REVIEWS
REVIEWS: The Clitoral Complex: A Dynamic Sonographic Study

https://doi.org/10.1111/j.1743-6109.2009.01231.xGet rights and content

ABSTRACT

Introduction

The existence of the G-spot remains controversial partly because no appropriate structure and innervation have been clearly demonstrated in this pleasurable vaginal area. Using sonography, we wanted to visualize the movements of the clitoris and its anatomical relationship with the anterior wall of the vagina during voluntary perineal contraction and vaginal penetration without sexual stimulation.

Aim

The aim of this presentation is to provide a dynamic sonographic study of the clitoris and to describe the movements of the quiescent clitoral complex during a voluntary perineal contraction. We aim to visualize the mechanical consequences of the pressure of the anterior vaginal wall with women who claim to have a special sensitivity of the G-spot area and vaginal orgasm. Histology and immunohistochemistry of the G-spot and other female genital tissues are beyond the scope of this study and have not been discussed.

Method

The ultrasounds were performed in five healthy volunteers with the Voluson® General Electric® Sonography system (GE Healthcare, Zipf, Austria), with a 12-MHz flat probe, and with a vaginal probe. We used functional sonography of the quiescent clitoris with voluntary perineal contractions and with finger penetration without sexual stimulation.

Main Outcome Measures

We focused on the size of the clitoris (raphe, glans, and clitoral bodies) and of the length of the movements of the clitoris during voluntary perineal contractions.

Results

The coronal planes during perineal contraction and finger penetration demonstrated a close relationship between the root of the clitoris and the anterior vaginal wall.

Conclusions

We suggest that the special sensitivity of the lower anterior vaginal wall could be explained by pressure and movement of clitoris' root during a vaginal penetration and subsequent perineal contraction. The G-spot could be explained by the richly innervated clitoris. Foldes P, and Buisson O. The clitoral complex: A dynamic sonographic study. J Sex Med 2009;6:1223–1231.

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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    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)

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