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Dr. C Sharath Kumar, Prof and Head, Dept. of Reproductive Medicine and Surgery, Mediwave Institute of Medical Science, Mysore 30 October 2023
The vulva of the female reproductive system harbors the clitoris. The clitoris is a tiny organ situated at the anterior junction of the labia minora and labia minora. It is the most sensitive organ that plays a key role in inducing female arousal and is also considered a stimulant organ.
Clitoris is the female homolog of the male penis, both of which develop from the genital tubercle of the fetus. A small part of the clitoris is visible, which extends above the vulva; thus, the clitoris harbors external and internal components.
Structure:
The clitoris is made of regular tissue, connective tissue, and muscle and is covered with a ‘clitoral hood’ – formed from the upper part of the labia. The body of the clitoris extends internally from the glans and appears like a small cylinder 2-3 cm long. The body extends to constitute the erectile corpora cavernosa and bulbs, which continue to the relatively lengthy crura – made of non-erectile tissue.
Glans are made of erectile tissue and are present within the labia. The root of the clitoris is the area where the nerves join and where the legs of the crura meet. This is also considered the pleasure area, as the vestibular bulbs of the clitoris rub against the vaginal wall at this site.
Blood Supply:
The blood supply of the clitoris is provided by the dorsal artery of clitoris – a terminal branch of the internal pudendal artery. The deep dorsal vein of the clitoris drains to the vesical plexus (Venous plexus of Kobelt).
Nerve Supply:
The dorsal nerve of clitoris branches off from the pudendal nerve to innervate the clitoris. It travels from below the inferior pubic ramus to the suspensory ligament of the clitoris. The DNC splits into two nerve branches on either side of the midline – closely following the crura of the clitoris.
Stimulation:
Clitoris develops from a network of erectile tissue – identical to the penis. The glans alone harbors nearly 8,000 nerve endings. When aroused, the clitoris swells with blood––stimulating lubrication within the vagina and enabling pleasure during sexual intercourse. Various sexual positions, like the clitoral alignment technique (CAT), can be practiced to achieve maximal arousal and stimulation during sexual penetration.
Sex toys may be used for clitoral stimulation, and are beneficial for those who are unable to achieve an orgasm during sexual intercourse.
Clitoral Orgasm:
Vasocongestion follows the arousal and engorgement of the clitoris, which triggers a muscular reflex that expels blood trapped in the adjacent tissues – leading to an orgasm. The glans returns to its normal state within a few seconds after an orgasm and to its normal position after 5-10 mins post-orgasm.
Clitoral Erection:
The erection is reached in 3 phases:
Function of the Clitoris:
The function of the clitoris is to provide sexual pleasure; it plays both procreative and recreative roles. The stimulation is routed through the brain – and the reflex prepares the female organs to receive and process the sperm for possible fertilization – for reproduction.
Clitoral stimulation causes physiological changes in the reproductive organs – rendering the cervix away from the semen pool, thus preventing the semen from traveling into the uterus too rapidly. This confers the sperm adequate time to attain mobility and is activated for egg fertilization.
Clitoral Disorders:
Clitoromegaly can lead to congenital adrenal hyperplasia (CAH) due to androgen misuse and hormonal imbalances like PCOS.
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