Anatomy of sex: Revision of the new anatomical terms used for the clitoris and the female orgasm by sexologists

Abstract

Sexual medicine experts and sexologists must spread certainties on the biological basis of the female orgasm to all women, not hypotheses or personal opinions. Therefore, they must use scientific anatomical terminology.

The anatomy of the clitoris and the female orgasm are described in textbooks, but some researchers have proposed a new anatomical terminology for the sexual response in women. The internal/inner clitoris does not exist: the entire clitoris is an external organ.

The clitoris is not composed of two arcs but of the glans, body, and crura or roots. “Clitoral bulbs” is an incorrect term from an embryological and anatomical viewpoint: the correct term is “vestibular bulbs.” The bulbocavernosus muscles are implicated in inferior vaginismus, while the pubovaginal muscle is responsible for superior vaginismus.

The clitoral or clitoris-urethro-vaginal complex has no embryological, anatomical and physiological support: the vagina has no anatomical relationship with the clitoris, and the clitoris is a perineal organ while the supposed G-spot is in the pelvic urethra. G-spot/vaginal/clitoral orgasm, vaginally activated orgasm, and clitorally activated orgasm, are incorrect terms: like “male orgasm,” “female orgasm” is the correct term.

The “vaginal” orgasm that some women report is always caused by the surrounding erectile organs (triggers of female orgasm). The male penis cannot come in contact with the venous plexus of Kobelt or with the clitoris during vaginal intercourse.

Also, female ejaculation, premature ejaculation, persistent genital arousal disorder (PGAD), periurethral glans, vaginal–cervical genitosensory component of the vagus nerve, and G-spot amplification, are terms without scientific basis.

Female sexual satisfaction is based on orgasm and resolution: in all women, orgasm is always possible if the female erectile organs, i.e. the female penis, are effectively stimulated during masturbation, cunnilingus, partner masturbation, or during vaginal/anal intercourse if the clitoris is simply stimulated with a finger.

INTRODUCTION

Orgasm is a normal psycho-physiological function of humans: women have the right to feel sexual pleasure, and for this reason sexual medicine experts and sexologists must spread certainties on the biological basis of the female orgasm to all women, not hypotheses or personal opinions, and they must use scientific sexual terminology. The embryology, anatomy and physiology of the female erectile organs, triggers of orgasm, are often neglected by sexological and sexual medicine textbooks, and some researchers have proposed and divulged new anatomical and physiological terminology for the sexual response in women. The aim of this review is to clarify whether these new terms used for the clitoris and female orgasm by sexual medicine experts and sexologists have a scientific basis.

CLITORAL TERMINOLOGY WITHOUT SCIENTIFIC BASIS

For some researchers the clitoris is also an “internal/inner” organ: “except for the labia, glans clitoris and vaginal introitus, the female urogenital tissues are internal” (O’Connell et al., 1998); “the internal clitoris may have individual differences bigger than 100%” (Gravina et al., 2008); “the internal clitoris is, in fact, involved and stimulated during penetration” (Buisson et al., 2010); “The G-spot (or area) is composed of individually different amounts of cavernosal tissue from the inner clitoris” (Jannini et al., 2010); “contact of the internal clitoris and the AVW… stimulation of the external or internal clitoris” (Jannini et al., 2012); “sexual pleasure from vaginal penetration, leading to orgasm, could result from indirect stimulation of the inner clitoris” (Jannini et al., 2014); “the internal portion of the clitoris” (Vaccaro et al., 2014); “the external component of the clitoral complex is the glans” (Oakley et al., 2014).

The external female genitalia, or vulva, are formed by the labia majora and vestibule, with its erectile apparatus: clitoris, vestibular bulbs with the pars intermedia, and labia minora. These structures are external to the urogenital diaphragm in the superficial anterior perineal region (Figs. 1 and 2). The entire clitoris is an external genital organ: the glans and body covered by the prepuce are visible/free while the roots are hidden, so the “internal” clitoris does not exist (Dickinson, 1949; Masters and Johnson, 1966; Testut and Latarjet, 1972; Chiarugi and Bucciante, 1975; Standring, 2008; Paulsen and Waschke, 2011; Puppo, 2013a, 2014a,c; Netter, 2014).

anatomy of the vulva

Figure 1. The vulva (from Puppo, 2011a). 1. Anterior commissure; 2. Clitoral body covered by the prepuce; 3. Clitoral glans; 4. Labia minora: the lateral parts form the prepuce of the clitoris, the medial parts form the frenulum of the clitoris; 5. Labia majora; 6. External urethral orifice; 7. Duct of Skene’s gland; 8. Ducts of minor vestibular glands; 9. Labia minora; 10. Duct of Bartholin’s gland; 11. Vaginal orifice; 12. Hymen; 13. Frenulum of labia minora; 14. Posterior commissure.

female perineum

Figure 2. The female perineum (from Puppo, 2014a).

Some researchers have stated: “the clitoris is composed of two arcs, the first consisting of two corpora cavernosa along the right and left ischiopubic ramus; they join on the summit of the vulva to form a bend 90 degrees forward: the raphe; the raphe ends in the glans clitoris, the visible part of the clitoris. The second arc consists of two bulbs that surround the lateral walls of the vagina” “the bulbs and cavernous bodies forming the erectile root of the clitoris” “the double arch of the cavernous bodies and bulbs of the clitoris” (Buisson, 2010; Buisson et al., 2010; Jannini et al., 2012, 2014); “the bulbs of the clitoris” (O’Connell et al., 1998, 2005, 2008; Gravina et al., 2008; Jannini et al., 2010, 2012, 2014); “the components of the clitoris, including the glans, body, crura, bulb, and root” (Oakley et al., 2014).

The clitoris is the homologue of the male’s glans and corpus cavernosa (Fig. 3). The clitoris, in the free part of the organ, is composed of the glans and the body located inside the prepuce; in its hidden part the clitoris is composed of the roots or crura, which are located alongside the ischiopubic ramus. The roots are joined under and in front of the pubic symphysis and constitute the body of the clitoris (not the “raphe”), which terminates in the glans. The roots, as in males, are covered by the ischiocavernosus muscles (Fig. 4). The clitoris is not composed of “two arcs” (Dickinson, 1949; Masters and Johnson, 1966; Testut and Latarjet, 1972; Chiarugi and Bucciante, 1975; Standring, 2008; Paulsen and Waschke, 2011; Puppo, 2011a, 2011b, 2013a, 2014a,c; Netter, 2014).

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