The Suspensory Ligament of the Clitoris: A New Anatomical and Histological Description

Abstract

Background The importance of the clitoris as an organ has been neglected by doctors and anatomists over the centuries. Its central role in female sexuality is widely recognized and respected. Although multiple studies have been conducted on the fundiform ligament of the penis, the literature concerning the suspensory ligament of the clitoris is extremely poor. The possibility to describe its complex structure may help us understand female orgasm and sexuality. Aim Carrying out an anatomical and histological study about the supporting ligaments of the clitoris and in particular the suspensory ligament of the clitoris. Study Design A total of 10 female cadavers were dissected specifically for this study. All the supporting structures of the clitoris were studied, photographed and measured. A histological study of these structures was also carried out. Results The suspensory ligament of the clitoris is a multidimensional structure consisting of three anatomically and histologically distinct components. The superficial layer originates from the anterior abdominal wall, it is the anatomical extension of the fascia superficialis of the abdomen. It mainly consists of loosely organized elastic fibers, fibroblasts and few loosely organized collagen fibers. The intermediate component also originates from the anterior abdominal wall through the extensions of the abdominal aponeurosis that reach the body of the clitoris. It completely encloses the clitoral body and sends lateral extensions to the labia majora. Histologically, this layer mainly consists of well-organized collagen fibers as well as fibroblasts. The deep component is shorter and extends from the pubic symphysis to the knee of the clitoris and also connects the two crus to the pubic symphysis. It almost exclusively consists of very well organized collagen fibers. Conclusion The suspensory ligament of the clitoris is a multidimensional structure that extends from the anterior abdominal wall to the clitoris. Unlike previous descriptions of the ligament supporting the clitoris, we observed that this structure consists of three anatomically and histologically distinct layers. These new anatomical considerations must be taken into account for any surgery affecting the subcutaneous tissues of the pubis and the abdomen as well as for reconstructive surgery of the clitoris and metoidioplasty.

Beyond the tip of the iceberg: A meta‐analysis of the anatomy of the clitoris

“…The body/corpora is shaped like a boomerang as it folds back on itself, meaning that it has an ascending and descending segment. The apex (most superior part of the body) is anchored to the pubic symphysis via the three‐layered suspensory ligament, that maintains the ‘bent’ position (Botter et al, 2022). The body is composed of two corpora cavernosa, separated by an incomplete septum.…”

“…The perceived lack of clinical importance of the clitoris has led to a lack of medical and scientific interest, especially when compared to its male counterpart, the penis (O'Connell et al, 2005). However, an understanding of the anatomy of the clitoris should be essential for surgeons performing vulvar procedures, including, but not limited to, gender affirmation surgeries (Zurada et al, 2018), urinary incontinence procedures, pelvic organ prolapse reconstructive surgeries (Azar et al, 2008), episiotomies (Muhleman et al, 2017), hysterectomies (Castiglione et al, 2015), vulvar cancer surgeries (Giannini et al, 2022), genital reconstruction for congenital adrenal hyperplasia (Almasri et al, 2018), repair following clitoral piercings (Dalke et al, 2013), cosmetic surgeries (Motzko et al, 2021), and reconstructive surgery following female genital mutilation (Botter et al, 2022).…”

“…suspensory ligament, that maintains the 'bent' position (Botter et al, 2022). The body is composed of two corpora cavernosa, separated by an incomplete septum.…”