REVIEWSREVIEWS: The Clitoral Complex: A Dynamic Sonographic Study
Introduction
The G-spot's role in vaginal orgasm [1] remains controversial: Is it a gynecological myth [2], a mystery, an anatomical or functional structure? The variability among thought-leaders makes research difficult 3, 4. Gravina et al. noticed that “physical difference should be taken into account as a source of physiological variability in female sexual response”[5]. Alternatively, each healthy woman has what O'Connell et al. have recommended calling: the “clitoral complex,” analogous to the penis in men [6]. Why then do some women have difficulties achieving vaginal orgasm if every woman supposedly had an equivalent of a penis? They should in theory be able to have an orgasm. Gravina et al. found an interesting sonographic finding: women who have vaginal orgasm have a thicker urethrovaginal space than those who do not [5]. But is this thicker space really a cause of the vaginal orgasm? Or is it an effect of the training of the perineal muscles so strongly involved in this type of orgasm?
Using a sonographic examination of the quiescent clitoris rather than magnetic resonance imaging (MRI) 6, 7 we used functional imaging to explore the topic in greater depth. Our purpose was to demonstrate that all the components of the clitoris move under a perineal contraction. We also aimed to demonstrate that vaginal penetration and a reflex perineal contraction tightly narrow the distance between the root of the clitoris (internal clitoris) and the distal anterior vaginal wall. From a mechanical point of view, if the root of the clitoris is related to the anterior vaginal wall, why would it not play a part in vaginal pleasure? Histology and immunohistochemistry of the G-spot and other female genital tissue are beyond the scope of this study and have not been discussed.
Section snippets
Methods
Five healthy, normal, 34-year-old women agreed to participate in this study. The women were heterosexual and sexually active. They had no history of gynecological diseases or surgery, and no medical condition that might alter sexual function. None used contraception or medication of any kind. They had no history of alcohol or drug abuse. No previous urodynamic and neurological evaluation had been undertaken. The sonographic examinations were performed from day 4 to day 12 of the menstrual cycle
Results
Information was collected with a sonographic examination of the clitoris [10]. The coronal plane was the most informative 7, 10. It was obtained by tilting the vaginal probe to the front of the clitoris, revealing the clitoris root. The clitoris roots are made of two clitoral bodies and two bulbs below them (Figure 1A–C). A four-dimensional (4-D) reconstruction permits a surfacing of the clitoris and displays very well the double vault of the clitoris (Figure 1D). Without stimulation, it was
Discussion
Ultrasound (2-D and 4-D) is a very useful, but highly underestimated, tool to conduct dynamic images study of the female genitalia. Ultrasound demonstrated that under a perineal contraction, the five components of the clitoris (glans, raphe, bodies, crura, and bulb) move in a certain way. The clitoris is not an inert organ: the vault of the clitoris is descending, the body/glans angle and the angle of the double vault decrease, the raphe pushes the glans anteriorly and downward. The vaginal
Conclusions
The pleasurable area called the “G-spot” could be caused by contact of the internal clitoris and the anterior vaginal wall. The proximity of the contact could be enhanced by reflex perineal contractions and vasomotors events, which occur in the case of erotic stimulation. The position of the richly innervated clitoris could explain the special sensitivity of this area. It may partially solve the mystery of the innervation of the G-spot.
Category 1
- (a)
Conception and Design
Pierre Foldes; Odile Buisson
- (b)
Acquisition of Data
Odile Buisson
- (c)
Analysis and Interpretation of Data
Pierre Foldes; Odile Buisson
Category 2
- (a)
Drafting the Article
Odile Buisson
- (b)
Revising It for Intellectual Content
Pierre Foldes; Odile Buisson
Category 3
- (a)
Final Approval of the Completed Article
Pierre Foldes; Odile Buisson
Acknowledgments
We are grateful for the free assistance of Laurent Buffo, http://laurent.buffo.free.fr, and “the communauté périnatale de Poissy.”
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Anatomical study of the clitoris and its implications on female genital mutilation and surgical repair
2021, Journal of Plastic, Reconstructive and Aesthetic SurgeryG-spot: Fact or Fiction?: A Systematic Review
2021, Sexual MedicineCitation Excerpt :In 3 studies a close relationship between the root of the clitoris and the anterior vaginal wall during perineal contraction and/or vaginal penetration and/or stimulation was described. In one of the studies, the authors assumed the root of the clitoris to be the G-spot34; Buisson et al. assumed the G-spot was the “clitourethtovaginal complex.”12,13 The descent of these structures had previously been described by Foldes et al.31 (Table 2)