By Cambria Oetken, DPT, PHRC Westlake Village
The Clitoris. We Found it!
There is conflicting evidence as to when the clitoris was exactly discovered and studied. It is thought to date back to 400 BC when Hippocrates described the clitoris as a protrusion which functioned to protect the vagina. There was a later time when anatomists denied its existence altogether. With religious and cultural influences, the clitoris was either disregarded or demonized and in the middle ages, it was even known as “the devil’s teat.” A procedure called a cliteroidectomy (removal of the clitoris) was even a commonly utilized medical practice to treat “hysteria.” With a confusing and lack of understanding about its history, it was only until recently in 2005 that O’Connell, Sanjeevan, and Hutson published in The Journal of Urology recognition of this organ of female sexual pleasure as a three dimensional organ through cross sectional imaging. We now know that the clitoris is more than what is seen on the surface composed of the internal paired clitoral bulbs, corporal bodies, and crura which is composed of erectile tissue. It was not until 2022 however that it was determined the clitoris is composed of 10,000+ nerve fibers which has been discussed as more than a human penis contains. Sounds pretty sensitive and important right??
Stop Ignoring the Clitoris
Historically, and currently, there is a lack of research in regards to the clitoris while the penis has been a counterpoint of research for centuries. Within this new era, the clitoris is becoming more recognized, understood and appreciated for its complexity and sensitivity as well as its importance in female sexual wellness. Luckily, there are prominent medical providers who are bringing more attention to this organ and to women’s sexual wellness as a whole. In a recent New York Times article, written by Rachel E. Gross, she interviews Dr. Rachel Rubin, a urologist and sexual medicine expert, who has been a pioneer in driving attention to women’s sexual health. Dr. Rubin is breaking down barriers around the context of the vulva and the clitoris being “private and shameful” parts thus further empowering the lives of women worldwide. In this article, Dr. Rubin states how the clitoris is “completely ignored by pretty much everyone,” and that “there is no medical community that has taken ownership in the research, in the management, and in the diagnosis of vulva-related conditions.”
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The article recognizes how there is little to no education about the clitoris in medical school and how women’s health and sexual health as a whole is not a focus for women at all. In fact, in many surgeries such as pelvic mesh surgeries, urethral surgeries even minimally invasive hip surgeries put this organ, its several nerve endings and supporting pelvic nerves at severe risk however is not protected by providers due to its historical lack of relevance, understanding and underlying anatomy.
Women’s lives can be severely impacted by damage to this important structure just as a male would be should there be damage to their counterpart. We now know that sexual wellness is a major part of health both mentally, emotionally and physically and thus should be treated with such importance as any other organ in the body.
Now for a quick anatomy lesson…
The clitoris is composed of more than just what we see as a knob on the external surface. What you see externally is the conveniently placed glans towards the top of the vulva with the clitoral hood draping over it. Think of this as the “tip of the ice berg” because beneath the surface are the much larger paired clitoral bulbs, corporal bodies, and crura, which are all composed of erectile tissue (as pictured below). Similarly these same structures can be identified in the male counterpart of the penis.
Men who are uncircumcised retract their foreskin to clean underneath. All people with a clitoris should carefully do the same, let us explain!
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Caring for and finding your clitoris
If you are having symptoms at the clitoris, such as pain, decreased arousal, decreased orgasm, absent orgasm, or additional arousal conditions such as persistent genital arousal disorder(PGAD)/genito-pelvic dysesthesia (GPD) it is important to share these concerns with your provider.
At Home Self-Exams
However, performing a self exam at home and becoming familiar with your anatomy can be a great start. Regular self exams can be helpful by using a mirror or by palpating the structures. Oftentimes there can be clitoral hood adhesions, vulvar dermatological concerns, smegma and keratin pearls around the clitoris that could be problematic. To examine your vulvar tissue, begin by laying back with a mirror in order to see the tissues appropriately. Begin by finding the clitoral hood or clitoris at the top of the vulva closest to your pubic bone. You can retract the clitoral hood with two fingers to expose the glans of the clitoris. The clitoral hood should move fairly easily and fully expose the clitoral head. If the clitoral hood does not move optimally or does not expose the glans there could be limited mobility or adhesions present. Also be aware of any smegma or discharge under the hood that could be building up.
A helpful strategy to potentially help with clitoral hood mobility and reduce buildup of discharge is by retracting the clitoral hood in the shower and letting warm water run over the area. Ensure you are avoiding harsh soaps or additional washes to this area to avoid irritation of the tissue. Again, it is always important to speak with your provider or a sexual medicine expert to address these issues.
Multiple pathologies such as pelvic floor dysfunction, pudendal neuralgia, PGAD, and vulvar dermatoses can lead to changes in sexual pleasure and can cause pain. Stay tuned to our blog for more in depth articles, if you have questions we are here to help and please reach out to us!
References
Half the World Has a Clitoris. Why Don’t Doctors Study It?
Human Clitoris Has Over 10,000 Nerve Fibers | Oregon Health & Science University (ohsu.edu). SexualDiversity.org
Maria Uloko, Paige Isabey, Blair Peters. How many nerve fibers innervate the human clitoris? A histomorphometric evaluation of the dorsal nerve of the clitoris, abstract was presented by Blair Peters, on Oct. 27, 2022, at the 23rd annual joint scientific meeting of Sexual Medicine Society of North America and International Society for Sexual Medicine.
Uloko M, Isabey EP, Peters BR. How many nerve fibers innervate the human glans clitoris: a histomorphometric evaluation of the dorsal nerve of the clitoris. J Sex Med. 2023 Feb 27;20(3):247-252. doi: 10.1093/jsxmed/qdac027. PMID: 36763957
Resources
Clitoral Pain: Unmasking Common Culprits
Clitoral Pain: Causes and Treatment
Why Your Clitoris Is In Pain [Youtube Video]
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tags: clitoral stimulation, clitoral hood, labia minora, glans clitoris, sexual arousal, nerve endings, female genital anatomy, female sexual function, female sexual response,