with increased pain during intercourse, with decreased libido and spontaneous arousability, and with diminished frequency of sexual intercourse and orgasm.
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Bladder exstrophy is a rare congenital anomaly isolated to the fetal genitourinary tract. In our patient, this defect necessitated removal of her bladder in her childhood and a distal neovaginoplasty in adolescence. Despite these surgeries, as well as several procedures for pelvic organ prolapse, the patient reports excellent sexual function and ability to achieve vaginal orgasms. (i) To report on the sexual function of a woman without a bladder or urethra who has undergone multiple pelvic reconstructive surgeries; and (ii) to correlate her self-reported erotic areas with magnetic resonance imaging (MRI) assessment. The patient completed a detailed sexual history, the Female Sexual Function Index (FSFI), the Female Sexual Distress Scale (FSDS), the Pelvic Organ Prolapse/Urinary Incontinence Sexual Function Questionnaire (PISQ-12), and the Health Survey Short Form (SF-12). Photodocumentation of her erotic tissue was correlated with a pelvic MRI with contrast. The patient reports ability to achieve vaginal orgasms 100% of the time. Her FSFI score was 29.4/36 with maximum scores noted in arousal, lubrication, orgasm and satisfaction. Her FSDS score was 7/48, which implies no sexually related distress. Her PISQ-12 score was 10/48, demonstrating a small impact on her sexual function related to her pelvic organ prolapse. Her SF-12 scores were 36.6 and 57.9. Photography and mapping of her erotic areas illustrated the superficial and anterior locations of the vaginal opening to be the sites of orgasm. MRI correlated these exact locations with clitoral tissue. Intact sexual function is possible in patients after reconstructive surgery for congenital bladder exstrophy. Due to the superficial location of her clitoris and separation of the pubic rami associated with this anatomic variant, sexual function may be enhanced.
Article
The anatomy and function of the G-spot remain highly controversial. Ultrasound studies of the clitoral complex during intercourse have been conducted to gain insight into the role of the clitoris and its relation to vagina and urethra during arousal and penetration. Our task was to visualize the anterior vaginal wall and its relationship to the clitoris during intercourse. The ultrasound was performed during coitus of a volunteer couple with the Voluson® General Electric® Sonography system (Zipf, Austria) and a 12-MHz flat probe. The woman was in a gynecologic position, and her companion penetrated her with his erected penis from a standing position. We performed a coronal section on the top of the vulva during the penetration. We focused on the size of the clitoral bodies before and after coitus. The coronal section demonstrated that the penis inflated the vagina and stretched the root of the clitoris that has consequently a very close relationship with the anterior vaginal wall. This could explain the pleasurable sensitivity of this anterior vaginal area called the G-spot. The clitoris and vagina must be seen as an anatomical and functional unit being activated by vaginal penetration during intercourse.
Article
To estimate the prevalence of self-reported sexual problems (any, desire, arousal, and orgasm), the prevalence of problems accompanied by personal distress, and to describe related correlates. The 31,581 female respondents aged 18 years and older were from 50,002 households sampled from a national research panel representative of U.S. women. Correlates of each distressing sexual problem were evaluated using multiple logistic regression techniques. The age-adjusted point prevalence of any sexual problem was 43.1% and 22.2% for sexually related personal distress (defined as a score of at least 15 on Female Sexual Distress Scale). Any distressing sexual problem (defined as reporting both a sexual problem and sexually related personal distress, Female Sexual Distress Scale score of at least 15) occurred in 12.0% of respondents and was more common in women aged 45-64 years (14.8%) than in younger (10.8%) or older (8.9%) women. Correlates of distressing sexual problems included poor self-assessed health, low education level, depression, anxiety, thyroid conditions, and urinary incontinence. The prevalence of distressing sexual problems peaked in middle-aged women and was considerably lower than the prevalence of sexual problems. This underlines the importance of assessing the prevalence of sexually related personal distress in accurately estimating the prevalence of sexual problems that may require clinical intervention. III.
Article
The glans clitoris is a target organ that is responsive to androgenic stimuli and enlarges throughout life. The size of the glans clitoris can be quantitated by determining the clitoral index (CI), which is the product of the sagittal and transverse diameters of the glans. Four hundred ten patients, ranging in age from 17 to 35 years, were examined. Ninety-five percent of 249 normal women had a CI less than 35 mm2. Of 85 patients with clitoromegaly (CI greater than 35 mm2) in addition to at least 1 other clinical sign of excess adrogenic stimulation, 53 (62%) had abnormally high values for either or both total serum testosterone and 17-ketosteroid levels. The CI is a useful bioassay for the clinical recognition of excess androgenic stimulation.
Article
In analyzing the responses of 100 predominantly white, well educated and happily married couples to a self-report questionnaire, this study examined the frequency of sexual problems experienced and the relations of those problems to sexual satisfaction. Although over 80 per cent of the couples reported that their marital and sexual relations were happy and satisfying, 40 per cent of the men reported erectile or ejaculatory dysfunction, and 63 per cent of the women reported arousal or orgasmic dysfunction. In addition, 50 per cent of the men and 77 per cent of the women reported difficulty that was not dysfunctional in nature (e.g., lack of interest or inability to relax). The number of "difficulties" reported was more strongly and consistently related to overall sexual dissatisfaction than the number of "dysfunctions."
Article
Hirsutism is usually associated with increased testosterone (T) production and metabolic clearance rates. Considerable overlap of plasma T occurs between hirsute and normal groups. Plasma levels of sex hormone-binding globulin (SHBG) and the factor T/SHBG might separate hirsute patients from normal subjects better than plasma T. A group of 39 hirsute females and 22 normal ovulatory control subjects were studied. Plasma T, androstenedione, and dehydroepiandrosterone were measured by radioimmunoassay; apparent free T (AFT) by equilibrium dialysis; and SHGBG by a method based on saturating the binding sites by labeled dihydrotestosterone. Mean levels of androgens and SHBG of the hirsute patients were significantly different from those of the normal subjects (P less than 0.01). Positive linear correlations were observed between T and AFT, T/SHBG and AFT, and T/SHBG and T; a negative correlation was observed between T/SHBG and SHBG, but no correlation was observed between SHBG and T or AFT. Thirty (77%) of the patients had elevated T/SHBG factors and 28 (72%) had suppressed SHBG levels. Only two patients (5%) had hirsutism associated with normal levels of androgens, SHBG, and T/SHBG. We conclude that SHBG and the factor T/SHBG separate the hirsute population better than any of the androgens studied.
Article
In a consecutive series of 41 hirsute women clinically classified as benign androgen excess, only 34% were found to have elevated plasma 'total' testosterone (T), 22% having subnormal sex hormone binding globulin (SHBG). When expressed as the ratio T/SHBG ('free androgen index'), 85% of the patients had values above the normal range. It is concluded that this index is more reliable than total testosterone in assessing androgen status in female patients.
Article
To describe vaginal anatomy related to sexual function in women. One hundred four women presenting for gynecologic care (mean age 55.8 years) completed questionnaires assessing sexual function and underwent measurements of vaginal caliber and length, and grading of vulvovaginal atrophy. Women who were not currently sexually active had a higher mean body mass index. Current sexual activity was not associated with differences in vaginal length or introital caliber. Among 73 sexually active women, 30 had one or both symptoms of dyspareunia and vaginal dryness, and 43 had neither symptom. Menopausal status, current use of estrogen, introital caliber, and vaginal length were not different in women with dyspareunia, vaginal dryness, or both when compared to women having neither symptom. Premenopausal women with dyspareunia, vaginal dryness, or both had significantly higher global sexual function scores, reflecting worse sexual function, when compared with premenopausal women without these symptoms (0.61 +/- 0.16 versus 0.46 +/- 0.15, respectively; P = .02); however, there was no significant difference in postmenopausal women (0.60 +/- 0.12 versus 0.61 +/- 0.12). Vaginal anatomy, measured by introital caliber, length, and vulvovaginal atrophy, does not correlate well with sexual function, particularly symptoms of dyspareunia and vaginal dryness.
Article
Few studies have investigated the prevalence of sexual dysfunction in nonclinical samples. In the present study, a standardized sexual function questionnaire was administered to 329 healthy women, aged 18-73 years, all of whom were enrolled in a Women's Wellness Center. About two-thirds of the sample were married or living with a partner, and most women were employed outside of the home. A broad range of sexual behavior frequencies were observed, with 48.5% reporting at least weekly intercourse, compared to 28.4% who were not sexually active at the time of study. Among the most common sexual problems reported were anxiety or inhibition during sexual activity (38.1%), lack of sexual pleasure (16.3%), and difficulty in achieving orgasm (15.4%). Other common problems were lack of lubrication (13.6%) and painful intercourse (11.3%), each of which was significantly more prevalent in the postmenopausal group. Despite these difficulties, 68.6% of the sample rated their overall sexual relationship as satisfactory. Age and relationship status were significant predictors of sexual satisfaction, with older women and singles reporting a higher incidence of sexual problems. Educational level, religious affiliation, and employment status were not predictive of sexual dysfunction in the present study.
Article
We used contrast enhanced magnetic resonance imaging (MRI) of the female genital organs to describe normal anatomy and differences between premenopausal and postmenopausal women. A total of 12 healthy premenopausal and 9 healthy postmenopausal women underwent MRI. A 1.5 Tesla system with phased array coils anterior and posterior to the pelvis was used to produce T1-weighted images before and after intravenous administration of MS-325 (Epix Medical, Cambridge, Massachusetts), a new gadolinium based blood pool contrast agent. Select structural dimensions were measured for reference. The clitoris and vestibular bulbs were well delineated on T1-weighted post-contrast images. The clitoral unit formed a brightly enhancing, wishbone-shaped structure lying just anterior to the inverted V of the bulbs, which surrounded the urethra and vagina. The urethral complex had a target-like appearance with layers that were discernible on T1 post-contrast images. The urethra, vagina and rectum formed a distinct complex within uniformly enhancing soft tissue. The vagina was well visualized in premenopausal subjects but without distinguishable mucosal rugae or clearly separate layers in postmenopausal subjects. Postmenopausal subjects were also observed to have smaller labia minora width, vestibular bulb width, vaginal width and wall thickness, and cervical diameter. Pelvic and genital structures were not well visualized on T1 noncontrast images. To our knowledge we describe detailed female genital anatomy for the first time using MRI with MS-325 contrast medium. The clitoris, vestibular bulbs, labia majora and minora, urethra, vagina, cervix and rectum are well visualized on T1 post-contrast images. The observed genital anatomy on MRI was consistent with descriptions in current anatomical texts. Differences in the female genitalia between premenopausal and postmenopausal women were discernible on MRI. These data are important for future studies using MRI for evaluating anatomical anomalies, postoperative changes and female sexual function.
Article
To describe variations in genital dimensions of normal women. Observational cross-sectional study. Elizabeth Garrett Anderson Hospital, University College Hospital NHS Trust, London, UK. Fifty premenopausal women having gynaecological procedures not involving the external genitalia under general anaesthetic. A cross sectional study using digital photography and measurements of the external genitalia. Clitoral size, labial length and width, colour and rugosity, vaginal length, distance from clitoris to urethral orifice, distance from posterior fourchette to anterior anal margin. A wide range of values were noted for each measurement. There was no statistically significant association with age, parity, ethnicity, hormonal use or history of sexual activity. Women vary widely in genital dimensions. This information should be made available to women when considering surgical procedures on the genitals, decisions for which must be carefully considered between surgeon and woman.
Article
The physiology and anatomy of female sexual function are poorly understood. The differences in sexual function among women may be partly attributed to anatomical factors. The purpose of this study was to use ultrasonography to evaluate the anatomical variability of the urethrovaginal space in women with and without vaginal orgasm. Twenty healthy, neurologically intact volunteers were recruited from a population of women who were a part of a previous published study. All women underwent a complete urodynamic evaluation and those with clinical and urodynamic urinary incontinence, idiopathic detrusor overactivity, or micturition disorders, as well as postmenopausal women and those with sexual dysfunction were excluded. The reported experience of vaginal orgasm was investigated. The urethrovaginal space thickness as measured by ultrasound was chosen as the indicator of urogenital anatomical variability. Designated evaluators carried out the measurements in a blinded fashion. The urethrovaginal space and distal, middle, and proximal urethrovaginal segments were thinner in women without vaginal orgasm. A direct correlation between the presence of vaginal orgasm and the thickness of urethrovaginal space was found. Women with a thicker urethrovaginal space were more likely to experience vaginal orgasm (r = 0.884; P = 0.015). A direct and significant correlation between the thickness of each urethrovaginal segment and the presence of vaginal orgasm was found, with the best correlation observed for the distal segment (r = 0.863; P < 0.0001). Interobserver agreement between the designated evaluators was excellent (r = 0.87; P < 0.001). The measurement of the space within the anterior vaginal wall by ultrasonography is a simple tool to explore anatomical variability of the human clitoris-urethrovaginal complex, also known as the G-spot, which can be correlated to the ability to experience the vaginally activated orgasm.
Article
A wide range of prevalence estimates of female sexual dysfunctions (FSD) have been reported. Compare instruments used to assess FSD to determine if differences between instruments contribute to variation in reported prevalence. Sexual Function Questionnaire combined with Female Sexual Distress Scale (SFQ-FSDS) was our gold standard, validated instrument for assessing FSD. Alternatives were SFQ alone and two sets of simple questions adapted from Laumann et al. 1994. Methods. A postal survey was administered to a random sample of 356 Australian women aged 20 to 70 years. When assessed by SFQ-FSDS, prevalence estimates (95% confidence intervals) of hypoactive sexual desire disorder, sexual arousal disorder (lubrication), orgasmic disorder, and dyspareunia were 16% (12% to 20%), 7% (5% to 11%), 8% (6% to 12%), and 1% (0.5% to 3%), respectively. Prevalence estimates varied across alternative instruments for these disorders: 32% to 58%, 16% to 32%, 16% to 33%, and 3% to 23%, respectively. Compared with SFQ-FSDS alternative instruments produced higher estimates of desire, arousal and orgasm disorders and displayed a range of sensitivities (0.25 to 1.0), specificities (0.48 to 0.99), positive predictive values (0.01 to 0.56), and negative predictive values (0.95 to 1.0) across the disorders investigated. Kappa statistics comparing SFQ-FSDS and alternative instruments ranged from 0 to 0.71 but were predominantly 0.44 or less. Changing recall from previous month to 1 month or more in the previous year produced higher estimates for all disorders investigated. Including sexual distress produced lower estimates for desire, arousal, and orgasm disorders. Prevalence estimates of FSD varied substantially across instruments. Relatively low positive predictive values and kappa statistics combined with a broad range of sensitivities and specificities indicated that different instruments identified different subgroups. Consequently, the instruments researchers choose when assessing FSD may affect prevalence estimates and risk factors they report.
The gynecology of childhood and adolescence. Philadelphia: WB Saunders
  • Huffman
24 Huffman J. The gynecology of childhood and adolescence. Philadelphia: WB Saunders; 1969:68–9.
Baring the body in the bedroom: Body image, sexual self-schemas, and sexual func-tioning among college women and men A 12-item short-form health survey: Construction of scales and preliminary tests of reliabil-ity and validity
  • Cash Tf
  • Maikkula Bs
  • Je Ware
  • M Kosinski
  • Keller
  • Sd
20 Cash TF, Maikkula BS, Yamamiya Y. Baring the body in the bedroom: Body image, sexual self-schemas, and sexual func-tioning among college women and men. Electron J Hum Sex 2004;7. 21 Ware JE, Kosinski M, Keller SD. A 12-item short-form health survey: Construction of scales and preliminary tests of reliabil-ity and validity. Med Care 1996;34:220–33.