Mercury News Staff Writer
An Australian researcher has found that the clitoris -- seemingly a small bump of flesh -- is far more extensive than previously thought.
The discovery is considered an important step in understanding how women function sexually -- knowledge that is about a decade behind a similar understanding of men. Beyond that, the new information also could help avoid surgical damage that wrecks a woman's sex life.
The anatomy books that doctors consult don't do the clitoris justice, says Dr. Helen O'Connell of Royal Melbourne Hospital. ``Sometimes the whole structure is drawn as a dot,'' she said in a phone interview Wednesday. ``They draw the tip of the iceberg, but not the iceberg.'' In reality, the clitoris extends up to 3 1/2 inches into a woman's body in a pyramid of tissue whose sole function is to give sexual pleasure, she reports in the current issue of the Journal of Urology. That's about twice as far as the anatomy books suggest. O'Connell also is tracing the nerves and blood vessels that feed into the clitoris, allowing it to swell and engorge during sexual arousal in much the same way the penis does in men. Because they have never been described in detail, these vital connections are in danger of being severed whenever surgeons cut into the area.
Dr. Jennifer Berman, a urologist and director of the Women's Sexual Health Clinic at Boston University, said the new report is an important step toward avoiding that kind of damage. ``When women undergo pelvic surgery, we just open it up and cut it out without any clear understanding of where these nerves and blood vessels are,'' she said. ``And we do that a lot. Something clearly has got to change.'' Vulnerable to damage The clitoris is also much closer to the urethra -- the tube that carries urine out of the body -- than doctors had thought. In fact, the clitoris surrounds this tube on three sides, making it vulnerable to damage when doctors operate on the tube, O'Connell found. Because doctors rarely ask women if surgery has diminished their sexual arousal or ability to have orgasms, no one knows how many suffer damage to the clitoris, Berman said. Depending on their age, between 16 percent and 75 percent of women complain of some kind of sexual dysfunction, from lack of lubrication during intercourse to diminished sensation or difficulty having orgasms, Berman said. ``It's going to lead to future research in this area,'' Berman said, ``which has been grossly neglected.''
In an interview reported in the upcoming issue of New Scientist magazine, O'Connell said she first noticed how little was known about female sexual anatomy in the 1980s, when she was training to be a surgeon. Descriptions of the clitoris were especially sketchy, she said. Although there were a few detailed accounts in the scientific literature dating back to 1897, more modern anatomy texts either gloss over this important organ or describe it by comparison to the penis, its counterpart in the male. And none of them rendered a detailed view of the clitoral blood vessels or nerves. ``For a surgeon,'' O'Connell told the magazine, ``that's unacceptable.'' Five years ago, she and her colleagues at the hospital began a series of studies that involved dissecting the cadavers of females who had died in infancy, in old age and at every stage between. Previously hidden One reason the clitoris hasn't been accurately measured till now may be because the bulk of it is hidden beneath the pubic bone and under fat, O'Connell said. And it may be that most previous dissections had been done on older women whose clitoral tissues had shrunk.
Researchers had also assumed that two bulbs of tissue, known as the bulbs of the vestibule, were associated with the vagina. She believes they are part of the clitoris instead, and should be renamed the bulbs of the clitoris.
O'Connell said she is still working to define the nerves that serve the clitoris, ``trying to get really consistent, good photography of the nerve pathways.''