Anatomy of the clitoris and the female sexual response

Abstract

The clitoris may be the most pivotal structure for female sexual pleasure. While its significance has been reported for hundreds of years, no complete anatomical description was available until recently. Most of the components of the clitoris are buried under the skin and connective tissues of the vulva. It comprises an external glans and hood, and an internal body, root, crura, and bulbs; its overall size is 9-11 cm. Clitoral somatic innervation is via the dorsal nerve of the clitoris, a branch of the pudendal nerve, while other neuronal networks within the structure are complex. The clitoris is the center for orgasmic response and is embryologically homologous to the male penis. While the source of vaginal eroticism might or might not be exclusively clitoral stimulation, it is necessary to understand the intricate anatomy of the organ to assess the data in this regard. Ultimately, sexual enjoyment entails a balance of physical and emotional factors and should be encouraged.

Persistent genital arousal disorder: Treatment by neurolysis of dorsal branch of pudendal nerve

“…The pudendal nerve gives off its rectal branch as it emerges from the pelvis, and then re‐enters the pelvis, traveling within the canal of Alcock, a fascial sheath derived from the obturator internus fascia. As the pudendal nerve crosses the pelvis on the surface of the obturator internus muscle, it contains its perineal branches and its dorsal branch (Balaya, Aubin, Rogez, Douard, & Delmas, ; Pauls, ; Robert, Labat, Riant, Louppe, & Hamel, ). The dorsal nerve is a sensory nerve to the clitoris; therefore neurolysis does not alter vaginal sensation (Pauls, ).…”

“…As the pudendal nerve crosses the pelvis on the surface of the obturator internus muscle, it contains its perineal branches and its dorsal branch (Balaya, Aubin, Rogez, Douard, & Delmas, ; Pauls, ; Robert, Labat, Riant, Louppe, & Hamel, ). The dorsal nerve is a sensory nerve to the clitoris; therefore neurolysis does not alter vaginal sensation (Pauls, ). The most common location of nerve entrapment observed within our cohort of patients was distal to the exit of the canal of Alcock, where the dorsal branch of the pudendal nerve exits the inferior pubic ramus canal, located where the inferior pubic ramus joins the pubic symphysis, and not at the exit of the canal of Alcock.…”

“…Nymphomaniacs may be considered sexually healthy women, who have increased desire, but lack other problematic symptoms of PGAD (Studd, ). Numerous authors have proposed that pudendal nerve entrapment may be a source of continuous arousal (Bedell et al, ; Filler, ; Pauls, ; Robert et al, ). From a historical perspective, many women suffering PGAD at that time may have been diagnosed inappropriately as a nymphomaniac (Groneman, ).…”

“…The hypothesis being tested in this study is that the underlying mechanism causing PGAD is a minimal degree of chronic compression of the dorsal branch of the pudendal nerve. This is the nerve supplying sensory innervation to the clitoris and is often referred as the dorsal nerve to the clitoris (Pauls, ). In 1980, it was reported that a minimal degree of chronic nerve compression was interpreted as a hypersensitive response to a vibratory stimulus when applied to the ulnar nerve in patients with cubital tunnel syndrome (Dellon, ).…”

Clitoral Epidermal Inclusion Cyst Resection With Intraoperative Sensory Nerve Mapping Technique

“…The perineal nerve innervates the remainder of the labia majora and minora. 7,8 Therefore, knowledge of clitoral and labial innervation can greatly aid in preoperative sensory mapping.…”