American Journal of Obstetrics and Gynecology
Meeting PaperSGS PapersAnatomy, histology, and nerve density of clitoris and associated structures: clinical applications to vulvar surgery
Section snippets
Materials and Methods
Vulvar dissections and microscopic examination with nerve density assessment of the clitoris, labia, and VB were performed in unembalmed cadavers obtained from the Willed Body Program at University of Texas Southwestern Medical Center (UTSW) in Dallas. Cadavers were excluded if they had a history of gynecologic cancer or evidence of metastatic cancer to the vulva. This study was exempt from review by UTSW Medical Center Institutional Review Board in accordance with Code of Federal Regulations,
Results
A total of 22 adult female cadavers were examined grossly; 21 were of white ethnicity and 1 African American. Age was a median of 70 years (range, 48–89); body mass index was 21.5 kg/m2 (range, 13.3–34.3 kg/m2). The most common cause of death was metastatic cancer (n = 11), with breast cancer being the most common. Tissue from 5 additional cadavers (aged 52–96 years) was examined microscopically. Available medical histories and dissections revealed no evidence of prior vulvovaginal surgery or
Comment
In this cadaver study, we provide further characterization of the path and anatomic relationships of the DNC, and discuss possible clinical applications to obstetric and gynecologic procedures. As this nerve provides sensory innervation to the glans, injury may result in decreased sensation, pain syndromes, and possible sexual dysfunction. Similar to other descriptions, we found that after emerging from the PM, the DNC was consistently encased in a dense connective tissue sheath adherent to the
References (35)
- et al.
A comprehensive review of the clitoris and its role in female sexual function
Sex Med Rev
(2015) - et al.
Anatomy of the clitoris
J Urol
(2005) - et al.
Innervation and histology of the clitoral-urethal complex: a cross-sectional cadaver study
J Sex Med
(2013) - et al.
The somatic and autonomic innervation of the clitoris; preliminary evidence of sexual dysfunction after minimally invasive slings
J Sex Med
(2012) - et al.
Neuroanatomy of the human female lower urogenital tract
J Urol
(2004) - et al.
Clitoral conventions transgressions: graphic representations in anatomy texts, c1900-1991
Feminist Stud
(1995) - et al.
Williams Gynecology
(2016) Te Linde’s operative gynecology
(2015)Female reproductive system Gray’s anatomy: the anatomical basis of clinical practice
(2016)Clincally oriented anatomy
(2018)
Campbell-Walsh urology
Ridley’s the vulva
Anatomy and physiology of the clitoris, vestibular bulbs, and labia minora with a review of the female orgasm and the prevention of female sexual dysfunction
Clin Anat
Anatomy of the clitoris and the female sexual response
Clin Anat
The suspensory ligament of the clitoris: connective tissue supports of the erectile tissues of the female urogenital region
Clin Anat
Anatomic study of the clitoris and the bulbo-clitoral organ
Dorsal clitoral nerve injury following transobturator midurethral sling
J Pain Res
Cited by (30)
Surgical anatomy of the clitoris and surrounding vulvar structures
2023, American Journal of Obstetrics and GynecologyAnatomic relationships of the clitoral body, bulbs of the vestibule, and urethra
2023, American Journal of Obstetrics and Gynecology“Depth of the dorsal nerve of the clitoris: Implications for cosmetic and urogynecologic surgery.”
2022, Journal of Plastic, Reconstructive and Aesthetic SurgeryThe Suspensory Ligament of the Clitoris: A New Anatomical and Histological Description
2022, Journal of Sexual MedicineCitation Excerpt :The authors also described the macroscopic features of the ligament: the superficial component appeared fibro-adipose while the deep component was fibrous. Cross-references to clitoris supporting tissues were made in multiple studies: Poirier and Charpy in 1901,5 Zacharin in 1963,6 Bertolini in 1966,7 Milley and Nichols in 19708 and O'Connell in 19982 and finally Jackson in 2019.9 This new description of the suspensory ligament of the clitoris may give us useful new information for clitoris reconstruction surgery in female genital mutilation (FGM) and for metoidioplasty surgery.
Anatomical study of the clitoris and its implications on female genital mutilation and surgical repair
2021, Journal of Plastic, Reconstructive and Aesthetic SurgeryCitation Excerpt :The measurements of the clitoral glans, body, and crura were grossly consistent with those seen in previous results.3–5,7,8,16 Regarding dorsal nerve measurements, the study findings were consistent with those of two recent cadaveric studies by Kelling et al.7 and Jackson et al. (2019)4 . In our study, the dorsal nerve diameters were slightly smaller in proximal measurements: at the clitoral knee and at emergence from the crus.
The authors report no conflict of interest.
Cite this article as: Jackson LA, Hare AM, Carrick KS, et al. Anatomy, histology, and nerve density of the clitoris and associated structures: clinical applications to vulvar surgery. Am J Obstet Gynecol 2019;221:519.e1-10.