1
|
Longhurst GJ, Beni R, Jeong SR, Pianta M, Soper AL, Leitch P, De Witte G, Fisher L. Beyond the tip of the iceberg: A meta-analysis of the anatomy of the clitoris. Clin Anat 2024; 37:233-252. [PMID: 37775965 DOI: 10.1002/ca.24113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 07/04/2023] [Accepted: 08/20/2023] [Indexed: 10/01/2023]
Abstract
An understanding of ranges in clitoral anatomy is important for clinicians caring for patients including those who have had female genital mutilation, women seeking genital cosmetic surgery, or trans women seeking reconstructive surgery. The aim of this meta-analysis is to investigate the ranges in clitoral measurements within the literature. A meta-analysis was performed on Ovid Medline and Embase databases following the PRISMA protocol. Measurements of clitoral structures from magnetic imaging resonance, ultrasound, cadaveric, and living women were extracted and analyzed. Twenty-one studies met the inclusion criteria. The range in addition to the average length and width of the glans (6.40 mm; 5.14 mm), body (25.46 mm; 9.00 mm), crura (52.41 mm; 8.71 mm), bulb (52.00 mm; 10.33 mm), and prepuce (23.19 mm) was calculated. Furthermore, the range and average distance from the clitoris to the external urethral meatus (22.27 mm), vagina (43.14 mm), and anus (76.30 mm) was documented. All erectile and non-erectile structures of the clitoris present with substantial range. It is imperative to expand the literature on clitoral measurements and disseminate the new results to healthcare professionals and the public to reduce the sense of inadequacy and the chances of iatrogenic damage during surgery.
Collapse
Affiliation(s)
| | - Rebecca Beni
- Department of Anatomical Sciences, St George's University of London, London, UK
| | - Su Ryeon Jeong
- Department of Anatomical Sciences, St George's University of London, London, UK
| | - Marina Pianta
- Department of Anatomical Sciences, St George's University of London, London, UK
| | - Annie Louisa Soper
- Department of Anatomical Sciences, St George's University of London, London, UK
| | - Patricia Leitch
- Department of Anatomical Sciences, St George's University of London, London, UK
| | - Gabrielle De Witte
- Department of Anatomical Sciences, St George's University of London, London, UK
| | - Lauren Fisher
- Department of Anatomical Sciences, St George's University of London, London, UK
| |
Collapse
|
2
|
Orozco-Poore C, Keuroghlian AS. Neurological Considerations for "Nerve-Sparing" Cosmetic Genital Surgeries Performed on Children with XX Chromosomes Diagnosed with 21-Hydroxylase Congenital Adrenal Hyperplasia and Clitoromegaly. LGBT Health 2023; 10:567-575. [PMID: 37319358 DOI: 10.1089/lgbt.2022.0160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/17/2023] Open
Abstract
Congenital adrenal hyperplasia (CAH) is most often caused by adrenal deficiency of 21-hydroxylase (21-OH). The resulting increase in androgens can cause clitoromegaly in fetuses with XX chromosomes. 21-OH CAH is the most common reason for cosmetic clitoroplasty in childhood. "Nerve-sparing" (NS) clitoral reduction surgeries are described as offering optimal cosmesis, while sparing sensation and nerve function. The methods used to demonstrate NS surgery efficacy, however, such as electromyography and optical coherence tomography, do not evaluate the small-fiber axons that comprise the majority of axons in the clitoris and that transduce sexual pleasure. Although some data show sparing of a portion of the main dorsal nerve trunk of the clitoris, the overall neurobiological consequences of elective clitoral reductions have received little attention. NS surgeries remove dorsal nerve branches that transduce sexual sensation, as well as the corpora cavernosa and cavernous nerve, which provide clitoral autonomic function. While most outcome studies focus on surgeons' perceptions of cosmetic results, studies that assess small-fiber function indicate significant nervous system and sexual impairment. Studies assessing children's clitoral function after surgery with vibrational testing have been ethically condemned. Decades of advocacy against medically unnecessary childhood genital surgeries have highlighted the subsequent physical and psychological harm. Recent studies with CAH patients indicate gender diversity and a lower prevalence of female gender identification than is often cited to justify feminizing surgery. The most effective and ethical NS technique for CAH may be acceptance of gender, sexual, and genital diversity as the infant develops into childhood, adolescence, and adulthood.
Collapse
Affiliation(s)
- Casey Orozco-Poore
- Department of Medical Education, Harvard Medical School, Boston, Massachusetts, USA
| | - Alex S Keuroghlian
- Department of Psychiatry, Massachusetts General Hospital/Harvard Medical School, Boston, Massachusetts, USA
- The National LGBTQIA+ Health Education Center at The Fenway Institute, Boston, Massachusetts, USA
| |
Collapse
|
3
|
Peragine DE, Kim JJ, Maxwell JA, Skorska MN, Impett EA, Cunningham WA, VanderLaan DP. Not Who You Are, But Who You Are With: Re-examining Women's Less Satisfying Sexual Debuts. ARCHIVES OF SEXUAL BEHAVIOR 2023; 52:3405-3427. [PMID: 37697094 DOI: 10.1007/s10508-023-02667-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Revised: 07/15/2023] [Accepted: 07/15/2023] [Indexed: 09/13/2023]
Abstract
Gender differences in appraisals of first intercourse are among the largest in sexuality research, with women indicating less satisfying "sexual debuts" than men. Dispositional or "actor-level" explanations for this gender gap are pervasive, yet research has largely examined heterosexual debuts in which actor gender and partner gender are confounded. We assessed whether women's less satisfying sexual debuts are better explained by actor gender or partner gender, comparing experiences of women who debuted with men (WDM) with those of men and women who debuted with women (MDW, WDW). Retrospective accounts of sexual debut were collected from 3033 adults. At first intercourse, we found that WDW had equal physical and emotional satisfaction to MDW, and more satisfaction than WDM, suggesting satisfaction gaps owing to partner gender, not actor gender. This pattern did not extend to a comparison event (first masturbation), where WDW and WDM had similar satisfaction, but less satisfaction than MDW, suggesting an actor gender gap. To identify sources of satisfaction gaps, we probed for corresponding differences in the circumstances of sexual debut. Sexual circumstances were more strongly implicated than nonsexual ones, with relative deprivation of glans stimulation explaining relative dissatisfaction at first intercourse, but not first masturbation, and orgasm explaining it at both. Findings challenge the view that the satisfaction gap at first intercourse reflects an inherent difference between genders. Indeed, they demonstrate similarities when partner gender does not differ and suggest strategies for ensuring equal sexual satisfaction-and equal sexual rights realization-at (hetero) sexual debut.
Collapse
Affiliation(s)
- Diana E Peragine
- Department of Psychology, University of Toronto Mississauga, 3359 Mississauga Road North, Mississauga, ON, L5L 1C6, Canada.
| | - James J Kim
- Department of Psychology, Western University, London, ON, Canada
| | | | - Malvina N Skorska
- Child and Youth Psychiatry, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Emily A Impett
- Department of Psychology, University of Toronto Mississauga, 3359 Mississauga Road North, Mississauga, ON, L5L 1C6, Canada
| | | | - Doug P VanderLaan
- Department of Psychology, University of Toronto Mississauga, 3359 Mississauga Road North, Mississauga, ON, L5L 1C6, Canada
- Child and Youth Psychiatry, Centre for Addiction and Mental Health, Toronto, ON, Canada
| |
Collapse
|
4
|
Jordal M, Påfs J, Wahlberg A, Johansen REB. "Damaged genitals"-Cut women's perceptions of the effect of female genital cutting on sexual function. A qualitative study from Sweden. FRONTIERS IN SOCIOLOGY 2022; 7:943949. [PMID: 36033981 PMCID: PMC9413146 DOI: 10.3389/fsoc.2022.943949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Accepted: 07/18/2022] [Indexed: 06/15/2023]
Abstract
Female genital cutting (FGC) is a traditional practice, commonly underpinned by cultural values regarding female sexuality, that involves the cutting of women's external genitalia, often entailing the removal of clitoral tissue and/or closing the vaginal orifice. As control of female sexual libido is a common rationale for FGC, international concern has been raised regarding its potential negative effect on female sexuality. Most studies attempting to measure the impact of FGC on women's sexual function are quantitative and employ predefined questionnaires such as the Female Sexual Function Index (FSFI). However, these have not been validated for cut women, or for all FGC-practicing countries or communities; nor do they capture cut women's perceptions and experiences of their sexuality. We propose that the subjective nature of sexuality calls for a qualitative approach in which cut women's own voices and reflections are investigated. In this paper, we seek to unravel how FGC-affected women themselves reflect upon and perceive the possible connection between FGC and their sexual function and intimate relationships. The study has a qualitative design and is based on 44 individual interviews with 25 women seeking clitoral reconstruction in Sweden. Its findings demonstrate that the women largely perceived the physical aspects of FGC, including the removal of clitoral tissue, to affect women's (including their own) sexual function negatively. They also recognized the psychological aspects of FGC as further challenging their sex lives and intimate relationships. The women desired acknowledgment of the physical consequences of FGC and of their sexual difficulties as "real" and not merely "psychological blocks".
Collapse
Affiliation(s)
- Malin Jordal
- Department of Caring Sciences, University of Gävle, Gävle, Sweden
| | - Jessica Påfs
- Department of Social Work, University of Gothenburg, Gothenburg, Sweden
| | - Anna Wahlberg
- Department of Women's and Children's Health, Akademiska Sjukhuset, Uppsala University, Uppsala, Sweden
| | - R. Elise B. Johansen
- Norwegian Centre for Violence and Traumatic Stress Studies, Department of Children and Adolescents, Oslo, Norway
| |
Collapse
|
5
|
Beni R, Fisher L, Longhurst GJ. The importance of diverse and accurate descriptions of genital anatomy in textbooks. ANATOMICAL SCIENCES EDUCATION 2022; 15:985-988. [PMID: 35593013 DOI: 10.1002/ase.2200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 03/31/2022] [Accepted: 05/17/2022] [Indexed: 06/15/2023]
Affiliation(s)
- Rebecca Beni
- Medicine M.B.B.S. Program, Institute of Medical and Biomedical Education, St George's University of London, London, UK
| | - Lauren Fisher
- Department of Anatomical Sciences, St George's University of London, London, UK
| | - Georga J Longhurst
- Department of Anatomical Sciences, St George's University of London, London, UK
| |
Collapse
|
6
|
García‐Mesa Y, Cárcaba L, Coronado C, Cobo R, Martín‐Cruces J, García‐Piqueras J, Feito J, García‐Suárez O, Vega JA. Glans clitoris innervation: PIEZO2 and sexual mechanosensitivity. J Anat 2021; 238:446-454. [PMID: 32996126 PMCID: PMC7812125 DOI: 10.1111/joa.13317] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 08/12/2020] [Accepted: 09/02/2020] [Indexed: 02/03/2023] Open
Abstract
The clitoris is a leading player in female sexual arousal, if not the main protagonist. Despite this role, studies performed on this structure with specific neuroanatomical techniques are few. This study focuses on glans clitoris innervation, with special emphasis on sensory corpuscles and the presence of the mechanotransducer protein PIEZO2 in these structures. Six glans clitoris samples were obtained at autopsy covering an age spectrum between 52 and 83 years old. Several types of nerve terminations including free nerve endings, genital endbulbs as well as Meissner-like corpuscles and Pacinian corpuscles, but not Ruffini corpuscles, were found. Although corpuscular morphology in the glans clitoris was subtly different from the cutaneous digital counterparts, their basic composition was comparable for both Pacinian and Meissner-like corpuscles. Genital endbulbs showed heterogeneous morphology, and the axons usually exhibited a typical "wool ball" or "yarn ball" aspect. Some of them were lobulated and variably encapsulated by endoneurial elements (65%); from the capsule originate septa that divides the genital endbulbs, suggesting that they are found in clusters rather than as single corpuscles. In addition, most corpuscles in the glans clitoris showed axonal PIEZO2 immunoreactivity, thus, suggesting a mechanical role and molecular mechanisms of mechanosensibility similar to those of digital Meissner's corpuscles. Our results demonstrate that sensory corpuscles of the glans clitoris are similar to those of other glabrous skin zones, as most genital organs are characterized by clusters of corpuscles and the occurrence of the mechanoprotein PIEZO2 in the axons. These findings strongly suggest that PIEZO2 participates in erotic and sexual mechanical sensing.
Collapse
Affiliation(s)
- Yolanda García‐Mesa
- Departamento de Morfología y Biología CelularUniversidad de OviedoOviedoSpain
| | - Lucía Cárcaba
- Departamento de Morfología y Biología CelularUniversidad de OviedoOviedoSpain
| | - César Coronado
- Facultad de Ciencias de la SaludUniversidad Autónoma de ChileSantiagoChile
| | - Ramón Cobo
- Departamento de Morfología y Biología CelularUniversidad de OviedoOviedoSpain
| | - José Martín‐Cruces
- Departamento de Morfología y Biología CelularUniversidad de OviedoOviedoSpain
| | | | - Jorge Feito
- Departamento de Morfología y Biología CelularUniversidad de OviedoOviedoSpain,Servicio de Anatomía PatológicaComplejo Hospitalario Universitario de SalamancaSalamancaSpain
| | | | - José A. Vega
- Departamento de Morfología y Biología CelularUniversidad de OviedoOviedoSpain,Facultad de Ciencias de la SaludUniversidad Autónoma de ChileSantiagoChile
| |
Collapse
|
7
|
Expression of androgen receptors in the structures of vulvovaginal tissue. ACTA ACUST UNITED AC 2020; 27:1336-1342. [DOI: 10.1097/gme.0000000000001587] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
8
|
Levin RJ. The overlooked reproductive function of the human clitoris-News media responses to the published review. Clin Anat 2020; 34:115-120. [PMID: 32716101 DOI: 10.1002/ca.23657] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 07/20/2020] [Indexed: 11/10/2022]
Abstract
A brief survey of how the news media reported and misreported on the publication of the review that revealed the overlooked empirical evidence for the reproductive function of the human clitoris.
Collapse
Affiliation(s)
- Roy J Levin
- Independent Research Investigator, Sheffield, UK
| |
Collapse
|
9
|
Rodriguez FD, Camacho A, Bordes SJ, Gardner B, Levin RJ, Tubbs RS. Female ejaculation: An update on anatomy, history, and controversies. Clin Anat 2020; 34:103-107. [PMID: 32681804 DOI: 10.1002/ca.23654] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 07/12/2020] [Accepted: 07/13/2020] [Indexed: 11/09/2022]
Abstract
Female ejaculation is a contentious topic. From a review of the literature, history indicates that it is not a modern concept; some females were aware of it in times past without understanding the role of the fluid or composition of the ejaculate. Over time, scholars experimented, mainly with anatomical studies, in an attempt to identify the source of the ejaculate and explore its physiological and anatomical benefits for the female sexual experience. Despite these studies, views about female ejaculation remain controversial and inconsistent, with no clear conclusion as to its function. This review discusses the history of studies of female ejaculation and presents various hypotheses from an anatomical and physiological perspective. After reviewing 44 publications from 1889 to 2019, it became apparent that clinical and anatomical studies conducted during recent decades provide substantial evidence in support of the female ejaculatory phenomenon. Anatomical studies have shown that the ejaculate originates in the paraurethral (Skene's) glands, but its composition has been debated. Female ejaculate differs from urine in its creatinine and urea concentrations. The fluid also contains prostate specific antigen (PSA) and could have antibacterial properties that serve to protect the urethra. While the specific function of female ejaculation remains a topic of debate, there is sufficient evidence to support the existence of the phenomenon.
Collapse
Affiliation(s)
| | - Amarilis Camacho
- University of Puerto Rico School of Medicine, San Juan, Puerto Rico
| | - Stephen J Bordes
- Department of Anatomical Sciences, St. George's University School of Medicine, St. George's, Grenada
| | - Brady Gardner
- Department of Anatomical Sciences, St. George's University School of Medicine, St. George's, Grenada
| | | | - R Shane Tubbs
- Department of Anatomical Sciences, St. George's University School of Medicine, St. George's, Grenada.,Department of Neurosurgery, Tulane University School of Medicine, New Orleans, Louisiana, USA.,Department of Structural & Cellular Biology, Tulane University School of Medicine, New Orleans, Louisiana, USA.,Department of Neurology, Tulane University School of Medicine, New Orleans, Louisiana, USA
| |
Collapse
|