The Anatomy of the Clitoris

The clitoris is part of the female genitalia, homologous to the penis

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The clitoris is part of the genital anatomy of individuals assigned female at birth. It is an erectile structure, and it is homologous to the penis. That means it develops from the same structures in the embryo and has many similar properties. Like the penis, the clitoris is an erectile organ, although the erectile parts of the clitoris are located internally and are not visible to the eye. The clitoris has no function other than to serve as a site of erotic sensation.

The anatomy of the clitoris is often described inadequately, and inaccurately, by many textbooks. The deep structures of the organ have historically been overlooked. However, there has been more attention paid to the anatomy of the clitoris as researchers have engaged in a more detailed study of female sexual function.

Anatomy

Structure

The clitoris is a complex structure, of which only a small portion is visible on the exterior of the body. The visible portions of the clitoris are known as the glans clitoris and the prepuce, or clitoral hood. The glans clitoris is packed with nerves, and unlike the rest of the clitoris, it does not contain any erectile structures. Covering the glans clitoris is a a fold of skin known as the clitoral hood. Technically, the clitoral hood is not part of the clitoris, but rather a portion of the labia minora. However, some scientists include it in clitoral anatomy.

The internal structures of the clitoris include the body (corpora), crura, bulbs, and root. Most of the erectile tissues of the clitoris are found in the body, crura, and bulbs. The body of the clitoris is relatively short and made up of two paired corpora, which each divide to form two long crura. These structures are made up of erectile tissue, and the crura surround the urethra. The bulbs of the clitoris are located along the exterior surface of the vaginal wall, along the line of the labia minora. They are also composed of erectile tissue and can double in size during sexual arousal, going from 3 to 4 centimeters (cm) flaccid to 7 cm erect.

The root of the clitoris is where all of the nerves come together, from each of the erectile bodies of the clitoris. It sits at the base of the body, at the juncture of the crura. Close to the surface of the body, and containing many nerves, this area is very sensitive to stimulation. The posterior portion of the root of the clitoris is near the opening of the urethra.

The erectile function of erectile tissue is managed through blood flow, and the clitoris is well supplied with blood vessels. The body of the clitoris is covered by the tunica albuginea, which is a sheath of connective tissue.

A number of different nerves supply the clitoris. These include the dorsal nerve of the clitoris, parts of the pudendal nerve, and the cavernous nerves. Stimulation of the clitoris may assist in the process of physical arousal due to the fact that these nerves also supply the structures of the vagina.

Location

The exterior portion of clitoris is located between the legs, inside the labia, and above the openings of the urethra and the vagina. It is covered by the clitoral hood, an extension of the labia minora. The internal portions of the clitoris wrap around the urethra and extend to the vaginal vault. The clitoris is attached to the pubic symphysis, the mons pubis, and the labia by the suspensory ligaments. These ligaments keep the clitoris in its bent shape. In masculinizing genital surgery, these ligaments are released to allow the clitoris to straighten and increase in length.

Anatomical Variations

Certain differences in sexual differentiation, or intersex conditions, are characterized in part by changes to the structure of the clitoris. Specifically, conditions such as congenital adrenal hyperplasia may lead to the enlargement of the clitoris, to such an extent that it appears to be a penis. This may include the relocation of the urethral opening to somewhere on the clitoris.

Historically, surgeons have "corrected" such ambiguous genitalia. However, in recent years, there has been pushback from some intersex individuals and their families as well as many doctors and researchers. Surgical alteration of the clitoris in infancy has the potential to have a lifelong, negative impact on sexual function. Therefore, many advocates recommend postponing such surgeries until such a time when a person is old enough to decide for themselves what they wish to do. The exception is in circumstances where anatomical differences may make it difficult or impossible to urinate. That is a problem that needs to be corrected surgically.

Function

The function of the clitoris is primarily to mediate sexual arousal. It serves as a locus of pleasurable sensation during sexual contact. Stimulation of the clitoris may also directly affect blood flow to the other genital organs and, therefore, both the subjective and objective elements of arousal.

There is a substantial debate about the role of clitoral anatomy in sexual function and orgasm. Research suggests that many, but not all, individuals assigned female at birth use clitoral stimulation, at least in part, to achieve orgasm. However, the specific elements of how differences in clitoral anatomy affect arousal and orgasm are not well understood.

Associated Conditions

There are relative few conditions that directly affect the health of the clitoris.

Clitoromegaly refers to an increase in size of the clitoris. Clitoromegaly in infancy is often the result of an intersex condition, and often does not require treatment. In children, new-onset clitoromegaly is often the result of neurofibromatosis. This can be treated surgically, if needed.

In rare cases, metastatic cancer from another site can cause lesions of the clitoris. Clitoral metastases have been reported in the literature from breast cancer, cervical cancer, and vulvar cancer. However, they are very unusual.

Lichen sclerosus can also affect the function of the clitoris. This autoimmune skin condition can, in rare cases, lead to significant scarring of the genitals. For individuals so affected, the clitoris can become covered with scar tissue. This only occurs in severe cases.

Tests

It is relatively rare to need medical tests performed on the clitoris. If there are changes in the size or shape of the clitoris, a biopsy may be needed to determine what is causing them. For individuals at risk of metastatic cancer, imaging may be used as well.

The one exception is when infants are born with clitoromegaly. When an infant is born with an enlarged clitoris, doctors will often try to determine the cause of this enlargement. This may involve blood tests to check hormone levels and/or genetic tests to look for different potential intersex conditions. Understanding the cause of clitoromegaly can provide insight into an infant's likely gender identity, and affect how parents choose to raise their child.

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Article Sources

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  1. Mazloomdoost D, Pauls RN. A Comprehensive Review of the Clitoris and Its Role in Female Sexual Function. Sex Med Rev. 2015;3(4):245-263. doi: 10.1002/smrj.61

  2. Yesodharan D, Sudarsanan B, Jojo A, et al. Plexiform neurofibroma of clitoris. J Pediatr Genet. 2017;6(4):244-246. doi:10.1055/s-0037-1602789

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