Anatomical Relationship Between Urethra and Clitoris

The Journal of Urology, 2005

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.

Clinical Anatomy, 2000

We aimed to define the gross anatomy of the supporting structures of the clitoris. We performed a dissection of the perineum of a series of 22 female and four male cadavers. Specific dissection of the clitoral and penile suspensory ligament complex was performed in four female and two male cadavers. Serial written observations and photography were used to document the findings. Our findings were then compared with the anatomical description of these structures in the historical and current anatomical literature. The suspensory ligament of clitoris consistently displayed two components: a superficial fibro-fatty structure extending from a broad base within the mons pubis to converge on the body of the clitoris and extending into the labia majora; in addition there is a deep component with a narrow origin on the symphysis pubis extending to the body and the bulbs of the clitoris. The supporting structures of the clitoris are more substantial and complex than previously described. Their shape, extent, and orientation are different from analogous structures of the penis, the suspensory ligament of which was found as described in the literature.

The anatomy of the clitoris is much larger than commonly believed. Besides the small tip of the clitoris known as the glans, which protrudes in the external genitalia, the crura (or legs) of the clitoris extend 9 cm inside the body, with erectile tissue adjacent to the vagina and urethra. This finding has significance for theories of female sexual responsiveness, including the differentiation of clitoral and vaginal orgasms. It also offers guidelines for preserving erotic response during pelvic surgery in women. The facts of clitoral anatomy, clarified with modern scanning procedures by surgeon Helen O'Connell and colleagues , have been repeatedly discovered, forgotten, and rediscovered, at least since 1844, when the German anatomist Kobelt made accurate drawings. Psychological reasons for why the true anatomy of the clitoris has so often been repressed or misrepresented by anatomists, psychologists, and other scientists are proposed. That most anatomists have historically been men may have led to disregard for precise charting of the clitoris that might lead to greater preservation of female sexual response. Envy by male anatomists of female sexual response may also play a role. Correct anatomical knowledge may significantly alter psychoanalytic theory and practice.

Neurology of Sexual and Bladder Disorders, 2015

International Urogynecology Journal, 2002

To reexamine the anatomy of the female urethra and related structures, three female pelves serially sectioned in sagittal, coronal or transverse planes, and four sets of transverse histological slides of female urethras, were studied. The observations were assembled, rendered as illustrations, and correlated with published works to present an overall explanation of the gross and histological anatomy of the female pelvis and perineum as related to continence. The figures accompanying the text present the anatomy in a series of views in the three anatomical planes. The anatomical relationships of the paraurethral and paravaginal tissues are examined in relation to the conflicting nomenclature applied to these structures. The figures show the spatial relationships within the pelves and perineum that explain their effective function in urinary continence.

Differentiation; research in biological diversity, 2018

The human penis and clitoris develop from the ambisexual genital tubercle. To compare and contrast the development of human penis and clitoris, we used macroscopic photography, optical projection tomography, light sheet microscopy, scanning electron microscopy, histology and immunohistochemistry. The human genital tubercle differentiates into a penis under the influence of androgens forming a tubular urethra that develops by canalization of the urethral plate to form a wide diamond-shaped urethral groove (opening zipper) whose edges (urethral folds) fuse in the midline (closing zipper). In contrast, in females, without the influence of androgens, the vestibular plate (homologue of the urethral plate) undergoes canalization to form a wide vestibular groove whose edges (vestibular folds) remain unfused, ultimately forming the labia minora defining the vaginal vestibule. The neurovascular anatomy is similar in both the developing human penis and clitoris and is the key to successful su...

Journal of Sexual Medicine, 2008

Factual presentations of sexual anatomy are required for educational purposes, for clinical and more general communication about sexual matters. To date, unambiguous, accurate and objective images with appropriate labeling to enhance specificity in communication have been lacking. Aim. The aim of this presentation is to provide a comprehensive overview of anatomy of the distal vagina. We aim to simplify the anatomy to reduce the confusion of historical descriptions. In doing so, we aim to avoid sacrificing any of the specific detail. This would aid communication between clinicians, researchers, and the nonclinician regarding this anatomy. Outcome Measures and Methods. This article reviews the historical and current anatomical literature. Systematic dissection and photography, histological study, and magnetic resonance imaging have been used as the basis for this presentation. Digital technology has been used to label, color, and highlight photography to provide clarity and permit diagramatization of photography. No distortion has otherwise been used in presenting images from cadavers or anatomical research. Results. The anatomy of the distal vagina and surrounding structures is shown and described in detailed. The distal vagina, clitoris, and urethra form an integrated entity covered superficially by the vulval skin and its epithelial features. These parts have a shared vasculature and nerve supply and during sexual stimulation respond as a unit though the responses are not uniform. Conclusions. Significant progress has been made in the field of female sexual anatomy and its pictorial representation. This may facilitate further progress in the related fields of female sexual health and education. O'Connell HE, Eizenberg N, Rahman M, and Cleeve J. The anatomy of the distal vagina: Towards unity. J Sex Med 2008;5:1883-1891.

2003

It has been demonstrated only recently, using gross anatomy techniques, that the clitoris consists of an erectile tissue complex surrounding the

The Journal of Sexual Medicine, 2010

The existence of the G-spot is controversial. Aim. To evaluate, by the use of three-dimensional (3-D) ultrasonography, the anatomic structures of the urethrovaginal space. Methods. Nineteen (Group I) eumenorrheic young women who experienced, and 20 (Group II) who did not experience a vaginal orgasm underwent two-dimensional (2-D) and 3-D ultrasonography and color Doppler analysis of the urethrovaginal space and of the clitoris during the early follicular phase of the menstrual cycle. Main Outcome Measures. 2-D ultrasonographic evaluation of the urethrovaginal space, and color Doppler evaluation of the urethrovaginal main feeding artery and dorsal clitoral arteries; 3-D volume calculation of the urethrovaginal space, and 3-D power Doppler analysis of vascular indices of the urethrovaginal space and clitoral body (vascularization index, flow index, vascularization flow index); hormonal evaluation. Results. The 3-D reconstruction of the urethrovaginal space demonstrated a gland-like aspect with small feeding vessels. The total length (19.1 Ϯ 2.7 mm vs. 17.5 Ϯ 2.1 mm; P = 0.047), measured with 2-D ultrasound, and the 3-D mean volume (0.59 Ϯ 0.13 mL vs. 0.26 Ϯ 0.07 mL; P < 0.001) of the structures contained in the urethrovaginal space were significantly higher in Group I than in Group II. The mean time since the last intercourse was 31 Ϯ 9 hours in Group I and 18 Ϯ 3 hours (P = 0.033) in Group II. The urethrovaginal space vascularization, the clitoral volume and vascularization, and the circulating hormonal values did not significantly differ among the two groups. The mean volume of the structures contained in the urethrovaginal space was correlated with time since intercourse (r = 0.685; P = 0.021) and with serum testosterone (r = 0.637; P = 0.032) and androstenedione (r = 0.744; P = 0.011). Conclusions. The structures we observed in the urethrovaginal space have a gland-like aspect and their volume is correlated with both serum androgen concentrations and time since intercourse. Battaglia C, Nappi RE, Mancini F, Alvisi S, Forno S, Battaglia B, and Venturoli S. 3-D volumetric and vascular analysis of the urethrovaginal space in young women with or without vaginal orgasm.

Journal of Sexual Medicine, 2009

A decline in sexual activity has been reported as women age. Aim. To compare, in young adult and middle-aged women, the clitoral volumetric and vascular modifications during the periovulatory phase of the menstrual cycle, and to analyze their relationship with circulating hormones, nitric oxide levels, and with questionnaires on sexuality, relationship, and depression. Methods. Fifteen young (18-25 years; Group I), and 16 middle-aged (35-45 years; Group II) eumenorrheic women were submitted, on day 14 of their menstrual cycle, to utero-ovarian and clitoral ultrasonographic analysis, and to color Doppler evaluation of the uterine and dorsal clitoral arteries. On the same day, hormonal parameters and plasma concentrations of nitrites/nitrates were assayed, and the two-factor Italian McCoy female questionnaire and the Beck's Depression Inventory questionnaire were administered. Main Outcomes Measures. Utero-ovarian and clitoral ultrasonographic analysis, color Doppler evaluation of the uterine and dorsal clitoral arteries; evaluation of hormonal and nitrites/nitrates plasma concentrations; administration of the two-factor Italian McCoy Female Sexuality Questionnaire and the Beck's Depression Inventory questionnaire. Results. The plasma levels of estradiol, testosterone, sex hormone binding globulin, and nitrites/nitrates were similar in both groups. Neither the ultrasonographic assessment of the clitoral body volume (0.82 Ϯ 0.24 mL vs. 0.73 Ϯ 0.26 mL) nor the Doppler analysis of the dorsal clitoral artery [pulsatility index (PI) = 1.35 Ϯ 0.31 vs. PI = 1.36 Ϯ 0.19] evidenced any significant differences in either Group I or Group II. The two-factor Italian McCoy Female Sexuality Questionnaire and the Beck Depression Inventory questionnaire gave the same results in Group I and Group II. The relationship between the different parameters evidenced that the NO2-/NO3-circulating levels are inversely correlated with uterine artery (r = -0.4611; P = 0.008) and dorsal clitoral artery (r = -0.331; P = 0.041) PIs. Furthermore, estradiol resulted inversely correlated with depression (r = -0.332; P = 0.045). The two sections (sexuality and partnership) of Italian McCoy Female Sexuality Questionnaire were positively correlated (r = 0.849; P < 0.0001) between each other. Conclusions. In eumenorrheic young adult and middle-aged women, the periovulatory clitoral anatomic and vascular modifications similarly occur. Battaglia C, Nappi RE, Cianciosi A, Busacchi P, Sisti G, Paradisi R, and Venturoli S. Periovulatory morphometric and vascular modifications of the clitoris in young adult and middle-aged women. A pilot study. J Sex Med 2009;6:2707-2714.