Anatomy of the Clitoris

Department of Urology, NeuroUrology and Continence Unit, Royal Melbourne Hospital, Victoria, Australia. Helen.O'
The Journal of Urology (Impact Factor: 4.47). 11/2005; 174(4 Pt 1):1189-95. DOI: 10.1097/
Source: PubMed


We present a comprehensive account of clitoral anatomy, including its component structures, neurovascular supply, relationship to adjacent structures (the urethra, vagina and vestibular glands, and connective tissue supports), histology and immunohistochemistry. We related recent anatomical findings to the historical literature to determine when data on accurate anatomy became available.
An extensive review of the current and historical literature was done. The studies reviewed included dissection and microdissection, magnetic resonance imaging (MRI), 3-dimensional sectional anatomy reconstruction, histology and immunohistochemical studies.
The clitoris is a multiplanar structure with a broad attachment to the pubic arch and via extensive supporting tissue to the mons pubis and labia. Centrally it is attached to the urethra and vagina. Its components include the erectile bodies (paired bulbs and paired corpora, which are continuous with the crura) and the glans clitoris. The glans is a midline, densely neural, non-erectile structure that is the only external manifestation of the clitoris. All other components are composed of erectile tissue with the composition of the bulbar erectile tissue differing from that of the corpora. The clitoral and perineal neurovascular bundles are large, paired terminations of the pudendal neurovascular bundles. The clitoral neurovascular bundles ascend along the ischiopubic rami to meet each other and pass along the superior surface of the clitoral body supplying the clitoris. The neural trunks pass largely intact into the glans. These nerves are at least 2 mm in diameter even in infancy. The cavernous or autonomic neural anatomy is microscopic and difficult to define consistently. MRI complements dissection studies and clarifies the anatomy. Clitoral pharmacology and histology appears to parallel those of penile tissue, although the clinical impact is vastly different.
Typical textbook descriptions of the clitoris lack detail and include inaccuracies. It is impossible to convey clitoral anatomy in a single diagram showing only 1 plane, as is typically provided in textbooks, which reveal it as a flat structure. MRI provides a multiplanar representation of clitoral anatomy in the live state, which is a major advantage, and complements dissection materials. The work of Kobelt in the early 19th century provides a most comprehensive and accurate description of clitoral anatomy, and modern study provides objective images and few novel findings. The bulbs appear to be part of the clitoris. They are spongy in character and in continuity with the other parts of the clitoris. The distal urethra and vagina are intimately related structures, although they are not erectile in character. They form a tissue cluster with the clitoris. This cluster appears to be the locus of female sexual function and orgasm.

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    • "Insular stimulation (and resultant genital sensation) was likely omitted from Penfield's studies due to insufficient electrode penetration. Given that the greatest portion of the clitoris is internal (O'Connell et al. 2005), it may be that much of its representation is mapped to the insula. A full mapping of female viscera may further implicate the insula in somatosensa- tion. "
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    ABSTRACT: The representation of the body in the brain, the homunculus, was posited by Wilder Penfield based on his studies of patients with intractable epilepsy. While he mapped both male and female patients, Penfield reports little about the females. The now iconic illustration of the map is clearly male with testicles, penis, and no breasts. In order to bring attention to this omission and to stimulate studies of female somatosensory cortex (SS), we discuss what is known about the map of the female body in the brain, including Penfield's findings in his female patients and subsequent work by others exploring the human female SS. We reveal that there is much we do not know about how the entire female body is represented in the brain or how it might change with different reproductive life stages, hormones, and experiences. Understanding what is and is not currently known about the female SS is a first step toward fully understanding neurological and physiological sex differences, as well as producing better-informed treatments for pain conditions related to mastectomy, hysterectomy, vulvodynia, and fibromyalgia. We suggest that the time is ripe for a full mapping of the female brain with the production of a hermunculus.
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    • "The sulcus between the glans and the prepuce of the clitoris is an inconspicuous structure, which has received little attention in the literature. As even its existence was mostly ignored (Rhodin, 1974; Moore and Daley, 1996; McLean, 1999; Larsen, 2001; O'Connell et al., 2005; Wilkinson and Hardt, 2007; Standring, 2007), factual knowledge about its development and microscopic anatomy is scarce. The data suggest that, as in the male, it develops on the dorsum of the clitoris as a downgrowth of a solid epithelial lamella, which temporarily connects the prepuce to the glans and later splits into the opposed surfaces of the preputial sac lined by cornified stratified squamous epithelium (Glenister, 1956; Cold and Taylor, 1999; Van der Putte, 2005). "
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    • "Once the surgical site healed, she no longer experienced orgasm from intercourse (Bonaparte, 1933). These results do not necessarily invalidate the theoretical premise of the surgery, as the clitoral area is heavily innervated (O'Connell et al., 2005). Thus it is likely that the surgical procedure, while repositioning the clitoris closer to the vagina, may have also denervated the clitoris. "
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