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.
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