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The Clitoris - Not A Small Penis

The clitoris is an organ central to female sexual pleasure; however, little was known about it until recently. Even now, much more research is needed to better understand its role. Unlike its anatomical counterpart, the penis, which was accurately described as early as 35 BC by Hippocrates, the clitoris still is not fully understood today. The history of the study of the clitoris is a long and complicated one. The clitoris has been known for centuries, but its true nature and function have been the subject of much debate and misunderstanding.

In the early days of anatomy, the clitoris was often described as a small, insignificant organ. Some anatomists even believed that it was vestigial or that it had no purpose at all. The clitoris was first identified by the Italian anatomist Realdo Colombo in 1559. He called it the "clitoris" (from the Greek word kleitoris, meaning "little hill") and described it as a "nervous body" that was "the seat of pleasure." However, Colombo's work was not widely read or accepted, and the clitoris stayed a mystery for centuries. In fact, Colombo's mentor, Andreas Vesalius, who was one of the greatest anatomists of his time, argued that the clitoris didn’t exist. In the 19th century, German anatomist Georg Ludwig Kobelt was one of the first scientists to study the clitoris in detail. He used dissection and imaging techniques to create a detailed map of the clitoris, and he showed that it was much larger than previously thought. Kobelt also argued that the clitoris was the primary organ of female sexual pleasure. Despite work by a few anatomists to reveal the true nature of the clitoris, the consensus among medical professionals and the public was a long-standing belief that women did not experience sexual pleasure in the same way that men did.

By the 20th century, there was a renewed interest in the study of the clitoris. In the 1910s, Sigmund Freud, despite knowing about the work of Kobelt, called the clitoris an "infantile organ." He argued that mature women transferred their orgasm from the clitoris to the vagina. His view led to the belief by most of society, even to this day, that vaginal orgasm is the goal and symbol of true womanhood. Given how few women can have an orgasm through vaginal stimulation alone, imagine the grief and shame that women throughout the 20th and 21st centuries could have avoided absent Freud! In 1998, Australian urologist Helen O'Connell published a groundbreaking study that showed that the clitoris was much larger than previously thought. O'Connell's work helped to dispel the myth that the clitoris was just a small nub of tissue, and it helped to raise awareness of the importance of female sexual pleasure. She showed that vestibular bulbs were attached to the visible clitoris and were part of it. O’Connell argued that the clitoris was actually shaped like an upside-down wishbone. The top includes the visible clitoris (glans), but it also has two legs (crura) that extend out and down, around the pubic bone, and into the front wall of the vagina. Her 2005 paper confirmed that the clitoris is 10 times bigger than most people thought, contains thousands of nerve endings, and is connected to the urethra and to the vagina. The entire clitoris, from the glans to the crura, is about 3.5- 4.25 inches long and about 2.5 inches wide. The glans is about 0.75 inch to 1 inch in diameter.

Your clitoris has one purpose - sexual pleasure. In fact, it is the only organ known to have the sole purpose of supplying pleasure. In contrast, penises serve multiple functions - reproduction and urination. Interestingly, penises and clitorises develop from the same ambisexual genital tubercle which, at about week 8-9 of fetal development, differentiates to form the appropriate sexual organ (assuming all goes normally). Most women require clitoral stimulation to orgasm. Studies show that only 25% of women are consistently orgasmic during vaginal intercourse. In short, despite their fetal starting point, a clitoris is not a mini-penis, but is instead a complex structure with a different purpose. For men, an orgasm is required for reproduction. In women, orgasms are not needed for reproduction (although some hypotheses suggest a role in reproduction at some point in evolution.)

In recent years, there has been a growing interest in the clitoris. This is due in part to the work of sex educators and activists who have been working to demystify female sexuality. Additionally, the development of new medical imaging techniques has made it possible to study the clitoris in greater detail. As a result, we now know more about the clitoris than ever before, and we are beginning to understand its true importance. A study from 2022 identified that there are more than 10,000 nerve fibers in the clitoris - 2000 more than previously thought. The study's authors argued that their finding are important because many surgeries take place in the groin region – hip replacements, episiotomies during childbirth, and pelvic mesh procedures to name a few – and a greater understanding of the clitoris may help health care providers know where nerves are located so that injuries are prevented. Important nerves in your clitoris include the dorsal nerve, portions of the pudendal nerve, and the cavernous nerves. The dorsal nerve is most responsible for clitoral sensation.

Due to the lack of research and commonly accepted misconceptions about the clitoris, women may not always get the support they need. In fact, many vulvar conditions go undiagnosed and untreated. For example, clitoral adhesions can cause pain, difficulties with arousal, and orgasmic dysfunction, but since many medical professionals have only a basic understanding of the clitoris at best, this condition may be overlooked and attributed to a psychological cause. Similarly alarming are the implications of conducting surgery on the clitoris, vulva, or any other pelvic structure without a full appreciation of the anatomy of the clitoris. Surgeries that can affect the clitoral anatomy have been done for many years, but there are still gaps in knowledge about the clitoris, which means that the clitoris can unknowingly be damaged during a surgery to correct another problem, potentially leading to sexual dysfunction for patients.

Some of the most common medical issues that affect the clitoris include:

  • Clitoral adhesions: Condition in which the clitoral hood, the fold of skin that covers the clitoris, sticks to the glans, the head of the clitoris, which can make it difficult or impossible to stimulate the clitoris and can also cause pain during sex. The exact cause of clitoral adhesions is unknown, but it is thought to be caused by a combination of factors, including inflammation, infection, eczema, lichen sclerosus, trauma, or congenital abnormality. Symptoms may include pain, discomfort, pain with sexual activity, itching, burning, redness, or swelling. Adhesions are normally treated with a topical steroid, but severe cases may require surgical intervention. Clitoral adhesions are more common during menopause because the decrease in estrogen levels during menopause can cause the skin around the clitoris to become thinner and drier, making it more likely for the clitoral hood to stick to the clitoris.

  • Clitoral atrophy: Condition in which the clitoris shrinks and becomes less sensitive. This can be caused by a number of factors, including menopause, childbirth, and certain medical conditions. In menopause, the clitoris is likely to be less sensitive than in earlier years, possibly due to reduced estrogen levels and changes in the vascular and nervous systems, resulting in the need for more direct and intense stimulation of the clitoris in order to achieve orgasm.

  • Clitoral pain: Can be caused by a number of factors, including infection, injury, and skin conditions. Infections such as yeast infections, bacterial vaginosis, and sexually transmitted infections (STIs) can cause inflammation and pain in the clitoris. Injury to the clitoris can occur during sexual activity, childbirth, or from other trauma. Skin conditions such as eczema, psoriasis, and lichen sclerosus can cause itching, burning, and pain in the clitoris. Allergic reactions to soaps, detergents, or other products can also cause inflammation and pain in the clitoris. Autoimmune diseases such as lupus and rheumatoid arthritis can damage nerves and blood vessels in the clitoris, leading to pain. Nerve compression can occur due to pregnancy, childbirth, or other medical conditions, which can cause pain in the clitoris and other areas of the vulva.

  • Clitoral cancer: The symptoms of cancer of the clitoris can vary, but they may include a lump on the clitoris, bleeding from the clitoris, pain in the clitoris, itching or burning in the area around the clitoris, and/or changes in the appearance, such as color, shape, or size, of the clitoris.

    • If you experience any burning, itching, pain, irritation, lumps, or changes to the color, texture, or size of your clitoris or other parts of your vulva, you should see your doctor as soon as possible. Early detection and treatment are critical to the best outcomes.

Research about the clitoris has languished throughout history because of sexism and social stigma. It wasn't until 1993 with passage of the NIH Revitalization Act that women were required to be included in clinical trials for new drugs! More funding and interest in women's health has resulted in advances in the past decade, but we have much more to learn about how women are different than men and how their medical concerns should be addressed. Progress can't come too soon!

(model of clitoris - all parts are internal except the small "button" at the top of the photo)

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