0022-5347/05/1744-1189/0 Vol.

174, 1189 –1195, October 2005

THE JOURNAL OF UROLOGY® Printed in U.S.A.
Copyright © 2005 by AMERICAN UROLOGICAL ASSOCIATION DOI: 10.1097/01.ju.0000173639.38898.cd

ANATOMY OF THE CLITORIS

HELEN E. O’CONNELL,*,† KALAVAMPARA V. SANJEEVAN AND JOHN M. HUTSON
From the Department of Urology, Royal Melbourne Hospital, Victoria, Australia

ABSTRACT

Purpose: We present a comprehensive account of clitoral anatomy, including its component

structures, neurovascular supply, relationship to adjacent structures (the urethra, vagina and
vestibular glands, and connective tissue supports), histology and immunohistochemistry. We
related recent anatomical findings to the historical literature to determine when data on accurate
anatomy became available.
Materials and Methods: An extensive review of the current and historical literature was done.
The studies reviewed included dissection and microdissection, magnetic resonance imaging
(MRI), 3-dimensional sectional anatomy reconstruction, histology and immunohistochemical
studies.
Results: The clitoris is a multiplanar structure with a broad attachment to the pubic arch and
via extensive supporting tissue to the mons pubis and labia. Centrally it is attached to the
urethra and vagina. Its components include the erectile bodies (paired bulbs and paired corpora,
which are continuous with the crura) and the glans clitoris. The glans is a midline, densely
neural, nonerectile structure that is the only external manifestation of the clitoris. All other
components are composed of erectile tissue with the composition of the bulbar erectile tissue
differing from that of the corpora. The clitoral and perineal neurovascular bundles are large,
paired terminations of the pudendal neurovascular bundles. The clitoral neurovascular bundles
ascend along the ischiopubic rami to meet each other and pass along the superior surface of the
clitoral body supplying the clitoris. The neural trunks pass largely intact into the glans. These
nerves are at least 2 mm in diameter even in infancy. The cavernous or autonomic neural
anatomy is microscopic and difficult to define consistently. MRI complements dissection studies
and clarifies the anatomy. Clitoral pharmacology and histology appears to parallel those of penile
tissue, although the clinical impact is vastly different.
Conclusions: Typical textbook descriptions of the clitoris lack detail and include inaccuracies.
It is impossible to convey clitoral anatomy in a single diagram showing only 1 plane, as is
typically provided in textbooks, which reveal it as a flat structure. MRI provides a multiplanar
representation of clitoral anatomy in the live state, which is a major advantage, and complements
dissection materials. The work of Kobelt in the early 19th century provides a most comprehensive
and accurate description of clitoral anatomy, and modern study provides objective images and
few novel findings. The bulbs appear to be part of the clitoris. They are spongy in character and
in continuity with the other parts of the clitoris. The distal urethra and vagina are intimately
related structures, although they are not erectile in character. They form a tissue cluster with the
clitoris. This cluster appears to be the locus of female sexual function and orgasm.
KEY WORDS: genitalia, female; clitoris; anatomy and histology; magnetic resonance imaging; history of medicine

The anatomy of the clitoris has not been stable with time, clitoris.1 By comparison, pages are devoted to penile anat-
as would be expected. To a major extent its study has been omy. Because surgery is guided by accurate anatomy, the
dominated by social factors. A number of anatomists from the quality and validity of available anatomical description are
16th century and thereafter claimed the discovery of the relevant to urologists, gynecologists and other pelvic sur-
clitoris, including Colombo, Falloppia, Swammerdam and De geons. Accurate anatomical information about female pelvic
Graaf. Prominent anatomists, notably Galen and Vesalius, structures should be found in classics, such as Gray’s Anat-
regarded the vagina as the structure equivalent to the penis, omy,2 the Hinman urological atlas,3 sexuality texts such as
Vesalius having argued against the existence of the clitoris in the classic Master and Johnson Human Sexual Response4 or
normal women. What constituted the clitoris, what it was any standard gynecologic text. These texts should provide the
called, what characterized normal anatomy and whether surgeon with information about how to preserve the inner-
having a clitoris at all was normal were controversial issues. vation and vasculature to the clitoris and related structures
Some recent anatomy textbooks omit a description of the but detailed information is lacking in each of these sources.
The clitoris is a structure about which few diagrams and
Submitted for publication August 18, 2004. minimal description are provided, potentially impacting its
Supported by the Bruce Pearson Fellowship of the Australasian
Urology Trust and a Victor Hurley Medical grant for dissecting preservation during surgery. Specific study of anatomical
equipment. textbooks across the 20th century revealed that details from
* Correspondence: NeuroUrology and Continence Unit, Royal Mel- genital diagrams presented early in the century were subse-
bourne Hospital, Victoria 3050, Australia (telephone: ⫹61–3-93479911; quently omitted from later texts.5 These examples, particu-
FAX: ⫹61–3-93475960; e-mail: Helen.O’[email protected]).
† Financial interest and/or other relationship with Continence larly with the backdrop of the clitoris being discovered and
Control Systems International. rediscovered, indicate that the evolution of female anatomy
1189
1190 CLITORAL ANATOMY

across the 20th century occurred as a result of active deletion

rather than simple omission in the interests of brevity. In
their diagrams the feminists of the 1970s expanded clitoral
anatomy to include the bulbs and even the urethra as part of
the clitoris.6 Were there excellent and accurate accounts in
the historical literature?
The relationship between the clitoris and related struc-
tures has also been under scrutiny. In fact, a modern anat-
omy text states: “The clitoris is thus in many details a small
version of the penis, but it differs basically in being entirely
separate from the urethra.”2 Few would argue that the ure-
thra is central to our territory as urologists. Recent research
has demonstrated the integral relationship between the cli-
toris, and the distal urethra and vagina.7–9
A search using the PubMed and Ovid databases was done
from 2004 back to 1966. Each relevant article was searched
to find the original research in English, French and German,
and when there was an English abstract. We related the
findings of modern anatomical research to the historical lit-
erature with the goal of perpetually clarifying female sexual
anatomy.
In this review of clitoral anatomy we clarify 1) the consis-
tent features of the clitoris that would logically define its
component parts, 2) the relationship between the clitoris, FIG. 1. Frontal view of dissected clitoris and vulva, as seen from
urethra and vagina, 3) the anatomy of its neurovascular perineum in fresh cadaver of 57-year-old postmenopausal woman.
supply, 4) its histological structure and relevance to new n.v.b., neurovascular bundle.
drug options, 7) historical descriptions consistent with the
findings of modern anatomical study and 8) the historical
literature that helps us understand the controversy sur-
rounding something as stable and uncontroversial as human
anatomy.

MODERN STUDIES OF CLITORAL ANATOMY

Results of gross anatomical studies using dissection and

magnetic resonance imaging (MRI) in adults. In a recent
series of dissections of fresh and fixed cadaver tissue
O’Connell et al observed that the clitoris is a multiplanar
structure positioned deep to the labia minora, labial fat and
vasculature, bulbospongiosus and ischiocavernosus muscles,
inferior to the pubic arch and symphysis with a broad attach-
ment to it, and via extensive supporting tissue to the mons
pubis and labia.7, 10 The clitoris consists of a nonerectile tip,
the glans and erectile bodies (the paired bulbs, crura and
corpora) (figs. 1 and 2). The latter bodies commence proximal
as the crura and join distal as a single body that projects into
the glans, which in turn projects into the fat of the mons
pubis. As here defined, the clitoris is a highly vascular entity
with a consistent relationship to the distal urethra and va-
gina. The latter 2 structures form a midline core in an oth-
erwise pyramidal shaped structure. The apex of the pyramid FIG. 2. Lateral view of dissected clitoris in fresh cadaver of 57-
is the most superior point of the clitoral body, where it at- year-old postmenopausal woman.
taches to the under surface of the pubic symphysis by the
deep suspensory ligament. This relationship is best seen on
MRI axial section (fig. 3).8, 11 The bulbs of the clitoris form external, as distinct from the remainder of the clitoris, which
the lateral margins of the base of the pyramid. The base of is deep to the epithelium, labial fat and deep fascia of the
the pyramid extends from the ischiopubic rami on either side perineum. Because of the superficial nature of the clitoral
ventral to the anus. glans, it has previously been the subject of considerable
As the clitoral body projects from the bone into the mons study, eg variations in its size and shape have been well
pubic fat, it descends and folds back on itself in a boomerang- documented.12
like shape. This is seen well on MRI sagittal section (fig. 4). Clitoral innervation and perineal neurovascular bundles
MRI differs from dissection views, in that it reveals the true are paired terminations of the pudendal neurovascular bun-
position of the clitoris relative to the supine position, whereas dles. They arise at the pelvic side wall. The clitoral neuro-
dissections are balanced on their base, which is rotated vascular bundle ascends along the periosteum of the ischio-
greater than 90 degrees from the supine position for balance pubic ramus to meet the neurovascular bundle from the other
during dissection. side close to the midline. Where the crura unite to become the
The suspensory ligament maintains this bent position, pre- body (the body of the clitoris), the clitoral neurovascular
venting it from becoming straight, as distinct from the penis. bundles pass to the superior surface of the clitoral body. After
A detailed description of the deep and superficial suspensory some minimal branching the dorsal clitoral nerves pass
ligaments is provided by Rees et al.10 The glans is a small, largely as intact, large neural trunks into the clitoral glans.
button-like extension of the body of the clitoris. It is partly The perineal neurovascular bundle supplies the urethra and
 CLITORAL ANATOMY 1191

FIG. 3. MRI of clitoris and its components in axial plane in pre- FIG. 5. Lateral view of dissected specimen of clitoris with its neu-
menopausal nullipara. Bulbs, crura and corpora are well demon- rovascular bundle (n.v.b.) in fresh cadaver of 57-year-old postmeno-
strated. These structures lie ventral and lateral to urethra and pausal woman. Int., internal.
vagina as cluster or complex. Reprinted with permission.11

travel at the 2 and 10 o’clock positions along the anterior

vaginal wall, and then at the 5 and 7 o’clock positions along
the urethra. This study in fetuses clearly demonstrates the
cavernous nerves, highlighting the importance of further
study in adults to define the anatomy accurately to preserve
their integrity during reconstructive and ablative surgery.
Histology, immunohistochemistry and clitoral pharmacol-
ogy. The histology of each component of the clitoris was
recently presented.14 The body is surrounded by a thick
tunica albuginea. On the outer surface of the body lie
branches of the dorsal nerves and vessels. In each erectile
core of the corpora lie the deep clitoral arteries.14 Briefly, the
clitoral body has a histology similar to that of the penis. It is
composed of conjoined corpora separated by an incomplete
septum (fig. 6). The septum continues in the midline halfway
into the glans.15 The corpora are surrounded by branches of
FIG. 4. MRI of clitoris and its components in mid sagittal plane in the dorsal nerve of the clitoris, although the bulk of the nerve
premenopausal nullipara. This midline sagittal section highlights
almost boomerang-like appearance of clitoral body, crura and glans. continues intact into the glans. Baskin et al emphasized the
Reprinted with permission.11 lack of nerves at the 12 o’clock position and the fact that the
lowest nerve density in the glans is on its ventral aspect
juxtaposed to the glans septum,15 which are facts of signifi-
bulbs, and on each side passes under the pubic arch to gain cance in genital reconstruction. The glans is a densely neural
access to this area. These neurovascular bundles are large structure that is not erectile in nature but is in direct conti-
and visible to the naked eye (fig. 5). The nerves are 2 mm in nuity with the erectile bodies to which it attaches. The cav-
diameter even in infancy. The cavernous or autonomic neural ernous tissue and its surrounding tunica albuginea extend
anatomy is microscopic and difficult to define consistently. In from the clitoral body into the proximal aspect of the glans.
dissection based studies it appears to be a network of nerves The glans contains dense vascular dermis and a large num-
rather than discrete nerves, although the anatomy appears ber of sensory receptors, especially Pacini’s corpuscles, which
to vary with 1 of the 14 specimens having a discrete cavern- provide deep sensation and sense vibration. Pacini’s corpus-
ous neurovascular bundle.7 In anatomical textbooks the dor- cles are also closely related to the neurovascular bundles and
sal nerve of the clitoris is not described but is noted to be “the their branches, which surround the body.
corresponding nerve. . . very small and supplies the clitoris.”2 Previous studies have included fetal tissue, tissue derived
Thus, the impressive size of the nerves, their course or ulti- from the clitoris at the time of its excision for pathological
mate destination is not provided. The arteries and veins are study or gender reassignment, or they have focused on the
treated similarly. Dissection and MRI clearly revealed the sensory aspects of the glans rather than on erectile tis-
arteries and veins of the dorsal clitoral and perineal neuro- sue.15⫺21 The histology of the crura resembles that of the
vascular bundles, and the bifurcation of the termination of body in its type of erectile tissue but it lacks the surrounding
the pudendal neurovascular bundle. The fat saturation se- neurovascular structures and internal vasculature. The
quence provided the greatest clarity of clitoral anatomy by bulbs are composed of spongy tissue.9, 14 The cavernous tis-
demonstrating excellent contrast between the white of erec- sue of the bulbs has larger spaces and few nerves relative to
tile tissue bodies and all remaining structures, including the the corpora, while there is no tunica albuginea, giving it a
urethra and vagina, but particularly against the fat, which purple appearance macroscopically relative to the pink of the
appears black.11 Recently Yucel et al reported that the cav- corpora and crura. The greater vestibular glands lying deep
ernous nerve supplies the female urethral sphincter complex to the bulbs can be seen in histological sections between the
and clitoris.13 The branches of the cavernous nerve were bulbs and the outer aspect of the distal vaginal wall. Further
noted to join the clitoral “dorsal” nerve at the hilum of the comprehensive study of the histology of the vulval structures
clitoral bodies. These branches stain positive for neuronal is required.
nitric oxide synthase. The cavernous nerves originate from Nitric oxide synthase has been demonstrated in many
the vaginal plexus component of the pelvic plexus. They studies to be the mediator of clitoral smooth muscle relax-
1192 CLITORAL ANATOMY

Terminology and its controversies. Various terms have

been used historically to refer to the clitoris and the word was
not used in the English literature until the 17th century.28
Hippocrates used the term columella or little pillar. Avicenna
named the clitoris the albatra or virga (rod). Albucasim,
another Arabic medical authority, named it tentigo (tension).
Amoris dulcedo (sweetness of love), sedes libidinis (seat of
lust) and gadfly of Venus were terms used by Colombo.29 It
would appear that in each instance the structures included
were the body and glans of the clitoris. Magnus was one of the
most prolific writers of the Middle Ages, famous for his ob-
jective observations.30 He stressed “homologies between
male and female structures and function” by adding “a psy-
chology of sexual arousal” not found in Aristotle. Magnus
devoted “equal space to his description of the male and fe-
male—whereas in Constantine’s treatise, references to the
female are quite incidental.”31 Magnus used the word virga
as the term for the male and female genitals.
De Graaf emphasized the need to distinguish nympha from
clitoris and to avoid confusion he chose to “always give it the
FIG. 6. Low power photomicrograph through clitoral body of
name, clitoris.”32 Since his 17th century description of the
2-year-old child reveals several large neural trunks, which are clitoris, there appears to have been constant use of this label.
branches of dorsal clitoral nerve. H & E, reduced from ⫻5. Nympha later became a term specific to the labia minora but
early on it was inclusive of the clitoris, ie an anatomical
concept similar to vulva. Confusion resulted from the varied
use of the term nympha. Park discussed the implications of
ation.22⫺24 The immunoreactivity of clitoral tissue does not
the linguistic imprecision that resulted from the confusion.33
appear to differ from that of penile tissue with the latter
The Greek word ␬␭⑀␫␶␱␳␫␨ (clitoris) is possibly derived from
having been studied extensively. The pharmacology and
the Greek word ␬␭⑀␫␶␱␳␫␨⑀␫␷, which means to rub.29 However,
physiology of the clitoris and vaginal wall were recently
the same Greek word ␬␭⑀␫␶␱␳␫␨ is connected to the word hill
reviewed by Munarriz et al.24 Apomorphine induced changes
and it is translated by some as the little hill.34 It may be that
in cavernous and vaginal blood flow have been observed in a
the ancients used the term clitoris as a play on words. The
rabbit model.25 Topical application of alprostadil resulted in
linguist Cohen devoted a chapter to a discussion of the sig-
a significant increase in peak systolic and end diastolic ve-
nificance and origins of the word clitoris.35 Suffice it to say
locity, as observed using duplex ultrasound evaluation of the
that the derivation of the word appears to be unclear to this
clitoris and labia.26 Estrogen has been shown convincingly in
day.
recent years to be the primary hormone subserving the fe-
Discovery and rediscovery of the clitoris. Park provided a
male sexual response, not testosterone, although the latter
detailed discussion entitled “Rediscovery of the Clitoris.”33
also has an influence. In animal studies sildenafil promotes
In the Renaissance (1545) Estienne was the first writer to
clitoral smooth muscle relaxation, resulting in increases in
identify the clitoris in a work based on dissection.33 In the
clitoral and vaginal blood flow as well as in vaginal lubrica-
report of Estienne the clitoris was given a urinary function.
tion. Despite considerable evidence that the mediators of
Colombo claims to have rediscovered the clitoris but the
clitoral and vaginal smooth muscle are similar to those of
claim of Falloppia in his report of 1561 appears more justi-
penile tissue, about which much has been written, the clini-
fied.36 He stated, “Modern anatomists have entirely ne-
cal value of those responses appears to be substantially dif-
glected it. . . and do not say a word about it. . . and if others
ferent. There is ongoing controversy about the role of type 5
have spoken of it, know that they have taken it from me or
phosphodiesterase inhibitors in female sexual dysfunction.
my students.”36 Apparently the discovery of Falloppia caused
The reasons for this difference are beyond the scope of this
an upset in the European medical community. Colombo, the
article.
successor to Vesalius in the chair at Padua, claimed to be the
first anatomist to accurately describe the clitoris.
HISTORY OF ANATOMY OF THE CLITORIS
In the 16th century justification for clitoridectomy seems to
According to Vesalius the female form is the same as that have been tied up in the confusion related to hermaphrodit-
of the male, the difference being that each genital structure ism and the imprecision created by the word nymphae rather
is inverted.27 In his model the penis corresponded with the than clitoris. The major French surgical text of Dalechamps,
vagina and there was no role for a clitoris. At that time the which was intended to “make broadly accessible the surgical
anatomists Falloppia and Colombo described the anatomy of knowledge of medieval and, especially the ancient authori-
the clitoris. In his opposition to the idea of a clitoris Vesalius ties,” contained some noteworthy discussion about surgery on
stated, “It is unreasonable to blame others for incompetence the clitoris and the social implications of clitoral anatomy.37
on the basis of some sport of nature you have observed in Following the chapter on hermaphrodites Dalechamps wrote
some women and you can hardly ascribe this new and useless about nymphotomia. Nymphotomia was an operation to ex-
part, as if it were an organ, to healthy women. I think that cise unusually large nymphae. However, what constituted
such a structure appears in hermaphrodites who otherwise unusually large nympha was the problem. He believed that
have well formed genitals, as Paul of Aegina describes, but I this was “an unusual feature that occurred in almost all
have never once seen in any woman a penis (which Avicenna Egyptian women” as well as “some of ours, so that when they
called albaratha and the Greeks called an enlarged nympha find themselves in the company of other women or their
and classed as an illness) or even the rudiments of a tiny clothes rub them while they walk or their husbands wish to
phallus.”27 approach them, it erects like a male penis and indeed they
Presumably it was difficult for the average anatomist to use it to play with other women, as their husbands would
rebel from the stand of such powerful anatomists as Vesalius do. . . . Thus the parts are cut off as is described in Aetius [an
and Galen. Confusion about clitoral anatomy was furthered early 6th century Greek writer] and others.”37
by the lack of consensus regarding its terminology. The work of De Graaf indicates that clitoral anatomy was
 CLITORAL ANATOMY 1193
rediscovered again in the 17th century. In 1672 he wrote, detail. It is a vascular entity ”which on both sides lies under
“We are extremely surprised that some anatomists make no the corpus clitoridis and is in direct contact with the upper
more mention of this part than if it did not exist at all in the end of the bulbus vestibuli. . . ”39 Our dissections identified a
universe of nature. In every cadaver we have so far dissected double row of veins surrounding the distal urethra adjacent
we have found it quite perceptible to sight and touch.”32 The to the bulbs. Figure 7 shows the diagrams of Kobelt repre-
work by De Graaf in the 17th century seems to be the first senting the pars intermedia, which did not correspond to any
comprehensive account of clitoral anatomy. structure seen at dissection or on MRI.
Thus, for periods as long as 100 years anatomical knowl- The bulbs have been applied various names, indicating
edge of the clitoris appears to have been lost or hidden, some confusion about the composition of the clitoris. In all
presumably for cultural reasons. The work of Kobelt men- modern textbooks they are referred to as the bulbs of the
tions yet other claimants for the discovery of the clitoris.38 vestibule. Kobelt listed some names that have been given,
Kobelt39 and De Graaf.32 The 2 most influential and de- including bulbus vestibuli, plexus retiformis, reticularis of R.
tailed descriptions of clitoral anatomy have been those of De de Graaf, crura clitoridis interna of Swammerdam, plexus
Graaf32 and Kobelt,39 both of which have been translated cavernosus of Tabarranus, corpus cavernosum of Santorini,
into English. De Graaf described the bulbs, calling them bulbe du vagin of the French, semibulb of Taylor and corpus
plexus retiformis: “The constriction of the penis (by the fe- spongiosum urethra.39
male) previously mentioned is assisted in a wonderful way by Kobelt provided a comprehensive account of the muscula-
those bodies which, when the fleshy expansions arising from ture surrounding the clitoris.39 His account of the role of the
the sphincter have been removed.”32 Lowry attributed the clitoris and vagina in the female sexual response is compel-
discovery of the bulbs to De Graaf.40 The account of De Graaf ling reading.
is the only one ascribing a physiological role to the clitoral Few other comprehensive accounts of clitoral anatomy
bulbs. were identified in the historical literature. An excellent de-
Kobelt provided a clear perspective of clitoral anatomy as it scription was provided more recently.41 These descriptions
was in the 1840s.39 “In this essay, I have made it my princi- should have guided the authors of anatomical textbooks to
pal concern to show that the female possesses a structure provide accurate information but that has not been the case.
that in all its separate parts is entirely analogous to the The typical anatomical textbook description lacks detail, de-
male; I scarcely dare to expect the same sort of success as in scribes male anatomy fully and only gives the differences
my studies of the male, as all previous attempts of this between male and female anatomy rather than a full descrip-
nature have always come to naught because our knowledge tion of female anatomy.
in regard to these female structures is still full of gaps.”39 His
account of female sexual anatomy is extremely comprehen-
sive. He performed dissection, comparative anatomy and in- CONTEXT OF ANATOMICAL CONTROVERSY
jection studies, the latter to simulate sexual arousal. He
subdivided the female sexual organs into active (clitoral shaft Clitoridectomy was an operation justified for millennia in
and vagina) and passive (bulbus vestibuli, associated mus- some parts of the world. Its practice has been reviewed in
cles, pars intermedia and the glans clitoris) organs. He de- recent years.42 However, it is not long ago that it was used in
scribed the internal macroscopic structure of the glans clito- Western countries, not as a religious ritual, but rather as an
ris in an era without histology. The arterial supply to the operation to treat a range of medical disorders, including
clitoris via the 2 dorsal arteries was observed. Minimal insanity, epilepsy, catalepsy and hysteria.43 In a prizewin-
branching of the dorsal nerves of the clitoris and the thick- ning essay Sheehan reviewed the practice of clitoridectomy,
ness of the nerves as they enter the glans were noted. “Here and the rise and fall of the prominent British obstetrician
they are, even before their entrance so very thick that one who wrote the textbook advocating clitoridectomy for a myr-
scarcely imagines how such an abundance of nerve mass can iad of female maladies.44 As Sheehan observed, “The 19th
still find room between the countless blood vessels of this Century medical profession wanted it both ways: the clitoris
very tiny structure.”39 The account of Kobelt is superb, as are was so unimportant to a normal woman as to not be missed
the accompanying drawings. The details of the suspensory if removed, yet lurking in its tissue was the greatest threat to
ligaments are not as well described as those in the Poirier female welfare ever known.”44
and Charpy41 account in the subsequent literature. At his trial Brown said, “I have come to the conclusion that
A controversial structure that Kobelt emphasized, partic- the operation of clitoridectomy was a justifiable operation—
ularly after his comparative anatomical studies, is a struc- not my operation, recollect, gentlemen but an operation . . .
ture he called the pars intermedia, which he described in that has been practiced from the time of Hippocrates and has

FIG. 7. Diagrams of Kobelt.39 Lateral view of erectile structures of external organs in female (left). Blood vessels were injected, and skin
and mucous membrane were removed. a, bulbus vestibule. c, plexus of veins named pars intermedia. e, glans clitoridis. f, clitoral body. h,
dorsal vein of clitoris. l, right crus clitoridis. m, vestibule. n, right gland of Bartholin. Front view of erectile structures of external organs in
female (right). b, sphincter vaginae muscles. e, venous plexus of pars intermedia. f, glans clitoridis. g, connecting veins. k, veins passing
beneath pubes. l, obturator vein.
1194 CLITORAL ANATOMY

been mentioned by all writers since that period again and comprehensive descriptions and diagrams of the clitoris since
again.”44 the studies of Kobelt.39 The lack of anatomical detail in pelvic
A recent review of female genital mutilation stated that as surgical texts has reinforced the blinkered approach to pelvic
many as 120 million girls and women worldwide have been anatomy typical of anatomical textbooks. The description of
mutilated. The difficulties involved in abolishing this prac- Kobelt with a few modifications but aided by MRI and pho-
tice are complex and the introduction of laws to stop such tographs of dissection provide a comprehensive account of
practices typically drive the activity underground.42 The female sexual anatomy.
practice of female genital mutilation reveals in the extreme The tale of the clitoris is a parable of culture, of how the
the interaction between female genital anatomy and the pre- body is forged into a shape valuable to civilization despite
vailing sociocultural framework. and not because of itself.50
According to Kaplan, until the practical study of Masters
and Johnson in 1966, “most clinicians believed that stimula-
tion of the clitoris produced ‘clitoral’ orgasm only in infantile REFERENCES
women, ie those who were fixated at an early state of devel- 1. Sinnatamby, C. S.: Last’s Anatomy. Regional and Applied, 10th
opment and had failed to achieve genital primacy. In short, ed. Edinburgh: Churchill Livingstone, pp. 298 –314, 1999
retention of clitoral sensation was considered prima facie 2. Williams, P. L., Bannister, L. H., Berry, M. M., Collins, P.,
evidence of neurosis.”45 Clinical research by sex therapists Dyson, M., Dussek, J. E. et al: Gray’s Anatomy, 38th ed. New
and sex educators revealed that women experience orgasm York: Churchill Livingstone, 1995
through indirect or direct clitoral stimulation. The report of 3. Hinman, F.: Atlas of Urosurgical Anatomy. Philadelphia: W. B.
Hite comprehensively reviewed female sexual experience.46 Saunders Co., pp. 389 – 406, 1993
4. Masters, W. H. and Johnson, V. E.: Human Sexual Response.
This is not to say that the vagina is not key to the female
Boston: Little, Brown and Co., p. 46, 1966
sexual response. A word that considers the clitoris, distal 5. Moore, L. J. and Clarke, A. E.: Clitoral conventions transgres-
urethra and distal vagina would possibly be more useful for sions: graphic representations in anatomy texts, c1900 –1991.
the site of female sexual response. Douglass and Douglass47 Feminist Studies, 21: 255, 1995
and Sevely48 discussed the issue of appropriate terminology 6. Downer, C., Chalker, R. and Sullivan, I.: A New View of a
for the organ responsible for the female sexual response. MRI Woman’s Body. New York: Simon and Schuster, 1980
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