The complexity of the clitoral nervous system as never before illustrated.
High-resolution images can be useful in births, gender reassignment and genital reconstruction. Study highlights significant gap in knowledge about women’s bodies.
What is the size of the clitoris? Where is it exactly? What is its structure like? Anyone who doesn’t know how to answer is not alone. Even for many doctors, these questions remain surprisingly difficult to answer even today, despite being essential to women’s sexual pleasure.
The lack of knowledge is due less to a lack of interest and more to a structural problem: for a long time, central organs of the female body were much less studied by Medicine than the male organs.
In the case of the clitoris, for example, its equivalent is the penis. Both have the same embryonic origin, have corpora cavernosa and become erect during sexual excitement.
A new 3D study carried out in the Netherlands and on bioRxiv now helps to fill this gap somewhat.
A research team led by Ju Young Leefrom the University of Amsterdam Medical Center, analyzed two bodies donated to science through a special X-ray procedure: the synchrotron radiation.
The technique allows you to obtain images of very high resolution and an extreme level of detail. Conventional methods, such as magnetic resonance imaging, can show general structures, but do not allow a spatial representation of the finest nerve pathways.
Map sensory nerves
In the images, the complexity of the clitoral nervous system becomes visible for the first time.
The researchers were able to follow the path of the nervo dorsal of the clitoris — the organ’s main sensory nerve — from the pelvis to the clitoral glans. Inside the glans, several thick nerve trunks branch out like a tree close to the surface, some of them up to 0.7 millimeters thick.
Contrary to what was supposed, the nerves do not become thinner, but continue to open into branches.
Furthermore, the images show that the nerve branches not only supply the glans, but also go to the foreskin of the clitoris and to the pubic mound.
Historical neglect
The fact that the clitoris has been neglected for so long is also due to having been reduced, for decades, to its visible part. In reality, most of the organ is inside the body. This anatomical reality was only systematically described in the late 1990s and early 2000s.
The Australian urologist Helen O’Connell played a central role in this process. With the help of magnetic resonance imaging, it was shown for the first time that the clitoris is not a small external bud, but a large, complex organ. It can reach between 8 and 12 centimeters in length.
The visible glans is just the external part of a structure that extends under the pubic bone, surrounds the entrance to the vagina and is made up of corpora cavernosa, which fill with blood during arousal.
At that time, comparatively detailed representations of the penis had already existed for decades.
Useful knowledge for surgeries
Ju Young Lee is a neuroscientist by training, and his focus has long been on the brain. In recent years, however, research has increasingly focused on peripheral nervous systems, such as the intestine.
At a large European conference, he asked if anyone was investigating how nerves from gynecological organs communicate with the brain. From the answers, he realized that the topic was not part of the concerns of his peers.
Lee couldn’t let the matter go. After his PhD, he went to the University of Amsterdam Medical Center, which is part of the international Human Organ Atlas Hub (HOAHub) project. The objective is to systematically map the human body using images obtained by synchrotron radiation — a kind of “Google Earth” of anatomy.
“Accurate knowledge of anatomy can help avoid nerve damage in surgeries in the vulva region,” he says. The researchers involved consider that the results may be especially useful in childbirth, gender reassignment surgeries, and reconstructive surgeries following genital mutilation.
Due to the lack of widespread knowledge among doctors about nerve pathways, changes in sensitivity or sexual problems are often no longer associated with surgical procedures or childbirth.
Gender gap in health
Gynecologist Mandy Mangler is faced daily with the gap that still exists between research and practice. When she saw the new images, she was excited — not because everything was new, but because they finally proved previous hypotheses.
“There is very little scientific production on the clitoris,” he says. “That the nerves reached the mons pubis and the vulvar lips was plausible. Now, finally, it has been demonstrated.”
Mangler makes a direct comparison with men’s health. At the hospital, he shares the workspace with urologists. “I see firsthand the size of the effort made to preserve the nerves in penis surgery,” he says. “There’s a lot of research, training and awareness.”
For her, this is a classic example of the so-called gender gap in health. Medical standards considered obvious for men continue to be lacking for women.
Clitoris is not an isolated case
The fact that central organs of the female body have been underestimated for a long time also stands out in other areas.
Recently, an investigation into the ovary showed that the tissue called ovarian tissue can contribute to hormonal balance and the embryonic development of the ovaries. Apparently, there is also a relationship with the formation of cysts. Described more than a hundred years ago, this tissue was then considered functionless and removed from anatomy books.
The new research into the clitoris does not answer all the questions, however.
“A complete picture is not possible. New technologies will always bring new discoveries”, ponders Lee.
Two samples were analyzed post-mortem of elderly women. How the structure and function of the clitoris changes throughout life—at puberty, pregnancy, menopause, or during the menstrual cycle—remains largely unknown.
