Original Research—Anatomy/PhysiologyInnervation and Histology of the Clitoral–Urethal Complex: A Cross-Sectional Cadaver Study
Introduction
The clitoris plays a central role in female sexual satisfaction. Although the anatomy of the clitoris was poorly described for decades, recent literature has documented its multiplanar nature and neurovascular supply 1, 2, 3, 4. This intricate organ is comprised of a hood, glans, body, vestibular bulbs, and crus that lie in the bony pelvis in close proximity to the urethra, vagina, vulva, and surrounding musculature [5]. Such a position renders a thorough awareness of its components and location imperative for the pelvic surgeon.
Although several studies have examined the anatomy of the female human clitoris 4, 6 and its structural relationship to the urethra 3, 7, 8, 9, there are few that detail their neurological interplay 2, 10, 11. These reports are restricted to murine models [12], male cadavers, [13], and the female human fetus 1, 14. Other research endeavours have focused on magnetic resonance imaging (MRI) of the human clitoris for a detailed description of its components. Such work has compared premenopausal to postmenopausal clitoral size during arousal and evaluated functional MRI of the cerebral cortex during clitoral stimulation 15, 16, 17, 18. Nevertheless, we lack an awareness of whether there are differences in the neuronal composition of the organ along its length, depth, and various substructures. Such information would be of use in educating women regarding the pathophysiology of their complex sexual response cycle.
Thus, the purpose of this study was to characterize anatomy and histology in the central components of the adult female clitoris order to discriminate whether nerve density varies depending on clitoral location. We hypothesized that the glans would be the most densely innervated portion with high proportions of nerves in the distal mucosa in contrast to the proximal erectile tissue.
Section snippets
Materials and Methods
This was a TriHealth Institutional Review Board (IRB)-exempt, single-center descriptive study utilizing female human fresh-frozen, unembalmed cadavers. Given this study did not involve live human subjects, informed consent was not required. Regardless, the utmost care and respect was provided after the procurement of three cadavers through the body donation program at the University's School of Medicine. Identifying information, such as medical history, was confidential and therefore unknown to
Results
The average age of the fresh female cadavers was 76 years (range 58–92). Macrodissection revealed the basic clitoral components. The clitoris was located within the vulva; the glans portion protruded slightly while the body remained buried. Along the anterolateral surface of the body laid the dorsal nerve of the clitoris (DNC). The clitoral body was positioned under the symphysis pubis and supported by the clitoral suspensory ligament. Beyond this attachment, the body was separated into two
Discussion
Our study has provided histologic characterization and nerve distribution of the central clitoris, by both macroscopic and microscopic components. As anticipated, the erectile tissue was notably deeper to the surface mucosal segment in the glans location than in the CUC, where the vestibular bulbs arise. Consistent with descriptions in current textbooks, the histologic appearance of erectile segments throughout all locations remained similar, with a tunica surrounding a highly vascularized core
Conclusion
We present an anatomic description of the innervation and histologic elements of the adult human clitoris. Increased density of small nerves in the glans suggests this is the location of heightened sensation, whereas decreasing quantity of nerves in segments closer to the urethra may indicate these zones are less important for sexual sensation. Knowledge of human clitoral nerve distribution is important for understanding female sexual responses and in planning surgical correction of pelvic
Acknowledgments
Joe Chovan, Medical Illustrator, Maineville, Ohio; and Martin Molony, College Lab Manager, University of Cincinnati, Cincinnati, Ohio.
Category 1
- (a)
Conception and Design
Susan H. Oakley; Rachel N. Pauls; Steven D. Kleeman; Catrina C. Crisp; M. Victoria Estanol; George K. Mutema
- (b)
Acquisition of Data
Susan H. Oakley; George K. Mutema
- (c)
Analysis and Interpretation of Data
Susan H. Oakley; Angela N. Fellner; Rachel N. Pauls; George K. Mutema
Category 2
- (a)
Drafting the Article
Susan H. Oakley; Rachel N. Pauls
- (b)
Revising It for Intellectual Content
Susan H. Oakley; Rachel N. Pauls; George K. Mutema; Catrina C. Crisp; M. Victoria Estanol; Angela N. Fellner; Steven D. Kleeman
References (26)
- et al.
Anatomical studies of the human clitoris
J Urol
(1999) - et al.
The anatomy of the distal vagina: Toward unity
J Sex Med
(2008) - et al.
Anatomy of the clitoris
J Urol
(2005) - et al.
The clitoral complex: A dynamic sonographic study
J Sex Med
(2009) - et al.
Anatomical relationship between urethra and clitoris
J Urol
(1998) - et al.
Female sexual arousal: Genital anatomy and orgasm in intercourse
Horm Behav
(2011) - et al.
Determining the course of the dorsal nerve of the clitoris
Urology
(2008) - et al.
Division of autonomic nerves within the neurovascular bundles distally into corpora cavernosa and corpus spongiosum components: Immunohistochemical confirmation with three-dimensional reconstruction
Eur Urol
(2011) - et al.
Neuroanatomy of the human female lower urogenital tract
J Urol
(2004) - et al.
Women's clitoris, vagina, and cervix mapped on the sensory cortex: fMRI evidence
J Sex Med
(2011)
Magnetic resonance imaging anatomy of the female genitalia in premenopausal and postmenopausal women
J Urol
A prospective study examining the anatomic distribution of nerve density in the human vagina
J Sex Med
The somatic and autonomic innervation of the clitoris; preliminary evidence of sexual dysfunction after minimally invasive slings
J Sex Med
Cited by (19)
Anatomic relationships of the clitoral body, bulbs of the vestibule, and urethra
2023, American Journal of Obstetrics and GynecologyClitoral Reconstructive Surgery After Female Genital Mutilation/Cutting: Anatomy, Technical Innovations and Updates of the Initial Technique
2021, Journal of Sexual MedicineCitation Excerpt :The crura are essential for female sexual function—in fact, they are highly sensitive to direct mechanical stimulation. This can be explained by the fact that they are located on the surface of the skin and are mainly composed of erectile tissue.20 There are fewer nerves in this segment than in the glans, but there are more than in the hood or the rest of the clitoris.20
Anatomy, histology, and nerve density of clitoris and associated structures: clinical applications to vulvar surgery
2019, American Journal of Obstetrics and GynecologyCitation Excerpt :In our microscopic analysis, we did not find erectile tissue in the labia minora or glans. This finding differs from reports suggesting the presence of erectile tissue in the labia5,9 and glans4,10–12,25; however, it is in agreement with findings reported by O’Connell et al8 We found erectile tissue in the CB, crura, and VB. The erectile tissue of the crura and body were similar in density, whereas that of the VB was less dense.
Genital Gender Confirmation Surgery for Patients Assigned Female at Birth
2019, Comprehensive Care of the Transgender PatientAndrogen Receptor Polymorphism and Female Sexual Function and Desire
2018, Journal of Sexual MedicineAnatomy of the Vulva and the Female Sexual Response
2016, Obstetrics and Gynecology Clinics of North America
Conflict of Interest: Dr. Rachel N. Pauls is affiliated with research support for BioSante Inc. and Trimel; Viveve Inc. Scientific Advisory Board. The remaining authors report no disclosures.