madman
Super Moderator
Abstract
Background: The clitoris is the primary somatosensory organ of female sexual response. Knowledge of its neural anatomy and related landmarks is essential for safe genital surgery.
Objectives: The aim of this study was to describe the distal course of the dorsal nerves of the clitoris and associated structures.
Methods: Clitorises of 10 fresh cadavers were dissected. Measurements of the dorsal nerves, suspensory ligament, clitoral body, clitoral hood, and clitoral glans were obtained. The course of the dorsal nerves was examined. Results: The dorsal nerves of the clitoris were larger than expected, ranging from 2.0 to 3.2 mm in diameter, on average, along their course in the clitoral body. In 9 of 10 specimens, the dorsal nerves could be traced to within 6 mm of the glans. They traveled deep to a superficial clitoral fascia but superficial to the tunica albuginea, were variably located between 10 and 2 o’clock, and were separated by the deep suspensory ligament (DSL) of the clitoris. The mean length of the descending clitoral body, from the angle to the base of the glans, was 37.0 mm. The mean distance from the pubic rim to the DSL was 37.7 mm.
Conclusions: The clitoral body is substantial in length, mostly lying superficially under the clitoral hood and mons pubis. The dorsal nerves of the clitoris are large and superficial, terminating at or near the base of the clitoral glans. Knowledge of this anatomy is critical prior to performing surgery near the clitoris.
The clitoris is the primary somatosensory organ of female sexual response. Understanding clitoral anatomy and the course of the dorsal nerves of the clitoris is important to safely perform surgery on and near female genitalia (Figures 1 and 2).
The clitoris is composed of multiple parts: the vestibular bulbs, crura, body, glans, and clitoral hood (Figure 3). The clitoral hood is defined as the entire length of skin anterior to the point at which the labia minora divides into the frenulum inferiorly and free edge of the clitoral hood superiorly. It includes both a proximal segment, which functions as clitoral shaft skin and a distal, retractable free end, which functions to protect the glans. The glans is a richly innervated structure that provides the primary sensory input for female sexual arousal through the dorsal nerves of the clitoris.1
Historically, there has been a paucity of information regarding clitoral anatomy in medical textbooks and journals. Within the last 15 years, this issue has been ameliorated with a small number of focused anatomic studies of the clitoris.2-7 However, coverage in the plastic surgery literature remains lacking. Correction of this gap is important, as plastic surgeons perform a number of surgeries in the area.
Knowledge of clitoral anatomy is especially important in the field of genital cosmetic surgery, which has rapidly gained popularity over the last decade. According to the American Society for Aesthetic Plastic Surgery (ASAPS) Cosmetic Surgery National Data Bank, 26.3% of plastic surgeons currently perform female genital cosmetic procedures. Labiaplasty, the only tracked surgical procedure in the National Data Bank, has seen a 217% increase in the last 5 years, with 10,787 performed by members of the ASAPS in 2017;8 however, 66% of these surgeons only perform between 1 and 10 of these procedures each year.9 Although the number of clitoral hood reductions has not been recorded in the Cosmetic Surgery National Data Bank, it is known that this procedure is often performed in conjunction with labiaplasty.10-12
Although techniques for female genital cosmetic surgery (FGCS) have been widely reported, the dorsal nerves and their anatomic course have not been well described in the peer-reviewed plastic surgery literature. Only 3 mentions of the dorsal nerves in peer-reviewed plastic surgery journal articles on FGCS exist to date.13-15 The absence of complete knowledge of this anatomy may place the dorsal nerves at risk for injury in FGCS, leading to loss of clitoral function. Likewise, monsplasty has the potential, if unsafely performed, to injure dorsal nerves and/or the suspensory ligament of the clitoris.
*The purpose of this study was to elucidate the pertinent clitoral anatomy and its neurosensory components, which are key structures to avoid and protect while performing surgery in the area of female external genitalia.
CONCLUSIONS
The dorsal nerves of the clitoris are sizable, measuring greater than 3.5 mm proximally in their course and 2.0 mm at the point of terminal arborization at or near the glans clitoris. The descending segment of the clitoral body is a longer structure than has previously been reported, measuring 37 mm in length, most of which is superficial and just beneath the clitoral hood, which proximally is clitoral shaft skin. The dorsal nerves of the clitoris variably travel between the 10 and 2 o’clock positions on the clitoral body just superficial to the tunica albuginea. Only a thin fascial layer lies between them and the proximal segment of the clitoral hood.
Release of the superficial suspensory ligament of the clitoris during monsplasty is safe and allows the elevation of the mons, but the DSL should not be violated in order to protect the clitoris and dorsal nerves.
Background: The clitoris is the primary somatosensory organ of female sexual response. Knowledge of its neural anatomy and related landmarks is essential for safe genital surgery.
Objectives: The aim of this study was to describe the distal course of the dorsal nerves of the clitoris and associated structures.
Methods: Clitorises of 10 fresh cadavers were dissected. Measurements of the dorsal nerves, suspensory ligament, clitoral body, clitoral hood, and clitoral glans were obtained. The course of the dorsal nerves was examined. Results: The dorsal nerves of the clitoris were larger than expected, ranging from 2.0 to 3.2 mm in diameter, on average, along their course in the clitoral body. In 9 of 10 specimens, the dorsal nerves could be traced to within 6 mm of the glans. They traveled deep to a superficial clitoral fascia but superficial to the tunica albuginea, were variably located between 10 and 2 o’clock, and were separated by the deep suspensory ligament (DSL) of the clitoris. The mean length of the descending clitoral body, from the angle to the base of the glans, was 37.0 mm. The mean distance from the pubic rim to the DSL was 37.7 mm.
Conclusions: The clitoral body is substantial in length, mostly lying superficially under the clitoral hood and mons pubis. The dorsal nerves of the clitoris are large and superficial, terminating at or near the base of the clitoral glans. Knowledge of this anatomy is critical prior to performing surgery near the clitoris.
The clitoris is the primary somatosensory organ of female sexual response. Understanding clitoral anatomy and the course of the dorsal nerves of the clitoris is important to safely perform surgery on and near female genitalia (Figures 1 and 2).
The clitoris is composed of multiple parts: the vestibular bulbs, crura, body, glans, and clitoral hood (Figure 3). The clitoral hood is defined as the entire length of skin anterior to the point at which the labia minora divides into the frenulum inferiorly and free edge of the clitoral hood superiorly. It includes both a proximal segment, which functions as clitoral shaft skin and a distal, retractable free end, which functions to protect the glans. The glans is a richly innervated structure that provides the primary sensory input for female sexual arousal through the dorsal nerves of the clitoris.1
Historically, there has been a paucity of information regarding clitoral anatomy in medical textbooks and journals. Within the last 15 years, this issue has been ameliorated with a small number of focused anatomic studies of the clitoris.2-7 However, coverage in the plastic surgery literature remains lacking. Correction of this gap is important, as plastic surgeons perform a number of surgeries in the area.
Knowledge of clitoral anatomy is especially important in the field of genital cosmetic surgery, which has rapidly gained popularity over the last decade. According to the American Society for Aesthetic Plastic Surgery (ASAPS) Cosmetic Surgery National Data Bank, 26.3% of plastic surgeons currently perform female genital cosmetic procedures. Labiaplasty, the only tracked surgical procedure in the National Data Bank, has seen a 217% increase in the last 5 years, with 10,787 performed by members of the ASAPS in 2017;8 however, 66% of these surgeons only perform between 1 and 10 of these procedures each year.9 Although the number of clitoral hood reductions has not been recorded in the Cosmetic Surgery National Data Bank, it is known that this procedure is often performed in conjunction with labiaplasty.10-12
Although techniques for female genital cosmetic surgery (FGCS) have been widely reported, the dorsal nerves and their anatomic course have not been well described in the peer-reviewed plastic surgery literature. Only 3 mentions of the dorsal nerves in peer-reviewed plastic surgery journal articles on FGCS exist to date.13-15 The absence of complete knowledge of this anatomy may place the dorsal nerves at risk for injury in FGCS, leading to loss of clitoral function. Likewise, monsplasty has the potential, if unsafely performed, to injure dorsal nerves and/or the suspensory ligament of the clitoris.
*The purpose of this study was to elucidate the pertinent clitoral anatomy and its neurosensory components, which are key structures to avoid and protect while performing surgery in the area of female external genitalia.
CONCLUSIONS
The dorsal nerves of the clitoris are sizable, measuring greater than 3.5 mm proximally in their course and 2.0 mm at the point of terminal arborization at or near the glans clitoris. The descending segment of the clitoral body is a longer structure than has previously been reported, measuring 37 mm in length, most of which is superficial and just beneath the clitoral hood, which proximally is clitoral shaft skin. The dorsal nerves of the clitoris variably travel between the 10 and 2 o’clock positions on the clitoral body just superficial to the tunica albuginea. Only a thin fascial layer lies between them and the proximal segment of the clitoral hood.
Release of the superficial suspensory ligament of the clitoris during monsplasty is safe and allows the elevation of the mons, but the DSL should not be violated in order to protect the clitoris and dorsal nerves.
