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CLITORIS

THOMAS P. LOWRY, M.D.

Co-Director, Marital Therapists Training Project, California State Department of Health;
Formerly, Research Associate, Reproductive Biology Research Foundation, St. Louis

And
4
THEA SNYDER LOWRY, M.A.

Co-Director, Marital Therapists Training Project, California State Department of Health;
Formerly, Research Assistant, Reproductive Biology Research Foundation, St. Louis

With Additional Contributions by

THOMAS G. MORRIONE, M.D., F.C.A.P. DONALD L. STILWELL, M.D.
Chief of Pathology Associate Professor of Anatomy
Northern Colfax County Hospital Stanford University School of Medicine
Raton, New Mexico Stanford, California
Formerly, Clinical Professor of Pathology
Downstate Medical Center
State University of New York A. STARK WOLKOFF, M.D.
Professor of Obstetrics and Gynecology
Assistant Professor of Physiology
University of Kansas, Kansas City

BEN R. HUELSMAN, M.A.
Medical Anthropology
Covington, Kentucky

BERRY CAMPBELL, Ph.D.
Professor of Physiology and Acting Chairman JOHN W. BINCKLEY, M.D.
Curriculum of Functional Correlates Obstetrics and Gynecology
California College of Medicine Corte Madera, California
University of California, Irvine

PROF. ENZO MARTELLA
Professore Aggregato di Genecologia
Docente di Clinica Ostetrica dell’Universita di
Napoli

ZUHDI T. FARUKI, Ph.D.
Formerly, Associate Professor of Philosophy
Prescott College, Arizona

LARRY Z. McFARLAND, D.V.M., Ph.D.
Late Professor and Chairman
Department of Anatomy TEE KAMEN, M.F.A.
School of Veterinary Medicine Advisor, San Francisco
University of California, Davis Sex Information Center

WARREN H. GREEN, INC.
St. Louis, Missouri, U.S.A.

LUIGI GIACOMETTI, Ph.D.
Scientific Director
Oregon Zoology Research Center, Portland

LINDA WHOOLEY, R.N.
Advisor, San Francisco
Sex Information Center

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CONTENTS

Chapter

I
Il
Ill
IV

Published by ‘

WARREN H. GREEN, INC.
10 South Brentwood Boulevard
St. Louis, Missouri 63105, U.S.A.

1976 by WARREN H. GREEN, INC.

Library of Congress Catalog Card Number 73-704
ISBN No. 0-87527-112-X

Printed in United States of America
(269)

Introduction

Anatomy of the Human Clitoris

Comparative Anatomy of the Clitoris
Neurophysiology of the Clitoris

Modern Conceptions of Corpora Cavernosa
Function in the Vagina and Clitoris
Cytochemistry of Clitoral Sensory Nerve
Endings

Some Issues in the Histology of the Clitoris
Pathology of the Clitoris

Surgery of the Clitoris

An Anthropological View of Clitoral and other
Female Genital Mutilations

Some Notes on the Etymology of the Word
“Clitoris”

Reflections on the Etymology of ‘‘Clitoris”’ in
Arabian Sexual Lore

The Cultural Psychology of the Clitoris
Perspectives on Anorgasmia: Toward a Female
Phenomenology

Varieties of Sexual Experience

THE
CLITORIS

Chapter I

INTRODUCTION
Thomas P. Lowry and Thea Snyder Lowry

The clitoris is the primary organ of sexual functioning in
human females; it is clear that it has no other function than to
receive and transmit sexual feelings. Ovid, the Kama Sutra and
modern treatises on sexual functioning all acknowledge the as-
cendancy of the clitoris for the creation and enhancement of
sexual receptivity, yet no systematic English language studies, to
assemble what little knowledge exists, have been previously un-
dertaken.

As it became increasingly clear that traditional psychoanalytic
therapy for sexual disturbances in couples and/or individuals had
little to offer, the new insights into sexual functioning and ef-
fective sexual therapy suggested the potential value of a collec-
tion of readings such as this. It was not a surprise to us to find
that the writers who chose to define, describe and interpret
female anatomy, physiology and psychology have usually been
men. As men who are interested in women, and as scientists
interested in natural phenomena, it is understandable that they
describe their theories and investigations. It is abundantly clear
to us, however, that it is inappropriate and misleading for one
sex to go further than that in interpreting the psychosexuality
of the opposite sex. This conviction was confirmed by a year on
the staff of the Reproductive Biology Research Foundation
(Masters and Johnson clinic) in St. Louis, where female thera-
pists deal with and are the advocates for women, just as the male
therapist’s role is confined to advocacy for the male client.

Thus we are painfully aware of the implications of articles
about women written largely by men. This imbalance was never
our intent, and we regret the decisions of the four nationally-
known women (a psychoanalyst, a sex educator, a family plan-
ning specialist, and a sex counselor) who, each for different
reasons and at different times, declined an invitation to con-
tribute to this book.

CLITORIS

With the rise of feminism and the landmark appearance of
publications such as Our Bodies, Ourselves, an end should come
soon to writing about women by men. Yet gynecology text-
books prepared by men will probably continue to be used in
medical schools, partly through inertia, partly through seniority
and political power, and partly because the objective anatomical,
biochemical, bacteriological nature of any organism is indepen-
dent of the sex of the observer. Of course, the metamessage is as
important as the factual content, and male bias will unavoidably
show through. We hope that future gynecology textbooks will
convey to students the experience of the patient, which is just
as vital to comprehend as the dimension of the pelvis. We look
forward to texts by female gynecologists that fully reflect both
their medical expertise and experiential wisdom.

Until then, this collection of readings represents an attempt
to assemble what is known, to offer possible interpretations, and
to suggest areas for future research.

Since every person is simultaneously an anatomical, chemical,
electrical, sociological, psychological and spiritual being, and
since no one of these aspects excludes the validity of the others,
we will attempt to present all this information and then to
synthesize it in a way that will add to the self-knowledge and
self-confirmation of women and to the understanding of men.

The book begins with the structure of the organ, perhaps the
least controversial aspect of the subject, continues with physiol-
ogy and concludes with the most subjective area: psychological
perspectives of the clitoris, as manifested in language, myth,
“beautification” rituals, and in sociological and _ psychiatric
speculations.

In the first chapter, Donald Stilwell outlines the anatomy of
the human clitoris, succinctly describing the tissues, ligaments,
blood vessels and nerves which constitute and surround the
clitoris.

Larry McFarland paints on the broader canvas of comparative
anatomy. Homo sapiens is but one of thousands of species of
vertebrate animals. On the evolutionary ladder, there are many
rungs between turtles and birds, and human beings, yet clitorises
and penes exist in almost all these creatures.

INTRODUCTION 3

An organ may have one function early in its evolution and
over the millenia change into something quite different. The
muscles and cartilages that kept mud out of the lungs of the
first amphibians that waded out of the primordial sea have now
evolved into the larynx, which, connected to the brain, produces
the immense complexity of speech. The function of the clitoris
in other species is unclear; so eminent an authority as Frank
Beach states that female animals probably do not experience
orgasm; Kinsey’s studies suggest they do, and experienced horse
breeders conclude from their observations that mares are orgas-
mic; Suzanne Chevalier-Skolnikoff’s study of the stumptail mon-
key showed that the female is clearly orgasmic during both
homosexual and heterosexual interaction. Breeders of other
domestic animals may also have strong opinions one way or the
other on the existence of orgasm in the females. Neurophysio-
logical observations, using vaginal or rectal transducers and septal
brain electrodes, will clarify these issues in the future.

Still, many non-human females apparently do not have or-
gasm. Why then do all mammalian species, and many birds and
reptiles, have a clitoris, complete with nerves, muscles and blood
vessels, with no known function? McFarland attempts to dispel
some of the mystery by summarizing what is known about the
clitoris of many familiar animal species, based on his richly
varied experience in vertebrate anatomy and veterinary medicine.

The terra incognita of human sexual functioning, both male
and female, is neurophysiology. Dr. William H. Masters has
hoped to organize a neurophysiological laboratory in order to
continue the work which came to a halt with the publication of
Human Sexual Response. Pioneering work in non-human sexual
neurophysiology has been done by Frank Beach in Berkeley.
Robert Heath at Tulane studied a few human females during
orgasm, utilizing deeply implanted brain electrodes, and A. E.
Comarr, formerly with the Long Beach Veterans Administration
Hospital, studied the sexual functioning of men and women with
spinal cord injuries. Their beginning efforts only hint at how
much more there is to learn. ' :

Berry Campbell, who has long been interested in Spero
neurophysiology, presents the results of some original and very

4 CLITORIS

valuable research. At least four points will be of interest to most
readers. First, Campbell confirms Ruth Herschberger’s observa-
tions that the innervation of the clitoris is similar to that of the
penis, and his study of the spectrum of nerve fiber size adds
neurohistological information not known before, although al-
luded to by Kinsey. Next, Campbell recorded and described the
differential activity of four separate vulvo-vaginal muscle groups,
each of which appears to play a different role in the progression
of arousal and orgasm. Third, and perhaps most important, is his
observation that the sexual organs exist in one of two distinct
physiological states: non-aroused, when stimuli have little sexual
meaning or value; and aroused, when the results of stimuli are
greatly different. In the aroused state, in addition to perceiving
external stimuli, the clitoris is stimulated by its own tumescence
and is a source of positive feedback in the transformation of
arousal into orgasm. Campbell then speculates on how engorge-
ment with blood may change the receptivity of the specialized
nerve endings. Finally, he suggests a theory of childhood nega-
tive sexual training derived from the foregoing, in which suppres-
sion of the first sensation of arousal prevents the feedback loop
of arousal-tumescence-arousal from being experienced and hence
the cycle is never established. This suggests a neurophysiological
learning model for the primary non-orgasmic woman.

Danesino and Martella, in a pioneering and previously untrans-
lated study, attempt to clarify the mechanism of clitoral erec-
tion. The tumescence mechanism of all erectile tissue (including
the nasal mucosa) is basically one of more blood entering than
leaving, but the exact mechanism for constricting the veins and
dilating the arteries has long been a subject for debate. These
two authors summarize previous theories, and outline the results
of their careful study of the clitorises of ten women, from very
young to very old.

While a nerve ending is an anatomical structure, its function is
not mechanical, like a tendon, but is instead electrochemical.
Giacometti and Machida studied the enzyme chemistry of seven
human clitorises, and describe their findings. How to interpret
the significance of their work js unclear, since the current
knowledge of sexual cellular cytochemistry is so fragmentary.

INTRODUCTION 5

In the chapter on the microscopic anatomy of the clitoris,
two issues are important. First, the original work was done en-
tirely with light microscopes, which lent relative simplicity to
histology, since the fine details remained invisible. With the ad-
vent of the electron microscope, an entire cosmos of complexity
has been opened. Because most medical research deals with life
or death conditions, the histology of sexual perceptivity has
been accorded a low priority and little new has been added
recently. The second issue is how women differ from one an-
other in the anatomy of sexual innervation. Krantz’s studies pro-
vide a physical basis for the psychological imperative that each
woman is the best judge of what she perceives and values. To
the best of our knowledge, similar quantitative research has not
been done on men.

The clitoris, like other reproductive organs, is not only vulner-
able to the usual diseases and injuries, but responds to the pres-
ence or absence of sexual hormones in particular patterns.
Thomas Morrione summarizes pathology in a variety of clitoral
abnormalities reported in the medical literature of fifteen coun-
tries.

Since there are diseases of the clitoris, there are remedies. A.
Stark Wolkoff, a gynecologist of long experience, reports on
treatment methods, including freeing “clitoral adhesions,” an
approach long advocated by LeMon Clark. Clark recommends
the dividing of clitoral-preputial adhesions as a means of enhanc-
ing female sexual response. Several colleagues (Harvey Caplan,
John Binckley, William H. Masters) suggest there may be an
element of suggestion in the good results, and that the psycho-
logical concepts of mild ordeal, benign permission-giving and rite
of passage are perhaps the reason for the successes more than
simply freeing the clitoris. Of course, in situations where hard-
ened smegmatic material renders sexual excitement painful, ne
simple surgical procedure is quite useful. Wolkoff s chapter also
Suggests remedies for dozens of other clitoral disorders, and ends
with the reasonable observation that if mystique surrounds ay
organ, it leads to exaggerated views and makes appropriate ESSE
ment harder to provide.

Only in the last few years have Western readers become aware

6 CLITORIS

of the culturally-sanctioned modifications of the vulva that are
found in some other societies. Ben Huelsman has performed a
prodigious task of library research, struggled with dusty covers
and yellowed pages, and assembled a very thorough discussion of
ritual mutilations of the clitoris and/or vulva. Many cultural ra-
tionalizations are given for these assaults, but at least two fea-
tures stand out: such surgical alterations make sexual-reproduc-
tive functioning difficult for- women, and they are usually
performed by women, clearly an example of survival by identify-
ing with the oppressor. Virginia Johnson Masters has said,
“Women are the great betrayers of women”; we could not agree

more.

One of the reasons given for vulvar mutilation is that women
would be too sexually assertive, unless literally whittled down to
size. This theory is consonant with Mary Jane Sherfey’s formula-
tion that the historical suppression of women was in recognition
‘of their capacity for unlimited multiple orgasm and the possibil-
ity of obscuring clear land titles by the production of offspring

by various sires.

- Huelsman describes the political struggles of Dr. Shandall of
Khartoum, who has been instrumental in reducing the ferocity
and number of these mutilations, but with only limited success.
Though women in the Nile Valley have suffered through ritual
circumcisions and infibulations since long before Cleopatra, it
would be surprising if a government edict put an immediate end
to this cruel and destructive procedure.

Before self-congratulation is in order, Western readers may
recall that only a century ago, a London surgeon, Mr. Isaac
Baker Brown, removed the clitorises of dozens of women, claim-
ing it was a cure for insanity and epilepsy.

The internal structure of language, in both syntax and the
nuances of vocabulary, tells us much about the culture of the
speaker, and also shapes the thinking of that speaker, since
thought is conducted in language. In the chapter on etymology,
the origins of clitoral vocabulary are sketched, and an attempt is
made to relate these word choices to the value system of the
culture.

A similar exploration of Arabic languages by Zuhdi T. Faruki

INTRODUCTION

underlines difficulties in transcultural psychology. Faruki,
though highly competent in English, seems to be writing in this
language while. thinking in his primary culture. Although Faruki
speaks highly of women, every American woman who read his
contribution reported immediate negative responses to it, per-
ceiving it as containing both simplistic and derogatory as-
sumptions.

In the chapter on clitoral politics, I attempt to synthesize
what has been written and said about the clitoris. The cultural
psychology of the clitoris is an emotionaily-charged subject,
incorporating at least three main controversies: first, the inap-
propriateness of males’ opinions in this area; second, the debate
over “clitoral”? and ‘‘vaginal’’ orgasm; and third, the interplay of
biology and culture in sexual response.

While some of the varying opinions can be synthesized, many
of them are beyond reconciliation. In these cases, Dr. Lowry has
indicated which views he believes to be relevant.

Thea Snyder Lowry’s chapter on the phenomenology of fe-
male sexual functioning, especially as understood through dys-
function, draws directly upon the subjective experiences of
women themselves, and indicates some of the complex variety of
that experience..She draws together the varied threads of child-
rearing practices, anatomy, role stereotypes, parental permission
and validation, and pathological experiences such as rape and
incest. She reiterates that while sex may be perfectly natural, it
is not always naturally perfect.

Linda Whooley and Tee Kamen, a team of highly competent
group psychotherapists (whose success rate with primary non-
orgasmic women is better than Masters and Johnson) discuss the
great variety in female sexual patterns, illustrating their observa-
tions with personal histories contributed by ten sexually active
women.

The stereoscopic views demonstrate the uniqueness of human
females. In doing marital-sexual counseling, we have talked with
many men who knew nothing of the location or uses of the
clitoris, and with many women who did not know that they had
one. Such persons might be able to gain knowledge from these
illustrations, which are both photographically clear and medical-

8 CLITORIS

j rs 1 r ry é medicine may also
ly appropriate. Counselors in psy chology and ye

benefit from exposure to the variety of anatomies. .
The purpose of this book is to decrease anxiety, to give space
j essay : e man organ, and
to hitherto uncollected essays on a neglected hu ge

7 further research. If it succeeds in any of
to suggest avenues of

these, we will be most gratified.

Chapter IT

ANATOMY OF THE HUMAN CLITORIS
Donald L. Stilwell

INTRODUCTION

This chapter is not meant as a full review of its interesting
subject, the clitoris, for there are more exhaustive and provoca-
tive sources: cf. R.L. Dickinson’s Human Sex Anatomy. The
bibliography chosen is selective both for ease and depth, which-
ever is desired.

External genital structures lie in the anterior half of the perin-
eum, the urogenital triangle. They are so formed as to protect,
cloak, and surround the vaginal and urethral openings, and the
phallus. The vulva or Pudendum muliebre (pudere, Latin, to be
ashamed; mulebritas, L., a womanly quality) encompasses labia
majora and minora, the enclosed vestibule of the vagina, mons
pubis or mons veneris (mons, L., mountain or elevation; veneris,
ref. to Venus), the clitoris and its parts: glans, body, and crura;
two bulbs of the vestibule, greater vestibular glands (Bartholin),
and the urethral orifice.

The erectile parts of these tissues are the cavernous bulbs and
clitoris, but while other vulvar tissues are not truly cavernous
they secrete, swell, and congest most characteristically during
sexual response. Many parts of the vulva are comparable or spe-
cifically homologous to male organs, but have adapted to vagina
and vulva as a receptacle and canal for parturition. For example,
the vestibular bulbs (male corpus spongiosum) are divided to
flank the vagina, thus, do not enclose the urethra. Vascular and
nervous structures are comparable: the pudendal nerve and in-
ternal pudendal vessels, pelvic splanchnic and hypogastric nerve
plexuses. Deep perineal structures are comparable: anal and uro-
genital triangle, anorectal fossa, the urogenital diaphragm and
perineal fasciae.

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mice

CLITORIS

THE PERINEUM

Anal and urogenital regions of the perineum are divided by a
line drawn just anterior to ischial tuberosities, passing across the
central tendinous point of perineum; this corresponds to the
deeper lying superficial transverse perineus muscle. Standard
sources ought to be consulted for a more thorough account than
can be given here. Since the vulva is related to deeper perineal
structures, a fragmentary view will be offered (Fig. 1).

The urogenital (or genital) triangle corresponds in shape and
location to the anterior part of the pelvic outlet; it is bounded
by symphysis, ischiopubic rami, and a line between the tuber-
osities. A fascial and muscular sandwich, the urogenital dia-
phragm, penetrated by vagina and urethra, fills this bony tri-
angle. External or superficial to the diaphragm lies the super-
ficial perineal space (pouch), the enclosing deep fascia, superfi-
cial fascia with adiposity, and skin. Above the diaphragm lies the
pelvic basin; immediately above it lie the pelvic diaphragm mus-
culature, bladder, and upper vagina.

Skin of the perineum is for the most part labial, which cor-
responds to scrotum. Its adipose layer is thick where it underlies
the labia majora, and peripherally it is continuous with pan-
niculus adiposus (superficial fascia) of abdomen (Camper’s fas-
cia), mons pubis, and thigh. The membranous deep layer of
superficial fascia is not well marked in the vulva; it continues
forward with the corresponding Scarpa’s fascia of abdomen. It is
attached laterally to rami, and behind to the posterior margin of
urogenital diaphragm.

Deep perineal fascia encloses the superficial space (pouch). It
passes above pubis to fuse with deep fascia covering rectus
sheath and external oblique muscle. Centrally it fuses with the
suspensory ligament of clitoris, and behind and laterally it has
the same attachments as superficial fascia, and thus limits poster-
ior extravasations. The superficial pouch encloses three muscles
and erectile bodies as in the male: bulbospongiosus (or bulbo-

ANATOMY OF THE HUMAN CLITORIS

ns] bulbocav-
ernosus m.

i sup. br. perineal n.
cutan. branch

4 post. femoral
| cutan. n.

deep br. perineal n.
| perineal n.

pudendal n. &

inf. rectal brr.
ischiocav, m.

cavernosus) muscle covering bulbs of the vestibule; ischiocaver-

Alcock’s) canal is uncovered, and lies medial to (T)
nosus muscles enclosing crura of the chitoris; and the small the ischial tuberosity. Enclosed in fascia of the canal the pudendal nerve

superficial transversus perineus muscle. In accordance with the

Figure 1. The pudendal (

12 CLITORIS

gives off inferior rectal nerves to anal canal, sphincter, and skin. Also in the

canal the pudendal nerve gives off the dorsal nerve of clitoris (18, origin
not seen) and the perineal nerve. The last gives off a deep branch, which
innervates sphincter ani externus, part of levator ani, bulbospongiosus and
bulb of clitoris, and superficial transversus peronei muscle. The superficial
branch forms medial and lateral labial nerves. In the illustration the lateral
branch anastomoses (15) with a perineal branch of the posterior cutaneous
nerve of thigh. Corresponding branches of the pudendal artery accompany
like-named nerves (illustration from Savage).

Other structures indicated by letters or numbers:
T — ischial tuberosity b — sphincter ani musc.
L — sacrotuberous lig. M — meatus urethrae
O — coccyx C — clitoris
A — anus 7 — prepuce
d— sup. transversus 18 — dorsal nerve of clitoris

perineus muscle 19 — ilioguinal nerve

h — ctus of clitoris 15 — anastomosis of nerves

smaller cavernous bodies of female these muscles are less exten-
sive, but nevertheless they function by contracting to encourage
erection of bulb and clitoris. Bulbospongiosi act together feebly
to tighten the vaginal orifice, from their flanking position.
Greater vestibular glands (Bartholin), and perineal branches of
pudendal nerves and deep pudendal vessels to pouch contents,
are other occupants of this areolar space.

The urogenital diaphragm is penetrated by urethra, but vir-
tually divided by the vagina. Its thick inferior (external) fascia,
the perineal membrane, is strengthened below the symphysis as
the transverse perineal ligament, which is separated by a milli-
meter gap from the arcuate pubic ligament. The symphysis,
arcuate ligament, and pubic periosteum afford attachment to the
suspensory ligament of the chtoris (Fig. 2). This gap is impor-
tant, for it transmits three significant structures:

a. The dorsal vein of clitoris

b. Deep lymphatics of clitoris (excepting skin)

c. Autonomic nerves to cavernous bodies
The dorsal vein is the efferent from clitoris and crura. Lym-
phatics follow this vein to paravesical and iliac destinations; only
skin and glans are directed to inguinal nodes. Sympathetic and
parasympathetic fibers, to vascular and erectile mechanisms, are

ANATOMY OF THE HUMAN CLITORIS

Pars acetabularis (rami ossis pubis) Pars acetabularis (rami ossis pubis)

----- Lig. suspensorium clitoridis

+---- Corpus clitoridis

Pars symphysica

Pars symphysica .-" (rami ossis pubis)
{rami ossis pubis)

i
Glans clitoridis

Figure 2. The relations, parts, and attachments of the clitoris are seen.
(Illustration from Kopsch.)

rami of inferior hypogastric (autonomic) plexus; a fair propor-
tion of vasomotor and vasosensory innervation follows tribu-
taries of the dorsal vein, retrograde, to the phallus.

Superior (internal) fascia of the diaphragm is indistinct. The
two layers meet behind to enclose the deep pouch, a thin sand-
wich filled with an almost inconsequential sphincter urethrae
muscle fused to deep transverse perineus muscle, and perineal
vessels to the bulb and adjacent tissues. Terminal perineal nerve
branches and nerve to the clitoris pass in this space to pierce to
their ultimate, anterior destinations. As additional functions
(Fig. 1) the superior fascia supports the attachment of vestibular
bulbs, Bartholin glands, crura, ischiocavernosus and bulbo-
spongiosus muscles.

THE CAVERNOUS OR ERECTILE BODIES

These are the glans, body and crura of clitoris, and vestibular
bulbs. The clitoris (Alectoris, Gr., not from the verb kleitoriazein,
“to tickle”) is situated at the anterior commissure of the labia
majora. It is mainly cavernous vascular or erectile tissue with an
enclosing sheath, formed of a small glans (L., acorn) or head,
and a short body of two incompletely separated corpora cavern-

14 CLITORIS

osa, continuous posteriorly with paired crura (L., legs). The clit-
oris is anchored via the crura to periosteum of ischiopubic rami
and to the pubic symphysis and its ligaments by a suspensory
ligament. It is the homologue of the penis, minus the male’s
corpus spongiosum and its enclosed spongy urethra.

Its body and head hang dependently by the suspensory liga-
ment, a midline band a centimeter or so broad, wider at its
clitoral attachment on tunica albuginea at the base of the body
and most medial part of the crura. Recently this has been more
fully described by Bertolini (66) whose account is consistent
with the degree of mobility recorded by Dickinson (749, figure
147). This range lies from about mid-pubis to perhaps an inch
below the arch during mutual pubic engagement by the sexes.

The corpora cavernosa clitoris are divided by an incomplete
fibrous septum beginning ventrally, extending most of its length,
as in the penis. The tunica albuginea is a dense fibroelastic cy-
linder, almost inexpansible, extending to the glans. Congestion
of cavernous tissue results of course in hardening and a variable
degree of elevation—erection. The anatomical concomitants of
this will be dealt with in subsequent discussion.

The glans (head) is a cap-like summit of the clitoral body,
comparatively undeveloped, cavernous and variably erectile with
a thin epithelium comparable to the membrane of adjacent pre-
puce and vestibule: stratified squamous onto which open a few
minor vestibular glands, which secrete mucus. Upon circumcision
this epithelium may become cornified and the glands disappear.

The prepuce, anterior forchette of labia minora, is a fold

above clitoris which may or may not shield the entire organ.
The tiny frenulum is a minute fold of conjoined labium on its
under surface. Minor lips are moist, ruddy, or pink, and are
covered with stratified squamous epithelium, cornified external-
ly. Minor vestibular gland ducts open into vestibule and urethral
orifice, as well as on the inner labial surface. Sebaceous glands
are common both internally and externally, but without associ-
ated hair follicles (Bloom and Fawcett, ’68, Stieve, *30). Central-
ly labia minora are composed of loose collagenous and elastic
connective tissue, with large vascular structures, venous presum-
ably, and semi-erectile or congestive.

ANATOMY OF THE HUMAN CLITORIS 15

Size of the mature clitoris is about 2.5
-2.5_cm. (glans and
body), with crura perhaps twice that ona widely

within individuals, on the basis presumably of inheritance and
endocrine influence. Its apparent prominence varies in accord-
ance with development of the adjacent vulva. There is no more
permanent response to excitement, autoerogenous friction, or
sexual experience than for the penis. Though the skin of glans,
prepuce, and labia may corrugate, hypertrophy, and congest
chronically with frequent activity, cavernous tissues do not par-
ticipate in reactive growth.

Readers further interested in size, excursion of position, erec-
tility, absence, “intersex” influence, as well as a broad view of
functional sex anatomy are advised to refer to an excellent and
original compendium, Human Sex Anatomy, by Robert L. Dick-
inson, M.D., 1949. Gerhardt (’33) deals comprehensively with
comparative anatomy, also presented in this book by L.Z.
McFarland, D.V.M., Ph.D. An overall anatomical view of the
human phallus is considered by Halban and Seitz (’24), Schroed-
er (730), or Stieve (730).

BLOOD VESSELS, ANATOMICAL MECHANISM
OF ERECTION, AND LYMPHATICS

Arteries of the phallus derive from the internal pudendal
branches of the internal iliac artery. Their paths and distribu-
tion, the arrangements and histology are too familiar to develop
here fully. Von Mdllendorf’s Microscopic Anatomy of Man (30)
is the best standard source. The reader of English is referred to
textbooks of histology, exemplified by Bloom and Fawcett
(768).

Tea walls are built of a much greater proportion of smooth
muscle than elsewhere, and show characteristic specializations. In
the dorsal artery and deep dorsal vein of clitoris, and their
branches, both circular and longitudinal muscle is to be found in
unusual formations. One is penetrating helicine (Gr. helix, a coil
eries, which control afferent blood and another
kenings of both arterial and
ing smooth muscle.

or corkscrew) art
is unusual subintimal pads and thic
venous walls, consisting of longitudinally-runn

16 CLITORIS

Tributaries of the dorsal vein are so muscular as to resemble
arteries. These arrangements of valvular control of blood flow
via afferent and efferent constrictions are unique in the human
body, even though visceral vascular control elsewhere is moni-

tored closely.

The deep dorsal vein of phallus does not follow the artery
back to perineum and pelvis. It is a midline vessel lying with the
artery and dorsal nerves on the tunica albuginea, and it begins in
a plexus of the glans, receives deep tributaries from the cavern-
ous spaces, and passes under the arcuate pubic ligament, then to
divide and enter the vesical plexus to join other pelvic veins. In
a small proportion of cases it may be tributary to the pudendal
vein in perineum.

Injection of the deep dorsal vein of the penis (Batson, °57;
Clemens, 61) introduces fluid into prostatic and vesical venous
plexuses, followed by immediate flow into sacral and pelvic for-
amina, and free anastomosis with internal and paravertebral
plexuses, ultimately into venous spaces in pelvis, vertebrae, cran-
ial sinuses, and skull. There is rich anastomosis with vena caval
and azygous systems, reversible with variance of pressure in
body cavities. It is this sytem which so readily explains metas-
tasis from viscera to skeletal structures in particular from pelvic
origins.

The mechanism of erection in male or female involves auto-
nomic nerves and their control of flow to and from cavernous
spaces. It is believed (Conti, 52) that ingress depends on activity
of parasympathetic fibers from $.2-4 (pelvic splanchnic, nervi
erigentes). Relaxation of the muscular walls and_helicine
branches of the dorsal artery produces a distension of trabecular
spaces of the cavernous bodies, and of the plexus of veins in
loose, subepithelial tissues of vestibule, labia, the bulb of vesti-
bule, as well as activity of glandular lubrication mechanisms:
greater (Bartholin) and lesser vestibular glands. Egress of blood is
blocked by the extraordinary pad and valvular structures in deep
dorsal vein and its tributaries, which drain cavernous spaces.
Sympathetic nerves arising from L.1-2 terminate the state of
erection and secretion by vasoconstriction of afferent arterial
channels and release of the venous mechanism.

ANATOMY OF THE HUMAN CLITORIS 17

Lymph node groups at inguinal and internal iliac locations
receive afferents from perineum and the vulva. Skin of the vulva,
prepuce, perineum and anus drains to superficial inguinal nodes,
glans skin to deep inguinal nodes. The remainder of clitoris, plus
vestibule, its bulb, lower vagina, urethra and bladder, and all but
fundus of the uterus follow venous drainage to internal iliac
nodes. This is in accordance with development of the visceral
and deep structures from cloacal origin, and skin from epitheli-
um between thighs of embryo and fetus.

DEVELOPMENT

A partial list of homologous organs is appended (Table I).
Any standard gross anatomy or embryology text (e.g., Patten,
’64) will serve as a fuller source of information and illustration;
only a summary will serve here.

TABLE I

SOME HOMOLOGIES OF REPRODUCTIVE SYSTEM
Male Female

no homologue upper vagina

prostatic utricle lower vagina

seminal colliculus hymen

urethra below utricle vestibule of vagina

urethra above utricle urethra

urethral surface penis labia minora

scrotum labia majora

glans penis glans clitoris

corp. cavernosum penis corp. cavernosum clitoris
corp. spongiosum penis bulb on vestibule

prostate gland urethral glands

urethral glands (Littré) minor (lesser) vestibular glands
bulbourethral gland (Cowper) major vestibular gland (Bartholin)

In the early embryo (9 mm., 4-5 weeks) a genital (phallic or
cloacal) tubercle forms over the pubic area, anterior to the
proctodeum. Its tissues become epithelial portions of penis and
clitoris. On the tubercle’s under surface a longitudinal groove
opens, the urogenital sinus. The groove becomes bordered by
genital folds (future labia minora). Proctodeum (future anus) and
urogenital sinus (future vagina and vestibule) are derived when

s
18 CLITORI

entic urorectal fold subdivides cloaca (5-6 weeks) into

the cresc
intestinal and urogenital portions.

Lateral to tubercle and nearer
swellings develop, later becoming labia majora and scrotum. Gen-

ital folds become urethral folds to close the penile raphé, but in
the female fail to close and become labia minora, enclosing the
derived vestibule. The original urogenital sinus orifice retains re-
lations as the vaginal outlet and vestibular area, only nominally
different from its embryonic relationship.

Preputial skin derives from a special epithelial fold at the base
of the fetal glans. The sheet of cells splits, forming the stratified
squamous and mucus secreting lining of prepuce, and covering
glans with a similar epthelium.

thighs genital, or labioscrotal

INNERVATION

The clitoris has somatic sensory, somatic motor, visceral
motor (autonomic), and vasosensory components. The pudendal
nerve, a mixed somatic nerve, and the hypogastric autonomic
plexus serve perineum and vulvar structures.

General sensation to skin of glans, prepuce, and body passes
in the pudendal nerve to lumbosacral plexus and to anterior
rami of spinal nerves S.2-4, via anterior sacral foramina. Prob-
ably many vasosensory fibers are also conveyed, though most
return to cord in autonomic nerves. Somatic motor fibers are
conveyed to perineal muscles, arising in cord anterior gray S.2-4.

Erectile bodies have sympathetic and parasympathetic (viscer-
al motor, autonomic), and vasosensory (visceral sensory) inner-
vation, terminating profusely in the specialized smooth muscle
wall of arteries and veins, and the semi-erectile blood spaces of
labial and vestibular tissues. These autonomics arise from thor-
acolumbar outflow [L.1-2(3)] and craniosacral outflow (S.2-4)
to enter the inferior hypogastric nerve plexus, and reach the
vulva and perineum by cavernous nerves and the pudendal
nerves.

Sympathetics arise from the lateral gray column of spinal
cord [at L.1-2(3)], pass via white rami to the lumbar gangli-
onated chain and its lower pelvic continuation, the hypogastric

ANATOMY OF THE HUMAN CLITORIS 19

plexus (the presacral sympathetic nerves). It comprises a simple,
bilateral plexus in whose ganglia pre- and postganglionic synapse
occurs. Its coccygeal termination is often termed ganglion impar.
Anterior to middle sacral foramina, it is joined by pelvic
splanchnic nerves (nervi erigenti) of the sacral parasympathetics.

From that point below, the plexus becomes inferior hypo-
gastric plexus. Its rami are distributed partly to lumbosacral
plexus, but mostly to arterial branches of the internal iliac
(hypogastric) artery, for pelvic and perineal destinations. Rami
to uterine artery become the uterovaginal plexus, whose lowest
fibers, now mostly postganglionic, pass beneath bladder, under
the arcuate pubic ligament, and follow outward the incoming
deep dorsal vein of the clitoris. Terminal distribution is to
corpora cavernosa, bulb of the vestibule, and other perivestibular
vascular walls. A large part of these nerves are vasosensory. Not
all is known about the specific cord level of origin, ganglionic
synapse, and the exact peripheral course of autonomic and vaso-
sensory fibers, but the summary above is generally agreed upon.

However, it is true that all these hypogastric and sacral
nerves, supplemented in part by the pudendal nerve, contain
both visceral sensory and motor fibers. They are indispensable
for ordinary and cord reflexes of vascular smooth muscle and
glands of pelvic and reproductive organs, and for erectile func-
tions.

The terminal portion of these autonomic nerves, as they pass
under pubis, is termed cavernous nerves. They follow deep veins
and arteries and their branches form an especially profuse peri-
vascular plexus. Along their course, especially at vascular branch-
ings, encapsulated corpuscles are numerous. These have hereto-
fore been named “genital corpuscles,’ misleadingly implying a
special sexual sensation. Their form is Pacinian, and their func-
tion is vasosensory. They correspond to the wealth of Pacinian
corpuscles monitoring blood flow in mesenteries, pancreas,
thyroid, digital vessels, and numerous other locations, invariably
paravascular.

CLITORIS
SENSATION

Skin sensation of labia minora, prepuce, glans, and body com-
prises the following modalities: pain, cold, warmth, and tactile
(touch, pressure, tickle, itch, localization, etc.). The pattern of
‘nnervation is not different from glabrous (hairless) skin else-
where. A triad of free, encapsulated (Meissner), and expanded tip
(Merkel) endings, superficially modified is also found in palm,
sole, and periareolar breast. All are exceedingly sensitive, and
characteristic qualities are recognized, or learned, for each zone.

Free endings ramify within stratified squamous epithelia to
the stratum lucidum, and in superficial dermis; they connect to
smaller diameter fibers, and probably serve for touch, pain, and
temperature. Larger fibers end in Meissner. corpuscles and struc-
turally similar endings in dermal papillae and dermis—confusingly
called Krause or Golgi-Mazzoni corpuscles. These are all tactile,
but archaic literature without basis assigns to some of them
“cold, hot or pressure” functions. Merkel, or expanded tip
endings, clasp the deep tips of epidermal ridges, and are assumed
to subserve touch and skin movement (see: Miller, Ralston and
Kasahara, 60; Cauna 58).

The mystique of a genital corpuscle is moderated by a knowl-
edge of its vasomotor function, and that no unusual nerve sup-
ply to the vulva, other than abundance, exists. Sexual and libid-
inous experience is only in part related to a wealth and variety
of receptors in skin. It derives also from learning, central dis-
crimination (of kind or quality of perception), and from erotic
conditioning. Engorgement greatly intensified it; therefore viscer-
al and deep somatic receptors must be involved.

REFERENCES

1. Dickinson RL: Human Sex Anatomy, 2nd ed. Baltimore, Williams and Wilkins
Co., 1949.

2. Kopsch Fr: Lehrbuch und Atlas der Anatomie des Menschen. Georg Thieme Ver-
lag, Stuttgart, 1955.

3. Bertolini R: Ueber die bindegewebige Befestigung der Clitoris des Menschen. Anat
Anz 18: 117-121, 1966.

4. Bloom W and DW Fawcett: A Textbook of Histology, 9th edition. W.B. Saunders
Co., Philadelphia, 1968.

ANATOMY OF THE HUMAN CLITORIS 21

. Stieve H: Harn und Gelechtsapparat: In: Handbuch der Mikroskopische Anatomie

des Menschen, Vol. VII, no. 2. Edited by W. von Mollendorf. Springer, Berlin,
1930.

. Gerhardt U: Kloake und Begattunsorganc: In: Handbuch der Mikroskopische der

Vergleichenden Anatomie, VII Band. 267-350. Urban and Schwartzenberg, Berlin,
1933.

. Halban J and L Seitz: Biologie und Pathologie des Weibes, IV Band, 512-519.

Urban and Schwartzenberg, Berlin, 1924.

. Schroeder R: Mannliche Gelechtsorgane. In: Handbuch der Mikroskopische

Anatomie des Menschen. Vol. III, no. 1. Edited by W. von Mollendorf. Springer,
Berlin, 1930.

. Batson OV: The vertebral vein system. Am J Radiol Rad Ther Nuc Med

78:195-212, 1957.

. Clemens HJ: Die Venensysteme der Menschlichen Wirbelsdule. Walter de Gruyter,

Berlin, 1961.

. Conti G: L’Erection du Pénis Humain et ses Bases Morphologicovascularics. Acta

Anat.14:217:262, 1952.

. Patten BM: Foundations of Embryology, 2nd cdition. McGraw-Hill, New York,

1964.

. Miller MR HJ Ralston IIJ and M Kasahara: The pattern of cutaneous innervation

of the human hand, foot, and breast. In: Advances in Biology of Skin, Vol. I,
Pergamon Press, Oxford, 1960.

. Cauna N: Structure of digital touch corpuscles. Acta Anatoom 32:1-23, 1958.
. Calabrisi P: The nerve supply of the erectile cavernous tissue of the genitalia in

the human embryo and fetus. Anat Rec 125:713-723, 1956.

. Savage Henry: The Surgery, Surgical Pathology, and Surgical Anatomy of the

Female Pelvic Organs, 5th edition. Churchill, London, 1882.

PrN

Chapter LI

COMPARATIVE ANATOMY OF
THE CLITORIS

Larry Z. McFarland

This chapter was not intended to be an encyclopedic review
of the structure of the clitoris for all vertebrates. Rather it is
intended to be a general presentation of the clitoris stressing
common anatomical features. Comments have been made on
specific mammalian species, especially on certain domestic ani-
mals and non-human primates. To this end 1 have drawn freely
upon the information presented in the encyclopedic works:
Marshall’s Physiology of Reproduction (Parkes, 1952), Primates,
Comparative Anatomy and Taxonomy (Hill, 1955, 1962, 1966;
1970), and The Anatomy of Domestic Animals (Sission and
Grossman, 1953). The taxonomy of animals mentioned follows
Mammals of the World (Walker, 1968) and the anatomical ter-
minology used follows the Nomina Anatomica Veterinaria
(World Association of Veterinary Anatomists, 1968).

I. OCCURRENCE OF THE CLITORIS
AMONG VERTEBRATES

A clitoris is found only among female amniotes, v7z., reptiles,
birds, and mammals. The clitoris is consistently present as 4
normal organ only in female mammals, where it is associated
with the evolution of the cloaca into separate anal and urogent-
tal orifices. More specifically, the penis and the clitoris are Te
lated to the development of the urogenital sinus into the penile
urethra of the male or into the separate vaginal and urethral
orifices of the female characteristic of the various species of
mammals.

A small clitoris can be found in reptiles (e.g., turtles, alliga-
tors, and crocodiles), and in some birds (e.g., ratites and anserl-
forms). In these non-mammalian vertebrates the clitoris 1s com
prised of erectile tissue similar to the corpus cavernosum.

COMPARATIVE ANATOMY OF THE CLITORIS

ll. GENERAL FEATURES OF THE
MAMMALIAN CLITORIS

The clitoris of most mammals is comprised of paired attach-
ments (crura clitoridia), a body (corpus clitoridis), and an ex-
posed or free area (glans clitoridis). The exposed part of the
clitoris is typically surrounded by a fold of skin or vestibular
mucosa (preputtum clitoridis) from which extends a frenulum,
and in many mammals the clitoris occupies a depression (fossa
clitoridis) in the cranioventral aspect of the vestibule or vulva.

The corpus cavernosum clitortds, homologue of the corpus
cavernosum penis, are paired muscles and are typically erectile
tissue which originate from the ischial arch creating the major
features of the crura and body of the clitoris. The origins of the
‘schiocavernosus and ischiourethralis (M. transversus periner su-
perficialis) muscles are commonly related to the crura of the
clitoris. The walls of the vestibule and labia, when present, are
comprised predominantly of constrictor muscles (M. constrictor
vestibuli and M. constrictor vulvac), homologues of the M. bulb-
ocavernosus (M. bulbospongiosus) of the male.

The M. retractor clitoridis, homologue of the M. retractor
penis, is a prominent muscle in those mammals in which the
penis is fixed to the abdominal wall (Bassett, 1961), e.g., the
Australian opossum, hedgehog, rat, rabbit, cat, pig, cow and
sheep, to name a few. The retractor muscle is lateral to the
constrictor vestibuli muscle and may assist in tensing the vulvar
orifice during copulation. For example, it has been shown that
stimulation of the clitoris in mid-thoracic spinal dogs induced
rhythmic contractions of the constrictor vestibuli muscle (Hart,
1970). Older work by Langley and Anderson (1895) in the fe-
male cat demonstrated that stimulation of the lumbar nerves
caused slight retraction of clitoris, constriction of the vulva, and
pallor of the clitoris.

Usually, the clitoris is not traversed by the urogenital canal.
Among primates it is common to find the ventral surface of the
clitoris grooved by the continuation of the urogenital sinus or
pudendal cleft. A clitorine urcthra is a normal structure of many
rodents, of the mole, of some primates, of the spotted hyena
and the elephant.

24 CLITORIS

An os clitoridis can be found embedded in the tissue of the

corpus cavernosum clitoridis of females of most species where an
os penis or baculum commonly exists in the male. Thus an os

clitoridis is common in most rodents and in some primates, car-
nivores, and cetacea.

The arterial supply to the clitoris, A. clitoridis, is typically
derived from the internal pudendal artery. A notable exception
is the mare in which a single artery, A. clitoridis media, is de-
rived from the obturator of the caudal gluteal artery. The A.
clitoridis typically divides into three branches: A. bulbi vestt-
bule, A. profundus clitoridis, and A. dorsalis clitoridis.

The venous drainages resemble the arterial supply. The vein of
the clitoris, V. clitoridis, usually receives three veins (V. bulbi
vestibuli, V. profunda clitoridis, and V. dorsalis clitoridis) before
joining the internal pudendal vein.

The lymphatic drainage of the clitoris, at least for the domes-
tic animals, goes to the superficial inguinal lymph nodes.

The nerve supply to the clitoris, N. dorsalis clitoridis, is de-
rived from the pudendal nerve. In those animals studied, nerve
terminals are reported to be especially numerous in the glans
clitoridis (Trautman & Fiebiger, 1952; Winklemann, 1960).
There are branched and unbranched free-nerve endings and cor-
puscular endings, such as Pacinian corpuscles and genital cor-
puscles. Furthermore, the number of nerve fibers passing in the
dorsal nerve of the clitoris of the ewe and cow has been found
equal to or greater than the number of fibers passing in the
homologous nerve to the penis of the ram or bull (Kitchell e
al., 1955).

Iii. FUNCTION OF THE CLITORIS
IN ANIMALS

The precise functional role of the clitoris in animals is un
known. Inferences can be made from various observations that
the nerves of the clitoris affect the central nervous system. For
example, certain mammals such as the cat and rabbit require
mechanical stimulation of the clitoris, vulva and vagina in ordet

to induce ovulation. In the practice of artificial insemination of

COMPARATIVE ANATOMY OF THE CLITORIS 25

cattle, it is well known that touching or squeezing the clitoris
will induce an immediate lordotic response which eases the an-
orectal pressure exerted on the arm. Stimulation of the clitoris
of spinal dogs causes rhythmic contractions of the M. constrictor
vestibuli (Hart, 1970), and stimulation of the clitoris in the ewe
results in fast and slow action potentials along the dorsal roots
of sacral nerves three or four (Kitchell et al., 1955). The fast
action potentials were believed related to striated muscle input
from the vulva whereas the slow action potentials were believed
related to input from the numerous genital corpuscles observed
histologically in the clitoris. Cutaneous stimulation of the clitoris
caused contralateral action potentials out of the ventral roots of
sacral nerves three and four, which is not observed following
cutaneous stimulation at other spinal segments, suggesting that
stimulation of the clitoris results in bilateral activation of the
lower spinal cord to discharge nerve impulses along the nerves to
the structures of the perineum (Kitchell et a/., 1955).

IV. COMPARATIVE ASPECTS OF THE
CLITORIS IN VARIOUS MAMMALS

Perissodactylia

Mare (Equus caballus). The clitoris is prominent. The glans
clitoridis is an ovoid structure about 2.5 cm. wide, and lies in a
distinct fossa clitoridis and is covered by a preputium. The cor-
pus clitoridis is about 5 cm. long and 1.5 cm. in diameter, and
the corpus cavernosum clitoridis is well developed with abundant
musculature and a septum. The glans clitoridis is richly inner-
vated and erectile, and the preputium clitoridis is non-glandular.
As estrus approaches the labia relax allowing the rounded glans
clitoris to be seen—which is referred to as the “winking effect”
associated with the breeding cycle of the mare. The labia of the
mare are smooth, prominent and hairless. Large erectile vestibu-
lar bulbs are present. See Fig. 3.

CLITORIS

Figure 3. Encapsulated nerve endings and free nerve endings in mare

clitoris. (8x)

Artiodactylia

Cow (Bos taurus). The glans clitoris is free and pointed, and
the corpus clitoridis is 10-12.5 cm. long and flexuous. The fossa
clitoridis is very shallow or completely absent. The glans clitor-
idis has a fibroelastic covering and does not contain erectile
tissue. The corpus cavernosum clitoridis has varying quantities of
fat cells in the trabeculae of the cavernous muscle. The skin
covering the labia of the cow is wrinkled and has fine hairs
scattered over it. The vestibular bulbs are prominent.

Ewe (Ovis aries). The glans clitoridis is pointed and enclosed
by a prominent fossa clitoridis. The clitoris is about 2.5 cm. long
and 0.5 cm. wide. The glans clitoris is erectile whereas the cor-
pus clitoridis is mainly fibrous in nature (May, 1970). See Fig:
4,

Sow (Sus scrofa). The fossa clitoridis is about 2 cm. craniad
to the ventral commissure of the vulva. The glans clitoridis

pointed and the corpus clitoridis is long and flexuous. The pres

putium clitoridis has numerous corpuscular endings.

COMPARATIVE ANATOMY OF THE CLITORIS

Figure 4. Genital corpuscles in the ewe clitoris.
Rodentia

Mouse (Mus). The vagina of the mouse opens independently

to the exterior (as is the case in most rodents), about 0.5 cm. in
front of the anus, and the vagina is not surrounded by any
structure homologous to the labia minora. The glans clitoridis
forms a small prominence, at times referred to as the “clitor-
idum,” just in front of the vaginal opening and is traversed by
the urethral canal. A small fossa clitoridis is present into which
opens the urethra dorsally and the clitoridal glands, homologues
of the preputial glands, laterally (Rugh, 1968).
Rat (Rattus). As in the case of the mouse, the vaginal orifice
Is separated from the urethral orifice. The clitoris is traversed by
the urethra, as described for the mouse, the fossa clitoridis en-
closes the clitoris, but the clitoridal glands open separately on
the “‘clitorium” and not into the fossa.

Hamster (Mesocricetus auratus). The clitoris is similar to the
rat and mouse, except there is typically an os clitoridis present.

Guinea pig (Cavia porcellus). The clitoris is well developed
and is traversed by the urethral canal. There is a characteristic
shallow groove running from the anus to the clitorus, and it

S
28 CLITORI

ures. The groove has been referred to
thralis. The vagina is normally closed
during estrus, and there is a diverticulum
between this membrane and the anus.

hides the underlying struct
as the fossa ano-vagino-ure
by a membrane except
(perineal sac or pouch)

Lagomorpha

Rabbit (Oryctolagus cuniculus). The rabbit’s clitoris is large,
reaching a length of 3 cm. It is located inside the ventral com-
missure of the vulva, and the glans clitoridis has a prominent tip
which projects toward the vaginal orifice. The paired corpus
cavernosum clitoridis are surrounded by a thick fibrous tunic.

Carnivora

Dog (Canis familiaris). In the bitch the clitoris lies about
2-3 cm. from the ventral commissure of the vulva within a prom-
inent fossa clitoridis, which is about 1 cm. in diameter. The
glans clitoridis projects into the fossa and contains erectile tis-
sue. The corpus cavernosum clitoridis are composed primarily of
fatty tissue in the axial area, and separated by a septum, and
they are enclosed by a fibrous tunic in which there are numer-
ous vessels and nerves. An os clitoridis is not usually present.

Cat (Felis domestica). The clitoris of the queen is about 1 cm.
long. The clitoris occupies a fossa clitoridis which is about 1 cm.
from the ventral commissure. There is usually a cartilagenous 0S
clitoridis located in the corpus clitoridis.

Spotted hyena (Crocuta crocuta). The urogenital canal tra-
verses a relatively large clitoris, which in the non-parous female
is almost indistinguishable from the penis of the male. The clit-
oridis is about 5 cm. long and 2.5 cm. in diameter near its base;
it is directed downward and forward, and a prepuce covers the
glans clitoridis, which is about 3 cm. long and has small spines.
The clitoris is erectile; copulation, parturition, and urination
take place through the urogenital canal traversing the clitoris
(Matthews, 1939).

COMPARATIVE ANATOMY OF THE CLITORIS
Primates

Taupatidae (Tree shrews). The clitoris is inconspicuous in the
shrews.

Lemuridae (Lemurs). The clitoris is long and the urethral ori-
fice is typically located at the base of the clitoris, except in the
ring-tailed lemur (L. catta) in which the urethra traverses the
clitoris. Some lemurs have not only a labia minora but also
prominent labia majora. The external genitalia are often as spe-
cialized as the penis.

Lorisidae (Loris, Galago). The clitoris is long and is traversed
by the urethra. An os clitoridis is present in at least one species.

Tarsiidae (Tarsiers). There is a bifid glans clitoridis concealed
by large labia minora. The perineal surface of the clitoris has a
median groove. During sexual turgescence the labia swell, the
urogenital cleft is distended, and the glans clitoridis becomes
visible as a lighter colored structure than the rest of the vulva.

Cebidae (New World monkeys). In New World monkeys the
clitoris is usually quite prominent, often pendulous, and fre-
quently resembles the penis. There is characteristically a ventro-
median groove on the perineal aspect of the clitoris, a pre-
putium, and paired frenula which continue from the edges of
the groove to the labia minora bordering the rima pudendi. Cata-
menial swelling of the perineum (sexual skin) associated with the
estrous cycle occurs in some species. An os clitoridis is present
in some.

Ateles (Spider monkeys). The clitoris is large and pendulous,
with a prominent ventromedian groove. There is usually a car-
tilagenous os clitoridis. The hook-shaped glans clitoridis is usual-
ly pigmented, is covered by a preputium, and lies in a fossa.

Alouatta (Howler monkeys). The labia minora and clitoris are
elongated giving the appearance of a pendulous apron about
25mm. square. The clitoris has a prominent ventromedian
groove, and the labia majora form the borders of the apron. The
entire vulva is brilliantly white, except for the blackened free
borders of the labia majora. In the young female the preputium
clitoridis may completely cover the clitoris creating a fossa.

Cebus (Capuchins). The clitoris is large and shaped similar to

ee =~
6 ES Sere er

30 CLITORIS

the penis with a cylindrical corpus and tapering collum. ‘he
glans clitoridis has a flattened mushroom-head with well defined
emarginate corona. The clitoris extends some 18 mm. from the
symphysis; the distal half is covered with a smooth, pigmented
skin whereas the proximal half has typical hairy skin. There is a
shallow ventromedian groove. A small os clitoridis is present.

Lagothrix (Wooly monkeys). The clitoris is a prominent
cylindrical organ almost as large as the penis. The glans is unpig-
mented and depending on the species may be smooth or have a
marked corona. There is a ventromedian groove, and the rima
pudendi is guarded by labia minora whose inner zone is unpig-
mented and whose outer zone is pigmented.

Callicebus (Titi monkeys). The clitoris resembles the penis,
but the glans clitoridis is more elongated and has a ventromedian
groove continuous with the rima pudendi.

Pithecia (Sakis). There is a prominent clitoris projecting from
the ventral commissure of the labia. The glans clitoridis is round-
ed with a distinct neck, the preputium clitoridis extends from
the labia minora, and there is a ventromedian pudendal cleft on
the clitoris.

Chiropotes (Red-backed sakis). There is a large area of naked
perineum with a short vulvar orifice and no distinct pendulous
clitoris. In C. Satanas there are no labia minora or majora and
within the vulva there is a widely flattened, bilobed clitoris
which is darker bluish in color than the vulva.

Cacajao (Cacajaos). The glans clitoridis is unpigmented and
measures 4mm. long by 2.5mm. wide, and there is a ventro-
median groove along its perineal half. The preputium is pig-
mented, and the lateral labia minora are marked by a reticular
formation of sulci. Labia majora flank the minora.

Saimiri (Squirrel monkeys). The clitoris is prominent and en-
closed by a preputium. Catamenial swelling of the perineal skin
is marked, the labia swell into hard parallel ridges some 4-6 mm.
in height, and the rima pudendi becomes everted behind the
base of the clitoris.

Miopithecus (Talopoin monkeys). There is a prominent glans
clitoridis and ventral cleft. The glans is globular, measuring

COMPARATIVE ANATOMY OF THE CLITORIS 31
6mm. long by 5mm. thick by 4.6mm. across. Sexual skin
changes are dramatic and extensive.

Erythrocebus (Patas monkeys). The glans clitoridis is globular
in form, rosy red in color, and projects a little beyond the
rather small vulva, whose folds suggest a labia minora and ma-
jora.

Cercopithecidae (Old World monkeys). In the Old World
monkeys the clitoris varies in size, and is often inconspicuous.
The organ is never perforated by the urethra, and an os clitoridis
may be present in some species. The labia minora are more
frequently developed than are the labia majora. Catamenial
swelling (sexual skin) of the perineum often involves the ischial
tuberosities, and its occurrence is irregularly distributed among
Old World monkeys.

Cercopithecus (Cercopithecus monkeys). The clitoris is usually
a bright pink to scarlet color, in contrast with the labia minora,
and in the non-erect state it is usually not prominent. Under
sexual excitement the clitoris becomes erect and is “presented”
to an interested male. The glans is acornlike in shape and has a
ventromedian groove. The corpus clitoridis is contained within a
cutaneous sheath, usually pigmented, which may terminate ina
crenated frill around the glans.

Presbytis (Langurs, etc.). The clitoris in Semnopithecus is con-
spicuous. It occupies a fossa and projects below the labia in
parous and non-parous females. Its body is 5 mm. long and the
ventrally grooved glans measure 4 x 3 mm. The urethra opens on
a urethral papilla in front of the vagina. The rima pudendi is
flanked by labia minora.

* Macaca (Rhesus monkeys, etc.). The clitoris is rather large
and has a shallow cleft on its ventral surface. The preputium
continues with the small labia minora. Labia majora are absent.

Papio (Baboons). The labia are well defined and ensheath a
relatively large clitoris. The glans clitoridis is a rosy red, bulbous
body with a ventral cleft. The perineum of baboons undergoes
remarkable catamenial swelling, and in some species the pre-
putium clitoridis enlarges into a pendulous lobe.

Mandrillus (Mandrills). The rima pudendi is not flanked by

39 CLITORIS
distinct labia. The prominent clitoris is guarded by a paper
: : d projects well beyond the ventral com-
wrinkled preputium, and Pro} PR Th r
missure of the rima pudendi. The glans 1s a ou ; g an
resembles the male glans except Its apex is deeply cleft. During
the sexual cycle the perineal skin is markedly swollen and a rosy
color; the swelling extends to the clitoris. :
Pongidae (Gibbon, orang, chimpanzee, gorilla). The clitoris
and the labia minora are generally well developed, especially in
the chimpanzee and some gibbons. The clitoris is both absolute-
ly as well as relatively larger in these anthropoid apes than in
woman. The clitoris lies in a fossa and is covered by a pre-
putium from which passes a prominent frenulum. The clitoris is
grooved on its ventromedial surface, and this becomes very con-
spicuous when the clitoris is everted. Catamenial swelling of the
perineum is noted in the chimpanzee and to a lesser degree in
the gorilla and the orang. No sexual skin is present in the
gibbon.

Sirenia

Dugong. The glans clitoridis is round and conspicuous and is
situated cranial to the urethral orifice. The vagina opens in a
shallow perineal groove, similar to that described for the guinea

pig.
Cetacea
Whale. There is a vulvar cleft, the cranial commissure of
which encloses the clitoris. The clitoris is an incurved, keeled
structure about 8 cm. long. The glans clitoridis is trilobed and

directed caudad. The urethra opens at the base of the clitoris.

Proboscidae

African elephant (Loxodonta africanus). The external genitalia
of the female elephant are carried ventral from the perineal re-
gion to open along the abdominal wall at a position similar to
that of the tip of the penis. This creates a very elongated uro-

COMPARATIVE ANATOMY OF THE CLITORIS 33

genital canal and clitoris, whose length is proportional. Thus the
external genitalia of the male and female are superficially simi-
lar. The urogenital canal is thinwalled with a large lumen. There
is little cavernous tissue in the corpus clitoridis, which forms the
roof of the urogenital sinus. The corpora cavernosa clitoridis are
prominent and run from ischial arch to the glans. A median
tendon to which attaches the M. retractor clitoridis is incorpor-
ated into the elastic sheath of the corpora clitoridis and it con-
tinues to the tip of the glans. The glans clitoridis is erectile, and
well innervated, and projects about 2.5 cm. from the cranial
commissure of the vulva (Perry, 1964).

Insectivora

In the mole (Talpa) the external genitalia of male and female
are very similar except during the breeding season. An anogenital
distance of less than 6 mm. is a presumptive female. The clitoris
is traversed by the urethra and the glans clitoris contains small
spines.

Monotremata
The clitoris is a vestigial to nonexistent structure associated
with the primitive reptilian-like cloaca present in female mono-
tremes.
Marsupialia
The clitoris of the more primitive marsupials, e.g., the virginia
Opossum and phalangers, has a bifid structure similar to that of
the penis. Kangaroos and wallabys have a cylindrical clitoris.
ACKNOWLEDGEMENT
I am extremely grateful to Dr. Benjamin Baker for his assist-

ance in gathering much of the reference material used in prepar-
Ing this chapter.

CLITORIS
REFERENCES

. Adams DR and DA Sutton: A description of the baculum and os clitoris of

Eutamias townsendii ochrogenys. J- Mammalogy 49:764-768, 1968.

. Bassett EG: Observations on the retractor clitoridis and retractor penis muscles of

mammals, with special reference to the ewe. J. Anatomy 95:61-77, 1961.

_ Hart BL: Mating behavior in the female dog and the effects of estrogen on sexual

reflexes. Hormones and Behavior 1:93-104, 1970.

. Hill WCO: Primates, Comparative Anatomy and Taxonomy. Wl. Haplorhini: Tar-

sidoidae. Edinburgh Univ. Press, Edinburgh, 1955.

____IV: Cebidae, Part A. Edinburgh Univ. Press, Edinburgh (1960).

___v: Cebidae, Part B. Edinburgh Univ. Press, Edinburgh (1962).

_____sSVSA: Catarrhini, Cercopithecoidea. Interscience Publishers, Inc., New York

(1966).

= VIII: Cynopithecinae, Wiley-Interscience, New York (1970).

_ Kitchell RLB Campbell TA Quilliam and LL Larson: Neurological factors in the

sexual behavior of domestic animals. Proc. Am. Vet. Med. Assoc., 92nd Annual

Meeting, Minneapolis, Aug. 15-18, pp. 177-189 (1955).

. Langley JN and MB Anderson: The innervation of the pelvic and adjoining viscera

Part Ill. J. Physiol. 19:85-121, 1895.

. Layne N: The os clitoridis of some North American Sciuridae. J. Mammalogy

35:357-366, 1954.

. Matthews LH: Reproduction in the spotted hyaena, Crocuta crocuta. Phil. Trans.

Royal Soc., series B, 230:1-78, 1939.

. May NDS: The Anatomy of the Sheep. University of Queensland Press, St. Lucia,
1970. ; ;

_ Parkes AS: Marshall’s Physiology of Reproduction, Vol. 1, part one, Longmans,

Green and Co., London, 1952.

. Perry JS: The structure and development of the reproductive organs of the female

african elephant. Phil. Trans. Royal Soc., series B, 248: 35-51, 1964.

. Rugh, R.: The Mouse: Its Reproduction and Development. Burgess Publishing Co.,

Minneapolis, 1968.

. Sisson S and JD Grossman: The Anatomy of the Domestic Animals, 4th edition.

W.B. Saunders Co., Philadelphia, 1953.

. Trautman A and J Fiebiger: Fundamentals of the histology of domestic animals,

8th and 9th editions. Translated by RE Habel and EL Biberstein. Comstock

Publishing Assoc., Ithaca (1952).

. Walker EP: Mammals of the World, 2nd edition, 3 vols. The Johns Hopkins Press,

Baltimore, 1968.

. Winkelmann RK: Nerve endings in normal and pathologic skin. Thomas, Spring-

field, 1960.

_ World Association of Veterinary Anatomists. Nomina Anatomica Veterinaria dis-

tributed by the Department of Anatomy, New York State Veterinary College,

Ithaca, 1968.

Chapter IV

NEUROPHYSIOLOGY OF THE CLITORIS
Berry Campbell

INTRODUCTION

A discussion of the neurophysiology of the clitoris must bring
together diverse and scattered data. Little of the literature deal-
ing with this subject and its role in sexual behavior has centered
around the functions involving the clitoris, per se, or the associ-
ated physiological and behavioral entities. Rather we find that
this tiny but impressive organ is given a subsidiary billing in the
varied literature of sexual function. Exceptions to this situation
are to be seen in the works of Masters and Johnson (1) who
correctly assess its importance in the female sexual response and
in the interesting analysis of Sherfey (2) who considers the on-
togeny of the clitoral function.

In the ensuing pages, I will attempt to bring the neurophysio-
logical literature of the clitoris into a clearer focus, to present
some original data related to sensory conduction from this or-
gan, to integrate clitoral function into the current concepts of
behavior, and finally, to proffer new hypotheses on the impor-
tance of arousal state in the sensory function of the clitoris and
the operation of positive feedback in sexual activation. The di-
verse roles of the varied perineal muscle groups in the female
sexual response will be detailed.

As all others who. have covered this ground before, I am
impressed with the neglect, which the literature evidences, of
this organ. Its emergence in the modern literature is obviously
related to the ‘sexual revolution” so widely advertised in the
current scene. Sherfey, more than any other writer, shows the
relevance of such a protean social force as the subjugation of
women to the current paucity of scientific understanding 19 this
area. With a viewpoint clearly feminist, she argues In an impres-
Sive and engaging way, not for the equality of the female, but

36 CLITORIS

for the essential superiority of the female sex. On the basis of
current embryology that the male is a modified female, differ-
entiated during the first trimester of pregnancy from the main
(some morphologists use the term “indifferent’’) sex by the ac-
tion of fetal male hormone, she arrives at a view of the natural
superiority of women from grounds somewhat different from
those of Ashley Montagu (3). I will not get directly involved in
the discussion as to whether female sexuality has a mirror image
relation to maleness (Oliver Wendell Holmes amusingly claimed
that the female genitalia were but those of the male turned
inside out). The reader is referred to the analysis of Beach (4).
Yet, the ensuing report was prepared very much with Sherfey’s
interesting views in mind and some of the interpretations may

bear on her thesis.

As with the paucity of literature (before the immediate pres-
ent) on the female sexual response, the clitoris may owe much
of its neglect to the widespread view that the organ has little or

no importance in reproduction. Were this true, the current ap-
preciation of sex as an entity separate from reproduction and
important in its own right would tend to correct this disregard.
In addition, we may well wonder if the role of the clitoris in
reproductive function, though not essential, may play an im-
portant part. Though I have no novel views on this subject, it
seems worthwhile to note the importance of genital stimulation
in those animals that ovulate as a result of coitus (Sawyer, 5).
As a species, man may have some residue of this pattern. Lacta-
tion in the human female is definitely affected by genital stimu-
lation as I have reported earlier (Campbell and Petersen, 6).

The importance of learning processes in sexual functions
would seem at first consideration to be slight. I should, however,
point out that while the impact of learned behavior on female
sexuality is more poorly understood than its similar role in the
male, the dynamic views of behavior, in which ontogeny merits
consideration, offer many aspects where learned behavior could
be of great importance. Some mention will be made of this in
the summing up.

NEUROPHYSIOLOGY OF THE CLITORIS
SENSORY PATHWAYS FROM THE CLITORIS

The neurophysiology of sensory function, especially as related
to sensory endings in the skin and pressure receptors of deeper
tissues, has been a difficult and disputatious subject for many
years. There has been a conspicuous lack of progress in the
attempt to relate modality of sensations to specific types of
receptors in the various areas of the skin (Weddell, 7). A review
of the extensive literature of this field would be out of place. I
will, however, present a generalized view based on various pub-
lished works which can serve as a unifying scheme and which
allows an analysis of the sensory conduction from the genitalia.

Table II presents a generalization of the inter-relations of type
of nerve endings, fiber size, speed of conduction and modality.
In spite of the fact that there is little agreement among various
investigators on the correspondence of the smaller end-organs to
the modalities of pain (in its several varieties), to temperature
discrimination and to light touch, there is considerable confi-
dence in the correlation of pressure sensations with the encapsu-
lated end-organs as indicated in the middle and large fiber parts
of this spectrum. The so-called genital corpuscles which are
found in such profusion in the clitoris furnished the starting
point for a study of the sensory functions of the genitalia which
I conducted, some years ago, with my colleagues, Ralph Kit-
chell, Andrew Quilliam and Lester Larson. The following ac-
count will review some of the published data from this study (8)
and also some hitherto unpublished material (Table Il).

Fiber Size Spectrum Studies of the Nerves to the Genitalia.
The conspicuous concentration of medium sized encapsulated
end-organs in the clitoris is reflected in the fiber size spectrum
of the innervation of that organ. In general, there is a correla-
tion of the diameter of the myelinated fiber supplying a sensory
end-organ with the size of the end-organ, its modality, and the
speed of conduction of the fiber. The pain-temperature-light
touch system is related to the small fiber component of peri-
Pheral nerves and to simple end-organs; pressure and genital
sense are mediated by encapsulated end-organs and innervated
by large fibers; deeper pressure and muscle sense are detected by

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NEUROPHYSIOLOGY OF THE CLITORIS 89
very large end-organs which are served by large fibers; deeper
pressure and muscle sense are detected by very large end-organs
which are served by the large myelinated fibers. In all classes,
the speed of conduction of the fiber is related directly to fiber
diameter.
A study of the fiber size spectra of the nerves of the pelvic
lexus was undertaken by the author and his co-workers, R.L.
Kitchell, T-A. Quilliam and L.L. Larson. The nerves of the
pudendal plexus was dissected from male and female sheep and
stained with a variant of the Pal-Weigert technique and sec-
tioned. The sections were photographed at a standard enlarge-
ment and the fiber size spectra measured with appropriate rings
on a plastic sheet and counted with an electronic counter. From
this emerged the pattern of fiber size spectra of the innervation
of the genitalia (Table II). Out of this large amount of data
(previously unpublished) the most relevant items have been ex-
pressed as histograms in Fig. 5.
The pudendal nerve (Fig. 5d) shows a fiber size distribution
of its 15,514 fibers which is rather typical of peripheral nerves

TABLE Ill

MODALITY

pain temp light touch light pressure deep pressure

SIZE OF

HM di 1
ENDING sma medium arge

(free nerve ending) (encapsulated) Pacinian corp)
muscle spindle)

SPEED OF

medium fast
CONDUCTION ay

40-60 m/sec 100 m/sec

10 12 14 16 18 20

Fiber size (u)

Fiber counts by diameter classes of the nerves of the pelvic plexus of a male (#154)
and a female (#183) sheep. This data, previously unpublished, is from a study made at

ae University of Minnesota by the author and his colleagues, Kitchell, Quilliam
and Larson.

ITORIS
40 CL

ee : si 404 153K 8 Rt.Dorsal N.of Penis |
2 Caudal Hemorrhoidal N Fibers: 2,248

167K 6 Lt-Sz root of rotentsl &: 167 K 2 Fibers: 1,061 a
Fibers: 5,

Lt Dorsal N.of Penis
£.Perineal N :
, 167 K 18 Lt .Super Fibers: 1,331
407 167K 6 Lt-S, root rae Fibers: 2,319 (near glans)
r
30

: Rt.Dorsal N.of Clitoris
3 167 K 27 Lt.Dorsal N.of Clitoris Fibers: 4,548
Sate 2 Fibers: 4,098

rs: 3,

ll.

i Telewh 1
a. 167 K 26 Lt.N.of Clitoris
Snecey aStSs Fibers: 2,954 14 16 18 20 22

ati +

alttth.

a alae gs arn ese ey Se Serre mpi 2 22

L s eee)

Figure 5.Histograms delineating fiber size spectra (as percentages) of
selected nerves of the pelvic plexus of sheep. Some of the data is from
Table 11, however, additional data is included from two additional animals,
#183, male and #154, female.

except for the abundance of fibers in the 12-14, 14-16 micron
classes. In comparison, a nearly pure cutaneous branch, the su-
perficial perineal nerve (Fig. 5f) shows more prominently the
peak centering at 6-8 microns which characterizes general cutan-
eous sensibility and shows lower percentage frequency of the
fibers in the 10+ micron classes. These latter correspond to the
genital innervation, Pacinian corpuscles, muscle afferents and the
alpha muscle efferents. In contrast, the caudal hemorrhoidal
branch (Fig. 5e), which is motor to the anal sphincter as well as
cutaneous sensory, shows a prominence at 16-20 microns which
is related to striated muscle, motor and sensory. At the lower
end of the spectrum, the contribution of the autonomic fibers is

NEUROPHYSIOLOGY OF THE CLITORIS 41
made clear by the skewed peak of the autonomic branch of the
pudendal nerve, the pelvic nerve or nervus erigens. Many of
these very small fibers enter the pudendal nerve via the fourth
sacral root though undoubtedly the greatest bulk of them enter
through a third sacral root. The pelvic nerve is given off as a
branch of the pudendal nerve close to its origin. It contains
principally the parasympathetic efferent fibers to the clitoris and
the perineum generally.

The nerve to the clitoris (Fig. 5, g and k) is distinctive in that
the general cutaneous component at 6-8 microns is minimized,
the 4-6 micron class is substantial, the mid-region (8-12 microns)
is prominent, and there is no conspicuous peak at 18-20 mi-
crons. Thus, we find in two animals (no. 167, no. 154) general
agreement in the fiber size histograms of the dorsal nerve to the
clitoris, each showing more than 4,000 countable fibers. It will
be understood that these figures refer to one-half of the specific
innervation of the organs only.

Meaningful comparisons of the nerve to the clitoris should be
made with the corresponding nerve in the male sheep. The dor-
sal nerve to the penis (Fig. 5, i and j) shows the distribution of
diameters of the fibers of this nerve near the base of the penis,
and near the glans, respectively. The more proximal section
yielded over 2,000 countable fibers, considerably fewer than in
the nerves to the clitoris. Some of this might be due to lack of
strict correspondence of the nerve sections in the male and fe-
male specimens, if that were possible. It may more probably
indicate that the innervation of the penis is less than that of the
clitoris for it agrees with our published findings in the bovine
species (loc. cit.), where the comparable figures were 4,033 (to-
tal of both sides) in the male to 7,733 in the female.

Spinal Reflexology of the Genitalia. Conduction of impulses
from the clitoris and neighboring regions of the vestibule to the
spinal roots of the second, third and fourth sacral roots has been
explored in cats (Campbell, Good and Kitchell, 9) and sheep
(Kitchell e¢ al., loc. cit.). Bipolar stimulating electrodes in the
region of the clitoris stimulated the end-organs with single con-
denser discharges and the conducted potentials were Peat
graphed, as they were led off from the spinal roots, on a cath-

CLITORIS

ale a a
Figure 6. Different characteristics of action potentials in dorsal root of S-3
of the ewe resulting from stimulation of the clitoris: a. as compared to

stimulation of wall of vulva. b. The traces are superimposed by multiple

exposure during a train of stimuli of increasing strength until maximal

response is obtained.

ode ray oscilloscope. A search was made for a component of the

compound action potential corresponding to the intermediate
mode of the fiber size spectrum so characteristic of the nerve to
the clitoris. Figure 6 shows that such a correspondence does
exist in a wave of intermediate velocity and threshold. The illus-
tration is of a set of recordings from a female sheep in which
the third and fourth sacral roots showed response to clitoral
stimulation, the third showing the most. When the stimulus was
confined to the clitoris, two separate waves were evoked, the
first arising in response to a weaker shock strength than the
second. This recording demonstrates the evolution of the com
pound action potential on the third sacral root in response tO
the application of a series of increasingly stronger stimuli to the
clitoris. The first peak develops early and shows little increase
with subsequent increase in stimulus strength. The second peak,
on the other hand, showed a higher threshold in that it became
maximal only with considerably greater stimulus strength than
the first wave. Its delay in reaching the spinal root indicates that
the fibers involved are more slowly conducting than those con
cerned with the earlier wave. In another such experiment, the

NEUROPHYSIOLOGY OF THE CLITORIS 48

yelocity of the first component was calculated as 110 meters/
second while that for the second component was determined at
50 meters/second. Moving the stimulating electrodes to the
mucosa of the lateral wall of the introitus results in a loss of the
second component with no diminution of the first. From these
facts we can interpret the second component as representing
conduction along the fiber size mode related to the encapsulated
nerve endings in the clitoris, the first component as the conduc-
tion on the fibers afferent and efferent to striated muscle.

The transmission of activity through the spinal cord shows
features which distinguish those levels mediating sexual reflexes
(S-3 to S-5) from the more cranial segments (L-5 to S-2) which
are concerned principally with locomotion. The most striking
feature is the presence of crossed reflexes and the lack of a
primary proprioceptive spike. It is a universal finding that single
shock stimulations of nerves of the lumbosacral plexus do not
evoke a reflex response in the contralateral ventral roots. The
midline of the spinal cord seems to serve as an effective barrier
to the spread of simple reflex activity. However, the third and
fourth sacral segments, those which are related to the genitalia,
show marked crossed-reflex activity. A single shock applied to
the S-83 dorsal root (Fig. 7c) results in a reflex return on the S-3
ventral root of the same side (ipsilateral) after slightly more than
3 milliseconds. This resembles the reflex of the same ventral
root in response to stimulation of the vulva (Fig. 16b) with due
allowance of conduction time from that organ (approximately 9
milliseconds). The comparable reflex on the contralateral S-3
ventral root (Fig. 7d), in response to dorsal root stimulation,
also resembles the ipsilateral response except that there is nearly
double the central latency and a slightly smaller amplitude. The
reflex returns of the S-4 segment are usually similar to those
found in S-3. The third and fourth sacral segments also demon-
strate interaction with neighboring segments (Fig. 7, ¢ and §)
both in relation to crossed and uncrossed reflexes.

These refiexes contrast sharply with those of the second sac-
ral segment (Fig. 8), not only in the involvement of crossed
pathways within the spinal cord but also in the absence of the
Proprioceptive spike. In the locomotor portions of the spinal

CLITORIS

msec

RRA UU OC oh
segments of spinal cord of the
f vulva. b. S-3 ventral root from
imulation of ipsilateral S-3 dorsa
ntralateral $-3 dorsal root. @

1 $-3 dorsal root. f. 8-3 ventral
tral root from

ewe: a. 9-9
stimulation
] root.

Figure 7. Responses of sacral
dorsal root from stimulation o
of vulva. c. S-3 ventral root from st
d. S-3 ventral root from stimulation of co
ventral root from stimulation of ipsilatera
root from stimulation of ipsilateral S-2 dorsal root. g. S-3 ven
stimulation of contralateral S-2 dorsal root.

NEUROPHYSIOLOGY OF THE CLITORIS

Figure 8. Response on ventral root, second segment, following stimulation
of its ipsilateral dorsal root. The arrow marks the location of the indistinct

shock stimulus artifact.

cord, which include the S-2 segment, the segmental reflex is
dominated by the very rapid response of the motor neurons to
the muscle afferents. This produces a rapid and highly synchro-
nized spike representing the response to muscle afferents from
striated muscle innervated by these segments. Thus the early
afferent spike of the compound action potential of the pudendal
nerve described above seems inadequate to initiate a fast re-
pau in the motor neurons. During the heightened excitability
ae ee stimulation, an early ipsilateral component was
an e S8-3 and S-4 segmental reflex which undoubtedly
fittes ca proprioceptive mechanism (Fig. 9, a and b). In a
eee = experiments, a definite proprioceptive spike was
Tiere e reflexes from the fourth sacral segment (Fig. 9c).
a constant finding in reflexes involving the fifth sacral

segment (Fig. 9d).
arenes eee phenomena seen in the cat and sheep
ae special central pattern of activity in the segments
fea the functions of the sexual organs. The presence of
fe moe reflex is associated with the synchronous activity of
ay ree elements of the genitalia in contrast to those mediat-
see e alternating action of the limbs. Correlated also with the
ee differences in patterns of function between these two
s, the limbs and the genitalia, is the relative preponder-

CLITORIS

f spinal cord of the ewe: 4. 8-3
f ipsilateral S-3 dorsal root. b. S-3 ventral
f ipsilateral S-3 dorsal root — note pres-
entral root
rsal root. d. S-5 ventral root from

Figure 9. Responses of sacral segments 0
ventral root from stimulation o
root from repetitive stimulation o
ence of an early component in the second response. ¢. 8-4 v

from stimulation of ipsilateral S-4 do
stimulation of ipsilateral S-5 dorsal root.

ance of the proprioceptive spike in the former and its lack in
the latter. It would appear that cutaneous afferents form the
driving force in the reflexes of the genitalia, a finding well in
accord with observations made on copulatory behavior.
Conductory Pathways to the Brain. The interaction of higher
centers with the spinal-integrated fractions of sexual behavior
involves, among other things, ascending pathways in the spina
cord and brainstem. The pathways of sexual stimuli from the
genitalia have been discussed with regard to the anatomy of the
end-organs, fiber size spectra of the peripheral nerves, patterns
of primary sensory stimuli, and reactions in the third and fourth
sacral segments. The present section details the results of an
experimental study in the cat of the sensory pathways from the
genitalia to the diencephalon and the cerebral cortex. Some °

NEUROPHYSIOLOGY OF THE CLITORIS 47

Ait material has been previously reported (Meyer et al., 10).
Specifically “sexual” stimuli have not been used, except inas-
much as the genitalia and the pudendal nerve were stimulated.
The pathways activated were thus not necessarily the ones which
transmit stimuli of sexual sign especially, but we may expect
that they are the ones which form the most direct and rapid
pathways for sensation from the genitalia. In the data presented
here we have attempted to delineate the routes, the conduction
speeds, and the patterns of the ascending signal and the reac-
tions of the higher centers to these. The several preliminary
experiments which were included in this series designed to ob-
serve the difference in these pathways between estrous and an-
estrous female cats were failures and the hormonal potentiation
of the specifically sexual signal in these conduction routes will
have to be examined more carefully without the limitations of
barbiturate anesthesia.*

The cats used in this study were anesthetized with Dial or
Nembutal. After surgery in which the spinal cord, cerebral cor-
tex, or brainstem were exposed, the biopotentials were studied
with a cathode ray oscilloscope. Recording electrodes were made
of glass capillaries drawn while filled with a silver solder. These
varied in diameter from 25 mu to 7 pw. They were mounted on a
3-way vernier electrode holder. All recordings were made of po-
tential differences at the microelectrode against a large ““ndiffer-
ent” electrode on nearby inactive tissue. A 3-channel stimulator
was used which delivered condenser discharges with time con-
stants of 0.01 to 0.1 milliseconds. Histological studies were
made in eight experiments and the. positions of the needle tracks
were determined. In two of these experiments, needle positions
for critical potentials were marked by electrolytic lesions and

See ccalized in the stained sections.
imuli were delivered to two sites for the genital stimulation.

With silver wire bipolar electrodes, they were led across the glans

ca by Kawakami and Kubo (Neuroendocrinology, 7:65-89, 1971) has

lobe that own ac cellular recording in the brainstem, hypothalamus and limbic

vagina. Th esttous) animals show a heightened response to stimuli delivered to the

only by f. y BE Sram estrogen may act on the higher centers directly or,
y facilitating the sensitivity of the genital end-organs.

less likely,

CLITORIS

Figure 10. Recordings from: a. dorsal rootlets, S-3; stimulation, penis. b.
dorsal rootlets, S-3, stimulation, tibial nerve. c. dorsum of cord, S-1; stimu-

lation, penis. d. dorsum of cord, S-1; stimulation, tibial nerve. Time, 1

msec.

penis or, in the female cats, to the vulva in the region of the
glans clitoris. In other experiments, the stimuli were delivered to
the central end of the cut pudendal nerve. In all experiments,
the tibial nerve at the popliteal space was sectioned and similarly
stimulated for comparison.

The Spinal Cord. The effectiveness of the direct stimulation
of the genitalia was determined by examining the activity in the
corresponding S-3 dorsal rootlets following single shock stimula-
tion. Figure 10 illustrates the deflections evoked by stimulation
of the penis and of the tibial nerve. There are constant differ-
ences between the potentials evoked by stimulation of the geni-
talia directly or by stimulation of the central cut end of the
pudendal nerve, on the one hand, and the potentials evoked by
tibial nerve stimulation, on the other hand. The pudendal nerve
field apparently is deficient in the fast conduction receptor fi-
bers and the resulting potentials at the dorsal rootlets are de-
layed and show a less abrupt commencement. The amplitude
also as compared with the corresponding tibial nerve potentials
is low. Thus the signal delivered by the compound action P°
tential to the spinal cord differs in the case of the pudendal

NEUROPHYSIOLOGY OF THE CLITORIS 49

way from that of the tibial nerve. The lower ampli-
tude and less abrupt onset is seen in the activity within the
spinal cord in the dorsal column of the local segments (contrast
c and d, Fig. 10). It is seen as well in the dorsal column records
at the C, segment (contrast Fig. 11, a and b with Fig. 11, c)
which show the corresponding differences in the central effects.

nerve path

Figure 11. Recordings from dorsal column at C,: a. stimulation, pudendal
nerve. b. stimulation, penis. c. stimulation, tibial nerve. Time, 1 msec.

Latency measurements and conduction distances as seen in
these experiments show that the average conduction velocity in
the pudendal nerve is 39 meters/second, and in the tibial nerve
is 68 meters/second.

Direct conduction in the dorsal column at the C, level was
obtained a number of times in experiments. Representative
traces of the activity are shown in Fig. 11. The average conduc-
tion velocity from the pudendal nerve field is 41 meters/second,
and mn the tibial field is 53 meters/second. Indirect or relayed
activity from the genitalia, and the tibial field as well, was re-
corded and measured in the lateral column. On the ipsilateral
se. aaly of the dorsal spinocerebellar pathway was clocked
i oe conduction velocities characteristic of this pathway.
ae, € data of these experiments, actual velocities within the
ae cord can be calculated in the one animal where in re-
Bee to stimulation of the clitoris and the tibial nerve, activity

as recorded in the ipsilateral column at the C; segment (one
pucendal nerve had previously been sectioned). Correcting for
€ peripheral conduction latencies and for the measured dis-

ps ies So

has a a Pn NS

50 CLITORIS

tances allowing 0.9 millisecond for synaptic delay, the velocities
within the contralateral column for pudendal and tibial activity
may be calculated at 70 meters/second and 130 meters/second
respectively. These are to be compared with dorsal column con-
duction velocities obtained in this animal in a like manner, of 41
and 53 meters/second. Such values in the instance of the tibial
nerve lie within the velocities reported by Grundfest and Camp-
bell (11). The slower velocity of the dorsal column fibers serving
the pudendal nerve has been detailed above. It is remarkable
that the calculated velocity of the conducted activity within the
spinal cord, presumably mostly on the secondary tract, is so
much slower than that from the tibial nerve field.

Our records of activity in the contralateral column show aver-
age conduction velocity and variation of 34 meters/second
(30-35 meters/second) for the pudendal nerve activity and 48
meters/second (43-61 meters/second) for the tibial nerve records.
This is significantly faster than the conduction velocities re-
ported by Collins and Randt (12) in the cat but slower than the
figures presented by Correa and Grundfest (13) for tract conduc-
tion in this region of the spinal cord of the monkey. The reason
for this discrepancy with the published data is not apparent,
though it is likely that our experiments were not exactly com-
parable to those of the previous authors. The rather wide differ-
ence between the conduction velocity which we have measured
for the activity evoked by pudendal nerve (or genitalia) stimula-
tion and that following stimuli to the tibial nerve, is in agree
ment with the observations presented above concerning the dif-
ferences in velocity of these two systems in the dorsal colum 10
the ipsilateral column. i

The Brainstem. In order to place the electrode into the bram-
stem or diencephalon the cerebrum was removed, exposing the
rostral portion of the thalamus and the third ventricle. Various
sites for penetrating these structures were selected as illustrate
in Fig. 12. Not all sites were used in each animal. The stations
(indicated by open circles for genital fields, closed circles fe
tibial nerve) are numbered from dorsal to ventral. Each statio?
was obtained by measuring the depth of the electrode where g
recording was elicited. On the assumption that the brain siZ©

NEUROPHYSIOLOGY OF THE CLITORIS

een aa ge a-e, of brainstem of the cat showing stations from

hify ike pay SERS recorded by micro-electrodes. The closed circles sig-

pudendal ne recording following tibial nerve stimulation, the open circles

the dorsal rve field stimulation. f The position of the tracks projected to
Sal surface of the brainstem.

52 - CLITORIS
remained relatively constant, these depths were located on an
appropriately scaled cross-sectional diagram. In two animals, le-
sions were made at each active position. The actual positions of
these two lesions agreed closely with their recorded depths. This
was evidence that our measurement method of determining the
location of each station was fairly accurate. There was, however,
a degree of uncertainty associated with the exact location of
each tract because the electrode could not be placed in precisely
the comparable site from one animal to another and the angle at
which the electrode entered the tissue could not be exactly
controlled.

The lemnisci were encountered in the ventrolateral tegmen-
tum and recognized by the short latency and characteristic en-
velope. Figure 13 illustrates two pairs of potentials, evoked by
stimulation of the pudendal nerve (upper traces) and of the
tibial nerve (lower traces). Amplitude of the potentials, as in the
spinal cord, was lower and the latencies longer in the responses
to pudendal nerve stimulation. The deflections were positive as
is characteristic of pure tract potentials and it is seen that the
onset of positivity (shown as “drop off” in the traces) is more
abrupt in the potentials evoked by tibial nerve stimulation.

Figure 13. Recordings from lemniscus at level of superior colliculus: a. stim-
ulation, pudendal nerve, record from track 4, station 1. b. stimulation,
tibial nerve, record from track 4, station 4. c. stimulation, pudendal nerves
record from track 3, station 4. d. stimulation, tibial nerve, record from
track 3, station 5. Time, 5 msec.

NEUROPHYSIOLOGY OF THE CLITORIS 53

ble activity is excited in the tectum by these stim-
wii. Figure 13 illustrates comparable potentials evoked by the
two pathways in the superior colliculus. The lower amplitude
and longer latency of the activity following stimulation of the
pudendal nerve illustrated by this pair of traces is a constant
finding.

In the tegmentum, between the superior colliculus and the
Jemnisci, potentials of low amplitude and of long latency (12-22
milliseconds) were encountered. These were interpreted as poten-
tials of the various nuclei of the reticular formation.

Considera

Fi :
vane 14, Recordings from superior colliculus: a. pudendal nerve, track 1,
ation 1. 6. tibial nerve, track 1, station 1.

aoe see! in the brainstem, activity was encountered in
agate » aes nucleus of the thalamus. Representative re-
te ae os 15) shows the small but definite activity evoked by
7 ficken al nerve stimulation. There is in these potentials little
aan ate cellular activity. The envelope of the deflection is
meee anne first 10-15 milliseconds of the activity and little

y 1s seen in the spikes, in contrast to the cellular poten-

54 CLITORIS

tials recorded from track 5. It is likely that the discharges re.
corded here represent impulses in the lemniscal fibers at or be-
fore their terminations.

Figure 15. Recordings in posteroventral nucleus of thalamus: a. pudendal
nerve, track 6, station 4. b. tibial nerve, track 6, station 5.

Single units of the lemniscal fibers were recorded on several
occasions. Figure 16 shows a series of such traces where two
discharging units were observed in a sequence of sweeps in
which they were responding to increasingly strong stimuli deliv-
ered to the penis. In all of the records, the two units began
firing in near synchrony. This latency of the initial spikes varied,
from threshold to strong stimulation, a full 3 milliseconds. As
the stimulus increased, the frequency of discharge of each of the
units increased from 400 per second to approximately 650 pet
second. There was no clear indication of stepwise variation in
the intervals and it seems clear that the repetitive firing on these
long fibers is an expression of the reaction to some long-lasting
excitatory state rather than the re-delivery of detonator-like sig-
nals through repetitive channels. ;

A record from the more dorsal part of the hypothalamus 18
shown in Fig. 17. This responded only to tibial nerve stimula-
tion and was remarkable in that the active site was signalled,
upon entrance of the microelectrode, by a spontaneous dis-
charge, apparently of one unit at a frequency of less than 100
per second. This died out in a few seconds and the area W®

- :

Figure 16. Sequence of records from posteroventral nucle

NEUROPHYSIOLOGY OF THE CLITORIS

\
'

on
a
rr
Se
aor
ea nin

us of thalamus
the stimulation

evoked by stimulation of penis. From top to bottom,

found to respond to tibial nerve stimulation with a latency © i
mMcreases. Time, 1 msec.

rahe

CUTE ACURA ees nt

a CLITORIS
more than 20 milliseconds. No sites in the hypothalamus Were
found which responded to stimulation of the genitalia or of the

pudendal nerve.

Pree

Figure 17. Recordings from medial hypothalamus: a. spontaneous activity
recorded upon entrance of needle electrode. b. potential evoked by stimula-
tion of tibial nerve after spontaneous activity had subsided. Track 5,

station 8. Time, 5 msec.

Further rostrally, a site in the thalamus was examined which
responded to both pudendal and tibial nerve stimulation (Fig.
18, a and b). The latency of the pudendal nerve response was 12
milliseconds to the first sign of activity. Four milliseconds later,

a discharge of several units appeared which was characterized by
high negative spikes. This was indubitably a cellular respons®
The response to tibial nerve stimulation consisted of a large
positive deflection with very complex spiking. Immediately be-
low this region, however, the response to tibial stimulation be
came simpler and showed a series of late single unit negative
spikes with a latent period of 20 milliseconds as opposed to 8.¢
milliseconds for the beginning of the overall deflection. The inl-
tial discharge frequency of this unit was about 700 per secoP©

NEUROPHYSIOLOGY OF THE CLITORIS 57

No marking lesion was made at these sites so exact localization
impossible, but the medial location of the track and the
secondary nature of the cellular response fits well with the inter-
retation that the site was in the medial thalamus and excited

was

by thalamothalamic connections.

Figure 18. Recording in medial region of thalamus: a. pudendal nerve, track
5, station 2. b. tibial nerve, track 5, station 2. c. tibial nerve, track 5,
Station 3. Time, 1 msec.

The traces of Fig. 19 illustrate the evoked potential at the
pericruciate cortex. They show the continuation of a feature

58 CLITORIS

which characterizes the pudendal nerve (and genitalia) records,
namely, the lower amplitude and the increased latency as com-
pared with the activity following tibial nerve stimulation.

Figure 19. Recordings from pericruciate cortex: 4. pudendal nerve. b. tibial

nerve.

The Long Pathways. These experiments demonstrate that the
activity evoked by stimulation of the pudendal nerve field in the

ascending sensory tracts and in the related nuclei are distin-
guished by their increased latencies, lower amplitudes, slower
rising time, and more restricted distribution than that evoked by
stimulation of the tibial nerve. There is little doubt but that
these properties are, for the most part, correlated with the spé-
cial sensory mode of the genital field and with the 10-14 #
nerve fibers which characterize these afferents. Both the puden-
dal and the tibial nerves contain general sensory components
with the peak of fibers in the 4-6 w diameter range. It is the
nature of these experiments, however, that they reveal most
clearly the activities related to the faster fibers present In the
nerves. In the case of the pudendal nerve, these are the 10-14 #
group related to the encapsulated end-organs in the phallus. The
tibial nerve, on the other hand, contains a more rapid compoh
ent of afferent fibers in the 14-18 m range, presumably muscle
and deep pressure afferents.

Perhaps the most unexpected finding in these studies
the conduction velocities in the dorsal column of th
cord, as well as of the ipsilateral and contralateral columns, |
very much slower than is the case in the tibial nerve activity”
The fibers of the dorsal column are, of course, central fibers °

was that
e spinal
are

NEUROPHYSIOLOGY OF THE CLITORIS 59

the primary sensory neurons and it is interesting to find that
their conduction velocity is matched to that of their peripheral
fibers. The implications of these findings in the secondary as-
cending tracts, however, are that signals are carried on fibers
somewhat matched in diameter to those of the peripheral con-

ductors.

BEHAVIORAL CONSIDERATIONS

Before discussing the genesis of sexual sensations in the clit-
oris, it would be well to discuss the importance of the phallus
generally in the formation and maintenance of the body image.
Self-awareness takes place in an individual largely through the
generation of a body image. On introspection, this proves to be
a rather complex amalgamation of awareness of the shapes, func-
tions and importances of parts of the individual’s body or per-
son. The distortions by which a person’s body image, as sensed
objectively, differs from a photographic image are spectacular
and meaningful. They are, of course, conditioned by the specific
life-history of the person and his social milieux. Of more interest
to us at this point are the distortions due to sensory innervation.
In general the parts of the body which figure most importantly
in our sensory consciousness are more vivid parts of the image.
The mouth and the finger tips are, of course, accentuated as are
the front surfaces of the body over the rear, the distal parts of
the limbs over the proximal, and the exposed parts over the
concealed. A good understanding of this is to be had from the
map of the body which is detected on the sensory cerebral
cortex and which is amusingly drawn as a homunculus by Pen-
field and Rasmussen (14). In this the tongue, lips, finger tips,
especially of the thumb and index fingers, are greatly exaggera-
ted with respect to their actual size. Though the representation
of the genitalia has been shown by these and other authors to
be on the paracentral lobule, the illustrations and texts are in
general non-committal as to their relative place in the sensory
homunculus. Not so with the behavioral scientists (and psychia-
trists) who point out the very early awareness of the infant of
his genitalia and of the concern which represents the social value

Cepeeeienecttt
TSG ASRS: Vitae

60 CLITORIS

and impact of these organs in the adult individual. There is,
however, a very special aspect to the sensory awareness of the
genitalia which must be understood in order to resolve the am-
biguities both of the neurologists’ and behaviorists’ treatment of
the place of the genitalia in the body image. In contrast with
the finger tips and mouth which have a sensory meaning and
sensitivity rather uniform in time, the genitalia, especially the
penis and the clitoris, have two alternative states of sensory
function, differing qualitatively and quantitatively. These states
are associated with arousal and with non-arousal. The non-arous-
al sex organ has a general cutaneous sensibility that differs little
from that of the surrounding skin areas, except perhaps a dis-
tinctly richer bed of end-organs. Upon tumescence the sensory
snflow from these organs is greatly changed both in meaning and
in sensibility. This alteration is very marked and may easily be
studied introspectively. It is clear that upon engorgement a sud-
den shift in the sensations from general skin sensibility to a
characteristic sexually meaningful feeling is made, with the qual-
ity of the sensations acquiring a voluptuous nature by which
they are presented to the consciousness in a quite different con-
text. We have discussed above the peculiarity of the end-organs
which one finds in the clitoris, penis, and associated sexual skin.
The nature of the sensation which carries a sexual “sion”? is hard
to define. It is an intriguing possibility that the genital corpus:
cles with fine distal fibers to the skin surface react to the tissue
pressure of tumescence as amplifiers of this sensory pattern, as
discussed in an earlier paper (8).

Recent works of Morgane (15) and Hoebel (16) have sus
gested that the several appetitive functions affected by ee
along the course of the medial forebrain bundle (feeding; ae.
ing, sexual behavior) are related to one another by being mo
lations of a behavioral activation circuit. According to these
findings, stimulations of this system in the lateral hypothaletile
may be expected to lead to activity on the part of the anim :
but the nature of the activity may be determined partly, *
least, by the influences of the external environment OF om
sources. Thus, under experimental conditions a rat might, y
stimulation at a single locus, be motivated to eating if food we

NEUROPHYSIOLOGY OF THE CLITORIS 61

resented or to mating behavior if a receptive female were prof-
fered instead. The interpretation is given that motivated behavior
has both the elements of general activation (the medial forebrain
bundle is shown to extend to the tegmental activating system)
and specific modalities. It is also seen that under such circum-
stances, the stage of the complex sequence of sexual or court-
ship behavior which is initiated by the stimulation is one that is
appropriate to the specific situation. These experiments and an-
alyses clarify and illuminate the matter of motivated behavior
and in doing away with the “feeding center” or “sexual center”
view make a more plastic and sophisticated model of behavioral
structure possible.

Importance of Positwe Feedback. In respect to the function
of the clitoris, or of the phallus generally, the above mentioned
progress in behavior experimentation calls to attention a func-
tion which has been generally overlooked. This is related to the
importance of positive feedback in crystallizing the inception of
a behavior sequence. Under ordinary conditions, as contrasted to
the greatly simplified surroundings in which motivational experi-
mentation is carried on, the choice of behavior to accompany a
particular arousal or activation event is not strictly alternative
but instead two or more behavioral sequences might be, to some
extent, appropriate. In some complexes of response, eating, mat-
Ing activity, and flight, for example, the initiation of the behav-
ior evokes a positive feedback mechanism which reinforces the
behavior selected. Introspectively, the sudden sharpening of ap-
petite upon commencing a meal is noted by all of us. This is in
part due to the increased gastric motility by which the stomach
Itself makes more imperative the activity leading to its filling.
With flight also, it is generally recognized that fear or the sharp
mMcrease in fear is consequent upon the initiation of running

away. Similarly, the inception of mating behavior has such ob-
vlous reinforcements.

_ The first sign of sexual arousal is tumescence of the phallus.
MEE in males this is principally an increase in size and then of
ae a that an awareness of the subject if not of the other
ee me becomes an important datum, in women the sensa-

endant upon tumescence of the clitoris are less inter-

SMA NOBAD ILM!

ser iitiired|

———

a CLITORIS

pretable as a change in size and turgidity br

it are at once volup-
tuous in a way that seems not to be characteristic of the penis

To be sure, the fully erect penis is a source of considerable and
important sensation of the most specifically sexual nature and
by this fact the erection tends to perpetuate itself in the absence
of other stimulation. But the clitoris seems through its own
generation of sensation to be more supportive. In each instance
however, it may be seen that the nature of the situation is on
of positive feedback—the action stimulates to more action and
the usual outcome is a rapid progression to a maximum arousal.
It should be noted in passing that whereas negative feedback is
more or less ubiquitous in biological systems and underlies near-
ly all finely regulated activity, positive feedback with its “ava-
lanche” effects is to be sought and found in those action se-
quences which cannot in the short run be considered as serving
homeostatic purposes (though in the long run they might pro-
mote survival of the individual or of the race.)*

*The sequence of sensations consequent upon arousal and tumescence of the clitoris is
probably of great importance in the very young child in the development of the
genital aspect of body image. This has important corollaries both in normal and
abnormal behavior. The spontaneous arousals which we can see so clearly in male
infants and again at the approach of puberty are probably paralleled in girls. Through
them the individual fills out the special area of body image corresponding to the
genitalia during socio-sexual stimulation. In the course of events, manual manipulation
becomes centered on the phallus and hand-to-clitoris pattern is established. Very little
is known about this: nearly all observations have been made on boys where the fact
of arousal is manifested by erection. The reason for attempting analysis of this grow-
ing-up pattern here is to offer my hypothesis that it is in this sequence that we should
look for the pathological effects of puritanical inhibition which seems to be the basis
of a certain amount of sexual inadequacy (lack of orgasm) in women. The fact that
the arousal sequence, important in learning or establishing dynamic body image; is one
which occupies a certain amount of time and consists of one level of pace
leading to another seems to me to offer an insight into the remarkable amount w)
inhibition which may be superimposed on subsequent behavior by overstrict ati
in the child’s bringing up. As I see the operation of this, the child is inculcated a
with a powerful negative response to the initial tingling sensation and learns tor ate
or completely abort the arousal sequence at a time when it has not acquire ua
overwhelming level of excitement. In a strict and overprotective environment, 4 -
inhibition not only becomes more effective through repetition but due to the Ba
sion of any verbal communication relative to it, it sinks into the unconscious min 3 i
is easily seen how such a mechanism could produce in a young mature oie
complete inability to undergo normal arousal and even a lack of appreciatio

such an organ as the clitoris exists.

NEUROPHYSIOLOGY OF THE CLITORIS 63

Specific information on which to evaluate the above hypothesis is not available to

me. However, I do offer the following account from an adult informant which gives

some insight into the operation of moral inhibition in the arousal sequence. This
woman was raised in a home of intense religious fervor and estrangement without
separation of the parents. Upon marriage she was anorgastic and it took several years
of intense coaching on the part of her experienced and sophisticated husband to
establish a pattern leading to orgasm. Later, she separated from her husband, became
intensely religious and inhibited all forms of sexual activity. She relates that she
recalls during this time waking from sleep in an arousal sequence leading towards
orgasm. Her guilt was so great that she would immediately become angry—even to the
point of slapping her own face—and the climax would be successfully aborted. Later,
this woman acquired insight into her own behavior, became sexually active and con-
tracted a successful second marriage.

Positive Feedback Mechanisms in Sexual Arousal. As pointed
out above, there is a positive feedback phenomenon by which
sexual arousal, when commenced, tends to be ‘“‘locked in” as the
dominant ongoing behavior much as other appetite satisfying
sequences are reinforced through feedback from their own _target
organs. Thus the consideration of the clitoris as solely, or even
primarily, an organ which responds to mechanical stimuli asso-
ciated with the sex act misses the point. The lack of attention
of this aspect of clitoral function is in part ascribable to a cur-
ious view among many investigators that “subjective” sensations
are not “physiological.’’ Thus we find in such leading contem-
porary works as that of Masters and Johnson (1) no discussion
of the type of sensation perceived by women during tumescence
and sexual activity, but only the “objective” features of the
sexual act are detailed. This, to me, seems like a dust bowl view
of physiology. Perhaps a sounder consideration would be that all
phenomena involving neural mechanisms are neurophysiological,
¢ven though some may be available at the present time only by
asking the people concerned what they feel.

Upon such questioning we are informed by several reliable
respondents that a tingling sensation is the first sign of sexual
arousal and that it in itself is a highly effective erotic stimulus
that does indeed tend to channel the attention on the sexual
situation which engendered it unless dispelled by some other
Stimulus or situation. The tingling sensation is replaced by, or,
Perhaps more accurately stated, grows into a buzzing sensation
as the sexual involvement becomes greater. This sensation in

64 CLITORIS

turn strengthens into what is described as a throbbing feeling of
the organ. Informants, of course, differ in their verbal patterns
as well as, seemingly, in the intensity of their experiences. The
further stage of this throbbing is, as related by one informant, a
further progression to an actually painful throbbing. Another
described the final involvement of the musculature of the geni-
talia: “Suddenly, I could feel each individual muscle of the per-
ineum as it began to contract spasmodically,” this last describing
an experience of unexpected confrontation at a social gathering
with a man who had, though of slight acquaintance, taken on an
intense sexual meaning for her.

In this description of the voluptuous feelings by which the
tumescent clitoris supports sexual attention and involvement, the
consideration is of the situation in which petting or intercourse
is not involved. This then is a measure of the meaning and
intensity of the sensations generated by the process of tumes-
cence itself. It should be pointed out here that little is known of
the sequence, or of the details of the actual swelling of the
clitoris and that unfortunately none is furnished de novo in this
report. Masters and Johnson have commented on the variation
from woman to woman of the erectile events and of the diffi-
culties in their observation. Anyone who has tried to make ade-
quate measurements of this organ in its states of action will
realize the formidable task it presents. We may suppose, how-
ever, that the pressure of the erecting organ is a stimulus to the
encapsulated nerve end-organs of the clitoris and that the pres-
sure of the neighboring tissues, which became engorged, and of
the arterial pulse in the later stages contribute to the impressions
of the informants which I have described above.

Mechanical stimulation of the clitoris is a most important
aspect of the consummatory sexual act. The infrequency of
those individuals who are able to deliberately progress through
the stages of arousal to the orgasm is remarkable and no critical
observations or experiments have been published on them. How-
ever, it would seem that many women are able to pursue this
ee during sleep or at the moment of waking up, for orgas™
in this setting is well known and commonly reported. Again, we
find little in the literature to help us understand the behavioral

NEUROPHYSIOLOGY OF THE CLITORIS 65

structure of these sequences. On the basis of preliminary obser-
vations, I am convinced that erection of the clitoris during sleep,
especially paradoxical or REM sleep, occurs in a fashion paral-
leling that described for the penis (Fisher et al.,17). There is,
obviously much more reliable information on the response of
the clitoris to mechanical stimulation as it occurs during inter-
course or during masturbation.

The Female Sexual Response. The difficulties involved in the
analysis of the role of mechanical stimulation of the clitoris
during intercourse are obvious. With two persons rather than one
volved and the lack of easy access for observation of the clit-
oris, a problem is presented which will have to be overcome by
a sophisticated recording approach using well-trained subjects.
The situation is not hopeless; Masters and Johnson have made
some very promising advances with their technique of artificial
coitus. In what is probably a more productive technique at the
present time, the inter-relation of clitoral function and consum-
matory sexual behavior may be approached experimentally in
analysis of masturbation to orgasm, especially with an elec-
trically driven vibrator.

Vibrating at the rate of 60 per second, a strong stimulus can
be delivered to the clitoris without actually touching the sensi-
tive glans. The nature of the stimulus is such that the excitation
produced is principally through the encapsulated end-organs
rather than through the general cutaneous afferents. There is
considerable variation from subject to subject as to the preferred
method of application of the stimulus. In the series of experi-
ments analyzed here, some of which are presented in recorded
form, the subject preferred a slow stroking of the mons and
shaft of the clitoris with the vibrator. These strokes lasted about
10 seconds each and were separated by an interval of approxi-
mately the same time. The readout of this type of experiment
can be made, as were those presented here, by placing a sensitive
transducer within the introitus or higher in the vagina and re-
cording the pressure as a signal on a physiological recorder. In-
formation was augmented by direct observation and by digital
Palpation during this series of experiments.

In the discussions above it has been pointed out that the

66 CLITORIS

sexual response does not correspond to what we ordinarily think
of as a reflex; that is, a simple response which occurs with
predictable frequency following a stipulated stimulus. The re-
sponse is as we shall see anything but simple and in fact involves
the entire motor behavior of the subject. With these reservations
in mind we will; however, examine the parts of the sexual re-
sponse which involve the muscles associated with the genitalia.
There are four groups of musculature which are involved primar-
ily im this reaction. First, there is the superficial musculature
which, in the human female, consists of a considerable number
of muscle fibers lying superficially and laterally to the mouth of
the vagina, and to some extent, encircling that orifice. The fibers
insert anteriorly upon the shaft and crura of the clitoris. In the
same superficial layer is also the transverse perineal muscle
which arises on the ramus of the ischium and inserts in the
connective tissue immediately behind the vagina, the perineal
body. The third member of this superficial musculature is the
ischiocavernosus muscle. This arises on the ramus of the ischium
on each side and inserts into the shaft of the clitoris in such a
way as to pull the clitoris downward when contracted, and at
the same time, constrict the crura of the clitoris.

A second set of musculature involved in the sexual response
consists of the muscles of the urogenital diaphragm. This is a
complex and rather strong aggregation of muscle fibers forming
a shelf-like diaphragm across the anterior or urogenital part of
the pelvic aperture. The muscle when contracted may be felt
from the lowermost part of the vagina as a shelf or shelf-like
projection.

The third set of musculature exceeds those already mentioned
in mass and strength and consists of the medial portion of the
levator ani muscles frequently differentiated by -pthe, ates
pubococcygeus. This muscle is detected by palpation as 4 wide
strap-like muscle running on either side of the vagina and uniting
behind the vagina as a sling.

The fourth and final set of the muscles considered here is the
intrinsic musculature of the lowermost end of the vagina. This
smooth muscle has rather different properties than the skeletal
or striated muscles described above. These four categories °

oluntary

NEUROPHYSIOLOGY OF THE CLITORIS

ele

)

I
eae,

| eA

ae PILE AS

ft
i
I
{|

Figure 20. A record of the complete female sexual response made by a

sensitive pressure transducer in the lower third of the vagina. For details,

see text.

68 CLITORIS

musculature are separately mentioned here because in the re-
sponse building up to the climax and in the orgasm itself, each
plays a particular role.

Figure 20 presents a recording from the pressure transducer in
the introitus of the vagina during the twenty minutes or so
occupied by the build up and release of the sexual response. The
recording obtained from this area consists of a series of slow (3
or 4 per minute) waves with more rapid wave responses written
upon them. In addition, there is a constantly rising baseline of
these pressure responses, and finally, a sequence of about one
per second contractions which terminates the response. Follow-
ing that there are two sets of three waves in which the subject
was asked “to make as strong a voluntary contraction as pos-
sible.” Each of the responses to this is underscored with a dot.
It will be seen in this record that seven or eight minutes follow-
ing the start of the stimulation the responses suddenly became
much more intense. It is at this time that the subjective sensa-
tions from the clitoris began to take on a throbbing character-
istic.

From a series of 10 such recordings and from twice that
number of careful digital palpations during similar sequences the
following conclusions have been drawn. Slow 3 or 4 per minute
waves represent powerful contractions of the urogenital dia-
phragm especially of those elements of it forming a sphincter
around the lower third of the vagina. Faster 15 to 20 per minute
waves superimposed on these slow contractions represent the

contractions of the levator ani. In Fig. 21 recordings during
similar sequences are presented with the pressure transducer in
varying positions in the vagina. In the lowermost record (Fig.
21, e), the transducer was 4 inches within the mouth of the
vagina, in other words, high in the posterior fornix. At this
position, the waves representing the levator ani are demonstrated
but the slow waves which I conclude are records of the contrac
tion of the sphincter elements of the urogenital diaphragm are
no longer clear, though recordings from the lower’ third of the
vagina (Fig. 21, b and c) show them very well. The baseline °
the record in Fig. 29 shows a gradual rise which is characterise
of all the records taken. This increase in baseline pressure is due

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CLITORIS

with transducer high in
ractions. 0.-f:
to show the

Figure 22. Six orgastic responses: a. record taken
the posterior fornix, showing the absence of the sharp cont
five records recorded from the lower third of the vagina
similarities of the responses.

° . e
to an increased contraction or tonus of the smooth musculatur

represents

of the lower vagina and, to an undetermined extent, 5 a
and O

also the increased hyperemia of the walls of that organ
the tumescence of the vestibular bulbs. Interestingly enough, the
superficial musculature takes no part in this response up tO the
commencement of the orgasm. With the orgastic response comes

NEUROPHYSIOLOGY OF THE CLITORIS 71

a series of rapid (ca. one per second) contractions which repre-
sent activity in the superficial musculature only. These are the
jschiocavernosus and bulbocavernosus as well as the transverse
perineal muscles. The contractions are of considerable strength
and may be seen as a rapid elevation and depression of the
clitoris as well as a bowing of the labia minor. Comparing the
responses shown in Fig. 22, a and b-f, one sees that in the
former where the pressure transducer was very high in the va-
gina, no record of these fast contractions is seen although the
orgasm represented in this was vigorous and typical in all
respects.

A feature of the orgasms which deserves some attention is the
very sudden rise of pressure in the lower vagina which is sus-
tained for a period of 12 to 15 seconds before the contractions
of the superficial musculature begin. This same feature has been
noted by Masters and Johnson who have pointed out that the
subjective sensation of orgasm commences at this point well
ahead of the muscular contractions. My observations fit their
statements completely. Figure 23 shows in considerable expan-
sion a more detailed curve from the pressure transducer in an-
other response.

The recordings here were obtained from one subject. It is a
remarkable feature that they are so similar. Whether this implies
that they may serve as “fingerprints” remains a moot point. At
any rate, as Fig. 21, b-f, show there is an unexpected uniformity
in these responses.

An attempt of justification should be made with respect to
the fact that all detailed observations of the sexual response in
this account were made upon one subject. The thousands inter-
viewed by Kinsey and the hundreds of subjects studied by Mas-
ters and Johnson have set the stage for a numerical qualification
which the present description does not measure up to. Perhaps it
should be borne in mind that as one progresses from the psycho-
logical to the purely physiological, there is a considerable con-
striction of the variation in activities and responses. By and
large, the purely physiological responses vary within narrow lim-
its, and these would probably be expressed as variations in the
duration of the various phases, number of contractions, strength

CLITORIS

re 23. The final three minutes of a female sexual response, recorded on

Figu

16.

an expanded time scale to show details but otherwise as Figure

NEUROPHYSIOLOGY OF THE CLITORIS 73

of contractions, optimal parameters of location and frequency of
stimulation, and the degree to which psychic stimuli and hor-
monal balance might inhibit or enhance the response.

SUMMARY

The clitoris, endowed with an amazingly rich sensory innerva-
tion, is supplied with nerves characterized by high population of
fibers of middle diameter, the nerve supply to the encapsulated
“genital” corpuscles. A unique central segmental reflex pattern
corresponds to this innervation. A hitherto unexpected matching
of the intermediate fiber conduction velocities by the secondary
ascending fibers making up the spinal and brainstem pathways
for this sensory system is reflected in the type of bioelectric
potentials recorded with microelectrodes in various levels of the
brain.

An analysis of the female sexual orgasm insofar as it is ob-
servable at the perineal field shows differential roles played by
four muscle groups, the levator ani, the pelvic diaphragm, the
more superficial ischiocavernosus and other perineal muscles and
the intrinsic smooth musculature of the vagina. The changeable
“sign” of the genital innervation and the place of positive feed-
back in the arousal process is examined and on the basis of
observations of the sequential steps in clitoral function in arous-
al, a hypothesis is presented concerning the effectiveness of in-
hibition upon the normal maturation of sexual responsiveness.

REFERENCES

- Masters WH and Johnson VE: Human Sexual Response. Little, Brown, Boston,
1-xiii: 1-366, 1966.

- Sherfey MJ: The evolution and nature of female sexuality in relation to psycho-
analytic theory, J Am Psychoanal Assoc 14:28-128, 1966.

< Montagu Ashley: Natural Superiority of Women. MacMillan Co., N.Y., pp- 205,

53.

- Beach FA: Review of physiological and psychological studies of sex and behavior
in mammals. Physiol Rev 27:240-307, 1947. ;

- Sawyer CA: Reproductive behavior. Jn Handbook of Physiology, Ed., John Field.
Am Physiol Soc Wash, Sect 1, Vol 11, pp 1225-1240, 1960. i

- Campbell Berry and Peterson WE: Milk “Jet-down” and the orgasm In the human
female, Hum Biol 25:165-168, 1953.

74 CLITORIS

7. Weddell G and Miller S: Cutaneous sensibility, Ann Rev Physiol 24:199-999
1962.

8. Kitchell RL Campbell Berry Quilliam TA and Larson LL: Neurological factors in
the sexual behavior of domestic animals. “Proceedings Book.” Am Vet M Ass
92nd Ann. Meeting, pp- 177-189, 1955.

9. Campbell Berry Good CA and Kitchell RL: Neural mechanisms in sexual behavior,
I. Reflexology of sacral segments of cat, Proc Soc Exp Biol & Med 86:423-426,
1954.

10. Meyer M La Plante ES and Campbell Berry: Ascending sensory pathways from the
genitalia of the cat, Exper Neurol 2:186-190, 1960.

11. Grundfest H and Campbell Berry: Origin, conduction and termination of impulses
in dorsal spino-cerebellar tracts of cats. J Neurophysiol 5:275-294, 1942.

12. Collins WF and Randt CT: An electrophysiological study of small myelinated
axons in the anterolateral column in cat. J Neurophysiol 19:438-445, 1956.

13. Correa RME and Grundfest H: Electrophysiological studies of cerebellar inflow. I.
Origin, conduction and termination of ventral spino-cerebellar tract in monkey
and cat. J Neurophysiol 17:208-238, 1954.

14. Penfield W and Rasmussen T: The Cerebral Cortex of Man. MacMillan Co., N.Y.,
i-xv: 1-248, 1950.

15. Morgane PJ: The function of the limbic and rhinic forebrain-limbic midbrain
systems and reticular formation in the regulation of food and water intake. Ann
NY Acad Sci., 157:806-848, 1969.

16. Hoebel Bartley G: Feeding and self-stimulation. Ann NY Acad Sct 157:758-778,
1969.

17. Fisher C Gross J and Zuck J: Cycle of penile erection synchronous with dreaming
(REM) sleep. Arch Gen Psychiat 12:29-45, 1965.

18. Wilson RA and Brevetti RE: Specific procedures for the elimination of the meno-
pause. West J Surg Obst & Gynec pp. 110-121, 1963.

MODERN CONCEPTIONS OF CORPORA
CAVERNOSA FUNCTION IN THE VAGINA
AND CLITORIS*

V. Danesino and E. Martella

Contributions to the knowledge and structure of the blood
supply of the corpora cavernosa of man are numerous, but in
the anatomy of woman, investigations of the corpora cavernosa
of the vagina and clitoris are scanty. The literature is fragmen-
tary and descriptions and interpretations are contradictory. All
are agreed that the structure is highly vascular, with blood
spaces (lacunae), surrounded by solid walls (trabeculae).

Sappey (1882) maintains that the structure of the clitoris is
identical to that of the corpora cavernosa in man, and he men-
tions nerve branchings which irradiate between the trabeculae.
Sappey distinguishes between two types of trabeculae: the fi-
brous and the muscular. These intertwine so that we can delin-
eate lacunar spaces, which are capillaries of enormous caliber,
extreme brevity and multiple anastomosis.

Rouget (1884) states that the trabeculae are composed of
muscular fibers, while Legros (1866), although he admits the
presence of the muscular component, describes also the presence
of connective fibers and of elastic fibers, and adds that some of
the trabeculae are formed only by elastic fibers.

Retterer (1890) considers the lacunae formed by a frame of
connective and elastic tissue, with muscular-fibrous cells, which
are under the endothelium. On the other hand, Klein and Kolli-
ker maintain that these fibrous cells are part of the trabeculae
and are scattered among bundles of connective and elastic tissue.

Anile (1919) doesn’t mention the corpora cavernosa but
states that the vestibular bulbs are erectile tissues, made of large
lacunae, limited by very fine strands (trabeculae).

Bartelli (1925) describes the bulbs of the vagina as being cav-

*Reprinted with permission from Archivio di Ostetricia ¢ Ginecologia (Napoli),

60:150-167, 1955. Translation by Benedetto Macaluso, M.D.

76 CLITORIS

ernous tissue, which is also formed by flexible Ase which anas-
tomize among themselves and which are separa on y eg ote
strands with scanty, smooth muscular fibers. Vi aS erence ic
the clitoris, the albuginea sends some aa. undles into
the trabeculae and forms a median septum, with numerous slits,

crossed by vessels which establish a functional continuity pe.

tween the corpora cavernosa of both sides.

Angelico (1939) in a meticulous investigation of the structure
of the corpora cavernosa of man and woman, in various ages of
life, maintains that in the adult, the trabeculae have a double
morphological structure. Some are formed by a connective
stroma upon which rests the muscular tissue; others by inter-
twined connective-muscular bundles. He also studied the struc.
tural modifications in the various stages of life and pointed out
that in old age, there is an increasing amount of connective
tissue and elastic fibers and rarefaction and condensation of
muscular tissue.

We have examined the structure of erectile organs in women
of various ages of life, and we have paid much attention to the
presence of blockage mechanisms and of arteriovenous anas-
tomoses, which we found in the core of the corpora cavernosa
and in the surrounding connective tissue. We have examined
about ten human subjects from a fetus at term (nine months) to
adults of about eighty-four years of age.

Tissue was examined microscopically with the usual tech-
nique, staining with hematoxylin-eosin, Mallory-Azan technique,
Weigert and orcein for elastic fibers, and silver impregnation for
the reticular tissue. It shows that in newborns, the erectile tissue
has an embryonal morphology, with scanty cytoplasm, round
nuclei and outstanding and yery fine connective strands, which
form envelopes around vessels, or fine bundles, among cells. The
lacunae are oval or round. The elastic fibers condense around
the lacunae and under the endothelium. The ratio between the

surface of the vessels and the surface of trabeculae is inverse
when compared to that of the adult. And, in newborn, the area
of the solid trabeculae is much greater than that of the lacunae,
which contain blood.

With reference to the invaginations described by Ebner, Roth-

MODERN CONCEPTIONS OF CORPORA CAVERNOSA FUNCTION 77
feed and Angelico as ball-valves, we do not consider these forma-
tions as blockage formations, but rather as crescents, which are
limited by the wall and made up of mesenchyme, with scanty
elastic fibers. Contrary to the muscular ball-valves of the cavern-
ous urethra which, according to Conte and Pirro, are present
also in the adult, these ball-valves of the clitoris and of the
corpora cavernosa of the vulva are transitory and are not found
after a few years of life.

After birth, differentiation of the erectile tissue evolves fur-
ther, and by the end of the second year, the trabeculae are
much more in number, are thinner, and surround round areas
and small spaces, which are oval and oblongated in shape. At age
two, the subendothelial fibrous cells show more elastic fibers,
and the invaginations tend to be reduced in number and in
thickness. According to Angelico, this is probably due to the
slit-like configuration of the lacunae, which makes it almost im-
possible to visualize the crescents.

In the adult woman, the trabeculae have a characteristic plex-
us-like morphology. The trabeculae of the corpora cavernosa are
generally large and thick, and the central morphological anatomy
is not much different, as far as thickness is concerned, from the
peripheral one. On the other hand, in the corpora cavernosa of
the clitoris, the trabeculae of the central area are thinner and
the blood-containing spaces are larger. Of special interest are the
muscular-fibrous cells, which become part of the core of the
trabeculae. Interesting also is the finding that under the endothe-
lium we find small bundles of fibrous cells which are oriented in
circles, and that in some places, circumscribe long areas of the
walls, following the folds of the walls.

In the peripheral trabeculae, the morphology of the fibrous
cells is varied. We see a few groups in which the fibrous cells are
placed longitudinally, but we also observe other groups which
are circular or oblique in shape. We do not agree with the opin-
10on, expressed by other authors, that in the clitoris, trabeculae
with connective stroma are prevalent. Instead, we see the peri-
Pheral area as being made up of large short bundles, with numer-
Ous smaller bundles, which are directed especially longitudinally,
and which also enclose small and numerous lacunae. In the cen-

78 CLITORIS
tral area, the main bundles are made up mostly of connective
tissue, and the lacunae increase in number and magnitude. But
also, in the central core, we may find subendothelial fiber cells,
which are oriented in many different directions.

It is useful to compare clitoral and corporal anatomy with
research of Motta, who described the fiber-muscular cells of the
ovary and the dehiscence of the follicle. Motta describes, in the
intrinsic apparatus of the ovary, a marginal layer with fibers
which are directed longitudinally and frontally, and also a mus-
cular net between the vessels, which surrounds the vessels of the
mesovary and of the bulb. Contraction of the muscular net com-
presses the vessels and decreases their volume, particularly of the
veins, which have weak walls and little musculature. The effect
is to decrease blood flow out of the ovary; it is, in essence, an
erection of the ovary.

There is much elastic tissue in the corpora cavernosa, concen-
trated in the peripheral trabeculae, where deep, isolated invagina-
tions protrude into the lacunae. Elastic tissue constitutes the
central axis or is spread out in a diffuse net, with very thin
areas, which is seen under the endothelium.

The statement by Rouget, that the walls of the lacunae are
mainly made up of muscular fibers, and the statement by
Legros, that the elastic tissue is prevalent everywhere, do not
seem to be correct. Our research shows the peripheral clitoris to
be more muscular, while the central structures are mainly made
up of connective tissue. The lacunae of the vestibular bulbs are,
on the other hand, of muscular-connective tissue. In older peo
ple, the lacunae are wider and the trabeculae thinner. We see
that the thickness of the frame is diminished which, of course,
entails a much wider dilatation, and the spaces which will then
contain blood are greatly increased in volume. As in other 0%
gans, after menopause, muscular tissue of the trabeculae is 1
duced. This atrophy may be quite extensive and is subject 0
individual variations. Connective tissue, rich in cells and scarce
fibrils, is slowly substituted for the muscular fibers. In some
subjects, as has been observed by Angelico, the connective tis
sues take the shape of compact and irregular conglomerates. The
reticular connective tissue is replaced by fibrillar connective {1S

MODERN CONCEPTIONS OF CORPORA CAVERNOSA FUNCTION

sue; by using silver impregnations only, in a very few cases, we
have been able to point out large, tortuous filaments around the
groups of fibrous cells. However, we have never been able to
discover the characteristics of the reticulum, which surrounds
the muscular elements in the adult. The increase in elastic tissue
is particularly constant near the albuginea.

In the axis of the trabeculae, it is common to find large fibers
which become thinner and which sometimes form a fine reticu-
lum under the endothelium.

We have not been able to find out the stain modification
described by other authors in other organs. As far as we are
concerned, our observations are the same as di Ciardi-Dupre on
the elastic tissues of the tube, and are the same as di Danesino
on the vagina. The specific staining reaction of the elastic fiber
does not change with age.

Having examined the structure and modification of the erec-
tile organs during various ages of life, we will now consider the
blockage mechanisms which regulate input and output of blood.
But first, we shall talk about the anatomy of the area. The
blood supply of the bulb is the bulbar artery, a branch of the
internal pudendal artery. The veins of the bulbs wind forward in
the plexus venosus intermediate, which connects the two bulbs
and these with the corpora cavernosa of the clitoris. These veins
end in collecting veins, which empty into the internal pudendal
vein. The bulbar veins communicate also with all the venous
system of the genitalia by means of dorsal superficial branches,
which end in the internal saphenous vein in the pudendal plexus
(See Fig. 24).

With reference to the physiologic function of the trabeculae,
Levi observes that the organs of copulation increase in volume
and change shape because of the input of blood. Firmness in-
creases because the expansion of the lacunae is opposed by con-
siderable resistance, which endeavors to constrict them. Some of
the resistance is from the fibrous envelope and by the muscular
apparatus which surrounds the whole organ; sometimes the dila-
tion of the vessels does not involve the whole system, but only a
portion. da,

With erection, we observe two main phenomena. The first is

CLITORIS

Figure 24. Bulbs of the vagina and the corpora cavernosa of the clitoris,
seen from the front. On the patient’s right is the artery; on the left are the
veins. 1. Bulbocayernosus muscle. 2. Ischiocavernosus muscle. 3. Vaginal
bulb in its albugineal sheath. 4. Peripheral portion, corpus cavernosum. 5.
Middle perineal fascia. 6. Deep perineal artery. 7. Alcock’s canal. 8. Inter-
nal pudendal artery. 9. Bulbar artery. 10. Dorsal vein of the clitoris. 11.
Connections to the subcutaneous abdominal veins. 12. Obturator vein. 13.
Connecting veins. 14. Veins of the labia minora. 15. Internal pudendal vein.
16. Bulbar vein.

the input of arterial blood. The second is the temporary block-
age of the veins which drain the erectile network. This mechan-
ism is regulated, according to our research, by a specific block-
age mechanism, which can be found in the arteries and the
veins. The arterial branches are provided with subintimal, longt
tudinal muscular fibers. These are on opposite sides of the wall,
sometimes isolated, sometimes contiguous, and are termed Pol-
sterarterien by Bucher (See Fig. 25). :

When the circular musculature of the media and the long!
inal musculature of the ball-valves contract, the lumen of the

tud-

MODERN CONCEPTIONS OF CORPORA CAVERNOSA FUNCTION 81

Figure 25. Diagram of circulation during engorgement (erection). In the
artery (1) the little cushions (2) are relaxed and the anastomotic tract (3)
1s closed by turgor of the epithelioid cells. The blood entering the corpus
cavernosum passes in small amounts through the nutrient arteries (5) and in
larger amounts through the helicine arteries (6 and 7) and into the lacunae
(8), filling them. The venous block (9) slows the flow out of the lacunae.

vessel is reduced, or completely obliterated, with consequent
diminution or interruption of blood flow. But the arteries which
penetrate into the corpora cavernosa give rise to two types of
ramification: a) so-called helicine vessels, which after a tract
Which may be more or less tortuous, run directly into the ven-
Cus lacunae, and b) the so-called feeding (nutrient) branches,

82 CLITORIS

which supply the trabeculae. The helicine arteries course near
the intimal ball-valves, which are morphologically. equivalent to
that described by Clara in the arteries of the calf of the man,
and by Mark in the erectile organs of the turbinate of the nose.
Under the endothelium, we note a continuous layer of fiber
cells, which are longitudinally shaped; sometimes the fibrous
cells are isolated in groups of two or three elements. Proceeding
externally, the myo-epithelial cells are prominent; these look like
vesicles and are devoid of myofibrils. More externally is the
media, with circular fibrous cells. The elastica is not always well
seen and is located among the myo-epithelial cells. Sometimes
we note rare fibro-elastic cells, isolated, among the epithelial
cells. The helicine arteries may also be constituted by a long
tract of wall, which has a serpiginous or glomerular path, with
epithelial cells. These cells appear as clear elements; the cyto-
plasm is strongly hydrated without fibrils, and has hyperchromic
nuclei. They form the intimal ball-valves or some section of the
wall. We have observed fibro-elastic cells isolated among the
muscular bundles, as observed by Andreassi in the umbilical
cord. Cytoplasmic granulations are very rare.

Schumacher (1907) has given to these elements the name of
myo-epithelial cells or postembryonal angioblasts, while Da Costa
(1945) uses the term “inchadas, tumefactas.’’ What is their ori-
gin? According to Krompecher, they are postembryonal angio-
blasts, that is to say, elements which have all the characteristics
of fetal mesenchymal cells, are incompletely differentiated, and
could give rise to neither myoblasts nor elastic fibers, although
they potentially may do so. Masson (1924) maintains that these
cells are neuromuscular elements, and Watska considers them
myoblast, that is to say, muscular cells which are not evolved.
But the problem to us is that of contraction. According to some
authors, myo-epithelial cells can contract by a mechanism, which
is analogous to that of the smooth muscular fiber, that is, they
may become shorter and thicker, although they are not provide
with myofibrils. Benninghoff has hypothesized that myo-epithe-
lial cells can contract or dilate the lumen by taking up or losing
water from the protoplasm; therefore, Havlicek has called them
sponge cells (Quelizellen).

MODERN CONCEPTIONS OF CORPORA CAVERNOSA FUNCTION 83

Figure 26. Circulation in the flaccid state. In the artery (1) the little cush-
jons (2) are contracted and the blood flow is reduced and diverted to the
anastomotic tracts (3) where it enters the efferent veins directly (11).
Blood flow is also reduced in the artery (4) which pierces the albuginea
(10). The reduced amount of blood which does flow is diverted mainly
into the nutrient arteries, runs through the capillary network and the con-
tracted lacunae and exits through the dilated efferent vein. The helicine
arteries are closed by the expanded myoepithelial cells (6 and 7).

Schumacher (1938) adds to the mechanical activity an endo-
Crine function: the secretion of acetylcholine or acetylcholine-
like substances on the peripheral vessels. Recently Krompecher
denies to the angioblasts any contractile property and considers
them as elements which can protect the vessel wall. As a matter

84 CLITORIS.

of fact, according to this author, in arteries devoid of myo-epi-
thelial cells, contraction of every fiber is up to 62 percent. In
the vessels with myo-epithelial cells, the contraction is reduced
to 5 per cent. This theory seems doubtful because often areas
with myo-epithelial structure are not provided with fibril cells,
which have a circular shape or longitudinal shape and, also, these
tracts of the wall are often found between adipose tissues and
connective tissues. In this case, the contraction of the wall is
normally sustained by muscular elements.

In summary, we are inclined to think, as Doctor Lambertini
does, that the myo-epithelial cells have as their function helping
the muscular cells. But, while the muscular cells respond directly
to nervous stimuli, the myo-epithelial cells also respond to chem-
ical stimuli. These (myo-epithelial) sponge cells, by absorbing
water, will diminish the flow of arterial blood and by a reflex
mechanism will deprive the tissues of blood.

We have observed sometimes in the smaller arteries, found
between the bulbocavernosus and_ ischiocavernosus muscles,
those specific apparatuses, which were called pedunculated ball-
valves, described first by Bucciante in the vessels of the human
prostate. These ball-valves are invaginations of the whole wall of
the media or of the intima of the vessel walls, and are provided
with a pedunculum, which herniates into the vessel lumen, and
when observed in longitudinal sections, look like spikes which
are free in the lumen. The core of these invaginations is fibrous
cells.

These structures are present in the uterus, ovary and vagina,
and are considered a valve mechanism to occlude the arteries.
However, we must also mention the viewpoint of De Giorgi, who
suggests that this particular structure may be only a mirage,
derived from the overlapping of several layers, depending on the
plane in which the section is being cut, since these arteries run 4
helicoidal (spiral) course. Undoubtedly, this kind of mistake can
be made if the microscopic technique is not exact, but a meticu-
lous examination of the slides, prepared by our techniques, al-
lows us to follow the morphology from the beginning of the
introflection to the very end of the pedunculum. We have, there-
fore, been able to show that in the female pudendal arteries, the

MODERN CONCEPTIONS OF CORPORA CAVERNOSA FUNCTION 85

invaginations are constituted of intima and media. We have ob-
served in two cases that the spikes contain the adventitial con-
nective tissue, we could clearly see the vasa vasorum.

We are particularly concerned with the small caliber arteries,
which have an undulating course. On the basis of our studies, we
believe that the arterial vessels, where these pedunculated ball-
valves are observed, correspond to the bending of the vasa vasor-
um, as Denesino has demonstrated in the human vagina.

On the basis of our research, we can give a functional inter-
pretation to these complex circulatory mechanisms. During coi-
tus and presumably in other physiological conditions (e.g., de-
hiscence of the follicle during the menstrual period), blood
through helicine arteries enters the lacunae of the bulbs in in-
creased quantity. Specific receptors produce, in the neurovegeta-
tive centers of the lumbosacral tract, an active state which, be-
cause of the summation of afferent stimuli, creates reflexively
vasodilatation of the vulvar area.

This mechanism apparently may also be elicited without any
local stimulus, by way of cortical impulses which, by themselves,
cannot induce activity of the neurovegetative centers of the lum-
bosacral cord, but can lower the excitability threshhold. Upon
reflex action, the blockage mechanism of the arteries is inhib-
ited, and (sometimes) the venous ball-valves contract, blocking
the venous lumen and causing the structures to engorge.

We have also considered the architecture of the fibrous cells,
which are oriented longitudinally in the peripheral areas and
have a variable arrangement in the central ones. The musculature
actively participates in the functional mechanism, because the
trabeculae increase in thickness in the flaccid state and diminish
in thickness during the erectile state. With reference to the al-
buginea, we cannot consider it as a simple envelope, since it has
a physiologic value in prohibiting excessive distention of the
organ. Therefore, we consider the albuginea to act indirectly
through a reflex mechanism upon the blockage mechanisms. :

Finally, we must point out that the corpora cavernosa ae
previously been interpreted as capillaries or dilated veins, :
following Braus, we think of this vascular net as a very Compt
cated arteriovenous anastomotic system. The intermediate seg-

86 CLITORIS

ment, interposed between the arterial system and the venous

lacunae is the helicine arteries, which have myo-epithelial struc-
ture.

In summary, from our research, it appears that the circulation
in the vulvar region is regulated in a reflex way by the neuroveg-
etative system. It presents some structural characteristics, differ-
ent from all the other organs, which can explain, on a mor-
phological basis, the complex circulatory mechanism set into
action by various physiologic conditions.

REFERENCES

ATTARDI G: Atti Soc Med Chir Padova 21:412-427, 1943.

BORSETTO PL: Atti Soc Med Chir Padova 23:815-822, 1945.

BUCCIANTE L: Arch Ital Med Sper 6:273-294, 1940; 7:361-414, 1940.

ID: Atti Soc Med Chir Padova 21:14-24, 1943.

ID: Medicinae Biologia 2—35-65, 1943.

ID: Monit Zool Ital 57 suppl. 11-47, 1948.

CAVAZZANA P: Ricerche Morf 22:1946.

CONTE G: Atti Soc Med Chir Padova 22:281-318, 1944.

: Ibid 23:289-304, 1945.

: Ibid. 23:305-309, 1945.

: Ibid. 23:572-577, 1945.

: Boll Soc Ital Biol Sper 20:651-653, 1945.

: Ibid: 23:339-341, 1947.

Ricerche Morf 22:1947.

: Ann Biol Norm Patol 1:150-161, 1947.

D: Acta Anat 11:383-400, 1951.

EBNER V v: Verhandl. d. anat. Gesellsch., 14 Vers. Pavia, 1900, Erg H Anat Anz
18:79-81, 1900.

GASPARINI F: Acta Anat 7:234-243, 1949.

GOLOWINSKI J: Anat H: 90:651-666, 1905.

MURATORI G: Chir Organi Mov 30:117-134, 1946.

MOTTA G: Riv Ital di Ginec X:3, 1929.

SILIOTTI I e Drei E: Riv Ost Gin Prat 30:553, 1948.

SILIOTTI I e BOLOGNESI N: Riv Ost Gin Prat 32:269, 1950.

SILIOTTI I: Riv Ost Gin Prat 34:337, 1952.

SILIOTTI I: Ost Gin Prat 35:1, 1953.

STAUDACHER V: Atti Ist Veneto Sc Lettere ed Arti 104:217-257, 1944.

STIEVE H HARN: und Geschlechtsapparat, in v. Mollendorffs Handb d mikr
Mensechen Bd VII/II. Springer, Berlin, 1930.

WATZKA MZ: mikr. anat Forsch 39:521-544, 1936.

BESSHEH

| |

— anat d

Chapter VI

CYTOCHEMISTRY OF CLITORAL
SENSORY NERVE ENDINGS

Luigi Giacometti and Haruo Machida

With the specialized staining techniques now available, it is
possible to delineate the chemical components of individual
nerve cells and subdivisions of the cells. It can also be shown
that different species have different cellular chemistries. The cu-
taneous nerve endings of cats, cows and goats have alkaline
phosphatase activity (1,2). Among the subhuman primates, only
gibbons show a positive reaction in their specialized sensory
nerve endings (3,4); the galago has alkaline phosphatase in the
hair follicle end-organs (5). Here we report observations on the
presence of alkaline phosphatase and cholinesterase activity in
the sensory end-organs in thé human clitoris.

In our study, we used the clitoris from seven subjects, ob-
tained five to six hours after death. Frozen sections, fifty to
seventy-five micra in thickness, were fixed for four hours in
chilled ten percent neutral formalin. Alkaline phosphatase was
demonstrated with the cobalt sulfide and the azo-dye techniques
of Gomori (6). For each tissue, specimens were also stained with
the method of Koelle and Friedenwald for cholinesterase (7) and
with the silver impregnation technique of Winkelmann for the
demonstration of neural elements. Our findings were as follows.

In the clitoris, the most frequently occurring nerve terminals
are the genital corpuscles, unencapsulated masses of naked axo-
plasmic neurofibrils which are rolled and twisted upon them-
selves. Since the structure of these elements 1s similar to that of
those found in other mucocutaneous surfaces, Winkelmann
named them all muco-cutaneous end-organs (9).

Genital corpuscles are found predominantly in the sub-papil-
lary layer of the dermis, more numerous in the lower half than
at the apex of the clitoris, and larger near the margin of the
labia minora than elsewhere. Each nerve ending consists of sever-
al irregularly wound, nonmyelinated nerve fibers imbedded in a

Li Serer,
Na pepcteaeUr

swe»

28) 3a Fontes we 5
f poe

ROG oi 8 pap
To RO

88 CLITORIS

non-nervous fine granular substance (Fig. 27). We have found no
end-organs within the stratified squamous epithelium of the clit-
oris.

Figure 27. Horizontal section from human clitoris, showing the characteris-
tic body of a mucocutaneous end organ. Winkelmann’s silver method.
(X300).

These structures are intensely reactive for butyrylcholinester-
ase as are all other end-organs (Fig. 28). Genital corpuscles, how-
ever, also show a generalized reaction for alkaline phosphatase
when tissue slices are treated with either the cobalt sulfide or
the azo-dye techniques (Fig. 29). The reaction is localized in the
non-nervous cellular elements around the nerve filaments which
are themselves unreactive. All of these end-organs have an en
zyme reaction, but the concentration varies among them and
from individual to individual.

The endothelium of the superficial capillaries and the larger
and deeper blood vessels of the clitoris are so strongly reactive
for alkaline phosphatase that vascular patterns can be studied

CYTOCHEMISTRY OF CLITORAL SENSORY NERVE ENDINGS

in"

"s Pi .

e. 4
yg
a” twee, Vs

Figure 28. Non-specific cholinesterase activity in the mucocutaneous end
organs in the human clitoris. (X100).

. a
3 ¥
ee ee

clearly in these preparations. There seems to be no relationship
between these sensory end-organs and blood vessels.

Having made these observations, what conclusions can we
draw from them? The significance of the alkaline phosphatase in
the muco-cutaneous end-organs is conjectural. The presence of
the enzyme in the extraneural substance may be of metabolic
Significance or it may play a role in the propagation of impulses.
We do not know if other muco-cutaneous end-organs have prop-
erties similar to those of the genital corpuscles. This points out
again the need of more such information on the tissues of man.

In summary, alkaline phosphate activity was found in the
muco-cutaneous end-organs of the human clitoris and appears to
be restricted to the non-neural substance surrounding the coiled
Nerve filaments. The distribution of the alkaline phosphatase in
the sensory end-organs corresponds with that of the nonspecific
cholinesterase.

CLITORIS

Figure 29. Field from the dermis of the human clitoris showing a positive
alkaline phosphatase reaction in a mucocutaneous end organ. (X250).

REFERENCES

1. Scheen SR Winkelmann RK: Alkaline phosphatase in the skin of certain animals.
Arch Derm 83:439-446, 1961. :

2. Winkelmann RK: Similarities in cutaneous nerve end-organs, in Advances in Biol-
ogy of Skin, Vol. 1, Montagna W (Ed.) New York, Pergamon Press, 1960.

3, Parakkal PW Montagna W Ellis RA: Skin of white-browed gibbon. Anat Rec
143:169-178, 1962.

4. Winkelmann RK: Cutaneous sensory end organs of some anthropoid
136:384-386, 1962.

5. Yasuda K Aoik T Montagna W: Skin of lesser bushbaby. Am J Phys Anthrop
19:23-24, 1961.

6. Gomori G: Microscopic Histochemistry. Chicago, University of Chicago Press,
1952.

7. Koelle GB Friedenwald JS: Histochemical method for localizing ch
activity. Proc Soc Exp Biol Med 70:617-622, 1949.

8. Winkelmann RK Schmidt RW: Simple silver method for nerve axoplasm. Proc
Mayo Clin 32:217-222, 1957.

9. Winkelmann RK: The mucocutaneous end-organ. Arch Derm 76:225-235, 1957.

apes. Science

olinesterase

Chapter VIT

SOME ISSUES IN THE HISTOLOGY OF
THE CLITORIS

Thomas P. Lowry

The traditional view is rather simple: the clitoris contains a
large number of specialized nerve endings (including “genital cor-
puscles”) which receive erotic stimuli and transmit them to the
rest of the body, producing pleasure and, perhaps, orgasm. Fur-
ther basic assumptions are that the skin (and deeper structures)
contain receptor organs, visible under the microscope, which are
specific to receiving various external stimuli, and that in all wo-
men these are concentrated in the clitoris. Like most arcadian
notions, these have proved to be not quite the truth.

The classic ‘“‘specific receptor” anatomy is illustrated in Fig.

' 30. The bulbs of Krause perceive cold. The receptors for heat

are Krause-like structures, or perhaps are the end-organs of
Ruffini. Touch is perceived by Merkel’s tactile discs, Meissner’s
touch corpuscles and the fine nerve endings around hair roots.
Pain is a function of the free nerve endings. Pressure is perceived
by the corpuscles of Pacini (Vater-Pacini). Pacinian corpuscles in
the genitals and nipples are the “genital corpuscles” (1, 2, 3))3

However, many of the encapsulated receptors are fundamen-
tally similar in their structure (a special connective tissue capsule
surrounding the actual nerve ending) and show such variations of
size and complexity that in actual life it is often hard to classify
a particular receptor into any of the types shown in the illustra-
tion. Further, recent experimental evidence makes it more diffi-
cult to equate one receptor to one sensation. Indeed, as Rose
and Mountcastle (4) point out there are now at least three
schools of thought: the classic school with specific receptors
receiving only certain stimuli, the Oxford “pattern” school,
which almost denies any specificity, and the Head school, which
divides neural receptors into primitive and specific, the so-called
Protopathic theory.

This is where things stood ten years ago before the electron

CLITORIS

Figure 30. The principle cutaneous receptors: a. bulb of Krause; b. organ of

Ruffini; c. Merkel tactile discs; d. Meissner touch corpuscle; e. free nerve

endings; f. corpuscle of Pacini; g. muco-cutaneous end organ. Redrawn

from various sources, by Steve Gilbert.

SOME ISSUES IN THE HISTOLOGY OF THE CLITORIS 93

microscope overturned much of classical histology, with ad-
vances in precision so great that students who graduated a
decade before this one can hardly recognize the new anatomy.
The changes can well be compared with those in Martian astron-
omy, which went from vague blurs glimpsed through the pulsing
atmosphere (with the traditional alarms of canals) to the stark
clarity of craters photographed from a passing spacecraft.

In genital histology, in spite of improved techniques, con-
fusion has’ reigned. Experts disagree with experts, even disagree
with themselves. In 1945, Weddell published a photograph of
endings in the skin of the forearm purporting to be Krause
end-bulbs, but in 1953 retracted this interpretation. In 1957,
Winkelmann (5) made a thorough study delineating the “muco-
cutaneous end-organ,” which he described as loops of nonmy-
elinated nerve fibers, rolled on one another in a spherical mass
about 1/20th of a millimeter in diameter, with no specialized
connective tissue capsule. These were widely distributed in the
subpapillary layers of the dermis of the glans penis, prepuce, lip,
tongue, eyelid, and perianal region. They were most concen-
trated in the clitoris and were absent in the nipple. He con-
cluded, “...one cannot expect that a specific genital sense
exists. If a specific function does exist for the mucocutaneous
end-organ, it would not be surprising if this would be the per-
ception of acute touch.”

However, the same author (6) writing ten years later in a
massive electron microscope atlas of skin anatomy, describes
only four special nerve endings: Merkel Cell, Meissner Corpuscle,
Vater-Pacini Corpuscle and Mammalian End Organ, which he
states is found “...in almost all mammals... ,” while he de-
fined the mucocutaneous end-organ as confined to primates.
How hard it must be to abandon one’s fondest creations, but
the anatomist today must be prepared to do just that. Sic transit
gloria anatomii.* The changes in this field are more than m

*In a recent letter, Winkelmann states, “In Comparative Biology of Primates, edited
by Buettner-Janush, I pointed out that the mucocuta:
Corpuscle become more and more alike as one descen
the reason I did not emphasize the mucocutaneous endorgan in Zelickson’s boo

neous endorgan and the Meissner

ds in the primate scale. This was
k.”

94 CLITORIS

anatomy alone; the chemists now deal with individual cells and
intracellular parts, as seen in Dr. Giacometti’s chapter in this
book.

The specificity of at least one receptor, the Pacinian cor-
puscle, seems beyond doubt. It responds to pressure (in fact,
will react to a displacement of less than a thousandth of a
millimeter, delivered in a ten thousandth of a second) and reacts
very little to warmth and to acid. This exquisite sensitivity is
important to this discussion, since according to at least one
author, the Pacinian corpuscle is the dominant receptor in the
clitoris.

Another traditional belief in clitoral histology is that the clit-
oris uniformly contains the genital area’s greatest concentration
of receptors. This idea is discredited by the work of Krantz (8).
After reviewing the enormous literature on genital morphology
(where contradictory findings are compounded by much of the
earlier work having been done on non-human species) he re-
ported his own study. He fixed and sectioned the genital tracts
(clitoris, labia minora, labia majora, perineum and entire vagina)
of eight human females, ranging in age from an 8-month fetus to
a 55-year-old woman, and made a meticulous microscopic study.
In the vagina, he found only a few free nerve endings. The
hymeneal ring had a few more free nerve endings and an occa-
sional Merkel disc. The mons veneris and the labia majora both
had large numbers of Meissner corpuscles, Merkel discs, Pacinian
corpuscles, free nerve endings, Ruffini corpuscles and Krause
corpuscles, and, of course, were the only areas with peritrichial
endings, since the other areas are hairless. The labia minora had
moderate amounts of Meissner, Merkel, Pacini, Ruffini and free
nerve endings; Krause corpuscles were the most common ele-
ment found.

The clitoris, by contrast, had only small numbers of receptors
subserving touch (Meissner and Merkel), but enormous numbers
of Pacinian corpuscles and large numbers of Ruffini, Krause and
free nerve endings. These same findings were also true of the
clitoral prepuce. The greatest number of receptors were found in
young adults; in the fetus, the receptors were relatively undiffer-
entiated, while in the oldest specimen, there were decreased
numbers.

SOME ISSUES IN THE HISTOLOGY OF THE CLITORIS 95

Krantz’ findings confirm the relative insensitivity of the vag-
inal lining (but cannot clarify the pubococcygeus kinesthetic re-
ceptor controversy). They also confirm the usual vulvar receptor
distribution. However, Krantz found a wide variation in the
quantity, quality and location of the various nerve endings; in
one of the eight specimens, there were almost no receptors in
the clitoris, but many in the labia minora. Such a distribution
would seem quite likely to produce a non-clitoral sexual sensitiv-
ity and a difference in preference in sexual technique. If the one
out of eight distribution holds up for the general population,
then the United States has twelve million women (of all ages)
who have an anatomical pattern of non-clitoral vulvar sensitivity.

Krantz’ work confirms, histologically, what was reported by
Kinsey (9) in 1953. Table IV summarizes these results, which
were based on a total of 879 women, examined by five exper-
ienced gynecologists (2 female and 3 male). They touched the
women, in the areas designated, with a smooth probe and the
subjects reported when they felt a touch. The tests of vaginal
sensitivity were done through a speculum, with care not to
touch the outer structures. In the table, a plus indicates re-
sponse, while a zero indicates none. Kinsey suggests that while
the ability to feel touch cannot prove that an area is erotically
responsive, it seems hardly probable that an area insensitive to
light touch would be sensitive to erotic sensations. It is clear
from these results that the labia are as sensitive as the clitoris,
especially the lesser lips.

In summary, the clitoris contains, in most women, a large
number of receptor nerve endings; in some women, other areas
may contain more. In almost all women, the labia minora are
also highly sensitive. Different neuronal patterns may produce
different sexual preferences. The correlation between the ana-
tomic appearance of a receptor cell and its actual function is
often unclear. The existence of a “senital corpuscle” remains
unproved. The work of the last century of microscopic genital
anatomy needs to be redone, using the electron microscope and
cytochemical techniques.

SOME ISSUES IN THE HISTOLOGY OF THE CLITORIS
CLITORIS

REFERENCES

Maximow AA Bloom W: Textbook : : ‘
7oRD ook of Histology. Philadelphia, WB Saunders Co.,

Strong OS Elwyn A: Human Ni : a
i948: euroanatomy. Baltimore, Williams and Wilkins,

Krieg WJS: Functional Neuroanatomy. New York, Blakiston, 1953
Rose JE Mountcastle VB: Touch and kinesthesis. In Field J: Handbook of Physi:
ology, section 1: Neurophysiology, Vol. I. American Physiolog; i ‘

oie siol 6
ington, D.C., 1959. ysiological Society, Wash
Winkelmann RK: The mucocutaneous end-organ—the primary organized sensor
ending in human skin. Arch Derm 76:225-235, 1957.
Winkelmann RK: In Zelickson AS: Ultrastructure of Normal and Abnormal Skin
Philadelphia, Lea and Febiger, 1967. ;
Giacometti L Machida H: Histochemistry and cytochemistr i

y of human skin. Arch

Derm 91:377-378, 1965. pero
Krantz KE: Innervation of the human vulva and vagina. Obstet & Gynec
12:382-396, 1958.

Kinsey AC: Sexual Behavior in the Human Female. Philadelphia, WB Saunders
Co., 1953.

+ 0+ + +

Typical Variation in Response in 15 Cases
Meith 6087, 619 1002112015, 14 15

+O+ + + + + + 0 +

TABLE IV

Total Number
, University of Indiana.

Responding

SS
c=)
he
=
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wo
for)
Ce]
a}
G
[o%)
=
ov
ue]
Ss
b|
S
Ax
a
ra
o
ue]
i=]
3
3
i?)
Ss
=
8
§
ky
s
8
§
Ss
iS)
oS
aS
s
&
is)
‘ss
‘Sy
8
=
OS
iss}
~_—
3
3
R
%
ny
ns
8
os)
vo
<

outer surface
inner surface

Structures
Right, i

outer surface
Left, inner surface

Right
Left
Clitoris
Right,
Left, ‘
Right Wall
Left Wall

Labia majora

Labia Minora
permission of the Institute for Sex Research

Modified from Kinsey,

Vagina

Chapter VIII

PATHOLOGY OF THE CLITORIS

Thomas G. Morrione and Thomas P. Lowry

The clitoris is subject to the ills that beset other organs, but
being able to respond specially to the stimulation of steroid
hormones, it has some unique to itself. This discussion will di-
vide clitoral pathology into two main areas: neoplastic and non-
neoplastic.

The latter include trauma, hormonal influences and chromo-
somal abnormalities. A British surgeon (1) reported an eleven-
year-old girl who appeared with severe swelling of the upper
vulva. Examination under anesthesia showed a sewing thread tied
tightly around the clitoris and prepuce. Later, she admitted ty-
ing it there, but gave no reason. The surgeon concluded, “‘It is
interesting to note that for homework, she had to write an essay
on ‘life in hospital.” We may assume that her brief visit to the
Radcliffe Infirmary would add considerable local colour to this
literary effort. Should this young lady contemplate taking up
surgery as a career, her ability to tie knots in any situation
would be, I think, unchallenged.” A more common cause of
trauma is the chafing of the center pants seam during horseback
riding; the same frictional action has on occasion also yielded
more pleasurable results.

Most women have one clitoris; some have two. One case was
that of a four-pound newborn with many congenital abnormal-
ities (2). Pregnancy was uneventful. There were two vulvas, each
with a clitoris. Cases of single vulvas with bifid clitoris have been
published in England (3) and Holland (4). A case which defies
ordinary embryological explanation is one in which there were
two clitorides, one above the other, in a woman otherwise nor-
mal (5).

Enlargement of the clitoris can be due to at least eight differ-
ent conditions; recently full discussions of causation and differ-

—=—~w
———— eee OO Ch aTSrt~CS—(<—C CLC crOCrLOr—C———<—C—CO

PATHOLOGY OF THE CLITORIS 99

ential diagnosis have been published (6, 7

). The antique litera-
ture reveals how much has been clarified: in 1837 (8) 2 married
woman, age 25, had enlarged labia and clitoris. The surgeon

blamed it on gonorrhea; she blamed a kick received four months
before. At surgery, she nearly bled to death. In 1849 (9) a
woman who had died of fever was found to have a clitoris with
a urethra in it; ovaries, uterus and vagina were present. The
Lancet reported (10) elephantiasis of the clitoris, with a growth
the size of “a very large cocoanut.” The role of the filarium was
unknown then; the discussion centered around why “...the
women of the South Sea Islands, although repulsive in their
habits, are rarely affected with such enlargements.”

Other more recent studies (11, 12, 13, 14) reflect the growing
awareness of how to distinguish the various causes of clitoral
hypertrophy: congenital adrenal hyperplasia, adrenal tumor, ma-
ternal virilizing disorder, iatrogenic (from hormones given to
pregnant women), true hermaphroditism, asymmetric gonadal
dysgenesis and male pseudohermaphroditism. Bruzzone’s studies
with castrated female guinea pigs, who received testosterone and
developed clitorides like hypospadic penises, illustrate some of
the experimental biology which has clarified these issues (15).

The last decade’s progress in chromosomal analysis now leads
to more precise and numerical diagnoses. The Poles have been
very active in this area of research. One case was diagnosed as
Turner’s syndrome with phallic enlargement (16); there was no
Y chromosome or Leydig cells in the medulla of the gonad. The
diagnosis was 45 XO karyotype. They later reported (17, 18)
cases of pure gonadal dysgenesis with hypertrophy of the clitoris
and 46 XY karyotype. They further defined this as “...a
syndrome in phenotype women with eunuchoidal body propor-
tions, infantile external genitalia and streak gonads.”

Bowen et al. (19) reported a puzzling case with no karyotype
abnormality. In two unrelated pairs of sibs, there was congenital
glaucoma, joint contractures and hypertrophy of the clitoris.
Homozygosity for a recessive gene is proposed as_the ae
Ehrenfeld (20) reported two males with enlarged clitoris. a if
were female phenotypes and had been raised as girls, but ha
male nuclear sex chromatin patterns. The clitoral enlargement

100 CLITORIS

j ogenic features; the
was congenital, as there were no other androg :

diagnosis was gonadal dysgenesis. :

Kriss (21) reported three cases of what he called acute cavern-
itis clitoridis; there was one case each of infection by streptococ-
cus, staphlococcus and gonococcus. Pilonidal cyst, whose exact
origin seems open to debate, has been reported three times as
occurring in the clitoris (22, 23, 24).

The area of neoplasm reaffirms the need for exact diagnosis.
Haddad (25) reported three cases, originally diagnosed as
pseudohermaphroditism, which turned out to have tumor, in-
stead, namely a lipoma, a hemangioendothelioma and a neurofi-
broma.

Carcinoma of the vulva is the fourth most common female
genital cancer. Following labia minora and majora, the clitoris is
the third most common site of origin. The usual metastases are
to the superficial and deep inguinal, the femoral, iliac and the
hypogastric lymph nodes (26). There are at least five articles
describing cases of primary carcinoma of the clitoris (27, 28, 29,
30, 31) and two describing secondary carcinomas there (32, 33).

A wide variety of other tumors have been reported in the
clitoris, many in the literature outside the United States. A rath-
er incomplete survey includes fibroma (34, 35, 36), epithelioma
(37, 38), granular cell myoblastoma (39), leiomyosarcoma (40),
melanosarcoma (41), melanoblastoma (42), glomus tumor (43),
neurilemmoma (44), teratoma (45), cyst (46), and keloid (47).
A case from the Philippines (48) of induration of the clitoris
proved to be granulocytic leukemia.

Diekmann et al. (49) reviewed sixteen cases of childhood von
Recklinghausen’s disease; diagnosis is most difficult since often
only pigment spots are present, not the typical cutaneous and
nerve tumors. A nine-year-old girl had, as her only manifestation
of neurofibromatosis, pigmentation of the vulva and marked en-
largement of the clitoris. Barros (50) reports neurofibromas the
size of hens’ eggs, in the clitorides of two women; his illustra-
tions show an excellent post-surgical cosmetic result.

One thing worse, perhaps, than a diseased clitoris, would be
none at all; three cases of clitoral absence have been reported—

101

PATHOLOGY OF THE CLITORIS

one in Roumania, in 1938, one by Dickinson (5 i
1971 in Manhattan (51). All sane cases ee ee isi 6
syndrome of extrophy of the bladder, with the clitoris usually
bifid and displaced laterally. The patient of Falk and Hyman
was an otherwise healthy 25-year-old woman, with no midline
pubic hair and a gaping urethra; she did have erotic sensation at
the upper end of each of her widely separated labia minora. The
authors concluded that, embryologically, she had just missed
having extrophy of the bladder.

In summary, the clitoris can be affected by almost every pos-
sible illness or malformation.

REFERENCES

. Burton-Brown J: Traumatic enlargement of the clitoris. Brit Med J 1:468-469,
1950.

- Kurth ME: Incomplete duplication of the female external genitalia or double
clitoris. Am J Surg 96:596-599, 1958.

. Jeffcoate TNA: A case of diphallus in the female. J Ob Gyn Brit 59:406-407,
1952.

. Versteeg JM: Diphallus in the female: diclitoris. Nederlandsch tydschrift voor
geneeskunde 98:15-17, 1954.

. Williams GA: A case of accessory clitoris. Am J Obstet 19:117-118, 1930.

- Dmowski WP, Greenblatt RB: Ambiguous external genitalia in the newborn and
prepubescent child. JAMA 212:308-311, 1970.

. Greenblatt RB, Dmowski WP: Significance of clitoral enlargement in a newborn
and preadolescent child. Med Aspects Hum Sex 5:98-121, 1971.

. Anonymous: Hypertrophy of the clitoris and nymphae forming a large tumour.
Lancet 1:837, 1837.

. Staniland S$: Superabundant development of the clitoris. Lancet 1:89, 1849.

- Marsden A: Elephantiasis of the clitoris. Lancet 2:196, 1857.

. Allen SW: Hypertrophy of the clitoris in an infant. J Kentucky Med Assoc
59:587-590, 1961. ¥

- Goldzieher JW, Rodgers K: Clitoral hypertrophy in one of nonidentical twins. Am
J Obst Gyn 86:882-885, 1963. Oe: i

. Fontan X et al: Generalized muscular hypertrophy, of precocious beginning, ma
facial lipodystrophy, hepatomegaly and clitoral hypertrophy; Arch Francatses de
pediat 13:276-285, 1956.

. Vines R: Multiple congenital anomalies associated with hypertrophy of the pre-
puce of the clitoris and the frenulum. Med J Austral 2:264-266, 1956. '

- Bruzzone S, Lipschutz A: Testosterone-oestradiol antagomism studied on the clit-
oris of the guinea pig. Acta endocrin 12:28-34, 1953. ; :

- Boczkowski K, Teter J: A case of gonadal dysgenesis with phallic enlargement in
a patient with an 45 XO karyotype. Endokryn Polska 15:579-586, 1964.

102

18.

195

20.

215
22.
23.
24.
25.

26.
27.

28.

29.

30.

31.

$2.

33.

34.
35.

36.

37.
38.

39.

40.

410
a

CLITORIS

Teter J: A case of gonadal dysgenesis in a patient with

i hili 5 r 1
Boczkowski K, Philip J sence of seminiferous tubules. Acta

46 XY karyotype, phallic enlargement and ab
endocrin 47:491-499, 1964.
Boczkowski K, Teter J: Two cases of
of the clitoris and 46 XY karyotype. End
Bowen P, Lee CSN, Zellweger H et alceAN
defects. Bull Johns Hopkins Hosp 114:402-414, 1964.

Ehrenfeld EN, Bromber YM: Syndrome of gonadal dysgenesis with enlarged clit-
oris in chromosomal males. Acta endocrin 28:540-546, 1958.

Kriss B: Cavernitis clitoridis acuta. Archiv fur gynack 157:39-43, 1934.

Palmer E: Pilonidal cyst of the clitoris. Am J Surg 93:133-136, 1957.

Betson JR, Chiffelle TL, George RP: Pilonidal cyst involving the clitoris. Am J

Obst Gyn 84:543-545, 1962.
Harris RE, Daly JW: Pilonidal cyst arising in the clitoris. Virginia Med Monthly

94:1-3, 1967.

Haddad HM, Jones HW: Clitoral enlargement simulating pseudohermaphroditism. J
Dis Children 99:282-287, 1960.

Benson RC: Cancer of the female genital tract. Ca 18:2-12, 1968.

Sawyer KC, Baker WG, McClure HE: A case of carcinoma of the vulva involving
only the prepuce and clitoris. West J Surg 57:589-591, 1949.

Napolitano M: Cytologic aspects of vaginal, vulvar and clitoral carcinoma.
Archivio di obstetricia e ginecologia 60:65-69, 1955.

Monti RL, Pepe AL, Guglielmone P: Considerations relating to a case of neoplasia
of the clitoral prepuce. Obstet y ginec latino-americanos 10:529-530, 1952.
Bancroft-Livingston G, Moolan-Feroze R: Carcinoma of the clitoris. Arch Middle-
sex Hosp 3:53-58, 1953.

Monteiro A, Quinet AA: Carcinoma of the clitoris. Obstet y ginec latino-
americanos March 1948, 75-90.

DalCanton G: A rare case of secondary carcinoma of the clitoris. Rivista d’ostet e
ginec pract (Milano) 39:649-52, 1957.

Marek CB, Hayden CR: Metastatic carcinoma of the clitoris, Am J Obs & Gynec
60:443-444, 1950.

Attwenger H: Fibroma of the clitoris. Archiv fur gynaek 121:135-137, 192?.
Pereira HCG, Freire APL: A case of fibroma of the clitoris. Hospital (Rio)
60:159-167, 1961.

Zambonini A: A rare case of myxomatous fibroma of the clitoris. Rivista ital de
ginec 26: ’e 300-310, 1943.

Monen SA: Epithelioma of the clitoris. Am J Obs & Gynec 32:882-884, 1936.
cea P: Epithelioma of the clitoris. Memoirs Acadamie de Chir 73:301-303,
Doyle WF, Hutchison JR: Granular cell myoblastoma of the clitoris. Am J Obs &
Gynec 100:589-590, 1968.

Yang Fa-Tuan, Lin Chen-Shih, ch’iu Juei-Kuang: Leomyosarcoma of the clitoris.
Chin Med J 84:552-553, 1965.

Ivens F: Melanotic Sarcoma of the clitoris. Lancet 2:1220-1221, 1926.

Votik O, Vacha K: Melanoblastoma of the clitoris. Sbornik Vedechych pract
lekarske fakulty Karlovsky Univ (Praha) 9:51-54, 1966.

pure gonadal dysgenesis with hypertrophy
okryn polska 16:651-657, 1965.
familial syndrome of multiple congenital

43. Stange HH, Glomus tumor of the clitoris. Zentralbl gynack: 73:803-810, 1951.

. Wei-Chen Cheng: Neurilemmoma of the clitoris

. Khaleque KA, Islam AFMN: Teratoma of the clitoris.

PATHOLOGY OF THE CLITORIS 103

73:1016-1017, 1966. J obstet gynaec Brit Cwlth

1962. J trop med hyg 65:276,

. Gonchar MA: Cyst of the clitoris. Akusherstevo t ginch 40:127, 1964
. Zeitz, H: Keloid of the clitoris. Archiv fur gynaek 188:134-141. 1956
. Villegas-Cinco A: Induration of clitoris and labia minora. "Philipp J Cancer

4:172-179, 1962.

. Dieckmann L, Huether W, Pfeiffer RA: Unusual manifestations of neurofibro-

matosis in childhood. Zeitschr fur Kinderheilkunde 101:191-222, 1967

. Barros P: Two cases of neurofibroma of the clitoris. Gynec pratique 377-385

1961.

. Falk HC, Hyman AB: Congenital absence of clitoris. Obstet & Gynec 38:269-271

1971.

. Dickinson-RL: Atlas of Human Sex Anatomy (2nd Ed.). Williams & Wilkins

Baltimore, 1949.

Chapter IX

SURGERY OF THE CLITORIS
A. Stark Wolkoff

The gynecological aspects of the clitoris, when compared to
the mythological or psycho-physiologic features, are very modest
indeed. This small organ, almost vestigial in the female, frequent-
ly designated as the analogue of the penis in the male, has
achieved recently almost unjustifiable importance.

Anatomically, there is much similarity in the two organs as
has been described in the chapter on anatomy, but functionally
there is very little similarity. Erectile tissue based on hydraulic
mechanisms using blood as the fluid force accounts for the erec-
tion and sexual similarity, but the functional alikeness stops
there. No sound consensus can justify the comparability of the
functional similarity of these two structures. Though both are
utilized in sexual activity, penetration demands the utilization of
the erect penis by the male, but frequently the clitoris has no
function in the female including that of sexual activity.

It is axiomatic that plastic surgeons do not attempt to con-
struct or restructure a clitoris to simulate the organ of the male
except in highly questionable cases of interest where even a
large, or hypertrophied clitoris is more acceptable “as a penis”
than no such structure at all. The clinical problem of intersex is
one such instance.

In a discussion of the diseases associated with the clitoris the
classic approach of anatomical, physiological, surgical, inflamma-
tory, and neoplastic can be utilized and most textbooks briefly
enumerate these conditions. The anatomical and physiological
notations have already been stated. The surgical problems are
few and the knowledge and skill to handle such problems are
not difficult to acquire. A brief outline is presented:

104

SURGERY OF THE CLITORIS 105

SURGERY OF THE CLITORIS

I. Procedures
A. Excision
B. Circumcision
C. Plastic repairs
1. Release of “hood” adhesions
2. Reduction in size
Il. ‘Treatment
A. Infections
1. Venereal
2. Non-venereal
B. Neoplastic
1. Benign
2. Malignant
Ill. Traumatic

The simplicity of the outline is based on a fairly large clinical
experience over a 20-year period in large indigent and university
clinics. The omission of reconstructions of the urethra and va-
gina is done to focus on the actual surgery of the clitoris. Fre-
quently, such surgical procedures utilize hypertrophied clitorae
for the purpose of reconstructing urethral and other defects of
the external genitalia, but so rarely that it is not within the
scope of this work to elaborate on the already large literature
available for such plastic repairs.

EXCISION

ant excision of the clitoris is a simple procedure which fol-
ell; Seneral surgical procedures involving any polypus (1). An
Uptical incision is made starting well above the base and ter-
eee well below. The incisions are joined and carried down
one the subcutaneous tissue to the fascia and periosteum
= See the symphysis. Undercutting is carried on utilizing cen-
eee Hemostasis is controlled with individual hemostats,
Bat and suture. With careful dissection, the actual clitoral
y and vein can be skeletonized and handled separately. Ap-

106 CLITORIS

proximation by layered closure with a subcuticular or horizontal
mattress suture of fine nonabsorbable material in the skin pro-

duces an acceptable result.
CIRCUMCISION

The technique for this ancient and overly glorified procedure
is similar to that done on the penis (2). The important feature is
separating the synechiae or adhesions of the foreskin over the
glans. This can be done by a fine probe or Keith-straight cutting
edge needle. After the foreskin moves easily over the glans, the
skin can be excised and the excised end approximated above the
glans to the superficial tissue with interrupted fine catgut su-
tures. A small plastic bell can be used if the clitoris is large
enough to facilitate the excision. The concept of utilizing this
procedure to enhance clitoral sensation in cases of sexual prob-
lems and frigidity has been much overrated in this writer’s opin-
ion. The idea that excitation is enhanced by exposing the glans
is not based on anatomical or physiological evidence. There is
much evidence recently gathered that erotic sensation is predom-
inantly conditioned, and the approach to inadequacy or frigidity
by circumcision is deplorable. Further, the concept that labial
and clitoral size can be equated to the degree and frequency of
masturbation should also be put to rest. The facts absolutely
deny this statement made so frequently in the older, and unfor-
tunately, even more recent literature.

The use of circumcision and clitoridectomy to reduce sensa-
tion in youthful and perhaps too exuberant wives by primitive
and ancient cultures is also not based on physiological reasoning
but may have its empirical acceptance on the probable resultant
inflammation, ulceration, abscess and scar tissue that would re-
sult from such a procedure. Such a miserable set of circum-
stances obviously resulted in reduced sensation and lowered
erotic feeling in the involved parts because of the associated pain
and discomfort accompanying coitus after such mutilation.

SURGERY OF THE CLITORIS
PLASTIC REPAIRS

The most frequently met conditions involving the clitoris i
that of synechiae or adhesions between the glans and Heel The
adherence of these structures results in trapped or ae ; "4
material designated smegma containing oil and Be ris
sudoriferous and sebaceous glands in the skin. Infection ae
poor vulvar hygiene frequently results in irritation which drives a
patient to her gynecologist. The dried out kraurotic conditions
found in menopausal women can also result in infection from
the poor barrier the senile skin makes to the invading or patho-
logic bacteria.

Culture and antibiotic sensitivity studies on the exudate fol-
lowed by suitable systemic antiobiotic and hot soaks is all that
is usually required. It is advisable not to use topical antibiotics
analgesics or other nostrums. After the inflammation has ae
sided a probe-like instrument can be used to sweep aside the
troublesome synechiae. This procedure is rarely of sufficient
consequence to hospitalize the patient. Systemic analgesic and
local anesthesia will generally suffice.

Another occasionally troublesome entity is hypertrophy of
the clitoris which is troublesome to the patient. This is usually
seen when the clitoris can be seen under tight fitting clothes,
particularly bathing suits or shorts. If the patient does not com-
Plain of this feature but merely seeks reassurance that her large
clitoris is not abnormal, the distinction should be made. A sen-
sible approach is to perform surgery on those that are obviously
i eee with tight fitting clothing. Formerly, amputation was
ae a ure resorted to, and even now is certainly acceptable
na seas circumstances. If after a complete work up and with
teri eer a there Is no genetic or organic disturbance m

unction, the surgical approach can be utilized.
algae excision is performed as previously described by an
he Incision at the base of the clitoris followed by plastic
eta over the amputated site when hemostasis 1s complete.
ane pa In size (3, 4) can be done by a slab incision, proximal
an g ans, Temoval of skin at the incision site, and transverse

proximation which shortens the clitoris without removal of

108 CLITORIS

tissue other than minimal skin. The result is a broad base which
is more acceptable aesthetically, and certainly decreases the em-
barrassment of the large erected clitoris which is the chief com-
plaint and for which the patient seeks relief.

TREATMENT OF INFECTION

The infection of the external genitalia which includes the clit-
oris, of coursé, must include the venereal group. Syphilis, which
is usually identified as a chancre, appears on or near the clitoris
in a significant number of primary cases. The identification is
made by the appearance of the treponema pallidum when the
exudate from the chancre is visualized under dark field micro-
scopy. Serology is utilized in later syphilis and the secondary
lesions rarely, if ever, involve the clitoris. Gumma have been
reported about the labia and clitoris. The more esoteric lesions
of lymphopathia venereum are rarely, if ever, seen because the
lymphatic drainage of the labia and clitoris is away from the

midline. This also applies to lesions of granuloma inguinale. The

lesions of herpes progenitalis and other D.N.A. viruses rarely are
seen about the clitoris although such viral ulcerations are fre-
quently seen about the labia. Condylomata accuminata has been
observed about the clitoris especially in young women who have
neglected large exophitic lesions about the labia.

The other infections about the clitoris usually observed clini-
cally are ulcerations and edema of mixed bacterial origins.

The treatment of all such lesions depends on the etiologic
agent and sensitivity studies. Cold and hot compresses usually
suffice for local treatment. Because of contact and atopic derma-
titis, salves and nostrums applied directly to the ulcerations can
result in eczematous lesions worse than the original ones.

NEOPLASTIC DISEASE

The presence of malignant disease involving the clitoris can be
primary or metastatic. Usually, the lesion is squamous cell car-
cinoma arising in the covering mucosa. Whether the causation 15
repeated infection or ulceration from minor trauma, or carcino-

SURGERY OF THE CLITORIS a
9

gens applied by sexual contact is not definitely kn
cell carcinoma and the spectrum of arene nown. Basal
been reported involving the clitoris and receiy esions have all
because of the mystique of the organ. A rent fate notice
yulvae is rarely reported in recent literature beca’ esion of the
tively high incidence. use of the rela-

The treatment for these lesions, no matter the erad
of the malignancy, is radical vulvectomy with aie one:
deep groin dissections. The deep pelvic nodes yee se
there are positive nodes in the groin, by a later operation He os
nant melanoma arising in simple or junctional nevi are ee ai
by radical vulvectomy as above, but more extensive Pte e
such as hemiamputations involving the torso, is not undef
Non-malignant neoplasms identified as such by ee ea

biopsy are treated by the biopsy at least and simple vulvectom
at most. y

TRAUMA

The frequency of traumatic lesions has not been well re-
corded because of the multiplicity of causative events. The
chronological classification can be used and the prepubertal
postpubertal, adolescent, adult and menopausal time periods on
serve as a satisfactory timetable.

PREPUBERTAL TRAUMA

ae stating wounds in the clitoral area from falls against ob-
sie ae abbing wounds by sex deviants are the most frequently
Pei. events. The usual surgical care of penetrating wounds is
a : stop hemorrhage, debride the wound area, cleanse with

ile solutions, suture primarily if possible, and protect the

a i 1 ’ Q . . . .
et from infection by suitable antibiotics and anti-tetanus
oid.

POSTPUBERTAL TRAUMA

A similar statement applies to this age group except the de-

110 CLITORIS

gree of lacerating and penetrating wounds is more severe. It is

probably advisable to shave the pubic hair for better exposure of
the wound site and easier suture application. This group as well
as that of the adolescent and adult have the additional problem
of human bite wounds in this area, which frequently require
wound healing by secondary intention. The additional problem
of gun shot wounds to secondary sex organs has also been oc-
casionally seen and as with carnal attacks must be reported to
the proper authorities. The treatment of such deep penetrating
wounds frequently involves exploration of the pelvis and abdo-
men for missile perforation of gut or other visceral organs. Or-
thopedic procedures for bone involvement must also be con-
sidered.

The menopausal female has the additional problem of poor
wound healing and atrophic skin about the involved area and
necessary estrogenic stimulation and vitamin supplementation is
advisable.

As a suitable closing statement it must be remembered that
the diagnosis and management of lesions of the clitoris are com-

' plicated by the ignorance and special emphasis attached to this
organ. If the veil of secrecy and confusion is removed, the evalu-

~ ation of the problem and the preferred modality of management
is almost without exception abundantly clear.

REFERENCES

1. HW Jones Jr. and GES Jones: The Gyn aspects of adrenal hyperplasia and allied
disorder. Am J Ob & Gyn 868:1330, 1954.

2. L Barinka et al Plastic adjustment of female genitals in adrenogenital syndrome.
Acta Chirurgiae Plasticae 10:99, 1968.

3. JK Lattimer: Relocation and revision of the enlarged clitoris with preservation of
the glans: An alternative to amputation. Urol 88:113, July, 1961.

4. Kaplan I: A simple technic for shortening the clitoris without amputation. OG
29:270, Feb. 1967.

mr,

=— =

Chapter X

AN ANTHROPOLOGICAL VIEW OF
CLITORAL AND OTHER FEMALE
GENITAL MUTILATIONS

Ben R. Huelsman*
INTRODUCTION

After more than a century of investigations among the peo-
ples of the world, physical anthropoligists and medical observers
still lack much basic data about human genitalia! Information
not accurately known about the comparative anatomy of the
females of various ethnic groups includes the size and configura-
tion of the clitoris, its varying lengths and positions in relation
to the vaginal opening and the meatus, and the appearance, size
and shape of the outer and inner labia. Among males of aise
ing ethnic and racial groups, little can be accurately stated as to
the length and circumference of the penis, both flaccid and
erect.

In the United States in a sample of one hundred adults, the
clitoral glans size averaged between 4 and 5 mm. in the ne
a and longitudinal axes (17). For non-white females, far less
eohiprative- deacrptve data’ on abecriite ell a
PCa coctolles ee white temales, the rea e 1S
ai eer ortuous path among the stacks of medical
Sa asies se libraries. The dust-covered works of writers
PiGAtcr ais ecades ago provide some of this data, along with
ite An ion and hypotheses of dubious value. An anonymous
nee age surgeon in 1898 claimed after years of travel in
ate e Negress CH that COILED Was more greatly de-
A Sicoat an the white in. clitoral dimensions. He offered no
Heweve, eee: or detailed measurements to sustain his theory,

). Moreover, he failed to distinguish between tribal

*This ch
aton aoe was partly funded by a grant from the Erickson Educational Foundation,
Ouge, Louisiana.

111

112 CLITORIS

groups in which the clitoris occurred naturally large and tribes in
which artificial elongation of the clitoris was practiced.

Independent of the French surgeon, an American medical ob-
server, Morriss, noted a seemingly racial variation of a different
kind in the clitoris (38). He estimated that eighty percent of the
“White Aryan” patients known to him possessed a clitoris in
which the glans clitoridis and the prepuce were bound together
by adhesions. While making no claim to having done field work
in Africa, he did offer the theory that adhesions of the clitoris
among black females were rather rare, but that he had seen at
least some among individuals of mixed blood, presumably a ref-
erence to mulattoes in this country. By naively implying that
white women represented the highest level of evolutionary devel-
opment among the major races, he then offered the fascinating
hypothesis that if his observations on clitoral ‘“‘degenerations”
among white females were correct, then Nature must be trying
to abolish the clitoris as civilization advances! Morriss began a
valuable line of research by citing the prevalence of clitoral ad-
hesions, however, and subsequent medical investigators in the
United States have confirmed his reports of clitoral adhesions.
(a will be taken up in more detail later, but it can be pointed
out here that adhesion is the current medical rationale given for
| female circumcision, along with clitoral hypertrophy and the so-
called hooded clitoris. It is by no means clear from the some-
_ what separate literatures of anthropology and medicine whether

_ adhesions occur with the same prevalence among women of var-
ious racial and ethnic groups.

My original intent was to assemble the anthropological data
on female genital mutilations, to speculate as to the possible
origins of such customs and to offer a critique of the existing
classifications of these practices as they still persist in the pre-
literate and non-Western worlds. However, during the course of
this research, which led to the examination of many medical
journals from the dates of their inception (e.g. The Lancet,
which began in 1825), I realized that the history of surgical
operations on the clitoris in Western civilization was equally ob-
scure and quite separate from the female genital operations prev-
alent among non-Western peoples. In fact, a larger literature

AN ANTHROPOLOGICAL VIEW OF F
EMALE GENITAL
-MUTILATIONS |
us
exists on these practices among primitivé peoples than is true of
eo

the medical literature on surgical alterations of
pudenda in the Euro-American nations of the female

CLASSIFICATIONS OF FEMALE
GENITAL MUTILATIONS

The modern science of cultural an re
developmental stage during the first ay eee es ies ihe
tury. Beginning three centuries earlier travellers, S diecanate _
physicians and missionaries began describing the ane Re a
they encountered in aboriginal cultures. One of these accou i
by an English physician (14) in 1847, offers one of the ae
scientific attempts to describe and classify the varieties of pana
genital surgery then prevalent in Africa. Daniell saw some, but
not all, of the kinds of female genital operations now ein to
have existed in Africa, and he felt that such genital operations
could be grouped into four headings:

1. Simple excision of the clitoris.

2. Excision of the nymphae.

hb Excision of both the nymphae and the clitoris.

4. Excision of a portion of the labia pudendi, with either or

all, of the surrounding structures.

“| ee did not travel to either Egypt or to the Sudan,
ane e done so, his classification of pudendal alterations
ae a included vaginal infibulation and Pharaonic circum-|
aoe oe referred to inaccurately as “Sudanese circum-
ae = aniell also noted that such operations upon eect
a nem performed by old women of the same tribe, a
on. a was continuously confirmed by later generations of
a ee ers who have studied genital surgery m Africa south
ene ahara, hereafter referred to as SubSaharan Africa. Dan-|
eA so informed his readers of the variation in age at which
ae eens took place. In West Africa, ages ranged from
= © nine years; in North Africa eleven to twelve years of age
ieee common, some girls not being genitally altered until
Son, ae sixteen, or even older. From the first-hand accounts

ell it is already possible to deduce that not all forms of

114 CLITORIS
female genital operations occurred in association with puberty
ceremonies, or as they later came to be styled, rites of passage.
The literature of anthropology has increased enormously and
many other regions of the world have been studied since Daniell
gave his early account. Descriptions of genital operations abound
in the literature of anthropology; however, in the opinion of one
critic (22) these accounts generally do not specify in sufficient
detail just what surgical alterations are involved. Ford indicates
that in many ethnographies the term clitoridectomy is frequent-
ly used as an undefined word signifying some kind of operation
on the clitoris. From my own survey of this literature I feel that
Ford is quite justified in his criticism of this fuzziness in ethno-
logical descriptions. The reader_often_cannot tell whether or not
the term refers to removal of the entire clitoris, its incision, and
whether or not the sheath and/or glans has been removed. He
feels that it is important to determine precisely what the opera-
tion consists of, as well as its effects upon the organ which has
been surgically altered, and further that it would be desirable to
know the significance any given people attach to the effects of
genital surgery. He is correct in asserting the value of obtaining |

—_—

highly accurate photographs or sketches to supplement the nar- |
rative accounts elicited in the field and in clinics and hospitals, |

where accurate medical records are apt to be kept.

Another anthropological critic of the vague terminology in
both medical and ethnographic writings on genital surgery (48)
not only deplores the quagmire of confusing, interchangeable
terms, but even suggests that the term circumcision should be
applied exclusively to operations on the penis, if indeed this
term is to be employed at all. Sometimes an author uses the
word excision, or as Daniell called it, simple excision, to refer to
the removal of the prepuce, glans and shaft of the clitoris.
Others call this same operation clitoridectomy or cliterotomy- |
At other times, depending on the individual observer and his

preferred terminology, the phrase female circumcision is used |

generically to include all possible forms of female genital
operations.

I feel female circumcision is a useful term but that it should
__ be restricted to that type of operation upon the clitoris in which

ee oe

only the prepuce of that or

gan is removed re F
5 S
ne shaft of the clitoris and the surrounding ane the glans,
of the Arabic/Muslim world where this custom heise - areas
’ e oper-

ation is called Sunna circumcision.

Terms like female circumcision and §
interchangeable, but only if each is explic
ing literature, seldom in agreement as t
fully sifted for internal contradictions be

terminology. One of the most thorough accounts of femal

ital operations in 19th century Africa (43) is tie See
mendable in overall descriptive precision. Nevelie count if
a collective account of all types of such operations ‘a se kd
feels able to refer to these practices as “types of female ci Ss
cision in the XIXth century.” I have incorporated the fisting Ot
such tribes practicing the varieties of female genital surger "ie
account being based in part upon Roles and incorporating HSE
mation from other authors. Table V gives a comparison of the

earlier Daniell classification with the nearly equivalent terms of
Roles.

unna circumcision are |
itly defined. The exist- |
© labels, must be care-
cause of the overlapping

TABLE V

COMPARISON OF FEMALE GENITAL MUTILATION CLASSIFICATIONS

Daniell
aniell (1847) Roles (1966)

1. Simple excision of the clitoris. 1. Glitoridectomy.
2. Excisi
epicnror the nymphae. 2. Clitoridectomy and removal of the
labia minora.
3. Excisi pate
aan of both clitoris and 3. Clitoridectomy, with removal of
z labia minora and majora.
4

: aiiision of a portion of the labia
pu endi, with either or all of the
surrounding structures.

ly eis i ang 2 of Roles were, and still are, the most common-
Toe oyed kinds of female genital operations in tribal, or Sub-
high os East Africa. This non-Muslim area is characterized by a
males evelopment of rites of passage for both sexes and young
must undergo circumcision by an older tribesman. Al- |

116 CLITORIS

though not identical, these two classifications, despite nearly
120 years’ separation in time, are quite comparable. The fact
that neither deals with Sunna circumcision or vaginal infibula-
tion is probably due to the authors’ desire to concentrate upon
non-Muslim areas of tribal East Africa, where these two kinds of
operation are usually absent.

One well-known pair of anthropological writers (41) considers
female circumcision and infibulation as quite distinct types of
female genital operations. Excision is seen as synonymous with
female circumcision, but under the latter, which they define as
the shearing of the inner lips and a portion of the clitoris with
knives of metal or stone, they regard a widely differing set of
surgical procedures as also constituting female circumcision.
These are: mutilation of both labia and clitoris, sometimes only
the labia and at other times only the prepuce of the clitoris.

One of the most comprehensive studies of female genital
operations has been done by a Sudanese gynecologist (44). This
work of Shandall also contains the most closely refined defini-
tions of the discrete kinds of operations. I have made only one
addition to the typonomy of Shandall, adding a-Type 2a, cir-
cumbustion, a term coined by the late Felix Bryk in his Voo-
Doo Eros. Except as noted before, the following classification
and comments are those of Shandall:

Type 1: Circumcision
This is analogous to that of the male. It consists of the re-
moval of the prepuce of the clitoris only, preserving the clit-
oris itself and the posterior larger parts of the labia minora. It
is the variety advocated by most authorities on Islam and is
called sunna circumcision in Muslim countries. The Arabic
- word sunna means circumcision.
Type 2: Excision (or reduction)
This consists of removal of the prepuce and glans of the
clitoris, together with the adjacent parts of the labia minora,
or the whole of it, without including the labia majora and
without closure of the vulva. This was the commonest type in
— Egypt before prohibition and is now taking the place of infib-

T
AN ANTHROPOLOGICAL VIEW OF FEMALE GENITAL MUTILATIONS

117
ulation in the Sudan sj “nas
oan since the legislation of 1946 prohibiting
Type 2a: Circumbustion
The removal of the entire clitoris }
glowing coal, placed in a spoon
charring of the clitoris-is accom
Eastern Hamitic people of Nort

> Dy means of charring; a
» Is the agent by which the
plished, among the Nandi, an

heast Afric i

al E a (10). During m
circumcision ceremonies among the Nandi, the pr ; =
removed by circumbustion. . eae

Type 3: Infibulation
This is really excision plus infi j i
type in the Sudan, ae it Aiea erie a
cision.” It used to be practiced in E aul ees
Egypt, and was the Heda ae eae a
re ca ed “Sudanese Circumcision.” Bein
known to the Ancient Egyptians, it probably entered he
Sudan through the north from Egypt and ‘“Pharaonic” oe
justified name. In this type the whole of the clitoris thr
whole of the labia minora and the adjacent medial part af a
labia majora in their anterior two-thirds are removed. The a
sides of the vulva are then brought together by silo cat ‘
sutures, obliterating the vaginal introitus except for a ei
Opening posteriorly to allow urine and menstrual blood to
ee In the past, a clasp of split cane was used to
ee the bleeding and bring the two sides together. In
maliland, thorns are used to fix the two sides together and
the wound is dressed with myrrh.
Type 4: Introcision
See ee! ae vaginal orifice is enlarged by tearing it down-
ae ee fingers bound round with opossum string.
Bear one parce performed by an old man trained for
RE a istricts the perineum 1s split up with a stone
fe ae ollowed by compulsory intercourse with a num-
dgmlw g men, and sometimes with the older men of the
5 Sees juvenate them, in a big tribal ceremony. This is
iced only in aboriginal Australia.

CLITORIS

DISTRIBUTION OF TYPES OF
FEMALE GENITAL MUTILATIONS

The geographic distribution of the various kinds of operations
‘on the female pudenda is quite revealing. In aboriginal North
America, north of Mexico, puberty rites were a component in
many Indian cultures, yet no female genital operations have ever
been reported for the area. It is generally believed that the an-
cestors of all New World Indians, including the Eskimos and
Aleuts, crossed the Bering Strait land bridge at least 12,000 and
perhaps as long ago as 30,000 years ago.

In South America in the eighteenth century, Father Xavier
Veigl learned that the Indians of Pano linguistic stock in Ecua-
dor had been in the habit of circumcising their girls in order to
allegedly make them more competent in their marital duties

\ (37). It is also reported (36) that infibulation of the female ©

_ existed among the Conibo Indians of the Rio Ucayali in Peru.
Citing the work of the German ethnographers Reich and Stagell-
mann, Montagu offers this account of an apparently authentic
instance of female infibulation in the New World:

As soon as a girl attained to mature age, a great feast was made in
which a fermented drink made of manioc roots, called maschato,
played an important part. After the girl had been made so intoxi-
cated by this beer that she was quite unconscious, the operation
began. She was stretched out on three poles of palo de balsa, and
in the presence of the whole noisy assembly an old experienced
woman cut around the introitus vaginae with a knife of bamboo
and severed the hymen from the labia pudendi so that the clitoris
was set quite free. The old sorcerers rubbed some medicinal herbs
into the bleeding parts, and after a while introduced an artificial
penis, made of clay, into the vagina of the maiden, the thing being
exactly the same size as the penis of the man betrothed to her.
Thereafter she was considered properly prepared to marry, and
was given over to her future husband.

Montagu adds that this operation differs from that customary
in North Africa only in minor details, e.g., in the latter area the
clitoris is normally removed during infibulation and the girl is
customarily conscious during the proceedings. He is correct in

—_— OM

’

AN ANTHROPOLOGICAL VIEW OF FEMALE GENITAL MUTILATIONS 119

citing still another difference in ceremony between the two con-
tinents: in the Old World infibulation js generally perf
between six and eight years of age and defibulation i‘ Ce ae
some years later, just before marriage. In the New ae foe
operations are, as it were, telescoped into one.

The appearance of female genital operations in the Ne
World cannot reasonably be ascribed to an Old World ori in
since there is no proven historic or prehistoric eben ee
tween the Indians of South America and the peoples of North-
‘ern and Eastern Africa. If New World manifestations of female
genital operations are to be sought in an Old World setting, it
should be aboriginal Siberia. Since the mongoloid Aeon oh
all American Indians probably had to pass through Pleistocene
Siberia on the way to the Bering Strait land bridge, the theorist
intent on an Old World origin for such customs should investi-
gate the cultures of the historic Siberian tribes for traces of
survivals of female genital operations. Alone of all the Siberian!
peoples, the Itel’mens, formerly known as the Kamchadals, of
the Kamchatka Peninsula, Northeast: Siberia, are said to have}
enlarged the labia by manual manipulation, although the evi- |
dence for this is far from conclusive (41). It would seem then,
that infibulation of females is largely limited to North Africa
gn that its probable occurrence among the Conibo Indians of
~<ru'is an example of the cultural process known as independent
Invention.
ee phe distribution of female infibulation (Fig. 31,
ane a strand) is purely Northeast African, with extensions
(48), a Nile Valley and the caravan routes westward to Nigeria

ke en infibulation “occurs among the Somali in Obok,
in Erite eila, Bender Djedid, among the Asaorta, a Saho group
ae a and among the various Galla groups. It does not occur
the a € so-called pagan or “true” Galla, but is found among
Calla anakil. It is known to be present among the Shoa and
ie ees to the west. However, it is generally absent among
amon sea population, although it is said to have existed
AnGt — e€ Amhara of that nation in the nineteenth century.
carer: source (30) claims that in the Sudan, vaginal infibula-
sts among the tribal groups known as the Hadendawa

120

CLITORIS

and the Beni Amir. Female infibulation is not only very ane
i Sudan, but is so deeply entrenched there that in the area
of Fae an estimated 75 percent of Sudanese women over
20 years of age were still found to be infibulated (44).

Figure 31. Northeast Africa, showing distribution of female infibulation.
(After Widstrand) —

Posterior introcision, sometimes called vaginal eee, :
found only in aboriginal Australia. The restricted Say - -
tribution, its absence among the peoples of Northeast a -
yet fully Islamicized, its lack of mention in the ae ae
possible existence in Pharaonic Egypt, all point to t is pe ee
as one of the most ancient of the several varieties © eae
genital surgery. With the exception of vaginal introcision ae ie
al Australia, female surgery is performed by older women ar
same tribe. There is a general trend toward the operation : es
being done on one girl at a time, instead of in mass pagar
of rites of passage. Outside the Muslim culture world, ate ae
ly in tribal, SubSaharan Africa, clitoral excision rat ae
rites of passage. A number of girls are simultaneously Fak.
ised, with elaborate pre-operative and post-operative cerem ae
After removal of the clitoris, the SubSaharan African g

AN ANTHROPOLOGICAL VIEW OF FEMALE GENITAL MUTILATIONS

121

physically isolated from her non-excised girl companions. After
rejoining the larger tribal community she is then considered to

be a woman, eligible for marriage to a circumcised young man
of the community.

TABLE VI

GEOGRAPHIC DISTRIBUTION OF FEMALE GENITAL OPERATIONS*

Sunna
Circumcision

Muslims in
Sudan and
Somaliland;
Muslims in
Eritrea and
Abyssinia;
Mandingos
Galla (some)
Bantu tribes
(some) and
some tribes
of Sierra
Leone, Kenya
and Ghana;
Muslims in
India and
Pakistan

Infibulation

Galla (some)
Eastern Galla
Somali
Danakil
Asaorta
Harrari
Hadendawa
Beni Amir
Shoa (some)
Sudan (general)
Skopts of
Tsarist Russia
Ancient
Egyptians;
pre-Islamic,
Ancient Arabs

*Omitting Aboriginal Australia

ye ee

Types of excision

Clitoridectomy Clitoridectomy Clitoridectomy Circumbustion
and Removal of with Removai of
Labia Minora Labia Minora and
Labia Majors

Gusii
Masai
Nandi (some)
Dorobo
Suk
Marakwet
Elgeyo
Taita
Samburu
Sebei
Legenyi
Arusha
Chagga
Gogo
Iramba
Sukuma
Itangi
Sambaa

Kikuyu (some) Kikuyu (some) Nandi (some)
Kemba Meru
Somali Mwimbe

Embu

Chuka

Hehe

Baha

ORIGINS OF FEMALE

GENITAL OPERATIONS

There are no historically new ritual genital operations on
either sex. It is impossible to determine which of the ie
Varieties of genital operations is the oldest or most recent. e
few documented instances of female genital ritual surgery in the
aboriginal New World appear to be independent inventions. oe
Posterior introcision of the Australian aboriginal appears to be
unique to them. It has never been recorded for any other ps
ple. My hunch is that this type of female genital op Soe: a
Mvented only once in the cultural history of mankind and wa

122 CLITORIS
confined to Australia by the process of geographic and historical
isolation. At the time of white colonization of Australia, the
aborigines had a material culture and technology roughly com-
parable to the Upper Paleolithic level of human cultural develop-
ment in Western Europe and Northern Africa, some 45,000 to
15,000 years ago. Nevertheless, the Australian aboriginal culture
was and is characterized by an extremely complex language,
social organization and by an elaborate set of puberty rites.
There were genital operations for both sexes, although such rit-
uals varied from region to region and were not uniformly pres-
ent among all aboriginal subgroups.

Did genital operations on either sex originate during the Up-
per Paleolithic and cave-dwelling era of human culture history in
the Old World? No one knows, of course. The cave art of the
Cro-Magnon inhabitants of Paleolithic France and Spain shows
no evidence of genital mutilations. Their obsidian blades and
finely chiselled cutting implements were sufficiently sophisti-
cated to perform genital surgery equal in complexity to that
practiced by the Australian aborigines. The hunting economy of
the Upper Paleolithic in Eurasia was based on the presence of
big game animals and these gradually disappeared and some
shifted their grazing sites northward towards the end of the last
glacial period. Man became a gatherer of food and a coastal
fisherman to supplant his diminishing reliance on game; this per-
iod of cultural development is called Mesolithic. It is devoid of
the great cave art of the Old Stone Age and hence offers no
evidence for the invention or practice of genital operations. The
Neolithic, literally New Stone Age, followed in the Middle East
and was characterized by the domestication of draft animals, the
invention of agriculture, pottery and the beginnings of seden-
tary, village life. The existence of genital surgery accompanied
by rituals can neither be proven nor disproven for this period of
prehistory.

Prehistory offers no archeological clues for the origins of gen-
ital operations. Around the eastern shores of the Mediterranean
a number of urban civilizations arose, hieroglyphic and cunel-
form writing systems emerged, social stratification became ¢?
trenched and bronze alloys and sophisticated political and mili-

SS
9
S&S

—p

Si TT a

AN ANTHROP
OLOGICAL VIEW OF FEMALE GENITAL MUTILATIONS 123

or Middle Eastern

: ; ‘ cultures

toms of ritual genital operations arose, independent ae ne
suc

practices in both the New i

logical culture of the rere oe pecouthie ‘eens
persistent theories for the origin of ritual St 1 e the most
that such customs began in Pharaonic ae hs j Grae “
(30) of female genital surgery in the Sudan aS ot aes
folkloristic account that the custom started aia aes
Pharaoh was afflicted from birth with a miniature ei aoe
of this, he was unable to enjoy the erotic eens his ; sae
subjects to the fullest extent. He finally issued a roche
that all females would be circumcised in such a ae as ny el
row the vaginal orifice. Thereafter he was able to savor Sy
sexual delights of his infibulated female subjects. Jisr s cole
that perhaps through the influence of slaves, the cutee of va: i
inal infibulation was introduced from Ancient Egypt into . |
Sudan, where it prevails today. : : |
Herodotus asserted that the Egyptians were taught the prac-
tice of female circumcision by some ancient but unspecified
Semitic people. In any event, the archeological evidence of mur-
als depicting male circumcision in Pharaonic Egypt is fairly solid.
The oldest pictorial representation of male circumcision discov-
ered thus far comes from the private tomb of Ankmahor at
Saqqara, in the mysterious “Plain of Mummies.” A relief depicts
a priest-doctor of the Sixth Dynasty (circa 2400 B.C.) in the act
of circumcising a boy. The text of Teti, which also belongs to
the same dynasty, makes mention of a god of circumcision. A
number of mummies show that the practice was common,
though not universal, throughout Egyptian history (5). Accord-
ing to Strabo’s Geography, Pharaonic Egypt was characterised by
both male circumcision and clitoral excision, interpreted to
mean in the case of a girl, the cutting off of sections of the
clitoris and the labia minora. Most royal female mummies’ states
of preservation do not permit firm conclusions about the exist-
ence of Pharaonic circumcision and vaginal infibulation (5). My
Own belief is that such customs did exist in Pharaonic Egypt but
that proof or disproof of this assumption must await even fur-
ther archeological exploration.

124 CLITORIS

In Ancient Egypt, female genital surgery seems to have taken
place between the ages of 14 and 15 years. It seems probable
that even the amorous adventures of Cleopatra may have been
conducted sans clitoris. One account (44) suggests that genital
surgery on Ancient Egyptian young ladies was limited to rulers,
priests and their respective families. Women from these social
and occupational classes may not have been able to inherit prop-
erty unless they had first undergone some form of genital sur-
gery (44). Shandall states that a large number of Pharaonically
circumcised mummies have been discovered, but only relatively
few were vaginally infibulated. He indicates, as Jisr had done
earlier, that perhaps these Ancient Egyptian forms of female
genital operations diffused into the north of the Sudan. He also
feels that female genital operations probably existed among the
Ancient Arabs, long before the advent of Muhammed the Proph-
et. Among the pre-Islamic Arabic peoples such customs may
have served the function of allegedly protecting shepherd girls
against sexual assaults, if the girls were otherwise unescorted by
males from their own group.

In the contemporary Sudan, Sunna circumcision of the female
is not an ordinance of Islam. The survival of the perhaps older
forms of female genital surgery in less Islamicized, less Arabized
parts of the Middle East is not unexpected. The Near East-
Middle East is an ancient mosaic of diverse cultures and the
cultural survival of ritual genital operations of possible Pharaonic
Egyptian origin would not be surprising.

One anonymous scholar provides this graphic portrait of daily
life in Pharaonic Egypt, citing the fifteenth of the British Papyril
(2). In this document, Armai, an Egyptian living within the
sacred precincts of the Serapeum of Memphis, presented the
following petition to the Stratagen, or high priest:

Tatemi, the daughter of Memphis, residing with him in the Ser-
apeum, has already amassed by her collections and by the free
gifts of visitors, a certain fortune, amounting to 1 talent and 390
drachmas, which she had deposited in his hands for safe-keeping-
Thereupon was he deceived in the following manner by Tatemi’s
mother. She pretended to him that her daughter had attained the
age, when according to Egyptian custom, she should be circum-

———

AN ANTHROPOLOTICAL VIEW OF FEMALE GENITAL MUTILATIONS 125

cised. Therefore, he should pa ;

the occasion of AME ana a eee: hands, so that on
erly dress and endow her daughter. If j

that this intention be not aie ee sould paticom S ape
daughter Tatemi in the month of Machis of ‘oem a her
would refund him the sum of 2,400 drachmas. tHe ei , she
this proposal and had handed to Nefori the said sum of pan
and 390 drachmas. But the daughter reproaches him claiining et
money back. Important business had prevented fie ae a 2
himself to Memphis, to there attend to this matter. Teen A
does pray that Nefori be cited before the tribunal, and made ne
subject of a judicial decision.

ght be able to prop-

The anonymous author of Praeputii Incisio felt that Ancient
Egyptians performed circumcision only on boys of the sacer-
dotal or warrior class, but that they submitted all girls without
distinction to some kind of genital surgery. As he interpreted
the ancient writings, Pharaonic Egyptian girls obtained their
dowries, thus in a certain way earning their marriage portions.
Herodotus, however, reasoned that since no woman in Ancient
Egypt was allowed to exercise any priestly function, female gen-
ital operations could not bring them any priestly advantages. An
unspecified Egyptian document dated to 163 B.C. is cited by
Montagu (37) to mean that clitoral excision was practiced on all
girls. I suggest that the evidence for such a sweeping assumption
is lacking. Among contemporary peoples who practice reduction
or complete declitorization, all girls are subjected to the opera-
tion in rites of passage. By implication, Montagu is claiming that
Pharaonic Egypt practiced rites of passage for all Egyptian girls
without exception and that the operation consisted of some
form of clitoral excision. This hypothesis remains unproven.
Montagu also notes that early medical writers have described the
excision of the clitoris or nymphae when they were observed to
be hypertrophied, or else when erection of the clitoris became
objectionable. Ghalioungi (24) alludes to the translation of one
Egyptian monument indicating that a boy had been circumcised
as part of a group of 120 boys his own age. While the evidence
1s slim, the possibility exists that something resembling rites of
Passage and involving male circumcision did exist in the culture
of Pharaonic Egypt.

126 CLITORIS

The exclusive evidence of genital surgery, with or without
public ceremonies, in the culture of Pharaonic Egypt has been
given many different and contradictory interpretations. My own
view is that some kind of vaginal infibulation and Pharaonic
circumcision apparently did exist in Ancient Egypt, although
mural and other pictorial evidence for this operation does not
yet exist. Some kind of declitorisation apparently also existed,
although I am not convinced that rites. of passage specified that
all Egyptian girls, regardless of social class, had to under go this
or any other genital operation. Were these genital operations
limited only to upper class girls in Ancient Egypt or did they
affect all classes of Ancient Egyptian society, including the cap-
tured slaves? Until archeologists uncover additional evidence, we

can only speculate.

DECLITORIZATION IN WESTERN
MEDICAL SCIENCE

American school children spend many hours learning of that
famous discovery by Christopher Columbus. As sex education
slowly spreads throughout the United States, they may have an
opportunity to learn of still another Columbus, who claimed an
equally significant discovery. One Realdus Columbus of Cremona
in 1593 ascribed to himself the honor of discovering the clitoris.
He even took it upon himself to suggest a name for the struc-
ture, which he believed had not been observed by anyone before
him (32). Had this Renaissance scholar been as familiar with
Latin as some of his medical and literary contemporaries, he
would have discovered that at least fifteen terms existed in that
language for the clitoris. Moreover, at least one of these terms
was a reference to the erectile qualities of this tiny organ.

Folk anatomical knowledge of the engorgement of the clitoris
among the English is graphically illustrated by the term “cunt
stand” from 18th century written usage, probably orally trans-
mitted from an even earlier period (11). One quality of the
clitoris which very early attracted the attention of both popular
and medical observers was its occasional hypertrophy. This was
especially true if the hypertrophy were pronounced, or occurred

9°

—

=—

AN ANTHROPOLOGICAL VIEW OF FEMATE GENET AP MUTILATIONS 197

jn combination with still another anatomic
George G. Sigmond noted that in the year
described as an hermaphrodite with a clitoris
was on exhibition in London and Paris.

whether surgery was attempted to reduce th
Still another early medical note on hypert
was the account given of one Marie Lefort
but the dimensions of her organ were not
did not say whether excision of the clitoris
by the beginning of the 19th century,
a variety of medical rationales, was becoming more prevalent,
and individual case histories concerning the pathology and sur-
gical removal or reduction of this organ were described in the
medical literature.*

About the same time that European travellers were learning
of the existence of clitoral excision among the peoples of Africa,
this procedure appeared in English and continental journals. The
European and English use of declitorization is generally ignored
in anthropological writings. This is because anthropologists have
concentrated on tribal societies, paying only slight heed to the
culture history of Western civilization. In The Lancet in 1825 a
description was given of an operation performed in Berlin on
June 20, 1822, by a Dr. Graefe. The allegedly idiotic fourteen-
year-old patient had a medical history which included both ex-
cessive masturbation and nymphomania. The operation was
credited with some interesting postoperative effects:

al anomalies. Dr.
1777 Marie Lange,
seven inches long,
It was not revealed
€ size of her clitoris.
rophy of the clitoris
in England in 1815,
given. These authors
was done. However,
excision of the clitoris for

After the cicatrization of the wound, a marked amelioration of the
Symptoms was observed. The propensity to self-pollution was near-
ly eradicated; a few suspicious motions, the remains of a long-
continued habit, were occasionally observed, but they were at
length discontinued. The intellectual faculties of the patient began
to develop themselves, and her education could now be com-
menced. She can, at this time, talk, read, reckon, execute several

*Repugnance toward clitoral hypertrophy was not limited to Western civilization. While

this attitude is by no means universal, the clitoris-excising peoples of tribal, SubSaharan
Africa view the retention of a large clitoris with disgust. By contrast, in Polynesia and

‘ronesia, a large clitoris is highly esteemed and viewed as aesthetically and sexually
desirable,

128 CLITORIS

kinds of needle-work, and a few easy pieces on the piano forte. It
is a remarkable circumstance that this young girl, on emerging
from moral lethargy in which she had sunk from infancy, assumed
at once, without any intervening gradations, the character and

tastes of adolescence.

The first four decades of The Lancet abound in case histories
of patients declitorized for a variety of medical reasons. Thus
one patient who was excised on September 9, 1837, had hyper-
trophy of both the clitoris and nymphae and a history of gonor-
thea prior to hospitalization. It was claimed that a complete
cure was effected after excision of the clitoris and removal of a
tumour, the precise location of which was not given. In the
pre-psychiatric era of nineteenth century Western medical _his- |
tory, a variety of medical rationales were given for excision of |
the clitoris. Among the most common cited for declitorization |
were hypertrophy of that organ, any kind of malignant growth |
on or near the clitoris and infantile, adolescent or adult mastur-

bation regarded as excessive.
A kind of occupational folklore about the clitoris and the

alleged benefits of declitorization developed within the medical
profession in the first six decades of the nineteenth century. For
some authors, the seat of nymphomania had a definite physi-,
ological locus; some saw it in the cerebellum, others in the uter-
us, some in the ovaries and some, finally, in the clitoris. In the
early 1800s this led to a wave of excisions in Germany, France
and England. At the height of Victorian prudery there was 4
great preoccupation with the effects of masturbation upon the
young of both sexes, a concern shared by the medical profes-
sion. Excision as a cure for masturbation was noted in Paris as
early as 1812 (46). Dr. Tanner offers fascinating insight into the
surgical practices and behavioral assumptions of that era:

A young woman was so addicted to masturbation that she became
reduced to the last stage of marasmus. Sensible of the danger of
her situation, yet not possessed of sufficient fortitude, or else
irresistibly impelled by the pleasurable sensations which resulted,
she could not command herself. If her hands were tied, she re-
sorted to friction against the edge of the bed. If her legs were
fastened, she managed, by moving her thighs, to provoke abundant

AN ANTHROPOLOGICAL VIEW OF FEMALE GENITAL MUTILATION
S

129

pollutions. Her parents took her ;
the example of Levret, he pete ee Mata,
which the patient and her parents agreed to an of the clitoris,
moved with one stroke of a bistoury, and “ organ was re-
vented by an application of the actual cautery ie va pre-

c peration

quickly succeeded, and the patient w
2 ; a :
She quickly recovered her health and Hemet of her fatal habit.

Following

The practice of declitorization r i i Pre

and greatest popularity in England aoe a canta RSS
ardent advocate was an English surgeon, Isaac Baker Br oe oie
wholesale application of clitoridectomy to almost ever "hi a
able kind of female pathology eventually resulted in ane oa
sion from the Obstetrical Society of London. Dr. hansen
early as 1866, was one of the most severe critics of ea
clitoridectomy, even expressing doubt about the alleged aoe
benefits of male circumcision (46). Citing a large number of ae
histories of his own private patients, Tanner questioned the
claims of the clitoris removers. A heated controversy over the
merits and disadvantages of clitoridectomy filled the pages of
The Lancet in 1866 and 1867. The majority of surgeons writing
in The Lancet saw less merit in clitoridectomy than did Brown.
Writing some time after the death of Brown, Tait (45) wrote:

Some thirty years ago, there lived and flourished in London, a
surgeon of great ability, Mr. Baker Brown, whose influence in the
ee of ovariotomy will be displayed in its appropriate place.
pees sane poe was not a very accurate observer, nor a logical
ane ee e found that a number of semidemented epileptics were
ly Sich oe and the masturbation was, in women, chief-
ao aa ri a excitement of the mucous membrance on and
logism - S OES. Jumping over two grave omissions in the syl-
con eae Piss the cart before the horse, he arrived at the
habi n that removal of the clitoris would stop the pernicious

it, and therefore cure the epilepsy. He operated on an enor-
mous number of cases, for epilepsy is very common, and patients
rey a to almost anything which promises a hope of relief.
Rea can be no doubt that many cases were temporarily bene-
tion Tes as cases of epilepsy are benefitted for a while by castra-
anise oa male), removal of the uterine appendages (in ee)
tion a ining (in both sexes). Besides Mr. Baker Brown's opera-

S had no mortality, and the reduction of the sexual distemper

Sie aa

130 CLITORIS

of a number of epileptics even for a while, or to some extent, was
of itself a benefit. But Mr. Brown carried his efforts to a most
injudicious extent, due to the fact he was suffering from very
extensive cerebral softening, and was really incapable of forming a

sound judgment.

Tait felt that the decision of the Obstetrical Society to expel
Brown was disastrous, since it led to discarding clitoridectomy
altogether, which procedure Tait felt still had some merit in
cases where the patient had a “depraved sexual appetite.” The
association between “excessive” masturbation and clitoridectomy
continued for some decades after Dr. Brown’s fall from grace
(21). Eyer, a Cleveland, Ohio, surgeon, also felt that Brown’s
colleagues had overreacted, and he described the excision of the
clitoris from one of his own patients, whose masturbation was
said to be of the clitoral type. Eyer reported that within eigh-
teen months the patient was improved in health, with only one
admitted instance of masturbation.

By the advent of the twentieth century clitoridectomy as a
cure for masturbation had almost disappeared, as medical views
on masturbation changed (18). Duffy has shown how, in the
later years of the nineteenth century, doctors and laity alike
agreed that masturbation was a physical as well as a spiritual
evil, and that its practice was fraught with the direst of moral
consequences. Anthropologists may have blind spots also, as
Ford has shown (22). Many ethnographic accounts of preliterate
people utterly fail to uncover attitudes towards masturbation,
the relative prevalence or absence, and differences in. practices
between boys and girls. Ford did generalize however, that among
most preliterate peoples, masturbation in children is more or less
tolerated, while the masturbation of adults, especially in public,
is rarely condoned.

clitoris, no people outside Western civilization has ever employed

tion.
It is by no means clear when medical writers stopped making

As far as I can tell from the ethnological reports on the|
various people who surgically alter female genitalia, including the |

excision of the clitoris as a supposed cure for female masturba-_

value judgments as to the allegedly prenicious nature of mastur-

> —

——

— | peer =

«i>

: =~

AN ANTHROPOLOGICAL VIEW OF FEMALE GENITAL MUTILATIONS 1
31
bation. In 1907 a Louisiana ici ‘
cekavior ‘among, NOL eee ce) Se reterred to this
able to trace the folkloristic belief that i ae and he was
insanity to eighteenth century medical writin See can lead to
unavoidable that physicians and surgeons ee 3 pee probably
cultural climate of popular opinion in the spats SS aaa a
ntury,

should seize upon clitoridectomy as
: ; a a means ee
abolishing the solitary vice.* of restraining or

FEMALE CIRCUMCISION IN
WESTERN MEDICAL SCIENCE

Female circumcision is the separation of the prepuc d
glans clitoridis, and the removal of the prepuce. aus h ad
indicated the nineteenth century interest in excision due ee ‘4
cern with masturbation. Although reaction within the sia al
profession to the widespread use of clitoridectomy as a eee
for female masturbation was largely responsible for the acetine
of that surgical procedure in the final three decades of that
century, the medical profession by no means lost interest in
surgical treatment for female masturbation and nymphomania
Doctors reflected their cultural climate and euphemisms were
Pea. the order of the day. Tanner (46) writing of female
ee 7 vee referred to “unhealthy practices.” A genera-
oe 5) warned against overrating the evil effects of
2 ae : ut advocated clitoridectomy in “selected cases.”
fee > however, specifically recommend the use of female

- cision, as did his contemporary, Morriss (38).
eee not only believed that adhesions between the
ee wi of the clitoris were most common as a racial
oe i es, but he also showed convincing (to him) clinical
oes ee his private practice that preputial adhesions and
aa oe of the clitoris had produced a variety of medical
one e e cited instances from his own practice of seeming

effected through circumcision. It is to his credit that he

Ae
€t us ho ‘
Rs Pe that the profession of medicine continues its current benevolent attitude

Ward "
the clitoris and its usefulness.

132 CLITORIS

was one of the first physicians to try to prove a causal relation-
ship between clitoral adhesions and a tendency towards mastur-
bation, by the collection of evidence rather than opinion. He
kept careful clinical records on the postoperative effects of this
operation and he offered scientific evidence that preputial adj
hesions, if uncorrected surgically, could result in severe compli}
cations in women or older girls. He claimed to have cured a
patient who had been a nymphomaniac for more than eight
years, noting that her prepuce was firmly adhered to the glans
clitoridis. Some limited support for female circumcision for clit-
oral adhesions exists to the present day.

Not long after the observations of Morriss, a study of mastur-
bation in fifty-two female infants (23) showed marked clitoral
adhesions, with the clitoris frequently buried in these adhesions.
It was suggested that in the. nervous, sensitive child irritation
from clitoral adhesions could result in infantile masturbation and
thence to “moral depravity,” left undefined. Freeman recom-
mended that in general more attention should be paid by the
medical profession to the condition of the clitoris in all young
girls with symptoms of nervous irritability. Following Morriss, he
maintained that female circumcision in such cases produced sat-
isfactory results, often with the pre-existing habit of masturba-
tion disappearing completely. A bit later a woman physician
from Texas (20) reported her examinations of more than two
hundred and fifty girls, noting that less than a dozen of her
charges were without anomalies of the clitoris, usually adhesions.
She defined a normal or non-pathological clitoris as one with a
prepuce short enough to expose the glans, with no smegma in
evidence, and with a glans free from adhesions when stretched
laterally. If only five percent of girls were ‘‘normal,” the mean-
ing of normal might be questioned. She found only a single
occurrence of an “hypertrophied” clitoris. Eskridge strongly dis-
agreed with previous writers who had insisted that clitoral hyper-
trophy was due to excessive masturbation. Her concept of pre-
pubertal masturbation was that it was due to external irritation,
or to outside influences rather than to an internal emotion. She
concluded that circumcision of girls relieves one of the greatest
causes of masturbation, going further in her enthusiasm for the

m
ww

HROPOLOGI

AN ANT CAL VIEW OF FEMALE GENITAL MUTILATIONS 133
hygienic benefits of circumcision for
her. The neutral, clinically descriptive
treats the subject of female masturba
medical writers who used such value-laden terms 6
pravity,” “solitary vice” or “moral leprosy” sae ag
female autoerotic behavior. Although individ
Eskridge resorted to widespread, and apparent
use of female circumcision, this surgical proc
as prevalent as had clitoridectomy in the fi
vious century.

My interpretation is that the procedure of female circum-
cision quietly gained limited adherents, devoid of the notoriet
of excesses of nineteenth century declitorizing, and that the ee
ual ethos of Western civilization, by Eskridge’s time, had begun
to turn away from Victorian morality, a fact now being re-
flected in the kind of language employed in medical writings.
Eighteen years after the publication of Eskridge’s study, a Hous-
ton, Texas, gynecologist remarked that many doctors seemed to
be unaware of the existence of female circumcision and there-
fore did not know the clinical indications for the operation, nor
the results that might be expected (29). Iams pointed out the
continuous line of medical evidence from Freeman, Eskridge and
others in which there was agreement that an adherent prepuce in
the clitoris was one of the greatest causes for producing local
uritation and inflammation. He also indicated that it had been
clinically determined by these and other researchers that the
puaees caused by pathological foreskin in the male may be
ee sroaud in the anatomically homologous clitoris, in addition

Seases peculiar to females. Iams also brought out that the
eer anents of female circumcision, i.e., Eskridge, Dawson, rite
Seat ieee himself as well, concurred that in the ae
ae i females such Hee eter may Ae a menta an
Fe CUMS: causing sexual perversion” as well as a
mon) He oses. The entire group of investigators seems a AS
cate at an adherent prepuce in prepubertal girls ros es
ees masturbation. As recently as 1963 it was ome fen aot
Sen a series of one hundred consecutive cases 0 vulvovag

ations, ninety-two patients had adhesions between pre

girls than any writer before
terms with which Eskridge
tion is a contrast with the

when referring to
ual physicians like
ly quite successful,
edure never became
rst half of the pre-

134 CLITORIS

puce and clitoris, and that in seventy-five they were definitely
great enough to interfere with normal sexual sensation. A case
history of a five-year-old was given in which the child was said
to be a compulsive masturbator, a nightly bedwetter and upon
examination, was found to have an almost completely hooded
clitoris. After circumcision removed the adhesions, the masturba-
tion and other symptoms were observed to have diminished.
Clark also indicated the marital difficulties of several women
whose clitoral adhesions caused them to avoid coitus as difficult
and painful. Further,

When a girl reaches puberty and menstruation makes its appear-
ance, wearing a menstrual pad may cause enough pressure upon
the sensitive clitoris with the adherent prepuce and trapped gran-
ules to produce excessive discomfort. When this is the case, men-
struation is a period of four or five days of real discomfort. A few
years later, at age 15 to 18, another factor enters into the situa-
tion. The girl becomes aware of young males and conscious of the
fact that it is pleasant to have one take an interest in her. But
some girls find this a physically disturbing experience. In a very
vague sort of way they are uncomfortable in an area about which
questions are taboo. They don’t know what to do. Covered with
guilt over the fact that this discomfort centers in what they know
is the sexual area, the only solution they can find is to keep boys |
out of reach and out of mind. Some of our most seriously dis-|
turbed young women probably have the genesis of their troubles}
in this relationship of adhesions between prepuce and clitoris. \

COMPLICATIONS FROM FEMALE
GENITAL OPERATIONS

Damage and complications from the diverse kinds of female
genital operations vary greatly, inasmuch as the extent of sur-
gery ranges from minimal, in the case of Sunna circumcision, to
extensive in Pharaonic circumcision and infibulation. The skill,
inexperience or carelessness of the midwife is another variable.
Thus, among the Kikuyu of Kenya, who usually practice only
excision, instances of unintentional infibulation, caused by 4
careless midwife, have been reported (34). If carefully performed
under aseptic conditions, Sunna circumcision probably involves
the least hazard to the health of the patient.

_—

—— S_—_—~—“—FeO/e

oir rh hrUhUhhCCUrHhCTTCTCTCSOS ;

AN ANTHROPOLOGICAL VIEW OF FEMALE GENITAL MUTILATIONS 135

By far the most comprehensive Study of the complications
from different kinds of female genital Operations is that of D
Shandall of the Faculty of Medicine, Khartoum, Sudan (44 a
examined 4,024 females, of whom 3,280 Se circumci : .

ised in
various ways and 204 were not. He divided the circumcised
group into two further subdivisions: Group A, consisting of
3,013 Pharaonically circumcised women, or what he calls Type 3
circumcision, and Group BR 807 women who were Sunna cir-
cumcised, his Type 1 circumcision. All uncircumcised women
were grouped into Group C. Additionally 200 prostitutes, not
included in the study group, were examined to find the distribu-
tion of the various types of circumcision among them. Three
hundred husbands were interviewed as to their opinions on fe-
male genital operations, and information about the sexual behav-
ior of their wives was elicited.

Immediate complications described among Group A included
shock, haemorrhage, retention of urine, injury to adjacent struc-
tures, and failure of the vulval wounds to heal. These complica-
tions have also been reported for such SubSaharan, non-Islamic
tribal groups as the Kikuyu and Ameru, who normally practice
clitoral excision rather than infibulation and Pharaonic circum-
cision. When Shandall compared his Group A patient sample
with 807 who had been circumcised in the milder, Sunna fash-
lon he found that complications were nearly six times more
common from the more drastic operation.

About 1950, local analgesia was introduced to at least some
Sudanese midwives and Shandall feels that because of this the
Incidence of complications from these operations is now declin-
Ing. Retention of urine was found in more than 10 percent of
the Pharaonically circumcised group. By contrast, this condition
was found in only 1 percent of the girls who had been circum-
cised in the Sunna manner. Failure to heal due to infection was
about seven times higher for the Pharaonically circumcised Be
ents than for the Sunna sample. For the former group, keloid
Scar formation was estimated to be ten times commoner than in
the latter group. Vulval cysts and abscesses were found in 51 of
the Pharaonic group, but in only 2 of the Sunna group. pe
the Pharaonically circumcised, urinary infection was discovere

CLITORIS

136

in 28 percent, while among the Sunna sample, it was found in
only 8 percent. Shandall’s indications for Sunna circumcision
include phimosis, the formation of smegmaliths on the clitoris
(especially if probing fails to clear the smegma), labial hyper-
trophy and a redundancy of the prepuce. He states that un-
treated phimosis can prevent adult women from achieving or-
gasm during coitus.

Only two kinds of genital operations were, of necessity, omit-
ted from this pioneering study done in Khartoum, namely the
4

excision typical of SubSaharan, tribal East Africa, and, of
course, the posterior introcision found exclusively among the
Australian aborigines. (I know of no comparable study of the
complications of posterior introcision among the Australian
aborigines, but there is some scattered date on complications
said to result from excision, or clitoridectomy.) Shandall’s hu-
manitarianism is in the finest tradition of the healing arts, for he
proposes needed reforms, which can be carried out within the
structure of the culture which produced these problems.

Figure 32. Reinfibulation followin.
only 4 mm, but can be stretched en
removed clitoris and labia minora. (

g third delivery. Remaining introitus is
ough for conception. Original infibulation
Photo courtesy Dr. A. F. Shandall.)

AN ANTHROPOLOGICAL VIEW OF FEMALE GENITAL MUTILATIONS 137

Figure 33. Large inclusion cyst in infibulation scar, later removed surgically.
(Photo courtesy Dr. A. F. Shandall.)

Among the Kikuyu of Kenya the operation differs slightly
from district to district, consisting in some areas of excision of
the clitoris only, in others excision of this organ plus cuts on
the Upper parts of the labia majora. In most cases (34) the
wound healed quickly, but in each district there were always a
€w cases of subsequent septic poisoning. This meant that the
wound took a very long time to heal, and that when it did
“ventually, a large scar tissue was left. Such scars made child-
birth difficult, and sometimes fatal.

A more detailed study of complications among the Kikuyu
(25) cites the usual aftercare afforded the girls. The patient is
led, or carried away, attended by sponsors or female relatives,
Who act as nurses. The wounds are washed and dressed daily and
the Sponsor sees to it that the opposing surfaces do not unite,

: ; ; lication of
Sometimes the sponsors fail, the surfaces unite, and there are genital operation (27). Five Kikuyu sities soe n of female,

ni ed 10-11 ye
varying degrees of atresia, up to complete closure. Dense bands had undergone excision shortly before admission a a a
of fibrous tissue form, enough to seriously interfere with labor Hall Hospital in 1958, were found to have caer eras
in at least 10 percent of the cases Gillan saw. At least one

in or near one or more joints. In each case the incision for
Kikuyu girl was circumcised forcibly; the wound became septic

removal of the clitoris was a vertical scar about one inch in
and the girl suffered greatly. Gillan reported many common length. Although the scars had healed well and theaiisninel
complications from excision among the Kikuyu. There is often glands were not enlarged, all patients developed symptoms which
painful urination (dysuria), since the vagina forms a secondary included fevers, pain and swelling of the jointeeelie Sento
reservoir for urine which drains through what opening it can appeared 13-21 days after excision. Hall interpreted the illnesses
find. In one instance, a calculus was found to fill the vagina.

as an epidemic illness due to a micro-organism probably intro-
Haematocolpos, an accumulation of blood in the vagina, was

duced at the site of a surgical wound..
said to be a cause of sterility and painful menses. In one case, What of the mental damage from all this cutting, scarring and
the cervix was shut off completely from the vagina by a dense

pain-inflicting? Marie Bonaparte (8), one of Freud’s early pupils,
membrane. Painful coitus (dyspareunia) was the most frequent remarked that mutilations are frequently described and rarely
result from excision; Gillan noted that 50 such cases was the

explained. This seems very true. Further, I agree with her com-
annual average at a single field hospital in Kenya. He found it ment that those who have investigated such operations seem to
surprising how many years of married life might elapse before have neglected their effects on female psychosexuality. She de-
relief was finally sought. Difficult labor was the most serious scribed several women excised for a variety of reasons. Case 1, a
complication, with most of the mothers stenosed to some de- German woman, was said to have been totally frigid deny
gree, which interfered with normal elasticity.

coitus, but remained a compulsive masturbator. She not onl
In 1942, another investigator (3) offered an even more pes- P y

, he sh i, : ; had undergone excision of the clitoris, but also ablation of both
simistic view of complications among the Kikuyu resulting from

Fallopian tub i i i thi -
clitoridectomy. He found bleeding is often profuse at the time | : ubes: and. ovaries Surgery eledg a

eo CLITORIS AN ANTHROPOLOGICAL VIEW OF FEMALE GENITAL MUTILATIONS 139
inserting a bunch of leaves to prevent this from happening. Arthritis may be the most unusual com
|

man’s symptoms. Bonaparte examined the patient and felt that
of excision, occasional i h; inflammation was al- gees P bene ly
? ionally leading to death; infla the erotogenic zone was located precisely on the scar of the

glans clitoridis. Case 2, an African woman of 40 and the mother
of two, had been clitorally excised when she was only 6 years
old, as had all her sisters, recalling the operation as very painful.
(Unfortunately, Bonaparte did not give ethnographic details on
her non-European cases of excision.) This woman was also said
to have been a childhood masturbator, and had the ability to
achieve orgasm even after excision. Case 3, a Mrs. B., also Afri-
Gan, suffered hemorrhage, fever and infection from a careless
sometimes cut into the vagina, causing both dysuria and the Jae which had caused extensive damage to the pea
growth of a circular band of dense, fibrous tissue where the ad not been known to have previously masturbated.

; ; : eni lat ee i i ess.
labia minora were accidentally sheared away. In both cases labor ie mutilation was recalled vividly and with great bittern Es
was rendered more difficult. afk €r marriage the patient was reported able to achieve Orga

cit very slowly, about one time in every three acts of coitus.

ways present, with extensive scarring of the parts affected.
Afterwards, menstruation is difficult and coition sometimes im-
possible, all of which reaffirm earlier reports. Prevention of col-
tus due to the operation occurred frequently enough among the
Kikuyu that they have a special word for it, ‘‘nduri.” Arthur
also concurred with Gillan’s account of great difficulties in child-
birth, with mother and infant sometimes dying. Brassington,
another Kenyan observer (9) saw among his patients of the
Ameru tribe, that careless operators, intent on excision only,

140 CLITORIS

Her erotogenic zone was described as being still located over the
clitoridal scar. Disagreeing with Freud, Bonaparte concluded that
the mere ablation of the clitoris was insufficient to “internalize”
the sexuality of women, that is, to reorient their sexuality away
from the clitoris towards the vagina.

Shandall points out that psychological trauma, while extreme-
ly variable, is sometimes very severe, despite the cultural condi-
tioning which should ideally cause the girl to look forward to
her circumcision (tahour) as a day of pleasure and celebration.
After the new clothes and presents, the severe pain is a rude
surprise, although in the Sudan at least, the girl knows that
some pain is to be expected and that she will be confined in bed
in her house for two weeks or more following Pharaonic circum-
cision. Shandall found that 80 percent of the women Pharaonic- |
ally mutilated had never had orgasm, as compared with 12 |
percent in the Sunna circumcised group. 3

However, the psychosexual ethos of the Arab/Muslim culture
world may be in the process of change. Thus, he reports that
the older husbands may have enjoyed the presence of Pharaonic
circumcision, but that the younger generation of Sudanese hus-
bands prefer a wife who shares more things with them, including
presumably, the ability to reach orgasm. The more educated
young men have recently tended to marry European girls, Arab
girls from countries practicing neither Pharaonic circumcision
nor vaginal infibulation, or wives of pure Arabic origin, whose
religious beliefs have saved them from the more drastic forms of
genital mutilation.

CULTURAL CONTEXTS AND
CLITORAL MANIPULATIONS

Ownership of a clitoris is not unique to the erect, featherless
bipeds who read these pages. This organ is found among the
tailless great apes, the gorilla, the chimpanzee, the orang-utan
and the gibbon, as well as among the tailed monkeys of the Old
World and New World. What is unique to mankind is culture,
which consists of shared, symbolic patterns of behavior that are
learned and not instinctive. Culture includes the structured ways

AN ANTHROPOLOGICAL VIEW OF FEMALE GENITAL MUTILATIONS
41
of acting that are found in a grou
historical tradition.

Much of anthropological theory concerns the diff
similarities among the various cultures of So eeit aai and
nographer studies a particular culture, or s arr | er e eth-
attempts to describe and reconstruct the aggregation ome and
elements observed. He is not only concerned with ee screte
tion of separate culture traits, but how these ae ee
ganized and work in a functioning, whole system. Ultimat ae
each culture is unique in its contents, structure and eet
combination of ideas. At the same time, however a ce ete
share categories of cultural behavior, known as ctassculaal sine
ilariti SS cOheconmacE denominators of culture; they are | Ra eran
occur in every preliterate and historic culture known to eth:
nography and history. George P. Murdock (39) offers a partial

list of such items, arranged in alphabetical order to underscore
their variety:

Pp of people sharing a common

Age-grading, athletic sports, bodily adornment, calendar, cleanli-
ness training, community organization, cooking, cooperative labor,
cosmology, courtship, dancing, decorative art, divination, division
of labor, dream interpretation, education, eschatology, ethics,
ethnobotany, etiquette, faith healing, feasting, family, fire making,
folklore, foot taboos, funeral rites, games, gestures, gift giving,
government, greetings, hair styles, hospitality, housing, hygiene,
incest taboos, inheritance rules, joking, kin-groups, kinship nomen-
clature, language, law, luck superstition, magic, marriage, mealtimes,
medicine, modesty, mourning, law, music, mythology, numerals,
obstetrics, penal sanctions, personal names, population policy,
Postnatal care, pregnancy usages, property rights, propitiation of
Supernatural beings, puberty customs, religious ritual, residence
rules, sexual restrictions, soul concepts, status differentiation, sur-
ery, tool making, trade, visiting, weaning, and weather control.

Before looking at some probable crosscultural similarities i
‘male genital operations, it is necessary to discuss age-grades
“nd the difference between biological and sociological puberty.
peclintes recognize different behavioral expectations for in-

» young adults and old people. In this minimal sense, age-
p Srsitate universal, although the contents of culture vary\

142 CLITORIS

enormously; some societies recognize additional age-grades, with
specific modes of promoting the youngest members to the next
older age-grade, whatever that may be.

Adult social status is not always conferred at the onset of
physiological puberty for either boys or girls. Biological puberty
in girls is marked by development of the breasts and mons ven-
eris, the growth of pubic hair and menarche. The age of first
menstruation varies greatly among the different racial and ethnic
groups of the world. It is true that sometimes physiological
puberty is the culturally determined time for “puberty cus-
toms,” but this is rare. One of the pioneering students of the
crosscultural rites associated with age-grading has rejected the
concept of “puberty rites” as inaccurate for this reason (47).
Van Gennep preferred to call such collective ceremonies and
rituals rites de passage, a special type of rite of initiation. He
supported the idea that most rites of passage are sexual in na-
ture and cited convincing evidence that promotion of the child
to the next higher age-grade often signified a change from the
more asexual world of the child to the sexual privileges allowed
adult members of that society.

In tribal Africa south of the Sahara, excision of the clitoris

occurs within a specific psychosexual cultural context. The ele- -

ments of culture included in this complex consist of age-grading,
mass ceremonies marked by special dress for the young initiates,
ritual ornamentation for both sexes, music and dancing, varying
periods of seclusion separating the initiates from their former
age-mates, and special training in sexual matters before resuming
communal living within the tribe. In general, it is possible to say
that clitoral excision and male circumcision in this part of non-
Muslim Africa take place at the age of physiological puberty, or
shortly thereafter. As will be seen from Table VII, the age at
which genital operations take place is quite variable.

It is readily apparent that there is no necessary relationship
between the customary age at which various cultures dictate
genital operations and the onset of physiological puberty. To
put it another way, not all rites of passage occur at physiological
puberty. What Murdock deems “puberty customs” are crosscul-
tural, but they most often do not include genital operations of

ee eee SSeS ohhh CUS

AN ANTHROPOLOGICAL VIEW OF FEMALE GENITAL MUTILATIONS 149

TABLE VII

AGE OF GIRLS AT TIME OF GENITAL SURGERY (after Shandall)

Age Country, Area or People
8 days Abyssinia

Few weeks Ancient Arabia

3-6 years Somaliland (Types I and II)

7-10 years Somaliland (Type III)

5-10 years Sudan

6-10 years Egypt (before prohibition)

12-13 years Most other African countries

14-15 years Introcision in Australia

14-15 years Bantu tribes of Africa (Types II and Ill)
14-15 years

Ancient Egyptians (Types II and Ill)

15 years plus Masai (shortly after marriage)

Swahili and Guinea (infibulate after childbirth)

any kind, either male or female. As I have pointed out for tribal
East Africa, however, this culture area is characterized by elabor-
ate ceremonies marking the transition of the girl from childhood
to adult status in her tribe, and clitoral excision is an integral
Part of this cultural complex. A very small number of aboriginal
tribes in South America constitute the only New World exam-
Ples of female genital surgery within rites of passage; the re-
mainder of associations of female genital operations with rites of
Passage occur in the non-Muslim cultural areas of Africa, south
of the Sahara, with the exception of the association of genital
Surgery and Australian aboriginal rites of passage. Vaginal infibu-
lation tends to take place on one girl at a time, is usually per-
formed by an older woman of the tribe, and is not characterized
by the presence of elaborate social rituals, The chronological age
a Which female genital surgery takes place reveals little about
the intent of the operation, however.

144 CLITORIS AN ANTHROPOLOGICAL VIEW OF FE
MALE GENITAL MU
TILATIONS 145

Box sls aie surgery during puberty ceremonies :

al excision or circumbustion of this organs boys eae clitor-
puces removed during comparable ceremonies b i elr pre-
circumbustion. Both the Nandi and. the Bagishu, Fee a by
Africa, are said to prefer girls with sexual experiente ee Ae) East
that cohabitation with them is easier. Young men of tee ane
tribes are reported to have little difficulty finding yeni two
sible, uncircumcised sweethearts. Bryk observed that aes
tion for both sexes is rather common among the Bantu-s ae a-
tribes of East Africa, occurring much more rarely ae moe
social status is achieved. He also noted that female Spreaee nek
takes place among uncircumcised girls of the pastoral societies of

All known cultures include one crosscultural category of be-
havior and ideals not mentioned by Murdock. I call this the
psychosexual ethos, defined as the culturally inherited and so-
cially shared set of modesty beliefs, attitudes toward masturba-
tion in the young and old alike, adultery and premarital virginity
attitudes, sanctions imposed against violators of such behavior,
and the sexual training of the prepubescent and postpubescent
young. It also involves a sexual aesthetic as to what constitutes
male and female ideal beauty, which may or may not include
definite ideas about the appearance of the female pudenda, in-
cluding or excluding the clitoris. Few peoples of the world have
failed to react to an hypertrophied clitoris, although here too

the responses seem determined by the lens of culture. Ethno-
graphic observation among the Nandi of East Africa gives an

example (10):

The reason given me repeatedly, for the circumcision of girls
among the Nandi, was that the children of the uncircumcised
would die. But this is an inference drawn from the existing inhu-
man custom of strangling the children of uncircumcised girls. So
this is no explanation at all. In answer to my question on the
circumcision of girls a village chieftain said to me, “We are Nandi,
we don’t want anything like that in front of our women!”’ And he
made a disdainful gesture with his little finger, as if he meant to
signify the clitoris.

The Nandi, who practice not only excision of the clitoris by
knife or razor blade, but also male circumcision, are unique in
their use of circumbustion of the clitoris and the male prepuce
during rites of passage. It can be seen even from the brief ac-
count by Bryk that a number of rationales exist among the
Nandi for clitoral excision, only one of which is the alleged
aesthetic repugnance of this organ to male eyes. The deviant, oF
non-excised Nandi girl probably would not be able to find a
husband.

Bryk’s massive study of the Nandi psychosexual ethos touches
on nearly every aspect of the real and ideal components of their
erotic lives. Virginity for both boys and girls is not very highly
prized in Nandi culture, especially before their rites of passage:

a, vr ev 7

SubSaharan East Africa. Nevertheless, girls, boys, women and
men regard touching the vulva with the hand as tndean Bagishu
boys known to masturbate are punished by their parents with
the reproach, “How can you take your penis into the same hand
with which you eat?’ Two Bagishu girls were observed to be
masturbating with skinned bananas, and other phalloidal objects
apparently serve as autoerotic devices in the area.

Even in marriage, husbands in East Africa are said to never
touch the pudenda of their wives; Bryk offers the opinion that
husbands and lovers in these societies do not know how to make
full use of the erogenous zones of their women. Presumably, this
is a reference to the precoital fondling of the breasts, buttocks
and mons veneris, since the clitoris has either been excised or
ae away to a residual stump during rites of passage. Some

igital autoerotic play involving the vagina, and perhaps the clit-
orls as well, occurs among the Maragoli and a few of the other
ale tribes in the area. By his account, fellatio, anal sodomy
Roe occur rarely, if ever, among the Nandi and the
pastoral peoples of East Africa who practice excision of

the clitoris during rites of passage.
ae ses Nandi and other clitoris-excising pastoral tribes of
on rica, there is sufficient descriptive material on the
Ti ethos within which such operations take place.
Bea of course, far less material on Pharaonic Egypt, the
Bite confirmed civilization in which genital operations took
on either sex. One impression of Ancient Egyptian

146 CLITORIS

) interprets the paintings and

psychosexual values (Hussein, 1964
by the Egyptian Pharaohs as

hieroglyphics on the temples built
showing the great respect with which ancient Egyptians regarded

sexual relations and the sacred aura which surrounded passionate
love. Sex was considered the magic divine force by which man
perpetuated himself on earth. To them the sexual relationship
was so divine that even brother-sister marriages were permitted,
although incest taboos of almost all other peoples forbid this
behavior.

There are several problems involved in any discussion of the
psychosexual ethos of the Arab Middle East, including the Su-
dan. Compared to Europe, it is true that the Arab culture world
is relatively homogeneous, although within the area itself there
are dramatic cultural differences. Corresponding to these cultural
differences, there is great variation in sex life. Marked variations
in attitudes and customs of a sexual nature exist among the
urban, village and Bedouin populations. Such regions as the
Arabian Peninsula, the Levant, the Nile and the Tigris-Euphrates
valleys are the homes of diverse Arab subcultures.

The demand for premarital virginity of the Arab girl is ubiqui-
tous, however, and comparable demands for premarital male vir-
ginity are not made. The Koran does not explicitly forbid
prostitution but discourages forcing a girl into prostitution
against her will. Although the Koran forbids or at least does not
sanction, any form of female genital surgery except Sunna cir-
cumcision, Shandall and others have confirmed the existence in
a number of regions of the Arab-Muslim culture world of both
female infibulation and Pharaonic circumcision. Since both these
varieties of genital surgery existed before the advent of Muham-
med the Prophet, they were already an important element in
pre-Islamic cultures, and conversion to Islam did not succeed in
eradicating these ancient customs. Among the non-Muslim
Somalis infibulation appears to function to prevent premarital
coitus, but it is the psychosexual ethos of Muslim culture, not
Sunna circumcision, which serves to reduce female, premarital
sexuality via coitus.

A description of autoerotic practices among Arabs and Jews
(19) notes several terms in Arabic for male masturbation, but

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AN ANTHROPOLOGICAL VIEW OF FEMALE GENITAL MUTILATIONS

147
only he, Consiiein term for female masturbation, that bei
sahq, signifying violent rubbing or sexual tae a Y ate

- [he Arabic

terms arrakeh and fettateh are translated as “
“fricatrice.”” The male masturbator is commo
the female a sahiqueh, both interpreted as de
It is the latter term which Edwardes renders
to the English “jerking off.” His impression is that A b
regardless of whether they are circumcised or not eae
inclined to masturbate in groups than is true of Not rs pee
that in general boys in this culture engage in ante a ia
more frequently than girls. In an apparent allusion Sac
circumcision, Edwardes feels that one of the post-operati aed
fects is the tendency of the girl to be prone to nen seid
compulsive masturbation. Bonaparte has brought out that Fre id
was greatly influenced by the ethnographic studies of Felix of.
among the Nandi, regarding this anthropological study of ie
clitoris-excising tribe as further proof of his contention that clit-
oral erogenicity is “‘anfantile” and becomes transferred to the
vagina as the girl matures to womanhood.

Edwardes emphatically disagrees with Freud, adding that:

she who rubs” or
nly called a zaliq,
rivative from zalg.
as most equivalent

Simple resection of the clitoral prepuce or hood, laying bare that
ieee to direct stimulation, causes in the healing process a
ae aaa age comms itch analogous to that felt around the
aie: gua eee y ROUGE GG male. Compulsive rubbing is inevit-
sont ace ete clitoris, being already swollen with the
Sidectas ation, adds to the aggravation. The old myth that clit-
aus a automatically transfers sensual response from the clit-
on vagina Is now exploded, Delicate, highly charged nerve
al ra sages reacting to friction sufficient to excite or-
Ge an aes of decreasing the masturbatory urge and de-
ae har ee e esire for vaginal Intercourse; amputation of the
Bee occ ae little or no physical change but exaggerates the
ae xual impulses. Any hy mpHotomy os removal of the inner
Sic a enacted to some extent in Islamic Africa, further com-
Se e€ matter. Frequently. the female gains little or no satis-
ae rom vaginal penetration simply because she has been
St O accept it as a sine qua non of male gratification, and

Ose who respond to it do not lose their natural desire for
€xtracoital contact.

148 CLITORIS

Edwardes offers some fascinating insights into the ae or
texts of autoerotic behavior among Arabs and Jews in ag id-
dle East, and it is unfortunate be aS pe. ie supply more
if aphic confirmation for his findings.
ee ie siti differences in customs are ee marked
throughout the area, and there has been some de 2s an
students of the Middle East as to the extent and kinds Oo e, e
genital surgery. Granqvist did not find these operations zt t ;
Muslim villages of Palestine she studied (4). Barclay, a a pe
anthropologist, made a study of a Sudanese village, including
sexual customs in genital surgery. He found that circumcision
(tuhuur) is performed on both sexes. Male circumcision 1s not a
puberty rite by which the boy is promoted to the next age-
grade, as is true of the Nandi, but no boy in the Sudanese
village would be regarded as a man until his ee a
ital surgery for both sexes takes place before physiologica e 5;
erty. Both Pharaonic circumcision and infibulation are ae eh
in the village, although both are regarded as haraam (prohibi o)
by the ‘wlama, jurists of Islamic law. Both operations oe :
cially outlawed in the Sudan not long after World War i
Nevertheless, both illegal operations persist 1n many areas 01 | i
Sudan and were far more prevalent in the village of Buurr fs
Lamaab than Sunna circumcision. Barclay found that ae
lagers believe the two more drastic operations are as muc : a
of being Muslim as male circumcision. Westerners who e -
such beliefs should recall the vigor with which Latin mee
meatless Fridays and St. Christopher medals have been defen
“essential to Catholicism.” i
~ The illegal operations are sometimes performed by Te
midwives; if these are not available, an unofficial midwife wil a
sought. The girl is usually taken to the Nile, often at nig 2
where her face is first washed. Prior to the operation, the Gees
phere is described as festive, with the girl being at the center :
attention in this society for perhaps the first and iets
Girls receive new clothes and gifts and feel they are Bree inet
grow up. Infibulation and Pharaonic circumcision occur aml -
accompanying cries, clapping and singing of attending are
these activities being designed to smother the shrieks an

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AN ANTHROPOLOGICAL VIEW OF F EMALE GENITAL MUTILATIONS 149

of the victims. After the Operation a
house for forty days; she receives
after the birth of a child. A girl
cumcised or infibulated is teased
of being a baby.

When a couple marry, intercourse may be almost impossible,
if the infibulation has been so tight as to prevent intromission.
One informant advised Barclay that in the “
would insert a candle into the woman befo
order to ensure the proper-sized opening. One
local women are oversexed and that this undes}
curtailed by infibulation. Most men in the vil]
infibulation but Barclay noted that a growing
er men seemed to recognize the dangers of the practice; how-
ever, few men are said to be willing to forego circumcision of
girls entirely. Younger men usually express a preference for
Sunna circumcision. Of fifteen male informants, only one ven-
tured the opinion that such operations were wrong because they
decreased the sexual pleasure for women. There may be a more
widespread and intense belief in infibulation among women than
among men, since the chief perpetuators of these practices in
the villages appear to be old women bent on preserving tradi-
tional ways. Many village men believe that Pharaonic circum-
cision somehow protects a woman from being sexually attacked,
or from having illicit sexual relations, and that infibulation is
good. because by reducing the size of the opening, coitus is made
more enjoyable for the men. As Barclay comments, the fact that
women cannot experience sexual pleasure is not even considered.
Buurri al Lamaab men apparently feel sometimes that it 1s a
little indecent for a woman to enjoy sexual relations.

While infibulation and Pharaonic circumcision appear to be
declining in some parts of the Muslim culture world, ate
Egypt, these ancient customs have only recently been cepa
borrowed by the Moro, Tira and other hill tribes of the oa
fan (40). Among these recently Arabized hill tribes the psyc
SexUal ethos inclides age-grades for both sexes, cee
Puberty rituals involving male circumcision and the Samar
‘male circumcision of the Pharaonic variety. Great stress nas

girl remains confined to her
guests for the first fifteen, as
who is not Pharaonically cir-
y other girls, who accuse her

old days” a man
re first coitus, in
folk belief is that
rable condition is
age still believe in
number of young-

150 CLITORIS

always been placed on female, premarital virginity among the
hill tribes. Pharaonic circumcision among them appears to have
begun when men in the villages began to marry outside their
own villages, bringing back circumcised Arab girls from other
villages.

The literature on the psychosexual ethos of Australian abor-
iginal culture is abundant. As might be expected from the vast
territory occupied by these people, there are regional and tribal
variations in the culture. In Western Arnhem Land (7) some
tribes were observed to lack rites of passage, performing neither
penile subincision, male circumcision nor vaginal introcision. In
the East Kimberly area, among some but not all tribal groups,
such customs were found to still persist (31). Before considering
the cultural context within which introcision of girls exists, it is
worthwhile to take a look at some of the more or less common-
ly held psychosexual, culturally patterned behavior of the Abor-
igines, remembering that not all tribes are identical in cultural
content. Except as otherwise indicated, the following material is
based on the research of the Berndts in Arnhem Land.

At an early age, children of both sexes who sleep in their
parents’ camps observe coitus, which stimulates their desire to
imitate such erotic acts. When such activities are carried out in
play with other children of the same age, they usually cause
much merriment and little worry. As Aboriginal children grow
older, their sexual behavior resembles more closely that of adults
and there is less public display of sexuality. Small boys and girls
play naked together, and there is a tendency to choose compan-
ions of the opposite sex. The whole attitude towards sex is one
of natural growth, and children’s behavior elicits little adult cen-
sure or repression. A girl usually has her first coitus at about the
age of nine years, although the boy rarely has coitus with ejacu-
lation until he has passed through his first initiation ceremony.
While the boy may just be embarking on his preliminary pre-
marital intercourse, the girl of the same age may have already
had five to six years of sexual experience and be capable of
bearing her first child. By the time a boy and girl have mutually
experimented in the sexual act, both turn to older partners to
obtain more experience and enjoyment. The boy learns to savor

AN ANTHROPOLOGICAL VIEW OF FEMALE GENITAL MUTILATIONS 151

the experienced ease of the woman, the Jar
and vagina, the size of her labia majora and
clitoris. The young girl, whose vagina has
normal adult coitus, turns to experienced, ol
been indulging in sexual activities for years.
the size of an adult penis that completely fills
as the strength behind a physically mature ma
body pressure.

Jealousy is prominent in both pre- and extra-marital relations
so these affairs are usually carried out surreptitiously, and ren
ther husband nor wife loses face. In contrast to the inferior
social status and required pre-marital virginity of girls in the
traditional Muslim culture world, the Aboriginal girl’s status is
economically, sexually and in other ways nearly equal to that of
the Aboriginal boy. The principal interest of Aboriginal women
is marriage, but at the same time extra-marital relations are the
norm and are expected and enjoyed as additional spice to mar-
ried sexual life. Nevertheless, extreme promiscuity has wide-
spread disapproval and a woman indulging in it can be made the
butt of jokes. Men may avail themselves of her sexual favors,’
but at the same time despise her for her “laxity.”

The Berndts report that some women are satisfied only after
a number of male ejaculations and that one intromission is “too
quick” for them to reach orgasm. This may explain why some
Aboriginal women desire the attentions of more than one man
during a night, or have extra-marital coitus during the day or
evening, when their husbands are away. Homosexuality among
either sex is rare. Only one instance was cited in which a boy
was known to have masturbated and there were no indications
of female masturbation.

The Australian Aborigines have one of the few known cul-
tures which places mythological importance on the clitoris. (7).

he Djanggawul, used collectively, is a name given to three An-
“estral Beings, usually Two Sisters and a Brother, whose ultimate
°rigin is shrouded in antiquity, but who may be closely associ-
‘ted with the Sun. These sacred Ancestral Beings are said to
pave brought with them to Ammhem Land a variety of emblems,
ymbols of their cult, including the sacred poles known as rang-

geness of her breasts
the erectness of her
been prepared for
der men who have
She wants to feel
her vagina, as well
n’s ejaculation and

152 CLITORIS

ga. The rangga are so sacred that they are used only on ritual
ground and may be seen only by fully initiated men or neo-
phytes, although women know of their existence and can de-
scribe their appearance and significance. The rangga, yam stick
and other phalloidal objects are interpreted by the Aborigines
themselves as penis symbols. They are hidden and removed from
time to time, symbolizing coitus. Waterholes themselves are vul-
va symbols, used often in song and mythology. Trees are penis
symbols and their roots called by the term used for penis. A
great deal of this erotic symbolism is expressed in sacred ritual,
posturing and actions. The most important focus in the Djang-
gawul is the emphasis upon procreation.

In some drawings, the Two Sisters are depicted with people
or children “flowing out” from their vulvas. The Djanggawul
have abnormally long genitalia. The Brother has an elongated
penis, emphasizing his role in procreation. The Two Sisters have
enormously long clitorises, for which the Aborigines offer no
explanation, except that the rangga, or sacred poles, may have
derived from them. When the penis and the clitorises of the
Djanggawul were eventually shortened, it is said that the severed
parts became rangga, or feathered strings. Berndt feels that the
elongated clitorises can possibly be explained by the tendency to
accentuate a female organ, or that they symbolically represent
the umbilical cord. He regards the former explanation as more
probable and points out the considerable stress placed in daily
life on the erectness of the clitoris during coitus. The clitorises
of many Aboriginal women are fairly well developed; they are
played with and handled by women from before adolescence in
order to increase their size, attract the attentions of men and
heighten the sexual satisfactions of both partners. Drawings from
the Yirrkalla area illustrate these ideals. In one illustration, the
Two Sisters are shown with lengthened clitorises, and the Broth-
er with his long penis; they are all holding rangga.

Kaberry’s impressions (31) of the Womeri and Ngadi tribes’
rites of passage is that where introcision was deemed necessary
before marriage, such rites seem to be the counterpart of male
subincision. Among the Lunga, introcision is not practiced, and
they denied that it ever occurred among them. The Ngadi be-

AN ANTHROPOLOGICAL VIEW OF FEMALE GENITAL MUTILATIONS 158

lieve that introcision facilitates sexual intercour

birth, as do some of the Queensland tribes. ‘Ae
girls’ first initiation ceremonies,

se and delivery at

here are myths of

menstruation and j isi

: : introcision

rituals. In one version, a female totemic ancestor tried to sub
ubd-

incise young girls and “make them into men” but they devel
oped into young women anyway. Women did not ee
of the secret male subincision rites, from which they are nee,

barred. Instead, the women seemed to feel pity for the “ a
fellow” undergoing this painful rite. The women had aoa in
which female totemic ancestors were responsible for birth, onset
of puberty, menstruation and introcision. :

It is believed that this rite must be performed secretly, away
from men, or else it has injurious after-effects on the girl. Like
subincision for men, introcision is often seen as a preparation
for marriage and is carried out under the direction of old wo-
men. It has taboos and mythical sanctions and rituals which
sacralize the operations, so as to allegedly reduce the pain and
dangers accompanying this genital surgery on girls.

THE CLITORIS IN POLYNESIAN AND
MICRONESIAN CULTURES

Studies of Polynesian and Micronesian societies illuminate the
variety of ways that the clitoris may be perceived through the
lenses of different cultures. The pre-European attitude towards
human sexuality in Polynesia can be described as frank, appreci-
ative and realistic. Sexual pleasure was never considered sinful,
repulsive or evil. This culture lacked the intense, romantic con-
ception of love as a kind of mysterious force, a concept present
in Western civilization since the Middle Ages. Polynesians saw
Coltus as simple and natural, like eating and drinking. Masturba-
ton for both girls and boys occurred without adult censure and
adults sometimes urged their children to play with themselves
when peace and quiet were sought. Sexual matters were dis-
cussed in an open, unembarrassed manner (15). No attempts
ae made to suppress erotic behavior in the very SATS oe
ti Ten grew older they learned to play various games in imita-

©n of their parents and elders, including sexual play. Coitus

154 CLITORIS

sometimes took place outdoors and on the beaches, occasionally
in the presence of the younger children. Dances of an erotic
nature were common.

Rites of passage for the Polynesian boy approaching biological
puberty included superincision of the prepuce. In most islands
of Central Polynesia this was performed by an expert, older
male and the custom still persists. The older man not only
makes the cut, but has the additional task of instructing the boy
in practical aspects of sexuality (35). Marshall indicates that the
superincised penis is still tantamount to a passport to sexual
adventure in this society. No more deadly insult has yet been
devised by the Polynesians than to publicly call a man unsuper-
incised, or to imply that his penis bears resultant smegma. In
contrast to many cultures, the Polynesian called for male genital
surgery, but not for female genital alteration. In pre-Christian
Polynesia, girls received family and public attention during rites
of passage, with attention focussed on the deliberate enlarge-
ment of the clitoris. Marshall observes the retention of surviving
auxiliary habits connected with this custom, e.g., discussions of
the size, length and shape of the clitoris still persisting as a
common topic of conversation for all age and sex groups.

In the Polynesian lexicon, many synonyms exist for the fe-
male genitalia. In both Samoa and in New Zealand there are six
terms for the clitoris, and nine exist in the Tuamotos. Nine ofr
more terms for male genitalia were found among the Maori of
New Zealand; some twenty items in the Maori lexicon refer to
female genitalia. Marshall stresses that only in Polynesia is there
any apparent need to classify the shape of the clitoris as ve
three or more degrees of pointedness. Much of the focus in
Polynesian culture patterns was oriented around attempts to ¢™
large the clitoris, and to provide formal sexual instruction for
the young. This sexual training provided the young girls and
boys with a basis for their future extended erotic activities with
a large number of successive partners. The one sexual term ab-
sent from the lexicon of the Polynesians is an equivalent for out
word “virgin”!

Polynesian art employed rather naturalistic depictions of the

human body. The Maori of New Zealand graphically portrayed

AN ANTHROPOLOGICAL VIEW OF FEMALE GENITAL MUTILATIONS 155

human genitalia and coitus on meeting houses, h i
carved over doorways, on weapons, canoes ddl =o he
artifacts designed for tilling the soil. Theil Smee
play with genitalia, fellatio and cuntilingtih cee ee
nesia the remains of sacred shrines still show em haat Uo
enlarged clitoris and the grossly large or reesei yee
Sei y presented
Multiple orgasms are highly desired and sought by both s
Bringing about female orgasm, or a series of them, contin ae
be the goal of the Polynesian male lover. Marshall sate =
that the Polynesian woman, young or old, lovely or sae setae
looks forward to orgasm as her birthright, regardless of the
wealth, status, or social rank of her sex partner. If her spouse
cannot bring about these moments of joy, she seeks a pet who
will suit her needs, despite possible danger to her marriage. In
quarrels between Polynesian mates, the subsequent vise
of mutual orgasm releases tensions and restores harmony, reunit-
ing the bonds between the partners. The Polynesian ile hear-
ing for the first time of those European and American one
who have never achieved orgasm, may ask with concern whether
this will not result in damage to their health.
Micro

external female genitalia also. In Ponape, efforts are made to
enlarge the clitoris and the labia minora, a task assigned to im-
potent old men (16). The Trukese woman whose_vulva_is “full.
oe things” is believed to attain orgasm_more_rapidly than other

en. These highly desired “things” include_a prominent clit-

See minora and abundant pubic hair. Ethnographic study
a =a = Ss en a a Se rene stim to
ee on. Devereaux felt that the tattooing functioned to make_
ae n—even_more_sexually_alluring, because her genitals.
scmed unusually ‘full of things.” Trukese_women_made_these

things” not only visible, but also audible. The ated the

labj : :
abia_and inserted objects which tinkled_as they walked, with

thei :
aes slightly apart. The possession of a vagina “full of

. . ——_—_——— De Ls
= is so important to the women of Truk that _arguin

Omen : i i i
may accuse e er of having “nothing” in their gen-

156 CLITORIS

italia. Gladwin and Sarason cite one incident in which two
women exposed themselves in public, allowing spectators to
judge the quality of their genitalia. The woman judged to be less
well-equipped appeared greatly humiliated. They observed that
women who do not regard their genitalia as sufficiently full of
things will not allow their sex partners to either see or manipu-
late their organs, although coitus may be permitted.

Devereaux indicated the great role played by the clitoris in
the sex lives of Trukese women and men. Another anthropolo-
gist, Goodenough, has conjectured that female orgasm on Truk
seems predominantly clitoral. In sexual foreplay men are said to
first rub the penis against the clitoris before inserting it. Full
penetration is achieved only when the woman begins to have an
orgasm. Citing field work done earlier in the area by Finsch in
1880, Devereaux has shown how a Ponapese man stimulates a
woman’s labia between his teeth, in a tugging and pulling mo-
tion reminiscent of fellatio. Trukese women enjoy urinating dur-
ing sexual foreplay, associating this emission with orgasm. Dever-
eaux has pointed out that women on Truk also enjoy having a
man urinate in them, after both have had an orgasm. Trukese
men demand their women achieve orgasm first, with high value
assigned to those capable of clitoral orgasm. In Devereaux’s
opinion, Micronesian women wish to duplicate male ejaculation

by urinating at orgasm. Perhaps he overlooks the involuntary
orgasmic loss of urine, which is not rare in American women.

SUMMARY

Daly, a psychoanalytic writer (13) has theorized that all peo-
ples have passed through a phase in the evolution of their cul-
tures in which circumcision for both sexes once existed. He has
further -assumed in his unilinear theory of the evolution of hu-
man culture that at some early but unspecified period, matrl-
archy was widespread, if not universal. I know of no reliable
anthropological evidence to support either of these sweeping
assumptions. It is true that rites of passage or puberty customs
are cultural universals. Some form or surgery is also a compon
ent of every known prehistoric and contemporary culture. How

ee —— ———

SO _.

AN ANTHROPOLOGICAL VIEW OF FEMALE GENITAL MUTILATIONS 157

ever, few peoples seem to have hit on the
tions, even when these same peoples prac
Nor is there any evidence that the varieties
for either sex are less prevalent now than in
Egypt. The idea of genital operations scarce]
white cultures of the New World, Siberia, Eastern Asia or in
prehistoric or historic Europe north of the Mediterranean. As-
suming the validity of the slim evidence for vaginal infibulation
among the Conibo Indians of South America, then it would
seem that this operation was independently invented at some
time in the prehistoric past, both in the New World and perhaps
also in North Africa. The vaginal introcision present among some
of the preliterate Australians appears to have been invented only
once in human culture history.

Tribal, SubSaharan Africa was, and still is, characterized by a
wide variety of clitoris-reducing operations, the most common of
which is simple excision, customarily done as part of the rites of
passage. I find it hard to believe that all such clitoridectomy can
be traced to a single origin in Pharaonic Egypt. I feel that clitor-
al excision was invented many times, what anthropologists call
independent invention, and that some peoples in this part of
East Africa got the idea from others by the process of cultural
borrowing. I believe that some of the ideas of genital operation
pent in Pharaonic Egypt, specifically infibulation, Pharaonic
a ae and perhaps also, male circumcision, have persisted

€ Pharaonic past. These ideas probably spread south-
anes vee remaining in the region in certain pre-Islamic
aie cultures. When the religious ideas of Muhammed the
nes pete throughout North Africa and the Near East,
tae - customs of female genital surgery were not entirely
creme espite the fact that the Koran sanctions only Sunna
“aA It may be that these ancient surgical practices of
nies ae Pharaonic circumcision fitted in nicely with the
cee ua ethos of Muslim cultural values, which stressed en-
—— Bee el female virginity, lack of importance of female
Th a pee and the lower social status ascribed to women.
te. Beane the persistence of traditional culture 1s such that it
prising to find survivals of such seemingly ancient

idea of genital opera-
tice rites of Passage.
of genital operations
the era of Pharaonic
y existed in the pre-

158 CLITORIS

forms of genital surgery in this part of the world. North Africa
has long been a cross-roads for the blending of old and new
cultural elements into distinctive, new combinations.

It is probably no accident that the most drastic and painful
types of female genital surgery have been preserved in a region
with such culture traits as great social isolation between the
sexes, heavy emphasis on the dominant male role, a traditional
art forbidding realistic representation of the human form, strict
standards of modesty in dress and a downgrading of the sexual
pleasure women may be expected to enjoy in coitus. Hussein, a
Muslim scholar, speaking collectively of the practices of “‘cliter-
otomy” in the region, has even suggested that the high divorce
rates in the area may be due in part to the relative inability of
Arab women to achieve sexual satisfaction in marriage after gen-
ital surgery.

In 1953, Marie Bonaparte remarked that the peoples of the
world may be considered as either friends or enemies of the
clitoris. She regarded those people who excise or reduce the
organ as its enemies. Peoples who distend the clitoris and labia
for erotic purposes she felt were friends of the clitoris. Peoples
who practice vaginal infibulation and Pharaonic circumcision can
be readily identified as enemies. The Polynesians and Micro-
nesians certainly fall into the description of friends of the clit-
oris. However, the great majority of peoples of the world lack
the idea of female genital surgery or manual enlargement of the
female genitalia. To extend the analogy of Bonaparte, I regard
most of the peoples of the world as neutral observers of the
clitoris. Except for the Djanggawul myths of the Australian
Aborigines and a small number of legends from Central India
explaining the creation of the clitoris, this organ is poorly repr
sented in world mythology and folklore. Except as already indi-

cated in Polynesia and Micronesia and among the prehistoric
Mochica people of Peru, the clitoris rarely appears as a motif 10
the preliterate art of the world. In some languages, only ong or
two terms exist for this organ. In Western civilization, few jokes
have ever been recorded about the clitoris except for the 8°
called ‘“‘man in the boat”’ stories. :

A kind of occupational folklore developed within the medical

AN ANTHROPOLOGICAL VIEW OF FEMALE GENITAL MUTILATIONS 159

profession in the West in the nineteenth century, and a small
number of surgeons saw the clitoris as the locus of nympho-
mania. Excision was used as a cure for “excessive masturbation,”
epilepsy and mental retardation. The practice of declitorization
in Europe coincided with the discovery of preliterate genital
operations in Africa by European explorers. I find no causal
connection between these two events.

Adhesions of the clitoris are not uncommon, and at least
some patients may benefit from circumcision. In the United
States, clitoral research has advanced greatly with the pioneering
motion picture work and laboratory studies of Masters and
Johnson. If their subjects had clitoral adhesions or surgically
reduced female genitalia, none were reported.

As Western culture spreads and as medical knowledge of the
clitoris grows, it seems predictable that Pharaonic circumcision
and vaginal infibulation, already beginning to decline, will some-
day disappear. This is already happening in the Sudan, where the
scientific and humanitarian work of Shandall and others have
introduced anaesthetics to midwives; Sunna circumcision is being
encouraged as a substitution for the traditional, drastic forms of
surgery. We have shown how the lens of culture affects the
perception of the clitoris, and how the psychosexual ethos inter-
relates with the type of female genital surgery practices. New
anthropological field studies of the clitoris and genital surgery
may give us further understanding.

REFERENCES

- Anon: Untrodden Fields of Anthropology, Paris, 1898. Privately printed, 2 vols.

- Anon: Praeputii Incisio. Panurge Press, N.Y. Privately printed, 1 volume, n.d.

- Arthur John W: Female Circumcision Among the Kikuyu. Brit MJ Oct 24, 1942.

- Barclay Harold: Buurri al Lamaab: A Suburban Village in the Sudan, Cornell

. ,. University Press, Ithaca, N.Y., 1964. 296 pp-
5. Bardis Panos B: Circumcision in Ancient Egypt, Indian J Hist Med, XI: No 1,
June 1967.

- Berndt Ronald: Djanggawul: An Aboriginal Religious Cult of Northeastern Arn-
hem Land. F.W. Cheshire, Melbourne, Australia, 1952, 320 pp-

‘ Berndt RM and Berndt Catherine: Sexual Behavior in Western Arnhem Land,
Viking Fund Publications in Anthropology, No 16, 1951, N.Y.

- Bonaparte Marie: Notes on Excision, Female Sexuality, pp 191-208, International
University Press, 19538, 225 pp.

wm CF DD

160 CLITORIS

9. Brassington HW: Notes on Female Excision as Practiced by the Ameru. Brit Med

Chirug J, Vol 49, 1932, pp 237-240.
10. Bryk Felix: Voo-Doo Eros. English Translation, 1964. United Book Guild, 251
Wik cae Henry: Slang of Venery. Chicago, 1916, privately printed, 1 volume.
12. Clark, LeMon: Adhesions between clitoris and prepuce. In Beigel, Hugo (Ed):
Advances in Sex Research, Harper and Row, N.Y., 1963, 261 pp.
13. Daly, CD: The Psycho-Biological Origins of Circumcision. Internat J Psychoanal,
XXXI: Part 4, 1950, pp 217-236.
14. Daniell WF: On the Circumcision of Females in Western Africa. Med Gazette,
London, England, 1847, pp 374-378.
15. Danielson Bengt: Sex Life in Polynesia, in Ellis, Albert (Ed) Encyclopedia of Sexual
Behavior, Hawthorn, N.Y., 1961.
16. Devereaux George: The Significance of the External Female Genitalia and of Female
Orgasm for the Male, J Amer Pschoanalytic Ass. 6: 278-286, 1958.
17. Dickinson Robert: Human Sex Anatomy. Williams and Wilkins Co., Baltimore,
1933, 145 pp.
‘is. Duffy, John: Masturbation and Clitoridectomy: A 19th Century View. JAMA
246-248, Oct. 19, 1963.
19. Edwards Allen: Self-Stimulation among Arabs and Jews, in Masters, R.E.L. (Ed)
% Sexual Self-Stimulation, Sherbourne Press, 1967, 352 pp.
20. Eskridge Belle C: Why Not Circumcise the Girl as well as the Boy? Texas State J
Med, 14: 17-19, May, 1918.
21. Eyer Alvin: Clitoridectomy for the Cure of Certain Cases of Masturbation in Young
Girls. Internat Med Mag. 3: 259-262, 1894.
292. Ford Clellan S: Field Guide to the Study of Human Reproduction. Human Relations
: Area File Press, New Haven, 1964, 60 pp.
‘923. Freeman Rowland: Circumcision in the Masturbation of Female Infants. Tr Amer
Pediatric Soc XX VI: 57-60, 1914.
‘94, Ghalioungi Paul: Magic and Medical Science in Ancient Egypt Barnes and Noble,
Inc., N.Y., 1963, 189 pp. :
25. Gillan Robert U: Notes on the Kikuyu Custom of Female Circumcision. Kenya and
East African Med J 6: 199-203, 1929. ;
26. Gladwin T and Sarason SB: Truk: Man in Paradise. Viking Fund Publications 1n
Anthropology, No. 20, N.Y., Wenner-Gren Foundation, 1953.
\97, Hall L: Arthritis after Female Circumcision. East African Med J, 40: No. 2, 55-57,
February, 1963.
28. Himel Augustin J.: Some Minor Studies in Psychology with Special Reference to
s Masturbation. New Orleans Med Surg, LX: No. 6, 439-452, December, 1907.
“99. Iams Frank: Female Circumcision. Medical Records and Annals, Feb 12, 1936, PP
171-173.
\. 30. Jisr JG: Circumcision in the Female. American Medicine, Vol 26, May 1920, PP
106-107.
31. Kaberry Phyllise: Aboriginal Woman: Sacred and Profane. Blakiston Company:
Philadelphia, 1939, 294 pp. :
32. Kanner Leo: A Philological Note on Sex Organ Nomenclature. Psychoanaly tte
Quarterly, Vol 14, 1945, pp 228-232.
33. Klausner Samuel Z: Islam, Sex life in, pp 545-557 in Ellis and Arbanel (
Encyclopedia of Sexual Behavior, Volume 1, 1964.

Eds)

AN ANTHROPOLOGICAL VIEW OF FEMALE GENITAL MUTILATIONS
161

34, Leakey LSB: Kikuyu Problems of the Initiation of Girls.
977-285, 1935.
35. Marshall Donald: The Sexual Bases of Polynesian Culture Pa
60th annual meeting of the American Anthr i ; ned Uipececu me
See opological Association, 1961. 22 pp,
\. 36. Montagu MFA: Infibulation and Defibulati i
: Anthropol. n.s., 47: 464-467, 1945. piles SINC, to
37) Neca ne Ae Mutilation Among Primitive Peoples, Ciba Symposia, Oct.
\ 38. Morriss Robert A: Is Evolution Trying to do away with the Clitoris? Americ
Association of Obstetricians, Gynecologists, and Surgeons, Trani Vol i
1892, pp 288-302. ;
39. Murdock George P: The Common Denominators of Culture, pp 123-145 in Linton
Ralph (Ed) The Science of Man in the World Crisis, Columbia University Press, N.Y
1945. rs
40. Nadel SF: The Nuba: An Anthropological Study of the Hill Tribes of the Kordofan.
Oxford University Press, 1947, 527 pp.
\41. Ploss HH, Bartels M, Bartels P: Woman, W Heinemann, London, 1935.
42. Reich A and Stagellmann F: Bein den Indianern der Urubamba und des Envira.
Globus, Bd 83, 1903.
43. Roles RC: Tribal Surgery in East Africa During the Nineteenth Century. East
African Med J 44: No 1, Part 2, January, 1967.
‘44, Shandall Ahmed Abu El Futuh: Circumcision and Infibulation of Females. Sudan
‘ Med J. 5: No 4, 178-212, 1967.
‘45. Tait Lawson: Masturbation. Med News, LIII: No 1, 1-3, July 7, 1888.
“46. Tanner Thomas H: On Excision of the Clitoris as a Cure for Hysteria, etc. Tr Obstet
Soc London, VIII: 360-384, 1866.
47. Van Gennep Arnold: The Rites of Passage. English translation, University of Chicago
. Press, 1960, 198 pp.
48. Widstrand Carl G: Female Infibulation. Studia Ethnographica Upsaliensia. XX: pp
95-124, Varia I, 1964, and Personal communication.

J Roy Anthropol Inst, 61:

Chapter XI

SOME NOTES ON THE ETYMOLOGY
OF THE WORD “CLITORIS”

Thomas P. Lowry

Psycholinguistics is the science of language applied to human
behavior. One aspect of this science is what words people choose
for objects and the emotional tone attached to that usage, such
as shame, contempt, pride or anxiety.

Linguistic analysis is an enormously complex subject into
which the novice ventures at his own risk. The perils of two of
my psychiatric colleagues may illustrate this. In 1943, Abram
Blau (1) stated that “... except for scientific terminology, there
seems. to be no vernacular, slang or obscene word in the English
or American language to designate this organ.” Blau claimed that
in eleven other languages there was a similar deficiency, and
concluded that the absence of vernacular terms indicated
“extreme cultural suppression of female sexuality.”’ He based
this on the theory of castration anxiety, i.e., having only a clit-
oris unconsciously means the penis was amputated, so let’s not
talk about the clitoris or give it a name.

In 1945, Leo Kanner (2), in the same journal, produced a list
of forty synonyms for the clitoris, but hastened to add that
these items were contributed “...not for the sake of argument
but mainly with the purpose of supplementing the data...
Dr. Blau’s article.” Kanner, truly a courtly colleague, concludes
that, “Dr. Blau is right in his main thesis.”

Table VIII indicates the immodesty of another essay into this
field, since the possibilities are so vast. Nevertheless, two things
seem worth attempting: first, following the derivation of the
word “clitoris” itself and, secondly, describing the psycholinguls-
tics of the terms in other languages. '

The traditional derivation is that, in classical Greek kleitorts
was derived from kleien (to shut or to sheathe), or from kleis (a
key) or that it means literally “hillock,” from a word kleitor,
which survives in the name of the Arcadian town of Kleitor-

162

SOME NOTES ON THE ETYMOLOGY OF THE WORD “CLITORIS
” 168

TABLE VIII
SOME LANGUAGE FAMILIES OUTSIDE THE WESTERN HEMISPHERE

[. Indo-European Family

. Germanic (English, Flemish, Dutch, Icelan
Geltic (Welsh, Gaelic) 7
Italic (Latin, Spanish, Italian, Portugese, Romanian)
. Albanian
Greek (Classic, Middle, Modern)
Baltic (Lithuanian, Latvian)
. Slavic (Russian, Polish, Czech, Slovene i
. Iranian (Persian, Kurdish) pBylearian)
Indic (Sanskrit*, Pali, Hindi, Urdu, Bengali)

dic, Danish, Yiddish)

POM OD >

Il. Semitic Family

. Akkadian (Babylonian*, Assyrian*)
Canaanite (Phoenician*, Ugaritic*, Hebrew)
Aramaic (Biblical Aramaic*, Syriac)
. Arabic (At least six types of arabic)
Ethiopic (Amharic, Tigré)
Hamito-Semitic (Ancient Egyptian*, Coptic)
. Hamitic (Berber, Tuareg, Algerian)
. Cushitic (Somali, Galla)

Om O >

Il. Turkic Family
A. East Turkic (Altai, Kizil)
B. West Turkic (Kirghiz, Bashkir)
C. Tatar (Kashgar, Uzbek)
D. South Turkic (Standard Turkish)

IV. Sino-Tibetan Family
A. Tibeto-Burman (Tibetan, Kachin, Burman, Naga)
B. Karen (Karen, Kayah)
C. Sinitic (At least six types of Chinese)
D. Meo-Yao (Meo, Yao)

V. Thai Family
A. Thai (Black Thai, Lao, Siamese)

VI. Austro-Asiatic Family
A. Viet (Vietnamese, Muong)
B. Mon-Khmer (At least 57 languages)

VII. Japanese Family
A. Japanese (No known congener)

VOI. Korean Family
A. Korean (No known congener)

IX. Mongolic Family
A. Eastern (Mongolian, Urga, South Mongolian)
B. Western (Oirat, Kobdo Oirat)

X. Finno-Ugric Family i
A. Finno-Permian (Finnish, Estonian, Permian, Lappish)
B. Ugric (Hungarian, Vogul)

XI. Malayo-Polynesian Family
A. Indonesian (Malay, Javanese, Balinese, Tagalog)
B. Polynesian (Hawaiian, Samoan, Tahitian, Tuamotu)

164 CLITORIS

XII. Dravidian Family
A. Tamil-Kurukh (Malayalam, Tamil)
B. Kanarese (Kulu, Kota, Toda)
Cc. Telugu
D. Central Dravidian (Gondhi, Bhil)
E. Brahui

NOTE: The capital letter headings indicate subfamilies. In parentheses are some of the
principal languages within each subfamily. Asterisks mark dead languages.

However, Marcel Cohen (3), a great French philologist, says it’s
not so. The Dictionnaire étymologique de le langue grecque does
not contain the word leitoris; in effect, it is not a word of
classical Greek. The word first appears as an anatomical term in
the works of Rufus of Ephesus (ca. 100 A.D.). In the next
century, Pollux Archaeologus used it in a similar way, giving the
spelling kl@toris. The word appears again in Hesychius, in the
sixth century and 500 years later in the works of Suidas. Its
transmission to north Europe is unclear, but it first appeared
there in Cotgrave’s French-English dictionary of 1611. None of
this supports the traditional Greek origin.

Cohen, on admittedly fragile evidence, suggests that a search
in India might be fruitful, since one of the lost books of Aris-
totle, in a passage dealing with the Indus River, describes a dark
precious stone called klitoris, which’ the natives wear as an Car-
ring. Another possible pathway is from the ancient Egyptian
k>t, meaning vulva. In “new Egyptian” there is the term krnt,
best translated as “penis pocket.’’ On the coast of Somalia,
kintir means “clitoris,’”’ while in Tigré, another coastal Ethiopic
language, “clitoris” is guantirat. Farther south, in Gourague, the
word is genter. In Harari, another Ethiopic dialect, we find
qintir.

The basic consonant framework is clearly qntr or kntr. By
exchanging the liquid sounds e/ and n one finds the consonants
of the Greek (klir); the equivalence of the nasal liquid n and the
liquid e/ is frequent in Semitic languages; examples abound in
Akkadian and Phoenician. Cohen concludes that kleitoris origin-
ated outside of Greek and bears a strong resemblance to syn
nyms in living Ethiopic languages.

Since the word “clitoris” has become established in English (a
basic international language for scientists) it has been absorbe

SOME NOTES ON THE ETYMOLOGY OF THE WORD “CLITORIS” 165
into. the technical and everyday vocabularies of many nations
either with the English spelling or in some transliteration: clit.
oride, klitoris, klitor, ku-ri-to-ri-su. Thus wherever “clitoris”
originally came from, it has probably returned.

American and British English seem to contain a few common
terms and many obscure ones. The most usual is “man in the
boat” (var. “boy in the boat’’), referring, of course, to the glans
surrounded by prepuce and labia. This term was in use before
World War I and probably centuries earlier, and appears on at
least one jazz record, The Boy in the Boat (Paramount 14010-B)
recorded by George Hannah and Meade Lux Lewis in 1930. The
opening stanza is:

Now did you ever hear the story “bout the boy in the boat?
Don’t wear no shoes or no overcoat.

Broad told me it happened like this: he loved to dive and
also to fish.

He went roaming in that shallow boat, with head hardly
rising

And his eyes popped to go.

Face is all wrinkled and his breath smell like smoke.
Talking about that boy in the boat.

Another synonym is “button.” In 1936, Lil Johnson recorded
Press my Button, Ring my Bell (Vocalion 03199) and in 19295

Bessie Smith sang I’m wild about that Thing (Columbia
14427-D):

What’t the Matter, papa, please don’t stall.
Don’t you know I love it, and want it all?
I’m wild about that thing; Just give my bell a ring.
You pressed my button; I’m wild about that thing.

ae Boy in the Boat seems to be identical to The St. Louis
tchler (4); both were frequent request numbers for the jazz

bands that played in the now-gone sporting houses (5).

AL. Mencken, in The American Language, states: “A chick’s

Cc . : 3 .
litoris Is the little man in the boat or among butch lesbians

166 CLITORIS

who are spectacularly endowed, a spare tongue.” The same term
is also seen in “‘spur tongue”’; both are usually regarded as Les-
bian or working-class negro terms.

D.W. Maurer, the noted authority on underworld argot and
confidence games, provides a plethora of synonyms from his
studies: “Miss Horner” is from the character Horner in Wycher-
ly’s The Country Wife, and has the meaning of the agent which
causes cuckoldry. “Spot”? was much used by married women of
a generation or two ago, and survives in “to hit the spot” now
that the sexual meaning is forgotten. “Stud’’ (in the sense of a
protuberance) is used in a boastful sense by Lesbians, who are
proud of the size of their clitoris; the term may also refer to the
woman herself or, of course, to a wellhung man. “Cock”’ is used
among Lesbians to indicate a butch clitoris; south of the Mason-
Dixon line “cock” is widely used by heterosexuals to indicate
the vulva and/or clitoris. ‘Prick’ is used in the same way by
butch Lesbians. “Jolly” is largely a British usage; with orgasm, a
woman “gets her jollies.” “Heater” is common among narcotic
addicts, who find conventional intercourse difficult, from the
physical effects of opiates, and satisfy their women with tongue
or finger. If the woman is the addict, the opiates tend to de-
crease her natural lubrication and patient attention to the clit-
oris is essential. “Crest” is possibly from British-Australian
rhyming slang—crested hen, Lesbian. “Comb” is from the roost-
er’s comb, referring to the erect clitoris. “Nuts” is much used by
pimps and prostitutes, derived from the woman “setting her
nuts off.” “Horn” is most likely related to the image of “riding
the horn (pommel)” while “in the saddle.” A “‘muzzler” is a girl
who unobtrusively rubs her clitoris against an attractive man in
crowded places like subways, and achieves orgasm. A “Gasper”
can be either the clitoris or a bull Lesbian. A “horsecock” is 4
large clitoris. The term is borrowed from the drag queens and is
always used about someone else, in either a derogatory or adula-
tory sense.

Cary (6) lists many other English synonyms, all of which ane
highly metaphorical, literary and/or seldom used: “‘cherry |
(usually means hymen), “cock’s crest,” “fleshy excrescence,
“fleshy knob,” “fud tongue,” “goad of Venus,” “joyspots

= = 7 rg ng ng i or? or?

SOME NOTES ON THE ETYMOLOGY OF THE WORD

“CLITORIS” 167

‘

99 66 ” ‘ s e ,
“nose,” “nymph,” “peeping sentinel,” “piece of flesh,” “
bd

: ahs wt
pleasure,” “sensitive spot,” “ or

tongue,” “treasure,” He %
Thus we see at least thirty-three known words for ie caer
the English language division of the Germanic subfamily of t of
Indo-European language family. :

What distinguishes a language family is that all the members
are derived from a parent language and the results of this heri-
tage can be traced in many similar words for common objects.
Thus for “mother” we have matr (Sanskrit), médir (Icelandic)
mae (Portuguese), moder (Swedish), mor (Danish), mutter (Ger-
man), mére (French), moeder (Dutch), mama (Rumanian) and
madre (Spanish and Italian). It will be interesting to see if such
striking similarities occur as we trace the words for “clitoris,” a
word used far less often than “mother,” through the various
language groupings.

THE INDO-EUROPEAN FAMILY

The Germanic sub-family includes English, which we have par-
tially discussed. The English word “tickle” derives from citelian
(Anglo-Saxon) into kittle (Scottish) and then to “tickle.” In
both medical and household German, Kitzler means “clitoris,”
literally “tickler.”” In Danish, the usual word is clitoris (var. klit-
aes ); kildrer (‘tickler”’), which is first known in an 18th century
midwifery textbook, is little used. A Danish physician (7) sug-
gests that the Danes are interested in “normal” sexual inter-
course and have little interest in other sexual avenues. The Nor-
wegians use kildrer; the Swedish say kittlaren, while the Dutch
use kittlelaar.

A Belgian physician (8) contributes some notes on Flemish
Philology: the technical word is kittlelaar, while popular usage
has wrat (wart), boon (bean), erwt (pea) and het ding (the
thing). The vulva is popularly prut, a derogatory term, seen In
Such terms as prutswerk (work which is poorly or shoddily
done); a less common vernacular term is viool (violin)—that
which is played with a fiddlestick. The haired pubis is sometimes
LES (mouse) and in French is chat (cat, pussy). The region of
ns perineum and anus, both male and female, is gat (hole) Oe

168 CLITORIS

kont, which probably resembles the vulgar French con (vulva),
and is probably related to the vulgar English cunt, which forms
the play on words in King Henry the Fifth, Ill, iv, 47, in which
Katherine, daughter of Charles VI mistakes count for con. All of
these may relate to cunnus (medical term for the pubic triangle),
from the Latin cuneus (wedge). Psycholinguistically, the Flemish
terms have a negative tone and seem to imply derogation of the
female genitals. As a final Lowland note, in Walloon, the lan-
guage of southern Belgium, the word for ‘clitoris’ is linwette.

Papyamentu, the language of Curacao, is a remarkable creoli-
zation of Dutch and Spanish. There are at least forty terms for
aspects of the female genitalia and the general tenor is one of
affection and goodwill. In addition to clitoris, used medically,
there are rintintin (little toy), lérchi (also meaning labia), tapa-
tapa di lérchi (lérchi’s cover), klep di lércht (tip of the léercht),
reberensya di tonto (Span., lit. reverence of the vulva), e kos de
léle (the thing to play with), tapa di donchin (cover of the
donchin), klit and djipopo (Jack-in-the-Box) (9). Of interest are
three contrasting words for “vulva”: konchi (Dutch, kont, plus
je, dimin.), fairly widely used; skochi (Dutch, little lap) which is
used by refined, old-style upper-class speakers; and konyo
(? Span.) which is widely used as an insulting term.

The Celtic sub-family includes Irish Gaelic, where “clitoris” is
brille (gossip, bungler or fooler). In Scots Gaelic, the term is
brillean (var. brillen) which is related to brilleineach, meaning
“lewd”; altogether a gloomy view of these matters.

The Italic sub-family is an echo of the Roman Empire. Cary
(6) is a rich source of Latin synonyms: caruncula (a little piece
of flesh), crista (cock’s crest), epiderus, murton (myrtle berry),
Venus and nympha. Kanner (2) gives columella (little pillar),
virga (twig), oestrum venerts (love’s frenzy), contemptum vivor-
um (living belittler), mania, dulcedo amortis (love’s sweetness),
sedes delectationis (seat of delight) and tentigo (from tendo,
from its powers of erection). Hyrtl (10) adds penis, mentula
(penis), cauda (tail) and coles (penis), most of which are fol-
lowed by muliebris (of a woman). Most of these terms, pleasant
as they are, probably saw little popular use.

Italian dictionaries give clitoride; allegria (gladness) is 4

SOME NOTES ON THE ETYMOLOGY OF THE WORD “CLITORIS” 169
scribed in the Camorra dialect; other terms of rarer usage are
ribrenzuolo (seat of shivers) and brimborion. The French have
not neglected these matters: Cary (6) gives aileron petit (little
wing), animal, bijou (jewel), bouton (button), corde sensible
languette (little tongue), nez (nose), nymphe, point, and, one
again, le petit bonhomme dans le bateau. Vernacular Spanish
uses similar analogies, with pepita (little seed) and lenguita (little
tongue). Other terms in frequent use, according to Maurer, are
cuerpo (body), pequeno cuerpo (little body), and cuerpo redondo
(round body). Pica is probably confined to Cuban police usage,
and is related to pica electrica, an electrode applied to the clit-
oris of a woman being interrogated; this technique was much
used under Batista, but may still continue. Spanish, Portuguese
and Romanian dictionaries all list transliterations of ‘‘clitoris.”

The most widely used Slavic language is Russian, where “clit-
oris” is the medical term, transliterated into the Cyrillic alpha-
bet. The other dictionary term is pokhotnik (lust). Official Sovi-
et policy is quite prudish, which may account for the scarcity of
published terms. In Polish, Lechtaczka is used, variously trans-
lated as tickler, delighter or titillater; Zaskotka is also used, with
its meaning obscure. The usual Czech term is postévacek (insti-
gator, inciter, stirrer-up).

In the South Slavic languages, Serbo-Croatian, in addition to
kiitorts has draxica (teaser, stimulator) and sekilj or sjektlj (tick-
ler). Bulgarian doctors use the Cyrillic transliteration, while the
vernacular term is ezi’che, meaning “a small tongue,” or in en-
gineering, “the cam to operate the bolt in a lock.” A translation
copy of kitzler is sometimes used, namely gudelnik (11).

_ Persian, closely related to Sanskrit, is derived from Old Per-
‘lan, spoken in the Iranian highlands millenia ago, and recently
infiltrated with Arabic elements. In Iran today, there are two
words for “clitoris” in common use: chocholeh, whose origin is
ecu is used in Tehran; the northern part of Iran ae oe
ee the clitoris resembles the shape of a Persian letter of the
name (12). ;
eee mother of the Indic languages is Sanskrit, Ula dere
i a more ancient Indic-Vedic dialect about 9000 B.C. om
was the language of the educated of India by 400 B.C. an

1
i CLITORIS
: men ? SOME NOTES ON THE ETYMO
Reena: today in specialized literary uses. Derived from it are LOGY OF THE WORD “CLITORIS” 17]
east sixteen modern Sanskritic languages spoken in Indi Ee LANGUAGE. TRANSLITERATION SCRIPT LANG
tan and Ceylon; related i i é 1a, Pakis- aS ist UAGE TRANSLITER
ylon; related to it are most of the modern Euro ¢ chinese ‘rit icing peace re : J ATION SCRIPT
anguages. There are at least six Sanskrit and Hindi ter we tins ng +t anskrit swarchattram @Qaqaqn
= SS " iia Lak=ie
clitoris (13). Yonilingam comes from yoni (vul ms for Gs " errr
vagina, rest, lair) and lingam (penis). B/ te eee matrix, 3 Buisshoiy Pz So Akkad EBS SAA
5) 2 ‘ hagcankura : adian bi
(vulva, part, share, portion) and sarah (swell fom ee r M" in ti Page itil late ay
hs : ) rout, i lipi
LABZ EOS ct is literally “vulva treasure.” Shishna cad sh ne 5 Mie Se = ipissatuiE Testes
‘ nas) é e "
ae penis,” hence bhagshishna and bhagshef. ae oe i chwu shian me sis vomit
co 4 1a "
aes smara Sie love) and chattram (umbrella). The ee ( i jitee A Be, gurusgerasteS SU EAT
. Raghuvira, a disti i : 2 : ate er AWD Oo hi ;
— ay EOSSNES lexicographer, considered bhagan- . 4 KR handut tu $4 oF Bee SY of,
ancient term for “clitoris” and suggested bhagshef | ccegaant laqlaqqu BUTT RTE TT
cane modern equivalent. All these terms show a rather str s a i" chyn shyan Ae inte, ; vt Tes at a
i 5 al = maqlal JET}
orward view of sex and seem devoid of i 18 : Japanese ikite-ir Neg MP 3
In contrast with these ancient origi pea eager, : u mane TE sumerian gette Te =]
cient origins, which includ Ror K +
nomena as the erotic sculpture of Rajurahe st den ee PAS ean onyal “ : Hebr ew handan TTOY
adopted a Puritanical vi 2 ES Sa Z on haeck e534 :
: iew of sex, perhaps r | 1 ui dagd®gan 727% 7
ee eek Gseaieations » P ps related to several | Mongolian oqusut PAR inl, : al 2 a a
Urdu, the official t : Tib Q > SHANE URL
ongue 2 : 2 etan cha-1 Qyy ‘i pS
Ae Ro andes ee of Pakistan, is a mixture of Persian, f a] es batar T1972
ty coat ve eens Sich hasano vocab a byacl¢ Nes) a 1 clitoris mylene
: e current repression of sexual k 5 “iG
nowled = Thai aa e 3
duced a poverty of sexual anatomy terms and ae at ae = vay avpiuliik stn seis < aMbe eel = UINNIM KMACICWA
i Diet nN ese =
oe used. Urdu dictionaries list only bazer which is cleatly ms oe cull aeriestieee US
“ = W 4 -
eee bes As a consultant to the Research in Mae pum kasan Wal 2 An a ginter &9Y FTC
ation Proj : " or es
iliseaag eae ; ee occasionally heard mothers using the r : med lamut 6WAAYVY6) " bellet TIF
Ss: chichi o 6 2 anskri
scribing some physical S :, and (2) peshaah kt jagh, while de- ta bhagankur “PTSX Persian chochol ek a) 342
cote aera ymptom related to that area or while \ bhagshi shna 271414 i aa. SS
: g about the masturbatory activities of the child The r i
first word reflects th i ‘ eae bhagkesh MIT@ET Urdu chi chi f: Sf
oe e attitude towards that area. The second 1s ; = mises
(14) Sen S Eee lacking adequate functional differentiation cae : peshaah ki jaghalau?
z wcht (dirty) seems related to the Persian chocholeh. Dr. r yoni lingam at hatertt . ETERS wo,
: bhagankur ah UTR : a naqwah opts

Be ’ 2 .
yee ace family uses the word munia, the diminutive or femin-
Oo Hae (penis), to denote “clitoris.” Other Urdu terms are
na j
Ms dae ae Ke ee one informant, and tana, sunga and tuta,
in older dictionaries. None of th
a : ese have wide usage
or clear derivations (15). ge

Figu :
gure 34. Genital terms in alphabets and scripts other than Western Euro-

Pean. See text.

THE SEMITIC LANGUAGE FAMILY

nown origi

ns in the area

pene Semitic language family has its k
ich surrounds today’s Suez Canal. Eas

t Semitic contains only

172 CLITORIS

the extinct Akkadian languages. Northern West Semitic com-
prises the Canaanite and Aramaic groups, while Southern West
Semitic has the Arabic and Ethiopic languages. Hittite is some-
times associated with the ancient Semitic languages because it
employed cuneiform writing, but it belongs to the Indo-
European family. The few Hittite sexual anatomy words known
are: kattan-kan kuit harzi (that which she has below), sal-natar
(womanhood) and assu pedan (the good place); none of these
are specific to the clitoris (16).

Akkadian is a general term and embraces Assyrian (2800
B.C.-650 B.C.) and Babylonian (650 B.C. e¢ seq.). In neither
language is “clitoris” clearly discernible, but many pubic area
references are known (17). Bissuru seems to mean vagina, since
texts specifically refer to the penis entering the bissuru; the
word has persisted nearly 5000 years and appears in classical
Arabic today as bathur or bazr. Uru has been translated euphem-
istically as “nakedness” and boldly as “cunt”; archeologists have
found votive pubic triangles of clay, specifically called uru.
Laglaqqu is translated either as “stork” (which fits a “birdy”
motif) or as a repeated imperative form of the verb laqa’um (to
take), literally “take-take.” GuruS-garaS is derived from garasu
(copulate) and is an informal and/or obscene term, not unlike
the Late Babylonian niki-niki (copulate-copulate).* Handuttu has
been rendered as “the coy one who winces.” Magallu (var.
maqlalu) is literally “the lesser” or “how puny it is.” The last
three terms are known only in specialist’s word lists. Lipisatu
corresponds to unclear expressions in Sumerian, such as kur-
papah (Mountain of the Sanctuaries). Sumerian, spoken in Meso-
potamia from 4000 B.C. to around 300 B.C., has no affiliation
with any other known language; ancient bilingual dictionaries
tell us that bissuru was the same as the Sumerian galla and that
laqlaqgqu corresponds to zarah,

The Canaanite languages are dead, except for Hebrew. The
Phoenicians left few anatomical writings; their interest was com

*Hymes points out that most colloquial terms for copulation fall into two classes:
hard and soft. The former are consonant-enclosed (“fuck,” “bang’’) or contain initia
expiratory consonants, in a cluster, such as “screw.” The latter use reduplication, as in
gurus-garas, niki-niki, pom-pom (Tagalog), shibi-shibi (Korean), budgy-budgy (Wishram
Chinook), yo-yo (Tagalog contact vernacular).

SOME NOTES ON THE ETYMOLOGY OF THE worp “CLITORIS” 178

mercial records; Ugaritic leaves us only one vulvar synonymon:
grd, pronounced qirbu, meaning literally, “midst.” There are no
references to the clitoris in either the Bible or the Talmud; this
may not be surprising, since the Orthodox Jew chants every
morning, “Blessed art thou, O Lord Our God, King of the Uni-
yerse, who hast not made me a woman.” Modern Hebrew has a
few expressions that are not widely used, but were coined for
purposes of anatomical description and teaching. Dagdegan is
derived from the verb digdeg (to tickle) which is first seen in
medieval Hebrew. Hamdan appears first in medieval Hebrew and
bears the meaning “covetous, lustful person.” Hebyénit is the
feminine form of hebyén, a noun meaning “a hiding place,”
which occurs once in biblical Hebrew (Habakkuk 3:4) and has
been used in this meaning ever since. Batar is of unknown ori-
gin. Finally, there is a straight transliteration of “clitoris” into
the Hebrew alphabet. There appears to be no vernacular term
(18).

Syriac is almost the only living remnant of the language
spoken by Christ. Modern Syriac dictionaries list four words, all
poorly attested and also said to mean “foreskin.”’ Bath dsd is
literally “daughter (berry) of the myrtle,” an exact equivalent of
the Latin murton. Gla‘ té is given simply as “clitoris.” Kipta is
possibly from kepptha, “vault”; kallthé is literally “bride” (19).
Aramaic contains bissuro, meaning “her flesh,” and seemingly
derived from Akkadian. North Arabic, the sacred tongue of Is-
lam and the common literary language of 40 million people, is
usually referred to simply as Arabic; there are many dialects.
South Arabic dates back to 900 B.C. and is used today only or
the Southern coast of Arabia and the island of Soqothri. Arabic
“rigms are discussed in the chapter by Z.T. Faruki. ce ne
_ Amharic is the principal and official language of Ethiopia; ue
‘Ss the daily vernacular of 3 million people; the other 19 million
Ethiopians speak a variety of other Hamito-Semitic tongues. My
informant, who asked anonymity, wrote, “There 1s little to be
‘aid about words relating to sexual matters in Ethiopia, where
though people are certainly much concerned with sex in prac-
Uce, it is in a somewhat unsophisticated (unpornographical) pie

°r instance, the same word (shint) is used both for urine an

174 CLITORIS

for semen, despite the extreme physiological and functional dif-
ferences. The word for ‘clitoris’ is guintdr, sometimes transliter-
ated as guinter. The word bellet is used to refer to organs
severed from the body, but also has the meaning of individual
body parts, especially ‘penis’ (properly qwella) and ‘clitoris,’ as
determined by the context.”

Ancient Egyptian spanned 4000 years and had several major
evolutions: Old Egyptian (3400-2200 B.C.) was largely picto-
sraphic; Middle Egyptian (2200-1580 B.C.) was pictographic,
alphabetic and syllabic, with further reliance on “determina-
tives” which described the type of word which it preceded. New
Egyptian (1580 B.C.-3rd century A.D.) saw the rise of Demotic,
a largely different writing system, the influence of Rome and
Greece, and an emphasis on legal documents; New Egyptian
merged into Coptic and disappeared. To further confusion,
hieroglyphics were also written in a cursive script and there are
no vowels; finally body parts present some of the most difficult
translation problems. Whether any term known ever meant “‘clit-
oris” solely is unknown (20).

In Old Egyptian, “vulva” was sometimes written as a triangle,
apex down. Since it was often shown split, and since “‘copulate”
was written as a penis entering the triangle, this pictogram seems
clear. Middle Egyptian is the source of the other terms. The
words (shown in Fig. 5) are a mixture of pictograph, alphabet
and syllable. No. 1, pronounced “th” is ‘a well full of water”
and. also “female organ.” No. 2 is “t”? and means “‘a bread loaf.”
No. 3 is an ideogram, the bicornuate heifer uterus (resembling
an IUD!). No. 4 is “a piece of flesh” and is a determinative
meaning “body part.” No. 5 is hmt meaning “uterus” or “vul-
va.”” No. 6 has the same meaning; no. 7 means “uterus’’; no. 8 1s
k?t meaning “vulva” or “vagina.” No. 9, also kt, has “lock of
hair” as the determinative and means “vulva.” No. 10, ¥d, means
“vagina”; with a “stone block” determinative, it means ‘“‘a grind-
ing mortar.” No. 11 and 12, sp-ty, means “two lips” or “lips of
the vagina”; no. 13 is sp-ty Sd, meaning “labia majora.” No. 14;
rn hmt is “orifice of the uterus.” No. 15 is “belly” or “privale
parts.”” No. 16, mwt rmt is “uterus,” literally ‘“mother of men.
No. 17, 3te-t is “vulva,” which appears in Demotic and becomes

|
|
|
|
|
|
|
|
|
|
|
:
|
,

SOME NOTES ON THE ETYMOLOGY OF THE WORD “CLITORIS” 175

es qonesana

hits a

25 Qa a

a
3. PP SS
1 13, Ins &

5. eel 1h, Pon OS
ales 15. an
7.228 16. eAdSe a9
8. all We cpu

9. alm 18. Nay

Figure 35. Egyptian hieroglyphic genital terms. See text.

OOTE in Coptic. Finally, no. 18, ‘wf, literally “chair,” is a
euphemistic “vulva.” Three thousand years later it is hard to
resurrect connotations, but it does seem that Middle Egyptian
sexual attitudes were straightforward and unashamed.

The Turkic language family includes the native tongues of 40
million people. Half these speak Turkish, in which the usual
colloquial term is fercin dilcigi, from fercin (sparrow), ail
(to ngue) and cig? (a diminutive ending). Medical dictionaries give
bizir, related of course to bathur and bi‘ssuru; Clitoris is also
‘tandard medical Turkish. As a coincidence, the totally unrelated

fer¢ means “vulva”? (21):

THE SINO-TIBETAN FAMILY

- One quarter of the world’s people speak these tongues, which
oes languages, using variations in pitch to distinguish mean

1 CLITORIS
ing. They are analytic in structure, using invariable monosyllabic
words and relying on word order to express grammar.

In Tibet, medical doctors never examine the female organs;
this taboo extends to language—there are no polite terms for
“clitoris,” but there are two obscene ones. The most common js
bya le. One derivation is bya (“‘action,” from bya-ba-byed, “to
do work,” meaning coitus) and Je meaning anything of no par-
ticular shape, hence “action bump.” Another suggestion is bya,
“chicken” and Ice le, “tongue.” A third informant suggests cha-lj
(hanging piece). The second word is sran ma me tog, literally
“flower of a pea pod” (22).

Chinese has been a living language for about three thousand
years. The written characters are standard but can be pro-
nounced in several ways; they also form the basis for written
Japanese, a totally separate language. The English transliterations
of the Chinese are National Romanization, followed in paren-
theses by other common ways of noting the same word. The old
literary general term for “clitoris” is yuh-tair (yii-tat, ju t’at),
“jade terrace.” Yuh is the character meaning feminine beauty.
The glans clitoridis itself, in old literary usage, is ji-sher (chi
shé), “chicken’s tongue”; the same characters in Japanese are
pronounced hinasaki. Chwu-shian (ch’u hsien) is also of old liter-
ary usage and is literally “chicken’s tongue.’’ Other old literary
terms are chow-shuu (ch’ou shu), “smelly mouse,” and
chyn-shyan (chin hsien) “lute string.” The statement, “The lutes
are in harmony” means marital happiness.

The clitoral area has at least four synonyms which begin with
the character in (yin), which is the yin of yin-yang. Yin 1s all
those aspects of being which are feminine, dark, passive, earth-
derived, moist and/or shaded. In dow (yin tdou) is literary, but
not of refined usage, and means “feminine bean.” In ti (yin tt);
“feminine peduncle,” is of formal, medical or technical usage. /”
her (yin hé), ‘feminine kernel” js widely used in learned or
neutral settings; the same characters are used for “clitoris” 10
Korean and Japanese; the latter pronounce it inkaku. The char-
acter her, standing alone, is the Japanese vernacular sane, also
meaning “‘clitoris.” In tiing (yin tin), “feminine rectus’”’ indicates
the erection capacity of this organ and is used in literary but

SOME NOTES ON THE ETYMOLOGY OF THE WORD “cLiToORIS” 177

unrefined settings; ézng alone is the name of a female disease
= wie,

93). Chinese “clitoris’’ terms seem to reflect a long, rich history

of sexual thought and a fine regard for delicate modes of expres-

sion. :
ai (Siamese) one can choose :
In Thai _( ) among the technical, edu-

cated awaya pruk kamnad setri pet (member arousing desire in
the female), the flowery pum kasan (desire knob) and méd
lamut (point of the lamut fruit); for vulgar usage there is tét.
The Thai love metaphors from nature; classical Thai poetry has
passages where the vulva of the beloved is compared to the lotus
flower, with the clitoris as one part of it (24).

In Vietnamese, there are two terms of Sino-Vietnamese ori-
gin: dm hach (lit. hidden kernel, perhaps from Chin. in her),
used technically and tuoc noan (bird’s egg). Other terms, of
unknown origin and usage, are hét xé (divided kernel), trung
chim (bird’s egg) and hét déu (bean) (25).

Japanese, surprisingly to Westerners, is totally unrelated to
both Chinese and Korean, even though it uses many Chinese
characters. “Sex in Japan is universally enjoyed (though without
much imagination or variety) while at the same time being con-
sidered ‘low class.” Women of middle class and above don’t use
words regarding their genitals. Men use such words according to
class and occasion. There is little emphasis on genital terminol-
ogy in Japanese pornography. Japanese women apparently all
masturbate, but you don’t need to know the word for it to do
that” (26). The usual dictionary word is inkaku, used medically
and in popular conversation; a modern learned form is for both
men and women to use the English, pronounced ko-r1-tu-ri-su. In
common usage is hinasaki (“‘chicken’s tongue”), derived from
the peak in the stiff hats worn from the tenth century down to
me late nineteenth. Vulgar slang is ikite iru mame (“living
eae ). A low class bar joke goes, “Do (en like beans? Yes, be
ee are living!”; everybody laughs. Sane (“seed”) is a Sire
wees the one usually encountered in modern eee cae
cytes It is perfectly respectable in middle-lower oa ae
dae 0 sum up, the Japanese are more Bovenne yi

©nventions than by any concept of “dirtiness 1n Sex.

n Korean, the Chinese characters in her can be used, pro-

178 CLITORIS
nounced on haeck; this is technical medical usage. The vernacyu-
lar konyal is the more informal term. Knowledge about nuances
of social usage is lacking (27).

Mongolic languages can be classed alone, or as a subdivision
of Ural-Altaic. Standard Mongolian dictionaries omit “clitoris, wp
but our informant gives a term transliterated from Cyrillic, as
okhsog, a derivative from the vulgar verb okho (“to have inter.
course’’). The Western Mongolian (Kalmyk) dictionary Sives a
term, phonetically cocig, with a literary spelling of ¢ couciq, de-
fined by the Russian term szkel’, which the Soviet dictionaries
refuse to define, due to official prudery! (29)

The Finno-Ugric family has extreme agglutinative structure;
no word has both front and back vowels (vowel harmony). In
Finnish, the literary word is hdvynkieli, a simple compound of
havyn and kiele (“vagina tongue”’); the identical vulgar word is
vitunkiele (“cunt tongue”) with the slang term substituted for
the medical. In the closely related Estonian, the word
habedvsmokad seems to be a direct loan-translation from the
German “shame lips.” Other Estonian words are kodisti (‘‘tick-
ler’) and klitor. The Hungarian (Magyar) is cstkld (‘“tickler”),
clearly derived from the German Kitzler.

THE MALAYO-POLYNESIAN FAMILY

This includes languages spoken in much of Southeast Asia and
in the vast sweep of the South Pacific. Indonesian includes
about 200 languages and dialects; Malay, a native or second
tongue for 80 million people, is the official language of Indo-
nesia. An Indonesian Moslem custom illustrates the high regard
in which the clitoris is held. When a girl is somewhere between
the ages of three and ten, there is a ritual washing of the clit-
oris. The little girl reclines on a ceremonijal bed, under which
incense is burnt and around which a fine cloth screen stands. A
religious official does the sprinkling, using air setaman, a watery
solution of sweet-smelling flower petals. Afterwards, the family
provides a celebration feast, according to their financial status-
In a culture so respectful of the clitoris, we will not be surprise
to find a warm, accepting vocabulary.

)

SOME NOTES ON THE ETYMOLOGY OF THE worp “CLITORIS” 179

avanese language varies on the basis of social rank. Common
speech, used for low to low or high to low, uses itil, which
occurs most frequently in Central and East Java. Itil seems de-
rived from kontol (penis) which becomes konti] (dim.) which is
shortened to ital. Another suggested derivation is from ittk-wttk
(tickle). Polite speech, used for high to high or low to high,
employs keléntit, but some intimacy is required. Extremely high
Javanese uses prono seen only in traditional court poetry, and
derived from the Sanskrit prana (breath, soul). In Javanese,
prono also connotes the heart as the seat of the emotions.*

Malay shares with Javanese the word itil. Kuntum piari (love-
bud) is used poetically. The Malay tampok labu (calabas stump)
is used jokingly for a large clitoris. Titik, meaning point or
(punctuation) period, is used in Balinese slang. In the Padang
area of Sumatra, the word used is bidji (seed). The dictionary
also gives sénggeh of unknown usage (29). Tagalog, the official
language of the Philippines, has puki for “vulva” and tinggil for
“clitoris.” The Visayan (Waray) dialect spoken on Samar uses
poyet or podoy for “vulva” and tusik or tuding for “clitoris.”
The words are in common usage; pride or shame can vary with
the situation (30).

Malinowski, who studied the famous Trobriand Islanders,
noted their novel ideas of sexual function: “In the process of
sexual excitement in the female, the eyes give the alarm, which
Passes through the wotuna (communicating ducts), takes posses-
sion of the kidneys and produces sexual excitation of the kasesa
(clitoris), ” The Trobrianders had names for the clitoris and
ae but, curiously, none for the labia or the vulva as a
Whole

The Tuamotuans of Polynesia have ten different words for

“clitoris,” reflecting the sexual focus of their culture; aan
(tongue); to (gash); io-io; tiro (uvula); tiro-tiro; karti oar
Oke (worm); kiko (naked flesh); teo (new growth); an one
(31). The Fijians use tottot and cui; these must not be use

of Praeputit Incisio, who

a cont
Yar ous author : ;
EBS RUE ress y7 HS cine f the clitoris removed in

a ates that around age seven, Javanese girls have a small part 0
‘remony called putingitil.

180 CLITORIS

publicly or before women. The central New Hebrides Islanders
on Nguna and Emau use napati ni sivirt (parrot’s beak) which is
also taboo in front of woman. The Tahitians say tera (mast of a
boat); the Dehu, Loyalty Islanders use he-ne-fiju (head of the
vulva); the Samoans use masisi, tela and tole (32). Hawaiian
terms are ke’o, %’o7l’o and kanaka, which also means a type of
man. The Australian aborigines speak over one hundred utterly
unrelated languages; we have data on two. The Mullukmulluk
use pan-moel (eye of the vulva), while the Yir-yoront use kot
nanpr. Kot means vulva or vagina and comes from kont, the
native word for a melon (Melo amphora) of vulvar appearance.

The Dravidian family of languages, spoken by over 100 mil-
lion persons in central and southern India, is wholly distinct
from the Indo-European languages, such as Sanskrit. In Kota,
“clitoris” is kut, (related to words for banner, crest of a bird,
nipple, point and extremity). In Tulu, kid? is variously trans-
lated as “vulva, posteriors, or membrum muliebre.” In Tamil and
in Malayalam, kuti: also has those meanings. The Tamil word
puntai, also meaning the female pudendum, may give rise to the
English slang of “‘poontang.” The migration of words, both car-
ried by ancient travellers and by British colonialists the last few
centuries must give origin to many surprising connections be-
tween cultures (33).

NATIVE AMERICAN LANGUAGES

The dozens of linguistic families of the natives of North and
South America defy summarization. Widely different families
exist a few miles apart. The complexity, has been compounded
by the over-refinement of many field workers who failed to ask
about sexual terminology; a double pity, since now many of the
languages are dying or dead. The dictionaries made by Christian
missionaries contain few sexual terms; however, there is som®
information available

In Maidu (northern California) pysim éni is literally Be
tongue.”” In Wappo (northern California) sinis means both oat
Ake

oris” and “uvula,”’ being derived from sine (sprout). In the a
ima dialect of Sahaptin (central Washington) smt ‘ik mea

SOME NOTES ON THE ETYMOLOGY OF THE WORD “CLITORIS” 181
“cJitoris.”” The sm prefix indicates the pubic area, and appears in
related form in shmtay (pubic hair) and in cognate forms in the
Nez Perce language: ¢.g., stmteey (pubic hair) and simke (penis)
The meaning of the -t’ck stem is not determinable.

In the Nass-Gitksan (northern British Columbia) language
dil’ts is “clitoris.” Nass-Gitksan society is highly stratified, with
an elaborate heraldry of family crests which are displayed on
totem poles, clothes and elsewhere. A few years ago, one of the
more important display crests of the sim lax xs guk (Real Eagle)
clan of the Eagle phratry in the village of Gitlakdamix was dijl’ts
sim’oogit (Clitoris Chief). The crest appeared on a wooden cere-
monial dish, carved in the shape of a vagina, which was dis-
played and used at potlaches. The usual Nass-Gitksan term for
“cunnilingus”’ is luu ts’eek (literally, “to inside-lick”); occasional-
ly speakers use the incorporated compound verb ts’eek dul’ts
(“to lick clitoris”’).

In the Klamath language of Oregon, the word for “clitoris” is
sits, pronounced like “seats.” The Hopi language of Arizona
uses mosinga. The etymology of both is unknown (34).

It is hard to escape the imprinting of one’s own culture and
time, but the study of language and custom can help cure per-
sonal myopia. I have found special help in this from such
sources as G.R. Taylor’s Sex in History, Wayland Young’s Eros
Denied and Benjamin Whorf’s Language, Thought and Reality.

This brief essay may indicate some of the light to be shed by
a thorough study of the etymology of sexual terms. Perhaps a
Professional scholar in philology or linguistics will use these
modest beginnings and pursue the etymology of “clitoris” with
teal scope and depth.

REFERENCES AND SOURCES

maleu, A: A Philological note on a defect in sex organ nomenclature. Psychoanal
Quart 192: 481, 1943. |
ppgeme Te A philological note on sex organ nomenclature. Psychoanal Quart 14:
228, 1945,
Senn M: Clitoris. Extrait de U’Annuaire de Philologie et d
Gillis V, 1937 (Melanges Emile Boisacq).
5.M * Internat Discophile. Summer, 1955.
Yr. Peter Tamony.

’Histoire Orientales et

ON Sale

Seine mat

182

24.
22.
risk

24.
25.
26.
Die
28.
29.

30.
$1.

2s
33.
34.

Additional helpful sources, found too late for inclusion are: Ishihara A,
Tao of Sex. Shibundo, Yokohama, 1968 (Chinese and Japanese); Alle
Sacred Mushroom and the Cross. Doubleday, Garden City, 1970 (Sumerian,
Hebrew, Greek); and Biggs RD: SA.ZL.GA: Ancient Mesopotamian Potency

CLITORIS

. Cary HN: Sexual Vocabulary. 5 vols. Priv. Print., Chicago, 1916.
. Dr. Thorkil Vanggaard.

. Dr. H. Rademaekers.

. Mrs. Mary F. Henriquez.

. Hyrtl J: Onomatologia Anatomica. Vienna, Brauemuller, 1880.

. Prof. N. Shipkowensky.

. Mr. Mehrnoosh Hashimian.

. Drs. K.C. Dube and Jaan Puhvel.

. Dr. Raihana R. Beg.

. Prof. M.R. Barber.

. Prof. Harry A. Hoffner, Jr.
. Prof. Dr. Wolfram Frhr. von Soden, Prof. Zuhdi T. Faruki, Dr. Robert D. Biggs

and Dr. Dell H. Hymes.

. Prof. Stanley Gevritz, Dr. H. Edery, Rev. Betty Sykes.

. Prof. Franz Rosenthal.
. Prof. Klaus Baer, Curator Kent R. Weeks, Prof. George R. Hughes, Mr. James

Weinstein, Prof. Richard A. Parker, Prof. Wolfhart Westendorf, Gardiner A: Egyp-
tian Grammar, Lefebre G: Tableau des parties du corps humain mentionees par les
egyptiens (Suppl. aux Annales du service des Antiquities de l’Egypte, cahier 17, p.
41), and Grapow H: Anatomie und Physiologie (Grundriss de Medizin der Alten
Agypter, I, Berlin, 1954). Translation help by Erika Hesse.

Dr. Orhan Sansoy.

Profs. Turrell V. Wylie, Stephen S. Wang and John R. Krueger.

Mr. Gary Snyder, Prof. F.K. Li, Dr. Stanley Wang, Prof. William F. Shipley, Mrs.
Lois Chang, Mr. William Togashi, Dr. P.M. Yap, Prof. D.R. Knechtges and Prof.
Fred West.

Prof. H.C. Ruyter.

Mr. Philippe Langlet.

Mr. Gary Snyder.

Mr. Sing-lin Chang.

For Mongolian, Kalmyk, Russian, Finnish and Estonian: Prof. John R. Krueger.
Dr. W. Roan, Prof. H.C. Ruyter, Prof. Soenjono Dardjowidjojo and Prof. G.K. de
Heer.

Mr. Adriano Dotingco.

Stimson JF, Marshall DF: A Dictionary of Some Tuamotuan
Peabody Museum, 1964.

Profs. Albert J. Schutz, Samuel H. Elbert and Darrell T. Tryon.
Burrow T. Emeneau MB: A Dravidian Etymological Dictionary. Ox
Profs. Bruce Rigsby, William F. Shipley and M.R. Barber.

Dialects. Salem

ford 1961.

Levy HS: The
gro JM: 7

tions. Augustin, Locust Valley, 1967 (Sumerian, Babylonian).

Chapter XI

REFLECTIONS ON THE ETYMOLOGY OF
“CLITORIS” IN ARABIAN SEXUAL LORE

Zuhdi T. Faruki

The universal Classical term in Arabic for the “clitoris.” or
the Greek klettoris, is: bathor, or bathur.* The derivation of the
Arabic term is from the verb bathara, meaning to sprout, to
grow. The noun, hence, means growth, protrusion, sprout. The
noun is masculine and singular. Its plural is formed by a modifi-
cation in the movement accompanying the letters, as shown
which means a volume of growth, many sprouts. The term in ce
plural form could be legitimately used to denote a mass phe-
nomena, such as would apply to the production and generation
of many individuals of a class. It is peculiar that in its singular
form it is used exclusively to denote the “clitoris.”
ee ne ee y ae in all Arabian countries
in ae ae of Pa stan to the distant shores of
Ace See ies O : orth Africa, local dialects and collo-
ies ey considerably to such an extent that each
renee a e said, indeed, to stand apart as a distinct and
ind ae sores Thus, literate people understand the Sea
Heese erivation of the Classical term for ‘“‘clitoris,” but
Baia ae eos improvised their own terms for the cele-
ese a uc vernacular and vulgar terms also derive from
eee assical origin, each being the simile or metaphor of

“1c image that has come to dominance among a people,
“noting a singled- hasi
Particular fun gied-out quality or meaning which emp asizes a
verhacular rar ction or feeling. Following is a partial list of the

erences to the clitoris in various Arab lands.

*Th
© phonetj
c P
te S of the term bathor in Arabic make it necessary that the “th” in the

Meee “PLO
his js nounced as the “th” in “the” or “that,” and not as the “th” in “threat.”

4 mello :
Vowels W or a flat “z”, but not as harsh or as sharp as our “z”. Again, the two

in bathor -
Ng their breath Cught to be pronounced in a short, snappy manner without extend-

| 183

\ the drone. When excited, the clitoris vibrates, erects, is restive

sexual excitement, among inhabitants of warm climates in

4 playing havoc with its bites.’’

184 CLITORIS
o , te 2
bathur, singular _ylé> noona Gy
ve 2 eo
bathur, plural Ue Zar. ZOOl, Lie JI: 95g
+ Bet ss | : ;
zanbur IIMS felfoula a 9-2 J 9
. “oOo -
antoot ab tar too: } ae
AIR
Sy
jnnawa oS LS akrooten Ay 9 —_—
forms of the letter "noon": © cS Fe x

Figure 36. Arabic terms for clitoris. See text.

Syria, Palestine, Lebanon and Egypt: In this central and sub-
stantial portion of the Arab heartland, the term in popular usage
for the clitoris is: zanbur. Zanbur stands in Arabic for the
drone, the wasp. Obviously, this is a metaphorical frame of ref-
erence, and scholarship among the common people attempts per-
petually to furnish an interpretation as to the rationale of the
term. Two qualities which characterize the genesis, function and
nature of this sexual organ may furnish a credible interpretation
which may account for calling it by a name after the wasp or

and almost flutters as though it is a little bird. Likening it to a
bird, or a birdy, as we shall see, is by no means uncommon in
other Arab communities. In the second place, the “7anbur,
meaning the male bee, enjoys a reputation of being nasty OP
account of its sting. While the clitoris does not sting a phallus
its approach, it is said to do so to its owner. In the heat of
finitely
more than among Western or Nordic girls, the females writhe in
incredible agony, often scream, bite, toss in heat, and are verit-
ably wild with passion. This center of sensitivity imparts a de-
gree of discomfort, so that when the girl complains of the com
gestion of lust, and of the scorching fire of desire, develops
distorted features, and tosses helplessly as though she were In 4
frying pan, it is not too far fetched, to harken to her exagget4
tion that ‘“‘a drone must have slipped between my legs, a0

THE ETYMOLOGY OF “CLITORIS” IN ARABIAN SEXUALLORE 15
Southern 1raq° The term for clitoris here is: antoot. This
vulgar (1-€-> conn pseSke) term connotes a diminutive
thing which 1s terribly restive, jittery, hoppin
aa ; pping,
extreme anxicty-

Baghdad and Northern Iraq: The common term here js:
innawa. us Soult easily be the diminutive of ein, which is
paapic fot CY°- ee Mere CONE CCULeE One m yasparieastthe
derivation of the mee denotes a possible linguistic rela-
tion to em. Nor is it far fetched to suppose that the name is
applied as Ces Se that guards, oversees, dominates or
otherwise receives the impulses on behalf of the entire region.

Libya: The common term for the clitoris here is: noona.
“Noon” is the letter “‘n” in the Arabian alphabet. When you say
“noona” you have first made it feminine, then made it singular,
one of a kind, and lastly you have converted it into the diminu-
tive mode. It is not uncommon in Arabic literary lore that
subtle, mysterious and generally inscrutable objects may acquire
4 semantic appellation from one single letter of the alphabet.
This practice is frequent in Arabian learned literature, and in the
Qoranic Holy Scriptures. In the context of sexual lore, ancient
books on sexology, both learned and vulgar, refer to the ability
and vigor for love-making, also the quality of being abundant in
com fe ely as possessing vitality or vigor or “the B.”
ai ae ee possibility of interpreting such a metaphor abides
f cterence to the written Arabic form of “n,” which possess
our different forms, depending upon whether it occurs alone, is
Joined to the Seal ma 3 aaa a
following | Preceding letter, is jome to the preceding
heen, S eters, or is joined to the following letter only, as
last ee Bey in F 1g. 36. The little upward SHOE: in the
it sits : eae of noon, is called in Arabic a “chair, and on
small and a dot. Might it not be that the clitoris, which sits
Name of oe one, yet crucial in meaning, could be called by the

“ that letter?
me aes : The clitoris here is called: zarzoor. ees is
“ttain whit € starling, an extremely puny, fast, quaint bir y:
Ave been €, neat, extremely attractive and symmetrical vaginas
é called a zarzoor in some popular tales. But you also

Correction of such a misnomer, and the reference of
only to the clitoris.

eager and in

ind

186 CLITORIS

Dr. William R. Mast adds that in the El-Milia district neay
Constantine, Algeria, the local term for “clitoris” is felfoula,
derived from the Algerian word felfel, or from the Classica]
Arabic foulfouloun, both meaning “red pepper.” The staple pep-
per eaten in Algeria has a short stem protruding from the base;
the stem is called cherdouda, “an extra piece of meat,” and it ig
that part that the clitoris is compared with. There is much bor-
rowed French in Algerian Arabic, and two other common terms
for “clitoris” are chapeau (hat), and petite coquette (little flirt),

Morocco: The clitoris here is called: tartour. Tartour stands in
colloquial Arabic for the crest, such as that of a cock or rooster,
also such as the white of an ocean wave. The lore here speaks of
the “feurdj abu tartour.”” This is, the “vagina of the crest.”
(Neither vagina nor vulva is the correct translation for neither of
them signifies the whole organ of copulation in women, as
“‘feurdj”’ does.)

Southern Morocco & Mauritania: The term for clitoris is:
akrooten. However, since it is listed sometimes as akurten, let
me assert here the very imprecise nature of the enterprise. As
the Berber language has no elaborate grammar, or stable and
scientific structure of derivation; also, in view of the fact that
different dialects dominate different regions in the vast expanses
of that land, ranging from the North Atlas, through the Middle
Atlas, across the Anti-Atlas to the plateau of Mauritania and its
desert shores, it is quite reasonable to assume that akurten may
be in use among some Berber tribes. It may be a vulgar cortup”
tion of akruten, for I conjecture that akruten spells out more
loyally the nature of Arabic linguistics than akurten..

Persia: The terms listed elsewhere, namely zal and
are authentic. Now, zal ought to be written thal, provid
the “th” in it be enunciated as the “th” in “the” or in ? ie
and not as the “th” in “threat” or in “thick,” Zal itself 1S Bs
ninth letter in the Arabian alphabet, used also by the peas -
Refer please to the above discussion on using single pee
denote a subtle referent. Zal qualifies here equally ante
Chocholeh is not the best Latin rendering of the ee a it
prefer either of the following: shosholeh or jojoleh. 1 be
means in common Persian, a plaything, a toy.

chocholeh,
ed that
“that,”

THE ETYMOLOGY OF “CLITORIS” IN ARABIAN SEXUAL LORE 187

The listing of qintir and its variations under some North-East
African headings is, I believe, correct; qintir, alias gintar, means
qa certain measure of weight. I am sure it is heavier than our ton,
put cannot say how heavy, perhaps a hundred times as heavy. It
is not a sense of exaggeration to reverse the order of things and
call so small an organ as the clitoris by a name denoting so
crude and enormous a referent as a gintar or even a ton. What is
being labeled here is not the actual physical organ, but its func-
tion and role in the game of love.

COMMENTARY

The Arab East abounds in manuscripts, volumes of love tales,
and countless books and pamphlets ranging in their treatment
from the broad and popular field of mass entertainment, to
what is referred to as precise sexology, the science of love-
making, the rejuvenation of youth and similar titles. Practically
nowhere in those annals and tales would the reader come across
derogatory references which belittle human worth, or connote
an implication of guilt, shame or baseness. Shame and guilt are
not part of the sexual lore of the Arab Muslim East. The
grounds for substantiating this claim exist readily in available
Herature, history, theology and various facets of social life. The
oS Rag coding quality in the Oriental approach to the issue of
Fe . ums °pinion of a celebrated authority among the Oriental-
the: oe a : where the feeling for the human extends almost to
the f= heights of transfiguration, banishing every vestige of

abs fe €. This is most evident in the tales and books the
ture, as rote on the practice of sex. Here, “‘. - in life, in litera-

on, - ay art, the act of love is expressed with an entire aban-
ing, in ae and wholesome joy; and is accepted as ei
vine vteeles ndamental essence, something of the activity of ae
Upon chasti - It is for this reason that Islam in particular loo s

e “tenes BOE as an ideal, but as an unfortunate Sees
and brilliant 1S from the Introduction, written by wake learne
Sexologist Allan Hull Walton, to Burton’s transla-

efzawi’s The Perfumed Garden, which has invaded our
AES only in recent years. Let me attract your attention

188 CLITORIS

also to the invaluable and revealing Terminal Essay of Sir
Richard Burton, included in his singular translation of the
Arabian Nights.

Learned scholars and public lecturers never, of course, have
occasion to refer publicly and openly to sexual practices or or.
gans in the East. A modicum of modesty prevailed until the
present. However, today, in literary circles, in homes and cafe
houses, conversation quite often turns to this delicious topic. I
have witnessed and participated in such occasions from the
banks of the Tigris and Euphrates in Iraq, to the celebrated and
cultured cafe houses of Cairo and Alexandria, to the literate
colloquiums of Syria and Lebanon, to many a friendly circle
across North Africa. Among groups of cognate inclinations and
symmetry of age, prudery is at a minimum, and often is referred
to as the “incapacity for passion, parading as virtue.”

Conversations in such societies abound with references to the
clitoris, for indeed its function and nature were heeded, and
discussed since ages ago. Often, some men betray genuine fear of
women with a developed clitoris, for this would mean that such
women are well-nigh insatiable. Such an insatiability is naturally
different from that of nymphomaniacs, for the latter never
achieve it, while the former never have enough thereof. Besides,
a woman with a sensitive and developed clitoris is extremely
demanding; and would not hesitate to “‘stick horns on her man’s
head” in her perpetual endeavor to seek love. I believe this was
the predominant grounds for circumcising woman. é

Now, as to the technique of circumcising wo
usually part of the vulva, the lesser lips thereof, ca
that were trimmed. In cases where the clitoris extended
usual or abnormal proportions, it, too, got the knife. This was
done with an eye of mercy on the future fortune of women:
The practice was widespread, further south towards the equal
and was done, as with the male, right after birth. This indisatas
inate practice was common in Egypt, only a generation OF be

; gate ; ‘or Egyptia?
ago. I know from experience that physicians 1n maj fe
cities, starting about the First World War and since, Nek ae
down any request for female circumcision among the ae a
While this practice probably came to an end in the north an

men, it was

Iled nymphs,
to un-

THE ETYMOLOGY OF “CLITORIS” IN ARABIAN SEXUAL LORE 19
big cities and among established families, I am inclined to think
that in Upper Egypt, littered with poor and hard working peas-
antry, the precautionary measure remains as much an sccanted
rite as male circumcision. The effect of eradicating or shortenin
the clitoris in girls, unmistakable in later years, is to SAA
ly Jessen and almost mortify the lust for love making. Stories are
told about women In warm climates who escaped circumcision:
now they are pathetic victims of the perpetual fire that nothing
can quench.

Other stories have it that some varieties of clitoris might ac-
tually resume growth after being circumcised to the root. I have
no way of verifying this, but I know from first-hand experience

' that women in the entire Arab East have no trouble locating
>

understanding, and accommodating the clitoris and its function. |
It usually, and if left alone without trimming, grows, often
dangles, and always is central and extremely sensitive in the love |
act. I am stressing this point, because it strikes me as being in ‘
sharp contrast to the genesis and development of the organ in| -
Western and Nordic women. Some of those latter variety hardly
show a protrusion at all. If I were engaged in coining a term for
ier tions in Western and Nordic women, even as the
eae ee writers were engaged in locating a fit simile, I
Wome b esitate in calling it, as it is manifest in Western
I » by such names as: “‘dot,” “button,” or “point.”

2 a eee literature of sexual lore, the clitoris, together
and nee woe ceula: has acquired some of the most colorful
to quote a appellations. Narrators and writers do not hesitate
organs; and Holy Scriptures when they speak of the sexual
elicious te ten speak of them, of the vagina especially, as the
matic th . delectable, the hot one, the beautiful, the aro-
fits aoe 5 ee eee: and other such congenial epithets.
ints, recj : prominent Arabian authors include in their writing
€Manatin ae or whole chapters on ways of eradicating the odor
ing and 2) ee the acinus the practice of cunnilingus, or kiss-
NOwn or a ing the clitoris alone, has apparently not been
they decid Serre by most men in Arab lands. I would say
ly not de edly did not know it, or need it, as they were normal-
nied, and denial is the root of extremities of human

190 CLITORIS

behavior. The situation perhaps is undergoing a change, especial-
ly after the prolonged periods of colonialism Arabs suffered
under the British, and more so under the French. When you
come nowadays, in open conversation among the intelligentsia,
the bourgeoisie, and the upper and upper. middle classes, across
references to variations in techniques of love making, you ought
not to be surprised; for the East is modifying a great deal of its
tradition, way of life and practices.*

In a recent diary I read written by a Beirut, Lebanon high-
brow-highclass call girl, she was most explicit on the central
issue of the clitoris in her business. She recalls that among her
clients, the old welcomed a chance to suckle on the clitoris, and
some of them would seek cunnilingus hungrily. She had a great
deal of difficulty accommodating them, not because the refined
practice displeased her, but because she invariably achieved bliss-
ful and repeated orgasm with this efficient method, and just
“did not want to be touched after that.”’ She also mentions that
she would not allow the majority of her younger customers to
indulge in the practice. The reason she gave for this is the cer-
tainty she felt “that sucking the clitoris, equally as cunnilingus,
and just the same as fellatio, were addictive practices, habit
forming, and end by conditioning the lover to them as a neces-
sary condition of his love making.” I am inclined to agree with
her, for I heard the same assertion from Parisian girls. The
Beirut call-girl narrated a few cases of Lesbian, passionate love
among some of her friends. She was not interested, herself, but
was astounded by the persistent, concentrated and sustained role
the clitoris played in such relations. It fed the fire, and sustained
the relation beyond the limits of emotional attachment. Her
implication was, I believe, that without full exploitation of the
sensitive organ, such an innocent and pure relation would not
last beyond the casual and emotional tie, which has narrow
limits. Truly an organ of many values and many aspects.

2 Nn a

an youth
pserva"

*One illustration of this point is the extreme popularity an :
lightened, liberal and enterprising circles in Cairo, Beirut, Baghdad, Tri E
Marrakesh hold My Life & Loves, by Frank Harris. It is ignored by Am
but in Europe, as in the East, it is emulated. This is a casual and objective ce

tion, and is not meant to imply value judgments.

chapter XLT

THE CULTURAL PSYCHOLOGY
OF THE CLITORIS

Thomas P. Lowry

We begin to realize that our brains are the most complex and
self-determining things in the known universe. After all the mea-
surements of atoms and galaxies are folded into laws in some
corner of our networks, there will still be universes of inter-
relationships in the rest of our networks to be discovered. If this
property of complexity could somehow be transformed into visible
brightness so that it would stand forth more clearly to our senses,
the biological world becomes a walking field of light compared to
the physical world. The sun with its great eruptions would fade to
a pale simplicity compared to a rosebush. An earthworm would be
a beacon, a dog would be a city of light, and human beings would
stand out like blazing suns of complexity, flashing bursts of mean-
ing to each other through the dull night of the physical world
between. We would hurt each other’s eyes. Look at the haloed
heads of your rare and complex companions. Is it not so? (36)

It is so, and sexuality is one of the most complex things
possessed by already complex human beings. To select one organ
2 all those related to sexuality may seem a foolish simplifica-
po anid to fragment this pink button of tissue among several
Specialists may seem even more foolish, yet it is worthwhile, for
the careful examination of the infinitesimal must yield under-
standing of the infinite. This essay, on the meaning of the
clitoris, will range far beyond that organ as an isolated entity.

. Ui fre are at least two ways to examine a subject: the reduc-
Honistic and the synthetic. The reductionistic approach follows
the rule of “nothing but” (Mary is nothing but an hysterics a
oes is just a ship of fools; patriotism is just a shield i
pucrcls): Objects are categorized at a single level of comp ;
a oe d then dismissed. The synthetic approach relies on the
Principle of hierarchies. su) fl the
ie tthur Koestler has brilliantly clarified the nas vane a

T approach. “Hierarchy” here 1s used not as 2

192 CLITORIS

organization with ascending levels of control, similar to the milj-
tary lines of command. In most animals the cells form various
tubes, the tubes form organs, the organs form organ systems
(respiratory, reproductive, etc.), and the systems finally form an
entire person. At every level, there is partial autonomy and par-
tial dependency. The heart can beat without consulting the
brain; an individual muscle cell can contract even if cut away
from the heart; a muscle enzyme may still be potent even if
separated from its parent cell. Yet an enzyme is not the muscle
cell; the muscle cell is not the heart; the heart is not the athlete.
Their independence is only partial.

As in the military, there is delegation of power: the general
does not command each soldier directly but controls through
several levels of officers. There is also delegation of responsibil-
ity: the private is responsible for himself and also to the ser-
geant, but not directly to the general. Further, neither the
general nor the aggregate of privates constitute the division. It is
the total of all the levels of the military hierarchy, responsible
both upward and downward, that constitutes the division. The
division in turn faces upward into another hierarchy—the divi-
sion is part of an army, the army is part of the defense depart-
ment and the defense department is part of the government. —

Injury, like organization, can go up and down the hierarchical
tree. If a man neglects his diet, his organ systems suffer. A
“rebellious” or self-directed organ system can create mischief for
the total man: witness the involuntary tic or the unexpected
erection or the stomach which is too acid. A single cell which
steps out of line may begin a cancer. A single defective gene
may affect not only the whole body, but the social and eco
nomic levels open to the damaged person. yer.

Skills and habits also take on hierarchical forms. A beginning
music student learns about individual notes, learns then to com:
bine them into chords and may go on to activities at further
levels of complexity, such as transposing from one key to ce
other, playing while hearing other musicians, and compos! 8
music for many instruments, using sophisticated harmonies.

In considering the clitoris from the point of view of hierare
cal analysis, I visualize eight levels of complexity:

hi-

THE CULTURAL PSYCHOLOGY OF THE CLITORIS 1938

1. The cosmic

9, The species-wide

3. The societal

4, The familial

5. The adult interpersonal
6. The adult intrapersonal
7. The anatomical

8. The electrochemical

THE COSMIC LEVEL

The cosmic realm includes such clearly extraterrestial prob-
lems as the clitorides of beings from other planets (little data so
far), concepts of God’s attitude towards sex (largely a societal
problem) and the cosmic bliss of orgasm (which is probably an
intrapersonal matter). Religious sexuality is more highly devel-
oped in Asia, and one of the clearest English language exposi-
tions of this is in the writings of C.M. Chen, a Buddhist yogi.
Since I am better versed in anatomy than theology, this will be
discussed under the former.

THE SPECIES-WIDE LEVEL

The species-wide level of organization includes those qualities
pe neter ste of all Homo sapiens. Our foremost feature is com-
ee a introductory statement by John Platt says in a few
~ =, at has taken me years to learn: that the human body
ae ee surpass all other systems in possible permuta-
Eaeteey variations. Eyes-open psychiatry is a royal road to a
Rete awe. Human complexity insures that all statements

f companions must be qualified and tentative.
aie eee major aspect of humanness is speech. The sounds
ae th ace monkeys and parrots are quanta jumps below the
aie - average three-year-old child. No one but us has the
ities e ie to babble, to combine practiced babbles into
standing hie s and through that indefinable process, under-
throne speak on our own. External and internal speech,

ich we can conceptualize and manipulate imagined

194 CLITORIS

ideas and objects, leads to philosophy and to the ability to think
about our thinking. What ape ever puzzled over the meaning of
its primateness? Of all the mammals, only the cetaceans match
our complexity. The porpoise’s chatter and the humpback
whale’s song may match our Demosthenes, but if they are
smarter, why haven’t they decoded our chatter?

As to the species-wide anatomy of Homo sapiens, we all begin
life with a clitoris! At the sixth week after conception, each of
us anatomically was a tiny girl, floating inside the uterus and
ready for the next communication from our genes. However, the
half of us who became boys felt, at about the sixth week, the
effect of a testicular inductor substance which stimulated our
fetal androgens and suppressed the growth of our ovaries. Thus
the penis is an exaggerated clitoris rather than the clitoris being
a poor cousin to the penis. These events will take on special
importance during later consideration of Freudian female
psychology (42).

Finally, the female Homo sapiens differs from ewes, does,
mares and all other female creatures in that she is the only one
to have orgasm (3). Being equivalent to the male in ecstatic
experience makes her unlike any other mammalian female. The
meaning in the field of morality seems tremendous: human —
uality is not meant only for reproduction. In fact, very lew
sexual contacts do, or should, lead to conception. eo

Not only will the earth not hold all the babies we can ma :
but natural law, if it is to be based on nature rather than som
theologian’s perversions of nature, seems to say to mos ea,
kind, but especially to woman, “Your lot is perhaps cae
children, but not just that. Your sexuality contains the re aa
ity of experience which is close to mystical; you can a Ee
with your mate a shared life whose depth is far beyo ee
economic, legal and gonadal necessity; your unique g

. ”?

z otential.

i i unto you of the breadth of womans Pp :
ris a sign y a ee a

t of man-

powe '
No wonder Platt sees our complexity as not

con, but as an awesome living sun.

THE CULTURAL PSYCHOLOGY OF THE CLITORIS 195

THE SOCIETAL LEVEL

The societal level of organization, or sub-whole, comprises
those areas usually included in sociology and anthropology. As
Ben Huelsman has elaborated, societal groups can have totally
opposite beliefs about the clitoris. Most Polynesian societies,
until bowdlerized by Christian missionaries, made a policy of
encouraging clitoral enlargement and held public inspections at
the temple, where the priest. would measure each maiden’s clit-
oris while she was spread-eagled on an altarstone equivalent to a
gynecologist’s table. This was an occasion, not of shame, but
pride and excitement, analogous in meaning to western society’s
coming-out parties and debutante balls.

In violent contrast we see the custom, widespread in North-
east Africa, of slashing off the clitoris with broken glass, old
razor blades or pieces of flint, in an operation as painful and
degrading as it is mutilating. Our indignation should be tempered
with the knowledge that a cleaner version of the same operation
was often performed by our grandparents’ generation as a
“cure” for masturbation. The ancient Chinese did not mutilate
the clitoris, but did consider a large one unsightly; classical
Chinese erotic art almost never shows the clitoris.

Kinsey’s studies form the first extensive examination of the
sociology of sex. He found that sexual beliefs and practices
varied from class to class more than from nation to nation (at
least in Euro-American societies). What a Liverpool dockworker
does in bed is more like a San Francisco dockworker than it is
like the performance of the Englishman who owns the dock in
Liverpool. In general, the working classes have the least interest
mM sexual anatomy and elaborate or prolonged sexual encounters,
while the educated classes are just the opposite. The lower
Classes regard the upper classes as effete, perverted and jaded,
while the upper classes view the sexual behavior of the workers
3 Promiscuous, animal-like and unimaginative. Social mobility
ea becdsipely obscure these differences, but in bed there are
Ate ee mslions, and a person’s amatory preferences are a surer
Tae his social station than is his income. A dry statistic may

Core this point: among Kinsey’s 33-year-old male subjects

;
|
/
|

196 CLITORIS

with a primary school education, 19 per cent had any oral-
genital contacts with their wife; for the same age group who had
some college, the figure is 49 per cent.

The laws governing sex in the United States seem to have
been written entirely to enforce lower class practices, since in
10ESE states it 4s'-a felony to do anything sexual, except

straight” intercourse with one’s legal spouse. A cynic has said,
“Teaching is the highest aspiration of the lower middle class.”
Perhaps law making and judging should be included in this state-
ment.

As an historical aside, I venture that a century from now,
sociologists will cite Playboy magazine as this generation’s great-
est single lever for producing toleration and compassion in the
area of morals.

Any discussion of societal problems should contain at least a
nod to the famous Generation Gap. The sexual revolution has
been proclaimed but two of the most reliable surveys (37, 38)
indicate little change in what young people are actually doing.
The trend seems to be less promiscuous sex and more stable
sexual liaisons, often leading to formal marriages. In such situa-
tions, it seems likely that more men will learn the location and
usefulness of the clitoris, and that a non-legal union would not
flourish long in the face of unskilled love making.

THE FAMILIAL LEVEL

e scientific
ormous
s tradi-

The next level of our hierarchy is the familial. Th
study of interaction within the family has had an en
expansion during the last decade. Family structure studie
tionally were done on New Guinea natives, not New Josey mae
tives; now such pioneers as Don Jackson, Virginia Sati, Eric
Berne and Jay Haley have changed all that. Every major Ameri
can city has family therapy and family study institutes. af

The complexity of an individual is complicated further ve
he or she participates in the prolonged and intimate inter ae
of a family. A family of five can form dozens of different i
binations of alliances—just on one subject. The only thing ott
preserves the sanity of family therapists is that there ge
tive themes and patterns, as illustrated in Games People UAL

THE CULTURAL PSYCHOLOGY OF THE CLITORIS 197

Families rarely would have occasion to discuss the clitoris as
such, but parental reaction to the universal childhood impulse to
masturbate may take many forms: horror, rage, disgust, neutral-
ity or pleasure. An attractive, well-to-do and neurotic woman of
my acquaintance spent her nights, when young, with her arms
tied to the bed with silk ribbons. In many other ways, she had
“every advantage,” but the final outcome of her parents’ life
style was to leave the girl a mental cripple. Such a person’s
ambivalent feelings toward her genitals would certainly include
the clitoris.

There must be a million methods of child-rearing, and every
bookstore is full of contradictory advice. What is clear is that
families can send their child strong messages about self-worth. If
the message regarding wholesome self-love is negative, the result-
ing adult will be crippled in his or her ability to love, both with
the spirit and with the body.

What families sometimes do that may be even more harmful
than directly negative messages is the sending of ‘“doublebind”’
messages, in which there are two simultaneous, mutually exclu-
sive commands. This produces confusion, rage, self-doubt and
perhaps even the behavior called schizophrenia. Therapists who
work with whole families see this in action. Usually, one mes-
sage 1s spoken, while the other, opposite message is conveyed by
voice tone, facial expression or body posture. A simple example
might be for the mother to say to her daughter, “But, Mary,
you know we love you,” while the mother’s face and hand
muscles betray a posture of hatred and rejection.
ae a psychoanalytic focus in the study of early
itl Caen. e Family Romance or oedipus complex. For girls,
eae a may be formulated as follows: at roughly age three,
Ae roe ae ou ae of her wish to have exclusive posses-
ile and female genitals snd their posrble uses! This change is
eon Stein as eat ah possible uses. This change is
open eee eased riva ry with brothers and sisters, but
ties oe ally in her relationship with father. The girl
oe = uP ace her father and be Daddy to her mother. When
Aen ce ae does not have a penis, a realization which
(erie ae ee ense feelings of shame, inferiority and jealousy
» She 1s enraged at her mother for having permitted

198 CLITORIS

her to be born without a penis. “In her rage and despair she
normally turns to her father as her principle love object and
hopes to take mother’s place with him” (4). The normal out-
come is for the little girl to be rebuffed by her father in her
desire to be his sole sexual love, and to renounce and repress her
oedipal wishes. Brenner emphasized, “the most important single
fact to bear in mind about the oedipus complex is the strength
and force of the feelings which are involved. It is a real love
affair.”

This highly compressed account of the oedipal relationship
does not do justice to the enormous psychoanalytic literature on
the subject. As in many areas of psychoanalytic theory, what
previously was accepted as an article of faith is now open to real
question as to accuracy, relevancy and universality. One of the
technical problems of individual psychoanalysis is that there is
no corrective reality process operating. In theory, the analyst is
silent and neutral and the patient’s free associations are com-
pletely spontaneous. The result should be aseptic, scientific and
objective revelation of the patient’s thinking. What seems clearer
in the last decade is that psychoanalysts have been naive about
the amount of suggestion that takes place. Respected investiga-
tors like K.M. Colby have begun to document the extent to
which the analyst’s expectations and theoretical constructs are
conveyed to the patient. A remark, a yawn, a sigh, a eee:
heavily in the chair—all these give constant “coaching,” in whic
certain trends are reinforced and others are suppressed, very
much like what behaviorists call operant conditioning.

When the whole family is present, the therapist (or therapist)
is outnumbered. His interpretations are more likely to be are.
lenged; the family interactions are seen “Jive” rather through be
bias of the solitary patient’s second-hand reporting. This suge a
that the family therapist may have a better chance of coe
family reality than the classical analyst. To go further, ig Eoin
(48) states that any therapist who sees only one spou
married pair is contributing directly to a divorce.

THE CULTURAL PSYCHOLOGY OF THE CLITORIS 199
THE INTERPERSONAL LEVEL

This leads to the next two hierarchical levels: interpersonal
and intrapersonal. They and the familial system are closely re-
lated. Except for children raised in orphanages, most people
spend the first decade and a half of life learning attitudes and
reactions from their family, responding with the nervous system
they have inherited, and adding their own spontaneous ideas. No
one factor seems clearly dominant; we are shaped on the anvil
of heredity by the hammer of environment. When we leave our
families, we usually establish a specially close tie with one or a
few other adults: a roommate, a lover, a spouse, a psychiatrist.
This is the hierarchial level I designate adult interpersonal, and it
is here that I want to examine the current major controversies in
sex research. It should be clear that the interpersonal level inter-
acts with all the other seven levels of organization.

Scientific knowledge about sexual matters in America today is
not a unified area, but is rather sharply divided into at least two
camps, which I term the Reichian dialectic neo-Berkeleyists
(RDN) and the physiologic viscographers (PV). The leading
RDN’s are Natalie Shainess, Leslie H. Farber and Alexander
Lowen. The PV’s are, of course, William Masters and Virginia
Johnson. I tend to sympathize with the PV’s. The two designa-
tions deserve some clarification.

Wilhelm Reich (born 1897) worked closely with Freud in the
carly days of the psychoanalytic movement, and was formally
expelled from the International Psychoanalytic Association in
1934. His early work emphasized that mental attitudes and mus-
cular tension were vitally interrelated; Reich believed that sexual
Inhibitions were not only the cause of personal misery but led
People to inflict their misery on others in the form of political
Tepression, inquisitions and the like. According to Reich there is_
4 correct type of orgasm which comes only from intercourse and
Only occurs when the intercourse involves involuntary pelvic
movements. Although I take exception to the insistence on only
one correct type of orgasm, I think most of what has just been
Summarized is highly useful.

Reich’s work after 1937 is less germane to this discussion,

200 CLITORIS

since it centered around the concept of “orgone energy,” which
many scientists dismiss as the creation of a gradually deteriorat-
ing self-deluded crank.

Richard Rabkin has observed that Reich is an embarrassment
to the orthodox Freudians since he represents the logical culmin-
ation of Freud’s ideas on orgasm. (It is said that the saving grace
of the English is that they never carry anything to its logical
extreme; the Freudians may wish Reich had been English.) The
relevant aspect of all this is that Freud and Reich and most of
their followers believe religiously that as a woman matures, her
sexual “leading zone” is “transferred” from the clitoris to the
vagina; if the woman continues to need direct clitoral stimula-
tion for orgasm, it is a sign of immaturity or neurotic illness.
This idea sprang into Freud’s head in 1910 without a visible
shred of experimental evidence and it has probably caused more
unnecessary worry than any other single psychological notion
(9).

Now about the neo-Berkeleyism. George Berkeley became
Bishop of Cloyne in 1734. In his several books on philosophy,
the central ideas are that 1) all qualities are known only in the
mind, 2) matter does not exist apart from its being perceived,
and 3) the observing mind of God makes possible the apparent
continued existence of material objects. As an example, if a tree
falls in the forest and no one sees it fall, then the tree and its
fall did not exist, except perhaps through and in the mind of
God.

The relevance of the Berkeleyistic view is this: the critics of
Masters and Johnson state that any person who would be a
subject in such research is a priori abnormal, that the conditions
themselves produce further bias, and therefore any conclusions
from sex research which uses direct observation and actual mea
suring devices are invalid. The RDN’s (41) claim that the only
reliable information is from patients, who are describing second
hand, days or even years later, events which cannot be verifie
or recorded in any way!

Dialectic is the philosophical principle that things are, a
become, their own opposite. The dialectic neo-Berkeleyans a
lieve in only that which has not been seen; any material ©

or will

THE CULTURAL PSYCHOLOGY oF THE CLITORIS 201

dence is proof of error. (In contemporary psychology, this is
also called chutzp ah.) One can only admire the confidence of a
group which claims as Its strongest proof the fact that it has no
direct observations.

Such a tour de force of Alice in Wonderland logic may be
spoiled by repetition, but there is more to come. Shainess (39)
sayS, “++: I question whether an ‘in vitro’ laboratory simulation
of coitus can bear any resemblance to the normal...” (the nor-
mal, presumably being determined by her own psychoanalytic
research), yet one paragraph later she states, “. . . possibly be-
cause it is rare for a healthy woman who has mastered her life
conditions to come into analysis, it is difficult to determine the
normal or healthy libidinal drive. ...” Since she begins by stat-
ing that her method is the correct one and then adds that it is
hopelessly biased, we may be seeing here an example of meta-
chutzpah.

Alexander Lowen (22), a long-time pupil of Reich, writes,
after having used 192 pages defining a correct orgasm, “No one
but the individual involved can state definitely whether or not
he or she has experienced an orgasm in the sexual act.” This, of
course, raises the question of how the analyst can tell the pa-
tient that his or her orgasms are not correct ones. The communi-
cation problems thicken as Lowen continues, “Contact and
friction alone, such as when the penis is masturbated or brought
orally to climax, can produce ejaculations but never orgasm.” It
is clear that Lowen redefines orgasm to fit his theory.

As a final note before discussing the physiologic visco-
graphers, I would like to indict the RDN’s on charges of Chron-
ological Primitivism, the belief that in some bygone Golden Age,
people and societies were more natural and healthy, but through
Tecent corruption have become degenerate and effete. Jean
Jacques Rousseau was fond of this notion. Chronological Primi-
tivism is clearly in evidence when Shainess says, “Sexual inade-
quacy in either sex is a sign of our times, and related to mant-
fold other aspects of our lives. We cannot turn back the Sloe
But we can search for what was meaningful in the past...
(40). ;

The objects of all this RDN excitement are the chief and

202 CLITORIS

almost only physiologic viscographers, William Masters and Vir.
ginia Johnson (26, 27). Physiological of course, because they
have actually been measuring real, live human beings having real,
live sexual behavior. Viscographers because they publish their
findings in a literary style which is thick, adhesive and nearly
unreadable. (Viscum means “bird lime,” a sticky substance
smeared on branches to capture small birds.) The RDN’s have
rightly criticized the Masters and Johnson writing style—but for
the wrong reasons.

The spoken conversation of both William Masters and Virginia
Johnson is totally lucid; it is very clear that they rewrote Hy.
man Sexual Response so it could not possibly be interpreted as
pornography. Established investigators should ignore such pos-
sible charges and say their say. The treatment of couples by
couples is sound therapy. Their verified results are better than
anyone else’s thus far. Their marriage-saving work needs the sup-
port of clear expository prose.

These polemics of doctrine are a prelude to the main theme
of this chapter: the clitoris and its role in interpersonal sexual-
ity. First of all, style is everything.

Mating is not random. Except for forcible rape (and even that
may sometimes be an exception) we choose our partners. Obvi-
ously, the real world sets limitations. An Irish secretary in Man-
hattan is not likely to find herself in bed with an Australian
aborigine. Geography, race, language, and social class are the
first selective determinants. The next step in the sorting process
is choosing among partners who are available. This is still a field
of vast complexity—masochists may seek sadists, hysterics may
seek paranoids, rescuers may seek alcoholics. Hopefully, most
matchings are healthier and less overdetermined. In time, nearly
everyone finds a companion who comes close to the ideal males
If the individual seeks someone like mother or father, this ints
duces another level of complexity, depending on the intensity if
the need and what the parent was like. Since only the individua
can know his or her own body’s exact preferences, the perfect
sexual partner exists only in masturbation fantasies. pict

The possible interpersonal combinations are endless, aD _
following aphoristic observations are highly selected. All coup

THE CULTURAL PSYCHOLOGY OF THE CLITORIS 2038

who are married have grounds for divorce. Moods change from
day to day. One of the few helpful marriage guides for men
occupies just five pages of Peg Bracken’s book, I Try to Behave
Myself. The spouse who calls out some other partner’s name at
the height of passion will have a lot of trouble—soon. Male
overreaction to a woman’s occasional coldness may be because
he knows: 1) she is basically capable of many more orgasms
than he is, and 2) as they both age, her superiority will be
accentuated. While it is more.common for a man to leave his
wife for a younger woman than vice-versa, this would be re-
versed if women’s taste in men were as indiscriminate as men’s
taste in women. Enough aphorisms.

Interpersonal psychology includes cooperation (or lack of it)
in the physical act of sex. Both technique and good will are
necessary. The sex technique advice in many marriage manuals
usually contains at least three harmful recommendations. The
first is for the man to find and rub the clitoris with his finger.
The flexible anatomy of the clitoris means it will usually escape
the searching digit and if the man is successful, his dry, cal-
loused finger will quickly make the clitoris raw. The second
Piece of advice is to “ride high” during intercourse, so that the
upper surface of the penis rubs the clitoris. The man who con-
scientiously follows this dictum will give his wife cystitis (from
crushing the urethra) and rectal pain (from the angle of their
union); just before orgasm the clitoris retracts so the whole ma-
neuver becomes impossible anyway. The third helpful hint is that
@ woman is mature only when her orgasms come totally from
vaginal stimulation. The worry from this idea, compounded by
the pain from the first two techniques is enough to impair any
Marriage.

. The soundest advice in interpersonal affairs is Richard Con-
on's—respect is the best aphrodisiac. Couples who give and
eo mutual respect will find their path broad and well lighted.
C alternative seems best illustrated by Alexander Portnoy—the
Solitary Don Juan.

CLITORIS

THE INTRAPERSONAL LEVEL

The sixth level of the hierarchy is the intrapersonal—the realm
of inner life, personal thoughts and communication with self,
dreams and reverie. The intrusion of others keeps the intra-
personal and the interpersonal in frequent contact.

A starting point for the study of the intrapersonal is the
observation that the human mind is constantly generating un-
willed, unintended images, sounds, smells and other sensory per-
ceptions that have no visible personal meaning (21); an analogy
might be the letters that bubble to the top of a kettle of alpha-
bet soup. They have no pattern or meaning. They are no more a
communication than the hum of an electric typewriter without
its typist. All the content is latent, formless; only the superim-
position of the owner’s volition can add meaning. The process of
conscious thinking is constantly influenced by these random sen-
sory eruptions.

Probably related are the subliminal sensations found by a
team of San Francisco neurosurgeons (20). They discovered that
small, brief experiences, either through sight or touch, may
come into the conscious mind only after a delay or even not at
all, but the arrival of the experience at the cortex can be deter-
mined immediately by an averaging computer, which can detect
what is usually invisible in the jumble of other brain events.
Other research (5) has shown that brain cells are spontaneously
and unpredictably active, and that only average figures can be
found for how much or when any network of brain cells will
fire. The basic housekeeping areas of the brain (e.8-, respiration
centers) have more predictable patterns of activity, but these to
are only statistically predictable, rather than being known at any
particular moment. eae

Thus the spontaneous generation of images, the unpredictal z
spontaneous activity of neurons, and the unconscious reecEue
of consciously unperceived events all create a continuing =
powerful background to the visible events of intentioP
thought.

Tice events of course have implications which could expan’
this inquiry to impossible proportions. Clearly daydreams,

THE CUL
TURAL PSYCHOLOGY OF THE CLITORIS
205

pela genes Py et ing, prayer, Prolonged wakef
tion and psychedelic drugs. Others are ter ie pa
dinary mental experience. This can Cues ak led b
if the letting go of inhibitions and Behe
sary to orgasm, is perceived as a personal —
orgasm becomes akin to death and dissolution A

pression for the brief change in consciousness A nace eal
French term petit mort (“little death”). Most of We vans
to risk many such little deaths since we feel sure of ane ar
ate rebirth. For some, the same sensations conjure up ie i
separation, actual death, dismemberment and bizarre transfi ura-
tions (13, ‘14). Again, some people welcome intense ae ae
of sexual time and space and enhance them with marijuana, LSD
or amylnitrite, which can make orgasm truly awesome.

A phenomenon which may link several of these elements is
the perception, while falling asleep, of a “something” touching
the face, mouth and hands (10). A likely explanation is that this
is a memory, from preverbal infantile experience, of falling as-
leep at the breast. The little that is known of the thinking of
infants suggests that they are quite unclear about what is them
and what is the outside world. This same disturbance in boun-
daries is seen in dreams and the perceptual changes of intense
Sexual experiences, which the healthy person can accept.

One of the problems of American intrapersonal psychology is
that so much of it is Freudian, either stated by Freud himself or
a follower, Almost all American psychiatry is either Freudian or
a Yeaction against Freud; he has become the point of reference.
However, the last twenty years have seen a mass of new material
‘nearthed regarding Freud’s personal blind spots, not the least
of which was his lack of understanding of women. Ti) isp no
eccuon to Freud’s courage, strength a eae Sears
oe peau: hovel ee seus aH That plus

ee middle-class Jew in Vienna in the’ sa het aks

* Own personal and family style make it prepo eve
Cribe to him a eG a bi ctivity. There may be theologi

per-human obje

y any extraor-
problem since,
Ness, so neces-
tegration, then

206 CLITORIS

cal logic in Christ’s being his own Father, but for Freud to have
been the only analyst to have analyzed himself (he refused
Jung’s offer) is a bit more than even his admirers Care to
swallow.

His visible bias shows in many scientific articles and personal
letters in which he clearly sees women as defective, inferior and
incomplete. Wheelwright (47) has tried to nudge the Freudians
away from such notions as penis envy by his offering of the
breast envy concept to explain male problems, but to no ayail.
One of California’s leading Freudian psychoanalysts (49) told
me, “It isn’t a matter of bias, the female genitals are ugly.”

The many theories of personality (i.e., intrapersonal psychol-
ogy) im western culture alone form such a tangled thicket that
any attempt to relate them all to female sexuality would easily
fill an encyclopedia. The followers of Jung, Freud, Rank, Adler,
Reich, Sheldon, Lewin, Eysenck, Pavlov, Murray, Allport, Berne,
Skinner, Rogers, Murphy, Mead, Fromm, Horney and Sullivan
would all be insulted if their approach were to be improperly
presented. I will leave this task to someone else and only sum-
marize what seem to be crucial points, based mainly on observa-
tional research, not speculation.

The ability of a woman to have an orgasm can be inde-
pendent of any partner and can be considered as an we
personal experience. Not only is a partner unnecessary (thoug,
desirable) but even pelvic physical stimulation 1s inne
Forty per cent of all women have had dreams which a et
orgasm (15). Masters and Johnson have several subjects ee a
roduce orgasm by deliberate fantasy. I knew a woman who 3
- i j ion; others are capable ©
an orgasm on learning of a job promotion; 0 Yen
orgasm during times of intense excitement, such as havi s a
political candidate win. There are several reports of orgas
ciated with nipple stimulation or viewing works of a ae ane

The converse is equally true. There are numerous nite
even with strong physical stimulation an orgasm 15 ae sy. 10
clear illustration of the inseparable nature of mind an == SOR
a remarkable essay (18) on the psychology of i heer en
mous woman novelist illustrates how men write “rab realistic;
exaggerated and fantastic way, while pine as one passage?
and emphasize the mental, not the physical side-

207
THE CULTURAL PSYCHOLOGY OF THE CLITORIS

abandoned by her lover, but later reunited with
him. She finds that she cannot respond: “Now this tiny grain 2
d bt arrested her orgasm. She lay back weary from desire an

2 es, but without the fulfillment. Pierre bent over her and
Od in Fi gentle voice, ‘I deserve this. You are hiding away, even
Pech you want to meet me. I may have lost you forever’ ves
‘No, not forever,’ said Elena. ‘Wait. Give me time to believe in

the heroine was

ain.’ 99
tee different this dialogue is from the aggressive angular,

external prose of most male novelists (and scientists). The wo-
man’s touch is more with the reasons, not the actions.

There have been various attempts to quantify and study who
has orgasm and who does not, and why. Terman (46) studied
556 wives who were part of his group of persons with I.Q.s in
the gifted range. He categorized their orgasm adequacy on the
basis of the question: “In sexual intercourse, do you experience
an orgasm always or usually (387 wives), or sometimes or never
(169 wives.) He then asked dozens of questions of both groups
and compared the answers, with some surprising results. The
group who had orgasms “seldom or never” seemed as happy in
most aspects of marriage as the other group. There were no
significant differences between the groups in their reaction to
losing their virginity. Also perhaps surprising is that the time
duration of each act of intercourse was about the same for both
groups, tending to eliminate the husband’s rapidity as a cause.
Thirty-two different questions about childhood experiences
yielded only one item which distinguished the two groups of
wives—the question of early sex education by parents: the more
education, the more orgasm. There were no findings which
would confirm an oedipal hypothesis. One of the few definite
conclusions was that the husbands of the orgasmically inade-
Tee pesePadl a “exceedingly strict”’ childhood discipline.

e adequate wives tended to be more cheerful

a eacanle: There were no differences in divorce rate for the
acer In general, the wife’s “personality” was the single
‘ena ant variable. The wives with less orgasm described
as Oversensitive, grouchy, regretful, prone to ask ad-

Vice and unsure of themselves.
Gebhard (8)

analyzed the answers of 1,026 women and found

208 CLITORIS

a greater connection between marital happiness and orgasm. Of
women whose coites ended in orgasm more than 90 per cent of
the time, 59 per cent described their marriages as very happy.
Interestingly, 38 per cent of the women with “very unhappy”
marriages also reached orgasm in more than 90 per cent of coital
experiences. Clearly, happiness is not everything. Gebhard also
found a clear positive correlation between the length of foreplay
and achieving orgasm: longer foreplay, more orgasm. The corre-
lation between duration of intercourse and frequency of orgasm
is also positive but more complex: “In brief, 16 minutes of
intromission suffices to bring essentially all women to the limits
of their orgasmic capacities.”

A Pennsylvania State University investigator (43) studied 80
unmarried college girls, 40 of whom usually experience orgasm
with coitus and 40 who had never had a coital orgasm, even
though they had a similar amount of coital experience. He
found several features characteristic of the girls who were or-
gasmic: they controlled their movements during coitus until near
orgasm when they lost (or relinquished) control; they felt about
the same degree of interest in sex as did their partners; they
“faked” orgasms more than the girls who never had orgasms;
and they were less stable in temperament. The non-orgasmic girls
exerted much conscious control over both internal and external
pelvic movements. This would tend to confirm Reich's ideas
about the necessity of giving up voluntary control during parts
of successful coitus. :

Two New York researchers (7) examined and interviewed eX-
tensively 42 female volunteer subjects under the age of 45. The
findings indicated that paper-and-pencil personality test ie
age of marriage and previous dating behavior had little correla-
tion with current sexual responsiveness. They did find strong
evidence that ability to tolerate and enjoy intense sexual feelings
was connected with successful sexual response, which confirms
the importance of not being afraid to “let go.” Another finding
was that a general enjoyment of life pleasures, including g°°
food, was a strong predictor of sexual happiness. A ie
special interest was a seven-possibility questionnaire, WF,
question was: “In your attaining orgasm, does clitoral §

—_<——

THE CULTURAL PSYCHOLOGY OF THE CLITORIS 209

tion contribute much more than vaginal stimulation.” The other
six questions were different shades of emphasis ending with a
question in which vaginal stimulation was dominant. The usual
response was that the clitoris and vagina were of equal impor-
tance, and, further, there were no clear correlations between
clitoral-vaginal preferences and any other variables. The team
concluded, “Such data... forcefully put the burden of proof
upon those who wish to maintain that the clitoral-vaginal dis-
tinction reflects important aspects of the organization of the
female personality.”

Marmor (24) was one of the first Freudians to raise the heret-
ical notion that Freud did not know much about women and
their orgasms. Marmor suggested a theoretical neurological mod-
el: female orgasm is a spinal cord reflex, set off by various
pudendal stimuli. If the cerebral cortex inhibits the reflex, high
degrees of stimuli to that most sensitive area (clitoris) are neces-
sary to “‘fire’’ the reflex; if the cortical influence is weak inhibi-
tion or facilitation, then more diffuse stimuli (vaginal stretching,
indirect clitoral stimulation) can cause orgasm.

A somewhat different approach to sexual classification is that
of Meyers (32, 33), whose ideas resemble Reich’s. Meyers bases
his classification on whether the woman does or does not swing
pe hips when she walks. Those women who swing their hips are

clitorids,” those who do not are “uterines.” The clitorid has a
knack with clothes; she lives for her man, for “la grande af-
faire.” Her search for the perfect partner is often unsuccessful;
the result is headaches, misunderstanding, depression, pelvic con-
S€stion and non-infective discharges. If these speculations could
be verified, the results would be highly useful in understanding
Marriages,

Stoller (44), who has devoted his career to clarifying the in-
terrelationship of sex (possession of ovaries, testes or neither)
and gender (the conviction that one is a man or a woman),
Sently takes Freud to task for his misogyny and unverified belief
a male superiority. Most evidence indicates that the core gender
ca of a woman (“I am a female”) is the simple acceptance

ody ego, which develops regardless of chromosomal state or
§enital anatomy, as long as the parents of the subject had no

210 CLITORIS

doubt that their child is a girl. Stoller remarks, somewhat sharp.
ly, “If Freud had treated a woman without a vagina, I think he
would have seen that the only thing a woman wants more than
a penis is a vagina.”

Thus the intra-personal level of organization includes. self-
image as a person and as a woman, the spontaneous flow of
thoughts, the ability to accept strong sensations and the projec-
tions of self in gait and posture.

THE ANATOMICAL LEVEL

The seventh level of our hierarchy is the anatomic, with em-
phasis on the nerves, muscles and blood vessels which make
sexual functioning possible.

The fundamental anatomy of female orgasm is hydraulic: the
pelvic, vulvar and clitoral veins and capillaries become engorged
with blood; edema fluid accumulates in the pelvic tissues; full
engorgement of the vestibular bulbs is associated with the onset
of about ten muscle contractions (orgasm) which empty most of
the extra blood and fluid from the pelvis. This progression of

is summarized in the now-famous Masters and Johnson

events
plateau, orgasm and reso-

four phase sexual cycle: excitement,
lution.

Many stimuli can produce this cycle of events: fantasy; breast
stimulation, rectal stimulation, direct clitoral-mons stimulation
and intravaginal intercourse; the latter two are by far the ee:
common. The resulting orgasms appear to be anatomically ! Fe
tical; the presently-used terminology, ©€-8-» vaginal orgasm, ie
confusion, and such terms as vaginally-induced orgasm or +
specify the regions OF mode of maximum stimulation, eet
introducing any claim of further understanding the mee pate
The following discussion of the functional anatomy OF Met
orgasm induction presupposes several conditions: the a eri pe
the vehicle for selling some undocumented personal, po”

; iscussion
professional viewpoint; the hypothetical woman wedi ae her
: . Agi cts ners
likes sex, is not resisting an orgasm, and espe Judes strons

sexual partner; and further, her sensory input inc

stimulation of the pelvic organs.

THE CULTURAL PSYCHOLOGY OF THE CLITORIS 211

The clitoris is the outermost sexual receptor. The glans of th
clitoris, visible as a button of tissue about Suetinarars si ihe
across, is located above the vagina, where the labia minora join
Only ten per cent of the clitoral structure is visible. The a
ninety per cent, equally important, lies like the two prongs of a
wishbone along the rami of the pubic bone. The glans ie the
Jabia minora both contain enormous numbers of receptor cells
whose sole function seems to be that of receiving pleustrable
stimuli. The entrance to the vagina is almost entirely surrounded
by the vestibular bulbs, a pair of blood vessel bundles, which
connect with the network of veins surrounding the rete of the
vagina. All these vessels serve as erectile tissue, contributing to
the narrowing and lengthening of the lower one-third of the
vagina seen during the plateau phase. The walls of the vagina
produce a clear fluid during sexual excitement, which lubricates
the area and makes penile movement easy and painless. The
lining of the vagina has few nerve cells, but this does not mean
there is anesthesia, since the pubococcygeus muscle, which sur-
rounds and attaches to the vagina, contains proprioceptive or
stretch-receptor cells. These (or some other pleasure receptors)
are concentrated in two grooves which can be described as lo-
fic i ae oe oes o’clock, if the vagina, seen from below is
Ry ee se ace. If the pubococcygeus is strong and
a ee ie s true in only about twenty per cent of women, —
digital ae “ ses can respond to touch, either penile or
ae Pinca : oa v sexual-pleasurable sensations. The strength of
tain Bees ; e location of the sensitive areas can be found
ee - y physical examination. Women whose pubo-
ae ae) usc § is weak and thin can be taught to exercise the
cae = will notice an improvement in coital sexual
ae Se Se a ee More than sixty per cent of
Ie meine issatisfaction can be greatly helped by this

Some women notice that the pubococcygeus sexual recept
are more sensitive id h cc joki ete
PORN sca on one side than another, and jokingly refer
eee aving left-handed or right-handed orgasms. Con-

iaphragms spread these structures laterally and make

vaginally-j out
Armold aes orgasm more difficult, according to the late

ee Senne oe eee

212 CLITORIS

Some recent research has suggested that the evidence for vag-
inal wall insensitivity may be challenged. Some mammals have
been found to have free nerve endings emerging from genital
corpuscles in the vaginal wall (16). An unresolved controversy in
this subject is the clear disagreement between Kegel and the
Masters-Johnson group. Masters states (28) that in itself the
pubococcygeus has nothing to do with sexuality, and that train-
ing of this muscle is of benefit only for minor degrees of urinary
incontinence; ‘“‘... under direct observation, the pubococcygeus
has been observed to relax during late plateau and orgasm, al-
lowing the mid-cervical diameter of the vagina to increase.”
Masters, however, seems to misunderstand Kegel, who does not
say that the pubococcygeus contracts during orgasm, only that
strengthening the pubococcygeus changes many neural, vascular,
and muscular aspects of the total pelvis, with increased sensory
perception-awareness (sensate focus) and increased ability to
achieve orgasm during intercourse.

The other data suggest, teleologically, that the pelvic organs
“want” or “like” to have internally-induced orgasms; in women
born with no vagina, an artificial vagina can be constructed,
where one should have been, and a woman can have normal
intercourse. Further, the lining of her new canal begins to pro-
duce the transudate fluid of a natural vagina, and within a few
months she is able to have vaginally-induced orgasms. A further
example of a ‘“cooperative”’ pelvis is seen in the recta of es
who _ practice anal intercourse. There is strong hypertrop y a
the hemorrhoidal vein network, which responds to arousal wl
vasodilation and flow of transudate into the rectum. The mys
cles around the rectum act like vaginal muscles, producing

strong, multiple orgasms. ;
nie Daag muscles may cause pain as well as rn
Paradis (35) reports 92 cases of patients who gee
complaints of rectal pain. On examination the be ee ie
Area’ is, not the rectum but the tendenous arc 0 f Bee
especially adjacent to the ischial spine

cygeus muscle, pe
elvic muscle tone

i ti
tients had poor P and habitually s4 spasm:

ositions, which probably caused the muscle es par
ene digital stretching of the attachments of the

muscles cured most of the patients.

THE CUL
TURAL PSYCHOLOGY OF THE CLITORIS 213

Male-female coitus certain i
Mb pibecdccveem nee
shown that the clitoris is stimulated nat oe
the penis, but through an indirect rou Wh
clitoral shaft points straight down or ee ]
during stimulation it moves almost 180 13
just before orgasm, retreating back under the prepuce, d b
contraction of the ischiocavernosus muscles. Each ee
is transmitted by the arch of tissues that goes ae ia ae
the vagina up to the prepuce and down to the other sid =
vagina and results in an intermittent pulling down of a oe
puce, which slides over the clitoris, leading to strong stim , : -
and contributing to an important clitoral aia “ te
vaginally-induced orgasms. ae

Another important area is the lower or outer one-third of th
vagina. This area becomes elongated and swollen, formin a
Masters and Johnson call the “orgasmic Hakan. The rete
of the pelvis, the swollen part of the vagina, and the rhythmic-
ally stimulated clitoris form together a unit which is al influ-
enced by coitus. Although at a particular time, with a particular
woman, one area of stimulation may be especially important, it
seems clear that coitus contributes potentially pleasurable cartel
to all of the pelvic organs.
ee stimulation of the clitoris (including mons traction,
ape ea (19) and vibrators) will produce orgasms with
oe So = than other modes of stimulation. The percep-
oe vel from the many receptor organs of the glans and

ta along the dorsal nerve of the clitoris to where it joins the
Pee nerve, which is formed from the anterior rami of the
the ; oe and third sacral nerves. The ‘exact nature of how
oe cord and brain facilitate or inhibit response to these
ae 1s unknown, but local electrical brain stimulation (29)
oat Own that many portions of the limbic lobe control clitoral

argement, and that these are the same neurological structures
Which can produce il tion.*

penile erection.

e than the vagina
hnson (27) have
direct rubbing on
en unaroused, the
ightly to the rear;
ces, rising up and,

is Heath’s discovery that
“pleasure centers,” deep
J Nerv Ment Dis 154:

r be

coe addition to the field of orgasmic neurophysiology
i is accompanied by spike and slow waves in the septal

M th :
3-18 oo Heath RG: Pleasure and brain activity in man.

214 CLITORIS

Stimulation of only one of the two principal areas (i.e., clitor-
al and pelvic) can produce orgasm. Women whose clitorides have
been removed can still have orgasms, vaginally induced; direct
clitoral stimulation, with no vaginal pressure can also produce
orgasm. Thus neither clitoris nor vagina by itself seems essential
to orgasm. There do seem to be some differences between clit-
orally-induced and vaginally-induced orgasms, beyond the anxi-
ety produced by theories of clitoral “immaturity.” Some of the
differences can be measured: contractions of the uterus and the
rectum are stronger, and more multiple orgasms are possible,
with clitorally-induced climax. The woman’s perceptions of the
various “types” or orgasm are hard to convey, first because we
lack suitable vocabularies for most bodily functions, and, sec-
ondly, because female sexual response can range along a wide
spectrum of thematic variations, all of which defy simple naming
or classification. With this caveat, women who have experienced
orgasm from both types of stimulation can often distinguish a
difference, and tend to refer to vaginally-induced orgasm as less
intensely focused and somehow more satisfyingly deeper. They
sometimes add that they feel more “womanly.” Most likely this
difference in sensation seen with some vaginally-induced orgasms
is because there is stimulation of the nerves of all the previously

mentioned areas. Anthony (1) writes of her additional pleasure

when receiving anal stimulation, along with the just mentioned

ones. ae
Each couple is different, too, in their anatomic matching.

angles of pelvic approach, the penis and vagina ratios and the

distribution of pelvic receptor nerves all differ. This po
consideration is charmingly described by Cc. M. Chen, the nae
dhist yogi of Kalimpong, who describes his connections wl a
Dakini (a woman who assists a man in Tantric meditation)

with his wife:

merely for play in
inside the lotus
tion of secret
antra of yajra
has its secret
t from one

I have found out the secret purpose was not
various ways but for finding the secret nerve
through many different attitudes, till a certain situa
nerve of the certain Dakini is found. In Buddhism T
love, it has been taught by gurus that each Dakint
nerve in her vagina but their situations are differen

THE CULTURAL PSYCHOLOGY OF THE CLITORIS 215

another unless and until, through many kinds of coitus in many
different postures, one cannot find out this secret nerve. In Dakini
A. vagina, her secret nerve may situated on east side but in Dakini
B. it may situate otherwise. When the secret nerve has been
touched by the male and has directly insert into the urethara,
both medeum nerve were interlinked then the great pleasure of the
female might get a sooner ejaculation much more fast than acting
on other postures which may not able to touch the secret nerve.
Once I was permitted by my Guru Kunjar Rimpoche to practice
vadra love with the pure land Dakini Miss Kuncho. First I had
tried with many other kinds of Coituc attitude, her secret nerve
has not been touched and her ejaculation was very slowly. After-
ward I used the posture like vajrasattva and his consort, i.e., both
set face to face her secret nerve was immediately touched, her
ejaculation happened very quickly. She could not but lie her head
on my shoulder. A great pleasure in her body made her soft and
could not sit straightly. She closed her eyes and felt very delight-
ful. But when I practiced with my wife her secret nerve could be
touched only by playing in the attitude of Paravittaka. As this
attitude was not sitting so she was like the bitch who rolled her
body on the ground with much pleasure. I never changed the
posture since her secret nerve was found out. So was she desired.

(6)

The question of multiple orgasms is also part of the RDN
versus PV controversy. When Kinsey published his book on
uemen (15), he was denounced by many critics, including Drs.
Bie cert epsy.choanalyst and gynecologist respectively,
ee cribed as -. . fantastic tales ...” the descriptions of
an cei given to Kinsey by his female informants. These
eee cs — be forgiven, for that was years ago, and they
, the double handicap of being both male and
a (39) at is harder to understand is that a woman physi-
anf uate to maintain today that multiple orgasm not
oe wes but is actually a type of frigidity! The exper-

ee EEE Meee and the repeatedly documented
mined . ae work do not seem to influence those deter-
a, Se vs. vagina controversy has yet another facet: some

Support of the “transference” idea comes from a

Non:F ,
Teudian, Dr. Arnold Kegel, the gynecologist who made the

216 CLITORIS

pubococcygeus famous. He believes that pubococcygeus weak-
ness is related to human upright posture. Gravity works against
the pelvis and what falls forward (up) in quadrupeds, falls down-
ward in us. Upright posture is so recent a development that the
species has not evolved a naturally reliable mechanism. This is
apparent in many young girls with lax pubococcygii and conse-
quent loss of urine when standing up. Before this is corrected by
pubococcygeus exercises, they guard themselves by using their
external muscles and keeping their legs tight together. With
chronological maturity and/or training the girl transfers sphincter
control to deep muscles. In contrast with Freudian transfer,
which involves hypothetical substances such as cathexis and libi-
do, Kegelian transfer is purely mechanical,. which leads to sim-
plicity, not only in explanation, but also in treatment. Kegel
observes that transfer of bladder control to deeper muscles also
produces the transfer of perception of sexual sensations.

A further note on orgasm involves orgasm as therapy. This
has been apparent to most people for millenia, from personal
experience. Now, the physical benefits can be made clearer. In
1949, Dr. Howard C. Taylor, Jr., a leading gynecologist, pub-
lished research showing that chronic unsatisfied sexual arousal
produced pelvic congestion and fibrosis. The treatment is clear:
relief must follow arousal. Dr. W. Edward Naugler, a San Fran-
cisco rheumatologist, has observed a syndrome of knee and thigh
pain, with mental depression. It is seen in middle-aged ee
who are single or widowed, and seems anatomically caused =
tension in the gracilis muscle, which extends downward from the
clitoris area. All cases have been relieved by masturbation. Many
women have discovered that masturbation relieves nee
cramps. This folk knowledge is confirmed by Masters and ee
son, who suggest that since pelvic congestion 1s like the ede |
of menstrual congestion and water-retention, the same ce sf
(orgasm) should be good for both. Clearly, there are many S} ie
tions where to refrain from orgasm is a deliberate decisio®
produce ill health. =

The anatomy of orgasm and the clitoris woul
moved from politics, yet here too there is serious
Wilhelm Reich denounced the fascists

d seem far Te
debate. Thirty

(and his per
years ago,

THE CULTURAL PSYCHOLOGY OF THE CLITORIS 217

sonal enemies) as sexually inadequate. Reich believed that lack
of fully-satisfying, vaginally-induced orgasms led to a state of
rage and frustration, which caused the brutal behavior seen in
dictatorship. His followers, especially in New York City, are still
of the same opinion. Diametrically Opposed is Anne Koedt, a
radical feminist, who has written a pamphlet, The Myth of The
Vaginal Orgasm, in which she states that vaginal intercourse is
not satisfying to women and is part of a male plot to weaken
and control women. She advocates clitoral satisfaction as the
way to be free of men. Apparently her views are a bit much for
some of her colleagues and another feminist, Nancy Mann, has
written a counter-pamphlet, Fucked-Up in America, in which she
concludes, “I’m sure it’s no coincidence that so many people in
this country have bad sex. It goes along with the general disre-
gard for human pleasures in favor of the logic of making a
profit... but for women to blame it all on men (or men to
blame it onto women) is bad politics.”

A further complication in judging the anatomic role of the
clitoris is that not all clitorides are the same; just as all other
organs and metabolisms have strong differences, so, too, with
the clitoris. Under the microscope (17) the mons veneris, the
labia majora, and the labia minora, as well as the clitoris, can be
seen to contain large numbers of specialized nerve endings,
which mediate and “report” the sensations of touch, deep pres-
me oe and sexual stimulation. While it is common to
a ese endings concentrated in the clitoris, many individuals
a o greater concentration in the labia minora or elsewhere
une ey endings in the clitoris. There well may be an
ee as well as an experiential basis, for the different

Ss of sensitivity and response seen in different individuals.

The functional anatomy of the clitoris might be summarized

ee Its sole use is pleasure; such use brings health and
Ss; and it’s not the only route to an orgasm.

218 CLITORIS
THE ELECTROCHEMICAL LEVEL

The eighth organizational level at which the clitoris can be
described is the electrochemical. Aspects of this are described in
the chapters on neurophysiology and histology. The complexities
of physiology necessitate oversimplification and division into
arbitrary compartments. Most of the body contains receptor
nerves which receive and report stimuli. The receptors may be in
the skin or in the deeper structures; they are the terminations of
nerves which run centrally, ending finally in the brain and/or
spinal cord. Some of the receptors, under the microscope, ap-
pear as bare, free nerve endings, while others have distinct
shapes; the latter seem to receive specific types of stimuli.
Touch, cold, warmth, and deep pressure are perceived and re-
ported by different-appearing microscopic structures; the recep-
tors for pain are nerve endings without the distinctive shapes
seen in the other receptors. :

The sensory nerves run centrally and have their main cell
bodies in the spinal ganglia, which lie lateral to the spinal cord.
The nerves terminate in the cord in connections with other

nerves; these in turn go in many directions and serve many

functions.

Each nerve is itself a complex s
of the nerve has a high concentration of potass
tive electric charge, with a potential of about 80 ;
The exterior of the nerve has a high concentration ©

ystem. When at rest, the inside
ium and a nega-
/1000 of a volt.
f sodium

‘5 sti ted, in
and a positive electric charge. When a receptor 1s spare ,
j j izati of the nerve ut m

some way it begins a depolarization ene

In a fraction of a second, the potassium
begin to exchange locations, and the electric ae s OORREE
This charge passes as a wave Up the nerve, at a ets
until the nerve reaches its termination In the iets “ee
aspects of the nerve in action are a Soe aan
uptake, and an increase in heat, all related pile cee Fe
sugar, promoted by the high energy compoune,

hosphate. re .
I" When the impulse reaches the termination of pe rte
other system conveys the impulse across the synaP

brane. nes ene:

a_i

THE CULTURAL PSYCHOLOGY OF THE CLITORIS 219

next nerve. At the tip of the first nerve are tiny “packets” of
acetylcholine, which begin to diffuse across the cleft between
the two nerves. Six hundred millionths of a second later the
acetylcholine reaches the far shore, attaches to receptor sites and
depolarizes the second nerve, which begins the movement of the
impulse up that second nerve.
In the brain alone, there are about ten billion nerve cells with
millions more in the rest of the body. All of them are busy
receiving and sending messages many times a second. What saves
the system from incredible chaos is the presence of synchroniz-
ing and coordinating systems. One of these is revealed by the
brain waves seen with the electroencephalograph (EEG). Ten
times a second, a wave of electrical activity commences at the
back of the brain and sweeps forward, fading away as it reaches
the frontal area, above the eyes. Many influences can create
variations from this pattern: sleep, age, alertness, epilepsy, brain
injury, low blood sugar and insufficient oxygen. The latter can
be related to sexual excitement in the following way: passion is
associated with heavy breathing; heavy breathing removes some
of the body’s natural carbon dioxide; this chemical change
causes the cerebral arterioles to constrict, which reduces cerebral
blood flow, which reduces the amount of oxygen and sugar
in tee ce beer ne Metre is reflected in
ae ; nes rom a cycle per second,
nen ge pattern (alpha waves) to a 3 cycle per second,
re r hig voltage wave (23). The subjective change is one of
“ing dizzy, disoriented, and mentally far away. These may ha
been the changes observed b i ri ies
a... 8s observed by a pair of Argentinian researchers
subjects masturbated while wired to an electroen-
Cephalograph. At orgasm, there were high voltage, thre 1
Per second waves. Mast d Joh : a gels
“cdl asters and Johnson ran EEGs in their early
he Ba. mostly muscle movement artifact, and pursued
ak ee aspects of orgasm no further (11). The brain waves
che. ae a a new significance in philosophy as well as medi-
training aie ae seems clear that religious meditation involves
oes. elf to have long periods of alpha waves and little of
requencies (45). Tantric Yoga and Karezza both urge

their f
O :
llowers to practice prolonged coitus, without ejaculation,

220 CLITORIS

while maintaining a spiritual outlook. Perhaps this can be inter-
preted numerically as, “Where three-per-second was, there shall
ten-per-second be.” There are inexpensive (ca. $150) devices on
the market, which will tell the wearer when he is producing
alpha waves. In the sexual realm, alpha training may do, central-
ly, what the Masters and Johnson squeeze technique does, per-
ipherally, in the treatment of premature ejaculation. Research
should be done to see if alpha waves and orgasm can co-exist.
Chemistry and electricity are inseparable in the body, as they
are elsewhere. The brain waves are changed by thought, by light
and by overbreathing. The menstrual cycle, with its influence on
sodium and water metabolism, produces changes which range
from insignificant to profound. One woman with Que wlohe
tension snapped at me, “Doctor, my brain is soggy! A Michigan
psychologist (2) studied twenty-six college girls and found that
at ovulation the dominant trends were self-confidence, satisfac-
tion and optimism. The same girls, two weeks later, were nee
sed with themes of death, mutilation, hostility and ~~) e
same fluid accumulation which seems to encourage § yee
thoughts in the brain tends to increase sexual responsivene

ive in the
the pelvis, since most women seem to be most receptiv

i itoris, and the ner-
i enstruation. Clearly, the clitoris,
ee i constantly influenced by 4

it 1 to, are
yous system it is attached bt pee
Seen of strong and sometimes contradictory electro

cal variations.

THE MULTILEVEL PERSON

i i i aneous-
Each person exists at all eight hierarchical ee va
ly. The strength, health and inclination of t % ae Beis
level vary with time. The summation effect © ae
factors may become clearer by two extreme ies ee
In a small Irish village (31), the cosmos (as Pe te unkee
church), the society, the family and the interpetss Re
are all so violently anti-sexual that most wom Bae dis 3 func’
hat they have a clitoris and have no experien ye erochem
ia nee member of a species and as gate n eae ae
cal entities, they function,

d by the

but these factors are

THE CULTURAL PSYCHOLOGY OF THE CLITORIS 221

save them. (At least one psychologist accuses the observer, Mes-
senger, of bias.) By contrast, on the Polynesian island of
Mangaia (25) all life revolves around sex. No male-female social
encounter ends without copulation. All adults are expected to
know a full range of coital and mouth-genital routes to climax.
All women expect multiple orgasms from every encounter and
will not keep a lover who fails them in this. At every one of the
eight levels, a woman and her clitoris are expected to be a
happy combination, and usually oblige.

Current American life falls between Ireland and Polynesia.
Most of us are neither as repressed as the Irish peasant, nor as
totally committed to sexual life as the Polynesians. In brief, the
level of sexual (especially clitoral) responsiveness of a woman
depends both upon her training and upon her innate strengths in
the realms of the spiritual meaning of sexual contacts; the or-
gasm ability that she shares with all members of the species; the
sexual expectations of her societal group; the particular varia-
tions of those teachings as conveyed by her own family; the skill
and personality of her sexual partner; her own internal fantasies
and belief about herself; the distribution, number and locations
of her anatomical nerve endings and pelvic muscle structures,
and the moment-to-moment balance of her various hormones,
electrolytes and other chemicals.

E.M. Forster remarked, “The perfectly adjusted organism
would remain silent.” And so, persons in harmony with themselves
do not experience these eight levels as discrete experiences and
spend little time thinking about themselves or their internal work-
ings. They respond without reflection, joyfully and fully.

REFERENCES

(P.C. — Personal communication)

» Anthony R: The Housew
mor, 1961.

- Bardwick JM, Vehrma
ut

-B

ife’s Handbook of Selective Promiscuity. Tucson, Sey-

ee n SJ: Investigations into the effects of menstrual cycle on
tin€ contractions. Psychosom Med 24, 1967.
fach FA: P.C., 1969.

+ 09

re i
5. eee An Elementary Textbook of Psychoanalysis. N.Y., Doubleday, 1957.
? The Uncertain Nervous System. Baltimore, Williams & Wilkins, 1968.

|
.
;

CLITORIS

Chen CM: Discriminations b
d t nidhi: 4 oe s
(India), Mani, 1969. etween Buddhist and Hindu Tantras. Kalimpong
Fisher S, Osofsk : ed Sa :
piamioen: sofsky H: Sexual responsiveness in wemen. Arch Gen Psychiat 17:
. pee PH: Factors in marital orgasm. J Social Issues 22: 88, 1966.
os Bae ee ae and Frigidity. Boston, Little Brown, 1963.
: wer QO: A contribution to the psychopathol i i ‘
Int J Psychoanal 19: 331, 1988. arreoere: ercaatremeimnt eens?
11. Johnson V: P.C., 1970.
: Kegel AH: Early genital relaxation. Obstet & Gyn 8: 545, 1956.
: Keiser S: Body ego during orgasm. Psychoanal Quart 21: 153, 1952.
“ i S: On the psychopathology of orgasm. Psychoanal Quart 16: 378, 1947.
3 a Ae xed = See Behavior in the Human Female. Philadelphia, W.B.
- ae = et al: in Brecher EM: The Sex Researchers. Boston, Little Brown,
» P- ~ ,
ea KE: Innervation of the human vulva and vagina. Obstet & Gyn 12: 382,
58.
S ane ns Kronhausen PC: The natural superiority of women as eroticists.
ros 1: 65, :
. Legman G: Oragenitalism. New York, Julian, 1969.
. Libet B: Documenting subliminal sensations. Med World News Sep 12, 1969.
. Lipin T: Sensory irruptions and mental organization. J Am Psychoanal Assoc 17:
1055, 1969.
. Lowen A: Love and Orgasm. New York, Signet, 1967.
. Lowry TP: Hyperventilation and Hysteria. Springfield, Thomas, 1967.
. Marmor J: Some considerations concerning orgasm in the female. Psychosom Med
16: 240, 1954.
. Marshall DS: Too much in Mangaia. Psychol Today 4; 43,1971.
. Masters WH, Johnson VE: Human Sexual Inadequacy. Boston,
1970.
_ Masters WH, Johnson VE: Human Sexual Response. Boston,
. Masters WH: Symposium, U. of Calif., San Francisco, 1965. ee
. Maurus M, et al: Cerebral representation of the clitoris. Exper Neurol 13: 289;

1965.

. Med World News, P- 17, Sept. 12, 1969.

. Messenger JC: The Lack of the Irish. Psychol Today 4; 41, 1971.
. Meyers TJ: The clitorid woman. Psychiat Quart 29: 1, 1966. — os 1, 186%
. Meyers TJ: The psychodynamics of the female pelvis. Dis Nerv Syst 24 ae oe
. Mosovich A, Tallaferro A: Studies on EEG and sex function orgasm. Dis Né

54: 218, 1954. ih nee tum
35. Paradis H, Marganoff H: Rectal pain of extrarectal orlgin- Dis Colon & Ree

- 306, 1969. ae
36. Sans The Step to Man. New York, Wiley, 1966. Quoted with permission:
37. Reiss IL: The sexual renaissance. J Social Issues 22: 123, 1966. Ae et 1965.
38. Schofield M: The Sexual Behaviour of Young People. Boston, Litt € sei Saonce
39. Shainess N: A reassessment of femine sexuality and erotic experience:
and Psychoanalysis. New York, Grune & Stratton, 1966. ;
40. Shainess N: The problem of sex today. Am J Psychiat 124:

Little Brown,

Little Brown, 1966.

1076. 1968-

4l.
42.

43.
44.
45.
46.

47.
48.

49.

THE CULTURAL PSYCHOLOGY OF THE CLITORIS . 228

Shainess N: Is there a normal sexual response? Psychiat Opinion 5: 1968

Sherfey MJ: The evolution and nature of female sexuality in relation to psycho-
analytic theory. J Am Psychoanal Assoc 14: 28, 1966.

Shope DF: The orgastic responsiveness of selected college females. J Sex Research
4: 206, 1968.

Stoller RJ: The sense of femaleness. Psychoanal Quart 37: 42, 1968.

Tart CT: Altered States of Consciousness. New York, Wiley, 1969.

Terman LM: Correlates of orgasm adequacy in a group of 556 wives. J Psychol
32: 115, 1951.

Wheelwright JB: P.C., 1961.

Whitaker CA: A reevaluation of “psychiatric help” when divorce impends. Am J
Psychiat 126: 1969.

Windholz E: P.C., 1961.

Chapter XIV

PERSPECTIVES ON ANORGASMIA:
TOWARD A FEMALE PHENOMENOLOGY

Thea Snyder Lowry

Although sexual functioning is perfectly natural, it is seldom
naturally perfect. Orgasm is the appropriate goal in sexual activ-
ity for both sexes, yet perhaps fifteen percent of adult American
women have never experienced a climax from any form of stim-
ulation (1,2) and perhaps half of all married women do not
achieve orgasm in coitus reliably with their partners (3,4). Has it
always been this way?

The sexuality of our primitive ancestors has been debated at
length. For the human race to survive, obviously, males must
ejaculate within the female’s vagina to ensure conception, but
orgasm for the female is not a biological necessity. Elkan (5) has
inferred from this fact that females are evolutionary late-comers
in achieving sexual climax, but Sherfey (6) contends that pre-
historic females were frequently and readily orgasmic. Unfor-
tunately for the theorists, the tens of thousands of Paleolithic
(35,000 B.C.—10,000 B.C.) European cave paintings do not con-
tain a single image of copulation, either human or animal (7).

Perhaps instead species survival depended on a middle range
of sexual interest for both males and females. If both parents
decamped in search of new sexual partners, their offspring could
not survive infancy; if mutual sexual interest were entirely ab-
sent, few replacements would be conceived. A female who Pa
came sexually involved enough to attract a mate who ee
protect her when she was most yulnerable would be more 4 2
to raise children than either the female who chose to abdica
her caretaker functions in the quest for sexual stimuli or the one
who constantly rejected the attentions of males.

Of course, sexual availability is not the same t §

i have much to do with subse
but pleasure leading to orgasm may i hicntien
quent availability. It is also likely that a trade-off w eae
assure the female a protective mate and the male a sex

hing as orgasm;

224 ,

PERSPECTIVES ON ANORGASMIA 225
ner would be recognized as workable ¢
woman to fake it was the Ice Age cav
tiny newborn with winter coming.

Whether female PSI Capacity is an evolving phenomenon
or not, what zs truly evolving is an increasingly strong conviction
among Western women that they themselves are the only appro-
priate persons to define and interpret their own sexuality. Kin-
sey’s studies suggested that there is an enormous range of inter-
est in sex for both males and females, and differences between
any two individuals may be vast. Sexual ideology has tended to
be either proscriptive or prescriptive while actually ignorant of
reality. Arrogance and naivete have burdened both scientific
investigators and lovers; males, who are usually one or the other,
have either failed to ask the right questions, asked no questions
at all, or misunderstood the answers to the questions they asked.
Dr. Jane Calder (8) says “...men can never know what female
sexuality is all about, because they are never more than tourists
in the female’s world and like all tourists, they frequently get an
other-than-straight count from the natives.”

Asked irrelevant questions, women have tended to answer in a
manner calculated either to make the questioner disappear or to
make him hang around; only rarely will a woman risk telling the
truth about her sexuality to a man.

_ Sexuality is specifically gender-linked, and inferences from the
€xperiences of the opposite sex have only limited relevance. It is
Phenomenologically impossible to engage psychologically in the
sexual personhood of the opposite sex. While it is quite true
that Many psychological aspects and emotional states are identi-
cal in both men and women, sexuality does not seem to be one
of these. Sexual emotions and sensations are uniquely and insep-
arably linked to the structures and minds experiencing them.

: Some of the reasons for this are obvious and need no elabora-
Hon: females are capable of pregnancy, possess different geatal
and undergo monthly tides of endocrine stimulation whic 2
Males ‘can: never experience. Females produce food for babies
"om their own bodies; females have much more sensitivity to
~“Ors than do males, thanks to estrogen. Female SN aed
SAMA yin fluénceevaneunte respond negatively or positively to

arly on. Perhaps the first
e dweller breast-feeding a

226 CLITORIS

the male’s pheromones in a way which is not understood today.
Females have female brains and respond differently from males
to steroid stimulation im utero, and exhibit response patterns
unlike males’ even as newborns (9). Finally, females are appar-
ently patterned both socially and constitutionally in different
ways in the utilization of their cerebral hemispheres.

The usual terminologies of anorgasmia are perjorative; I use
terms which are operational and descriptive rather than disparag-
ing or suggestive of dysfunction or inadequacy. What other au-
thors define as primary non-orgasmic response or total frigidity,
I term a pre-orgasmic state; the implication is clear that the
woman has not yet identified or experienced orgasm but can
easily learn to do so. Secondary anorgasmia is that condition in
which the woman has been orgasmic in the past but now exper-
iences difficulty in having reliable orgasms in a way that she
values; psychoanalysts might describe this as partial frigidity.
Low sexual tension is self-explanatory; for some women sex is a
low-priority activity, and they truly wonder what others see in
it.

Since most sexual disorder classifications are male creations,
the sexually unresponding woman, then, is probably not what
males think she is. Her non-response stems from no learning
(preorgasmia), communication difficulties (secondary anorgas-
mia), or low sexual tension. Kinsey demonstrated that the usual
statistical distribution obtains in frequency of sexual outlet;
some perfectly normal persons simply have no interest in sex. A
confusing factor is that some women have orgasms and are ee
aware of them. The old saying, “If you’re not sure ifs youre
having orgasms, you aren’t!” is false. This situation will be dis-
cussed later. Z i

What kinds of women tend to be regularly orgasmic? Prelim-
inary evidence would seem to indicate: athletic women, creative

: S
active women, women who were tomboy

women, dancers,
women who are

growing up; women who are able to relax, ae
aware of their bodies and their senses, and women who hon ‘i
the sexual component of their lives. Women who are nee
izing, women who are defiant, assertive, alive; women W

PERSPECTIVES ON ANORGASMIA 227
self-esteem, who can say Yes and No and really mean it; and
some women who are shy and passive—all these women en be
reliably orgasmic.

Women who have never experienced orgasm from any source
of stimulation and who have sought therapy to change this con-
dition seem to have enough factors in common to substantiate
the assertion that “‘frigidity” (a derogatory psychoanalytic label)
is culturally determined and socially conditioned. It is simply
the psychological state of a woman turning out to be what she
was programmed to be. Some analysts—including females
(10)—employ the term to describe nearly all women, since they
define “‘frigidity’’ as difficulty in achieving an imaginary entity
called vaginal orgasm. This demonstrates imperfect anatomical
knowledge; the analysts confuse the birth canal with the organs
of sexual pleasure.

BACKGROUNDS OF PREORGASMIC WOMEN

The family backgrounds described by women who have never
experienced orgasm have similar features. Usually the parents
devalued sex, rarely exhibited demonstrative behavior such as
affectionate touching, and clearly approved of “self control.”
Sex was regarded either as taboo or as sacred and divine, or.
frequently was never mentioned at all. As a girl, the typical
Preorgasmic woman received subliminal or overt messages not to
ee her body and never to “play with herself.” Sometimes she
or explored herself and was (or believed she was) punished for

IS, and often her household had severe modesty rules.

During adolescence, prohibitions became stronger and her par-
Ho regarded sex out of context. The growing girl may have felt
Shame and disgust at the appearance of pubic hair, breasts and
menstruation. When she began dating, she was taught that a
Sa girl must suppress and deny sexual feelings, “control” her-
a ane the male, and remain vigilantly on guard lest she “go
ae * and “set in touble.” She got the message that far worse
a aving a disfiguring injury or flunking out of school would
eee to disgrace her family by a pregnancy or a “bad

ation.” Some families made violent accusations of promis-

228 CLITORIS

cuity where none existed. In others, the girl perceived sexual]
hints or demands from relatives, while mother looked the other
way.

Frequently a preorgasmic woman has grown up to believe
that she does not own her genitals, and that her sexual organs
belong to her parents or her husband, to God or the doctor, but
never to herself. She is rather vague about her anatomy and
usually has never looked at her own vulva. Some of these wom-
en are aware that their mothers and sisters neither experience
nor expect orgasms.

TWO TYPES OF PREORGASMIC WOMEN

Preorgasmic women usually exhibit one of two responses to
sexual stimuli: no or low feelings, or high feelings. Women with
low feelings often characterize themselves as “asexual,” and
make such statements as, “I am totally turned off by sex,” “T
hate to be touched,” “I have never felt turned on in my whole
life,” “I know other people feel sex, but I have never felt the
slightest twinge,” “In sex, I endure, I submit, I pretend... ,” “I
guess I must be frigid.’’ Quite frequently these women report no
pleasant feelings, no sexual fantasies and no physical sensations
whatsoever “down there,” “below the waist.” They may have
mildly romantic daydreams but rarely erotic mental images. In
the course of treatment, they usually surface anger at their par-
ents, at a religious upbringing and at the lack of sexual tension.

The preorgasmic woman who has high feelings —who reaches
plateau but doesn’t “go over the top”—describes a slightly differ-
ent situation. She is very aware of sexual feelings and is often
close to psychological explosion from the high levels of frus-
trated sexual tension. Her family background may be similar,
but she has allowed herself to perceive sexual feelings, and the
result has proved deeply anxiety-provoking, because she worrles
about “not coming.” Often she has been in psychotherapy,
which changed nothing, or has involved herself in a pe
search for the “magic penis” which could make it happe?- Th
women are troubled by a vicious cycle in which they are con
vinced they will fail again, avoid sexual activities

because of

PERSPECTIVES ON ANORGASMIA 229

their frustration, predict failure and then experience it, which
inevitably leads to further frustration and avoidance. The spec-
tatoring and obsessing are probably the primary reasons for the
failure to reach orgasm. Such a woman frequently blames her
partner for his inability to cause orgasm; she often believes that
any interruption to love play must signal the end of arousal for
her; she frequently has plenty of fantasies; and her anger is
usually directed at the sexual tension itself, at her partner, or at
herself.

Both types of women may have already experienced orgasm
and not recognized it as such. This failure to label the experi-
ence is because:

— the sensations that are felt are either suppressed, ignored or
assumed to be something other than arousal-into-orgasm

— some women’s body awareness is so guarded that they do
not perceive stimuli, even—for instance—a non-sexual touch
on the forearm

— women are frequent witnesses to males’ orgasms, but rarely
are present at another female’s sexual climax. Until recent-
ly women have been extremely reticent even with close
friends to discuss what actually goes on. If a woman as-
sumes that she is like a man, she may expect something
like a dramatic erection, a visible ejaculate and detumes-
Eonecs She may look for much muscular activity, energetic
thrusting motions, involuntary pelvic movements, vocalizing
and heavy perspiration in herself. Her own patterns of re-
sponse may be different,'so she labels it as non-response

she herself may be the stimulus for the male’s response; his
cagerness and speed may incur premature ejaculation and
mark the end of love play

she may not be particularly aroused by the male’s arousal
if she is inexperienced

230 CLITORIS

— she may believe it is her duty to satisfy the male, and be
distracted from her own bodily sensations

— she may have heard or read about peak experiences, and
believe that orgasm will be like a skyrocket, atomic ex-
plosion, or will cause fainting or insanity

If she is questioned carefully, the woman who thinks she has
never had an orgasm may recall situations in which she did have
tingling, fluttering, pulsations, throbbing, “drawing sensations,”
contractions, warm feelings on the skin, spasms, waves, a sense
of flooding or release, and a feeling of peacefulness afterwards.
She was having orgasms but not labelling them as such.

What is even more confusing, however, is another situation in
which the woman is having multiple orgasms and failing to label
any of them. She fails to stop the stimulus following an orgasm
in a series, finds herself in plateau but doesn’t recognize it, and
ceases sexual activity. Instead of completing the response cycle,
she stops on the upswing and is left frustrated and unrelieved)
(44512). :

Both kinds of women are usually trying to will an involuntary
response while simultaneously suppressing all the sensations lead-
ing to orgasm. They are somehow convinced that they can rock-
et from research and development straight to blast off without a
countdown. Frequently they are consciously striving to make
themselves obtain an orgasm and are unable to experience the
very phenomena which permit climax to occur. A pee
woman expects her partner to cause an orgasm 1n her witho os
sense on her part of what might be helpful toward that ca

She has not assumed the responsibility to understand her 0
sexuality and to take control over the direction o

wn pleasure. ;
ee ee airs some women are afraid of men in Bee ees,
lives, having had negative experiences while oe ee 5
ficant number of preorgasmic women lived with an re ae
situation for years until they could escape; others we Mee:
course, improperly handled abort ee
Such a woman may be unable

f love play for

of rape, painful inter
other traumatic situations.

PERSPECTIVES ON ANORGASMIA 231

imagine any pleasure could be possible from a sexual situation,
yet is willing to try to overcome her conditioning. Not infre-
quently such a woman has no feelings.

ROLE AND GOAL EXPECTATIONS

Two other patterns of non-responsivity can be identified, cen-
tering in role and goal expectations.

A role-centered preorgasmic woman feels that she has no right
to pleasure. To be truly feminine, she believes, one must be
all-giving; one’s husband, one’s children and one’s employer all
come first, and a good woman is glad to accept the leftovers.
She has grown up hearing that women should cater to everyone,
conceal their competence and protect their male from painful
knowledge because men have fragile egos. Men’s pleasure is self-
validating; women’s pleasure is self-sacrifice. She believes she
must prove herself pleasing by making certain her husband ejacu-
lates; only then can she allow herself to seek pleasure, but it is
usually too late. This approach hasn’t produced her orgasm, so
she has redoubled her efforts to please her husband, only to find
things are twice as bad.

She protects her partner from the painful information that he
is not stimulating her in a helpful way, that she is beginning to
despise sex, to despise him for enjoying it while she does not,
and to despise herself for faking it and being unauthentic. She
then vacillates between feeling pride at being “feminine” and
fury at being “frigid”; while she is aware that she has gained
control over sexual feelings just as she was taught, she knows
that she is missing something. Though pleased with the role of
Super-mother, super-wife, super-secretary or super-feminine, a
Part of her still yearns wistfully to be super-female—a sexually
fesponsive and adult woman.

_The goal-oriented preorgasmic woman is one who has put a
high priority on achievements. Her sense of identity is derived
ee academic success, career exploits, performing well in the
ae Ms making a name for herself outside the home. Often such
age are quite witty, remarkably articulate, intellectually

» extremely creative or deeply involved in public life as

T6h=— — Coe

232 CLITORIS

professionals or volunteers. Some goal-oriented women give the
impression of speeding through life, unwilling to slow down for
Sess except as an afterthought. Some are quite tense most of the
time; some seem angry, strung out, agitated; others depressed
and distant. In any event, having placed not necessarily a low
priority on sex, but a higher priority on other things, they often
postpone doing anything about anorgasmia until they begin to
view orgasm as an achievement they desire. This very striving is
what stands in the way of its happening.* Most goal-directed
preorgasmic women experience high sexual arousal and cannot
“set over the top.” (See Table IX)

TABLE IX

RESPONSIVITY MATRIX OF PREORGASMIC WOMEN
FREQUENT TRENDS

Low High
Feelings Feelings

Fear of men. Inappropriate sexual experiences such
as incest, rape, traumas, etc. x
Super-feminine role: self-sacrificing, super-mother,
super-wife, always pleasing others. “Sex is important x or x
only to mate.”
Goal-oriented: striving, driving, valuing achievement. x

“Sex is not important; success is.””

FEARS OF ORGASM

Both kinds of preorgasmic women fear orgasm. Their feeling
is that they would be vulnerable, or that they would lose con

trol, were they to experience it. i:
Those whose main fear is vulnerability feel that orgasm wou

leave them too open to psychological pain and emotional hurt.

rie : ; ith the verbal left-
thinking about the situation wit which

*The woman is usually consciously !
hemisphere instead of using the mode of consciousness of the right-hemisphere,

is non-verbal and receptive.

PERSPECTIVES ON ANORGASMIA 233

“If I become orgasmic,” a woman will say, “I’d be entirely in
his power,” or “I might become addicted to sex and neglect
everything.” If orgasm were to occur, “I might be too helpless
to defend myself.” (This last statement supports an argument
that the cave-woman remained on guard, perhaps on the lookout
against predators that might attack during sex and devour her
young. The fear of being vulnerable may relate to a deep sense
of responsibility in females that is part of a collective uncon-
scious sense that “‘somebody ought to mind the store.’’)

The fear of loss of control is related to the messages about
“sood girls” that women receive growing up. It is also the fear
of the unknown physical response: orgasm might cause her to
lose control of her appearance, urine, feces, consciousness, sex-
uality. Some women say their fear of orgasm is that it would
change them physically (13) and “then everyone would know,”’
or mentally and “then I might not recognize myself.” They fear
dependence on one man forever, on masturbation, on a vibrator,
or on water. “If I were orgasmic, I wouldn’t be a good girl
anymore,’’ “I would have to grow up.”

Yet sexual climax is natural and orgasm in infants under one
year has been described by Bakwin (14) and in very young girls
by Kinsey (15). Why is it our culture programs out pleasure for
women?

Women in our culture do not receive permission to be sexual
beings (16) until marriage, and then only partially. The style in
which women are required to present themselves is defined as

feminine,” and femininity is anti-orgasm. Femaleness (which is
determined by XX chromosome at least) is pro-orgasm. “Permis-
sion”’ should come from the major role model—the same-sex
Parent, but for women it is rarely clearcut. Teen-age boys re-
Celve much clearer messages about their sexuality; when father
hands over the car keys to his son leaving for a date, the male
Tole-model is symbolically handing over manhood. The adoles-
cent boy is told that it is OK to be sexual, just don’t get caught.
The adolescent girl is told “don’t even think about it.”

Little girls are dressed in tiny skirts and then punished for
showing their underwear. Little girls are discouraged from exer-

ae CLITORIS

cise, from climbing trees and playing ball: all methods of en-
hancing the spatial perception and body awareness so essential
to sexual functioning. Girls are praised for waiting on other
people and hiding their anger and disappointment, for relinquish-
ing their power and becoming passive. Girls are brought up to
hide their intelligence and feign ineptitude.

Boys are praised for body contact sports, for spatial activities
such as running, climbing, kicking, throwing and catching balls,
and learning to operate machinery, all of which enhance depth
perception and strengthen the right hemisphere in ways that
probably enhance sexual responsivity.

Toilet training is another area in which males have the advan-
tage over females for their future sexual responsivity. When a
boy is being taught to stand up to urinate, he receives praise
several times a day for holding onto his penis. Every time the
two- or three-year-old boy initiates urination in the right place—
lets go—he is praised for holding onto his genitals. Girls, by
contrast, are placed on the seat and urine simply flows down-
ward from gravity; a girl need not touch herself or assume any
special control over its direction. She is touched only by inter-
mediary substances—the underpants, the toilet paper, the wash-
cloth. She never experiences praise for touching her genitals
directly with the hand.

Girls are probably programmed to be i
than are boys, and girls must cover two parts of their bodies.
Girls are taught how to please others, how to walk, sit, stand
and be “feminine”; boys are taught to value their bodies and
use them vigorously and derive pleasure therefrom. Girls are
taught cooking, needlework, reading, music and sewing: all left-
brain activities. Girls are taught to make changes in themselves
for the sake of others; boys are taught to change the world by
manipulating objects and concepts. And a boy starts with his

modest more severely

own penis!

Girls growing up in our culture rarely discuss t :
with other girls, since it goes against the cultural norm (at ae
in the middle class) even to acknowledge having sexuality, x :
-to-an-end, usually “catching” a mate. A girl w
her reputation will report to others how §

heir sexuality

cept as a means
wishes to protect

PERSPECTIVES ON ANORGASMIA 235
aged to kee

n from others—siblings arents
friends—women grow up ignorant of practicall SD iy ,
would be helpful in becoming orgasmic. ee

Certainty igus who masturbate either assume everyone does as
they do ( I'm not pene or no one does (“I’m perverse’’)
But since it is never discussed :
_s» Boys often experience beaten Wa rescence
! ally, from rough-hous-
ing with other males, being stimulated by playground equi
ment, or absent-minded fooling around with the penis es 's
highly accessible. Many boys have heard about raasttrbation
from other boys and go home to try it. For many boys, learnin
how to masturbate is an accomplishment to boast abfmat. It .
not so for girls.

From dating on through adult life, women are taught that
they must control the situation in sex, usually in a totally nega-
tive manner. It is always stopping what is going on, never begin-
ning or continuing. Women are expected to exercise restraint;
men to push the limits. Girls “must” stay out of trouble (bad
reputation, conceiving, getting boys mad at them for teasing,
etc.) and boys are “‘expected”’ to get into trouble.

_The functions that are physiologically discrete in women—
elimination, reproduction and pleasure—are all united in men.
The male’s penis combines what is separate in females, and
males have derived erroneous theories of consonance from this
fact. Since the organ that seems meant to receive the penis
provides the male his pleasure, he assumes that it ought to pro-
vide pleasure to the female. When it has not, males have defined
her as inadequate or sick.

Women learn how to experience femaleness from women;
femininity is achieved for the male. Women can learn much
from males and can be usefully counseled about careers, disease,
academic matters and so on. But male counselors can never cred-
ibly convey the experience of being another sex and perceiving
emotions and sensations inevitably felt only by another sex.
Males seem unable to escape conveying an “ought” label to their
clients; female therapists are well aware of what “‘is,’’ and are
more able to help a woman distinguish among her perceptions

236 CLITORIS

and emotions in ways males cannot (18). Of all the books that
purport to convey the female experience, Sexual Honesty: By
Women for Women (19) seems to be the most believable and
useful.

Marilyn Marcus (20) has said that “women have two left
brains.” The high verbal ability of some women and their sensi-
tivity to stimuli are two important factors which are detrimental
to sexual pleasure (21). Even when women know how to be
orgasmic, the intrusion of thought acts as a powerful suppressor
to bodily sensations. It is commonly believed by husbands that
wives come to bed with “too much on their minds”’ purposely
to frustrate them; what may be true is that a woman has enor-
mous difficulty in shutting down thinking and switching to what
Deikman (22) terms the receptive mode, which is right-hemis-
phere consciousness. In teaching women to experience their
bodies, a very useful distinction is to instruct them to listen to
their own breathing. This exercise is helpful for at least three
reasons: hearing is largely a right-brain activity; attending to
body sensations helps suppress cognitive (left-brain) activity; and
attending to breathing aids relaxation, encourages alpha wave
states and enhances sexual perception. The utilization of breath-
ing may call to mind a classic definition, ‘““Yoga is the intention-
al stopping of the spontaneous activity of the mind substance.’

What should be clear, in this discussion of sexuality and the
preorgasmic condition is that the major sexual organ is between
the ears. As long as women are programmed to suppress, deny;
alter and distort their sexual awareness, there will be anorgasmia.
If male theoreticians insist on a sexuality which doesn’t exist,
there will be women who, in trying to please men, will lose their
power to be sexual.

Women-—such as Betty Dodson, Kathie Kelly and the Boston
Women’s Health Collective—are the legitimate definers of female

Women must accord themselves adult personhood,

sexuality. ewreultere

since it seems clear that neither their partners nor t

will readily do so.

Do oo

—
ow On

11.

12.

13.

14,

15,

16,

PERSPECTIVES ON ANORGASMIA 237

NOTES AND REFERENCES

. Kinsey AC, et al: Sexual Behavior in the Human Female. Philadelphia, W. B

Saunders, 1953, p. 544. At age twenty, forty-seven percent of the sample had
never experienced orgasm from any source; at age twenty-five, twenty-three were
still totally anorgasmic.

. Lederer WJ and Jackson DD: The Mirages of Marriage. New York, W! W. Norton,

1968, p. 124. They estimate that “more than half of all women married an
average of ten years and having three children have never experienced an orgasm.”

. Kinsey AC, et al: op cit, p. 375.
. Brown DG: Female orgasm and sexual inadequacy, in Brecher R and Brecher E,

An Analysis of Human Sexual Response. New York, Signet, 1966.

. Elkan E: Evolution of female orgastic ability, Int J Sexology 2:1, 1948.
. Sherfey MJ: The evolution and nature of female sexuality in relation to psycho-

analytic theory, J Am Psychoanal Assn 14:28, 1966.

. Tompkins C: Thinking in time. New Yorker April 22, 1974, p. 111.

. Calder J: Women’s Sex Talk. New York, Signet, 1974.

. Bardwick JM: Psychology of Women. New York, Harper and Row, 1971.

. Salzman L: Sexuality in psychoanalytic theory, in Marmor J: Modern Psychoan-

alysis. New York, Basic Books, 1968, p. 131. “Freud’s views ... were endorsed
by many female analysts including Helene Deutsch, Melanie Klein, and Therese
Benedek.” Salzman’s paper is a helpful clarification of modern psychoanalytic
theory, which deserves wide attention; he incorporates recent physiological data.
Bardwick JM: op cit, p. 65. “The more closely the female orgasm approximates
the intense orgasm of the male, the more satisfying, satiating and ‘final’ that
orgasm is.”

Kinsey AC, et al: op cit, p. 376. “Hamilton (1929) considered multiple orgasms
related to clitoral orgasm, and labeled it nonterminative minor climaxes and in
actuality an orgasmic incapacity.” This view was shared by Kelly (1930) and
Clark (1937), according to Kinsey. More current authors (Katchadourian HA and
Lunde DT: Fundamentals of Human Sexuality. New York, Holt, Rinehart and
Winston, 1972) similarly misinterpret the Masters and Johnson type B female
response cycle, and as recently as 1966 a woman psychoanalyst asserts that mul-
tiple orgasms are a type of frigidity (Shainess N: A reassessment of female sexual-
ity and erotic experience, in Science and Psychoanalysis. New York, Grune and
Stratton, 1966).

Haley J: Uncommon Therapy. New York, W.
which describes the work of Milton Erickson, ;
Suggesting that there are immense physical changes in the sexually active woman.
Her skeletal calcium changes, her foot size increases, and there cine transformations
of eyebrows, chin, jaw, nose, hips, spine, hair and breasts after ‘‘as short a time as
two weeks of ardent lovemaking.”

Bakwin H: Erotic feelings in infants and young ¢
126:52, 1973.

Kinsey AC, et al: op cit,
recorded autoerotic behaviors in girls under three.
Berne E: What Do You Say After You Say Hello?. New York, Grove, 1972, p.
124, develops the concept more fully. He says that children learn from the parent

of the same sex and do it for the parent of the opposite sex.

W. Norton, 1973, pp. 108-109,
contains a fascinating discussion,

hildren. Amer J Dis Children

p. 141, cites more than a dozen authors who have

238

17.

18.

ii):

20.
21.

22.

CLITORIS

Friedman LJ: Virgin Wives. London, Tavistock, 1962, p. 39. The spindle in Sleep-
ing Beauty symbolizes “mother’s prohibition of sexuality to her daughter.”
Friedman LJ: op cit, p. 34. “Those (therapists) who are the most experienced and
sensitive with vaginismus and unconsummated marriages ... are all women. They
are the most cognizant of the emotional implications and to the relationship
meanings of treatment, possibly because women have an empathetic understanding
based on their own life experiences.”

Hite S: Sexual Honesty: By Women for Women. New York, Warner, 1974, pre-
sents a cross section of responses to a questionnaire about subjective experiences
in sexual functioning in women age fourteen through sixty-four.

Marcus M: personal communication.

Bardwick JM: op cit credits both Masters and Johnson (p. 60) and Sherfey (p.
67) with the observation that sex and thinking are incompatible activities.
Deikman AJ: Bimodal consciousness, in Ornstein RE: The Nature of Human
Consciousness. San Francisco, W. H. Freeman, 1973, p. 71: “In most receptive-
mode conditions ... an active relationship with the environment takes place, as in
the case of . . . lovers in sexual intercourse.”

Chapter XV

VARIETIES OF SEXUAL EXPERIENCE
Linda Whooley and Tee Kamen

With the advent of the woman’s movement and its concomi-
tant feminine awareness, women began actively pursuing their
sexual independence. Early in 1972 in the San Francisco Bay
Area, Lonnie Barbach pioneered a radical new approach to treat-
ing anorgasmia in women (1). The Barbach method, which we
use in a series of classes on female sexuality, teaches women to
become orgasmic through self-stimulation. Once orgasmic, they
can begin to share this response with their partners, if they so
desire.

In the process of teaching these responses, we discovered sev-
eral distressing voids. First, we became aware of a lack of knowl-
edge of their own bodies by the women in the groups. Many
adult women have never looked carefully at their own genitals,
and many do not have correct names for their sexual anatomy.
Correct labeling is an essential step toward reclaiming their
bodies and accepting their own genitals in a positive way.

Secondly, in researching the topic of female sexuality, we
discovered a dismaying lack of literature on the topic of female
masturbation. We decided to supplement this scant information
by developing our own resources and practical guidelines in this
area. In order to teach women how to stimulate themselves to
orgasm, we began to gather specific details about how orgasmic
women pleasured themselves. Women often ask us what areas are
sensitive and where other women stimulate themselves. Another
concern is that of how and with what women stimulate them-
selves. The following is a summation of some of the material
that we tell our classes:

Primarily, women stimulate the glans (h
the clitoris. The motions may include rubbing, orp
on the shaft, and rubbing, tweaking, squeezing, pinching, or
tapping the glans. They may use one OF more fingers or their

(head) and the shaft of
rolling or pressing

239

re re

240 CLITORIS

whole hand. They may also stimulate either side of the shaft,
the inner and outer lips, the vestibule area or the opening of the
vagina. Many women include some form of anal stimulation or
anal containment in their self-sexuality. Some enjoy vaginal con-
tainment of an object, e.g., candles, bananas, cucumbers, plastic

jars, along with clitoral and/or anal stimulation. Many women~
>

also like to stroke their breasts, stomach, or inner thighs.

The one consistent element in the way women touch them-
selves is that it is rhythmic and repetitive. Lubrication is often
used: vaginal lubrication, saliva, jellies, lotions and oils, including
cooking oils. The actual stimulation can be applied in many

VARIETIES OF SEXUAL EXPERIENCE 241
OUR QUESTIONNAIRE

The women in our classes bemoan the lack of accurate, un-
biased information on the subject of self-stimulation. For this
reason, we developed a questionnaire on methods of self-pleasur-
ing, so that factual material would be available to women. We
distributed the questionnaire to a number of acquaintances and
have summarized here the responses of ten women.

Such a small group cannot, of course, be generalized to the
population as a whole. What it does do is to confirm our conver-
sations with hundreds of women, in personal and telephone

counseling; women are less like each other than men; women
have a very wide variety of sexual experiences, styles, prefer-
ences and patterns. The following histories will illustrate this.

ways. Women use their hands, a stream of water (as from a
bathtub faucet), pillows, bunched bed clothes, vibrators, candles,
and other objects—primarily to stimulate their clitoris. Positions
for self-pleasuring range from lying on the back with legs widely
spread, to various side postures, to squeezing the thighs while
lying on the stomach. Women may move their body against a
stationary object, they may move the object, or they may move
both in unison. We encourage women to experiment in order to
fully develop and perceive their own orgasmic potential.

We also support women in their search for what turns then
on. Fantasies and erotic literature are shared and discussed in.
class. We encourage participants to write female-oriented erotica. wy i

TERRY. Terry is a 27-year-old office worker with a Master’s
Degree., She is bisexual, sometimes preferring men, sometimes
women. She socializes her sexuality in monogamous relationships
and closed marriages. Her first orgasm was from using her hand.
She is now orgasmic with partner through oral sex, manual stimu-
lation, and combinations which include manual stimulation.

“I started masturbating when I was twenty-two. Prior to this I
had had relationships with men which ranged from terrific to satis-
factory, depending upon the man involved. I had been playing
with myself for some time, as I found that I would get itchy
whenever I would get horny. I would rub a lot, but never to
orgasm. Actually, I didn’t really realize that it could happen by
myself alone. I guess I was kind of naive, sexually (I was!).

“Then, about age twenty-two, I met a woman at school (whom
I later married) who told me about masturbation—how it was done
and what would happen. This was hand stimulation only. How-
ever, my activities were limited—at least I masturbated a lot less
; than I do now.

Most of what is now available is developed from a male point of ~
view, although this, too, can be arousing.

Ve Re awe voice resentment at the male orgasm. They. be-
lieve it to be easier and more reliable than their own. Often ee.
and women expect that a woman should reach omgasm co
penis in vagina alone, as men do. This type of Look, ma, -
hands!” orgasm is simply not in the realm of reality for a gr

number of women, since, neurophysiologically, the clitoris oe yl Al “My wife and I really enjoyed masturbation. Frequently, oe) or
i : . he other (more usually me, as my sex drive was stronger than
d the vagina is the reproductive organ. 4%! wy t morenuseellyamne
ae satis nie in ie male’s penis ‘xdditional manual stim- U a hers) would be horny and the other would be too tired to do
unctions ar 5

anything. I would masturbate and she would hold me and urge me
On and caress me. Thus, we both felt satisfied. In fact, masturba-
tion became a very large part of our sex lives. We would have
races to see who would come first, and/or try to both come at the
same time—the one waiting for the other.

“In fact, we didn’t like the word ‘masturbation’ and wanted

ulation by partner or self is often essential for the fem a
gasm. This information, along with confirmation by other eae
members, allows the women to develop realistic eines ae
and patterns of behavior. It is essential that women (an a
understand that male and female sexual patterns ar

identical.

{
i
;
|
:

242

CLITORIS

another one for the process. After all, men had vac, Be wom-
en should have something, too. So, we vente our own: ‘rubup,
i to describe it accurately.

ee aan ean vibrators in ‘rubbing-up.’ They don’t seem to
achieve orgasm all by themselves, but As a little hand stimula-
tion, they do just fine, especially if you're pretty tired.

“Now, I usually rub-up every night. I need at least one orgasm
just to relax me for sleep and more frequently than not, I rub-up
again. With hand stimulation, I can come three or four times in
the space of about twenty minutes or less—if my hand holds out.

“Right now, rubbing-up is my only form of sexual stimulation
and that’s O.K. Masturbation is really quite satisfying for me. Hav-
ing become very adept at it, I find self-sexuality allows me a lot of
freedom. I’m not dependent upon another person for sexual fulfill-
ment. The loss of a partner does not now mean an end to my
sexuality. Actually, I’m very dependent upon it now and really get
up tight and horny if I haven’t rubbed-up for a couple of days.

ANNIE. Annie is a 23-year-old artist with a B.A. in art. Her
sexual orientation is self, hetero, bi, and combinations of two men
and one woman or two women and one man. Her socializing pref-
erence is deep multiple relationships. She first masturbated at age
nineteen using her hand while stoned. She remembers being caught
pretending she had a penis (baseball bat) at age five se ae
spanked. She is now orgasmic with partner using a combination o

i ibrator.

i Za eed know what my sexual preferences are. Masturbat-
ing with pornography is my latest reality. Anal-manual dee
are particularly stimulating, as is male homosexual activity. oe
of my orgasms in the last months have been while reading

Pearl. I like trashy sexist American porn, too. ane

“I generally use my hand (right, middle finger), since my ate a
tor conked out. Masturbation is my only . (almost) sure metho 2
reach orgasm. More House gave me my first pemesecs to Mae.
myself. I am still working through my ‘shoulds’ and I want to

a . .
‘i MARIE. Marie is a 33-year-old with a Master’s Degree in Liter-
ature. She is heterosexual. At around age seven she first ae
bated; she experimented with water in the bathtub and also wit ef
dog. She is now orgasmic with partner with penis in vagina a

h oral sex.
Sie had a pet dog who began to lick my vaginal area and foun
liked it very much. After that I encouraged the dog to lic a
Soon after, a friend told me about using the stream of eden
the bathtub. I used this method more often because t ae
wouldn’t always cooperate. Later I found that a lipstick con

VARIETIES OF SEXUAL EXPERIENCE

worked Venyi Well: For a time I also used a lar
do not like using my fingers when I actually
pa! I have hooked myself badly with my fingernails. During my
marriage, I continued masturbating regularly. I find sex with a
man quite different from masturbating and enjoy both equally.
Masturbation has the plus of being available at all times. Sex with
a partner has a warmth and physical closeness and mental to-
getherness that I enjoy. During some teenage lesbian experiences, I
learned a great deal about caressing foreplay and where I like to
touch or have my body touched. I still have found no man who
can touch me as gently as another woman or myself.

“By the time I heard my first scare stories about masturbation,
e.g., deafness, insanity, I had been masturbating so long that I
knew those things had not happened to me and must be more
adult lies. However, I did have knowledge from the very beginning
that what I was doing would displease adults, so I was always very
careful. I didn’t ever feel guilty about masturbation, but did not
talk about it to anyone until recently for fear of upsetting them.”

CINDY. Cindy is 23-years-old with two years of college. Prefer-
ring self and homosexual activity, she socializes in casual multiple
relationships, one primary with another secondary, and enjoys
group sex. She is orgasmic with partner through oral sex, manual
stimulation, and oral and manual combination. She is also orgas-
mic with “dyking,” i.e., mutual rubbing of genitals with thighs.
She started masturbating at age thirteen when her sanitary napkin
would rub her during the night.

“My sanitary napkin would get caught up tight during the
night, and I’d wake up in the morning to find myself rubbing
against it. I never knew what orgasms were, however, until I
started having them with a lover (male) when I was eighteen, and
didn’t begin consciously masturbating until a year or so ago. I
have only in the past one-half year succeeded in having orgasms by
masturbating.

“Once my mother saw me with my hand in the front of my
pants purely for exploratory purposes—I don’t recall any pleasur-
able sensation—and gave me a lecture on dark, warm, moist places
being ideal for breeding germs (I was maybe five). :

“About two years ago a friend gave me her old vibrator. I
didn’t do much with it until a year or so ago, when I began to be
attracted to the idea of being able to be sexually independent can
not have to go out and cruise every time I got horny and eae
have a lover (which I usually didn’t have). I mainly used my hand,
but it took so long to get anywhere near orgasm I always gave up.
Then, about six months ago, I started playing exciting music Uae
masturbating and finally succeeded in coming all by myself.

ge quartz crystal. I
want to come, be-

243

244

CLITORIS

ELLIE. Ellie is a 36-year-old. She is a sex counselor with a
Master’s Degree. She is heterosexual and presently involved in an
open marriage; she first masturbated at twenty-four using her
hand. She is presently orgasmic with partner through oral sex,
manual stimulation, and penis in vagina, plus self-masturbation.

“My partner stimulated me manually to orgasm after my first
intercourse experience. Wow! So that’s what it’s all about. Now I
use my hand, a vibrator or water. I’ve had the experience of three
vibrators at the same time, in the clitoral, vaginal and anal areas.
There’s no way to put the sensations in words!”

MARILYN. Marilyn is a 27-year-old teacher with a Master’s
Degree. She lists her sexual preferences as: self, hetero, homo, and
bi. She socializes in casual multiple relationships and monogamous
primary relationships. She was twelve when she first masturbated
by using her hand. She is now orgasmic with partners with penis
in vagina, using additional stimulation on the clitoris.

“When I was twelve or so, I used to play a game in the bath-
room with the door locked while I was supposed to be taking a
shower. I would pretend that I was a baby, put a washcloth be-
tween my legs, spank myself as if I had been a bad child, and then
I would urinate. Eventually I guess, it led somehow to rubbing
myself and one time I came without. knowing what it was. I took
awhile before I’d masturbate by touching my clitoris directly—I
did it through my undies for a long time. Recently I’ve gotten
into vibrators—no insertion—clitoral only, and I really like it. I
tried water, but it’s never worked.

NAN. Nan is forty, has a B.S. Degree and is a registered nurse.
Her sexual preferences are self and hetero and she socializes her
sex in casual multiple relationships and in one primary with other
secondary relationships. She was thirty-five when she first mastur-
bated, using her hand while reading an erotic book.

“I do not remember anti-masturbation messages. I did get fear-
ful messages from my mother regarding rape, pregnancy, being
taken advantage of, etc. Sex education and facts about menstru-
ation were good. Information about pleasure, emotional warmth,
etc., very scanty.

“I was especially concerned about being non-orgasmic Ww.
got married (at age thirty-two)—got bad advice from MDs, i.e.,
very common and not important.’ I started reading sex books—
David Reuben, The Sensual Woman, etc. and thought about get-
ting a vibrator. First orgasm while reading. Vibrator was great.
Later started being orgasmic with partners who would take the
time to stimulate my clitoris directly.

“J usually masturbate in bed with finger or vibrator—sometimes
_sometimes with cylindrical objects in vagina and/or rec-

hen I
St’s

stoned

VARIETIES OF SEXUAL EXPERIENCE

tum. Also, I masturbate wi ‘

come otherwise. I am i sa taeetie ere Gane ene Cake
most partners are too—some joining me in ates rs eau find that
masturbate once or twice a week depending o ki hes homed
pening. Sometimes I can happily go a 165 . ae Ai else is hap-
great sleeping pill when I’m tense or jumpy.” Wiiglaeae

AMANDA. Amanda, age thirty, is a bisexual who enjoys grou
sex and voyeurism. She likes serious multiple relationships iar
are non-monogamous only. At twenty-one she began masturbatin
She told her psychoanalyst and he said it would 2
mia (which she already had).

“Started masturbating after I’d been balling without orgasms for
iso Ree Nene io Seat an inpatient at Hillside Mental
et aap sir ne ; a primary complaint of hysteria and

gasmia. A Freudian analyst told me it
was bad for me in all the usual ways;—with some trepidation I got
into masturbating every night. I had a weak orgasm after about a
week and one incident of urinating that scared me a lot.

“I got out and masturbated on the sly with(out) my old man—
his duplication of my techniques still didn’t do it. My first orgasm
with a partner was at age twenty-three—regular with partner from
age twenty-five. I didn’t masturbate then out of guilt even though
he would sometime deliberately make me go without orgasm for
months.

“Age 25 I had baby, and got liberated. I’m masturbating rarely,
without guilt, but not much interest—believed it would lower my
desire with partners.

“Orgasms with partners are now pretty regular. First orgasm
during intercourse was in 1970. First multiple with partner 1973.
Since joining San Francisco Sex Information staff, I have become
much more active with myself. Use self-sexuality and fantasy a
lot-—finding out more about myself every day.

“Have been exploring my asshole; I now prefer to get it on
with my left hand on my clit and my right hand with two fingers
in my cunt and one in my asshole. Showers are nice. Fantasies put
me to sleep, but orgasms wake me up.

“Not multi-orgasmic by myself. Vibrators are nice for foreplay.
I like masturbating with partners and while fucking a lot! I find it
impossible to read even clinical and anatomical sex books without
pausing to masturbate, ditto porn, even S & M!”

SHERRI. Sherri is a thirty-nine year-old sexuality discussion
leader. She is bisexual and prefers to have one primary relationship
with other secondary ones. She first masturbated at age thirty-
three using her hand. She is now orgasmic with penis in vagina,
with oral sex, and with manual stimulation.

give her inorgas-

245

246

CLITORIS

“J was about thirty-three, and although I had played around a
little with my genitals, I had never before masturbated to ae
I was lying on the couch talking on the phone with a oo ie
recently met. I was planning on having my first date witl im that
evening. I was very excited because it had been a long time since I
had been with a man. As I was talking with him, making arrange-
ments for our date, I was fondling my genitals. I was so horny and
could hardly wait to be with him sexually. After we hung up, I
continued to rub myself, right on the clitoris, and I had a fantastic
a to that time I had not been orgasmic at all. I did not
really have any information on what orgasm was, so, for all these
years, I was ‘imagining’ orgasms in my head.

“I kept practicing with my new found joy, became more aware
of what I was missing during sex with partner, and after about
two years, I told the man with whom I was living that I was not
being orgasmic with him, nor with any other man. I then got a
vibrator and after a little practice by myself, I masturbated in the
presence of my partner using my vibrator. Knowing that I could
bring myself to orgasm after my partner had climaxed, helped me
to relax more with him and I stopped ‘trying’ to have orgasms
during intercourse. Instead, I just focused my attention on the
total lovemaking experience, tried out a lot of different positions
in intercourse, and had the comforting thought of knowing I could
reach my orgasm afterward by myself. Eventually, when me
suspected it, I had orgasm with his penis in my vagina. oe
ly, I masturbate myself during intercourse and reach orgasm mos

of the time. I feel really good about my responsiveness and so
does my partner.

~_JESSICA. Jessica is twenty-nine and has completed two years of

college. She is heterosexual and enjoys self-sexuality. She ae
her sex in one primary relationship, with other secondary on :
prefers open mutual open marriage. At age nine or ten she pie
to masturbate using her hand and a back scrubber in the bathtu
She is now orgasmic with partner in penis in vagina, with st
stimulation and with a combination of penis rubbing clitoris

VARIETIES OF SEXUAL EXPERIENCE

then up and down. Then also trying other positions .
mirror, rubbing on the cold sink, standing in shower

on, under water while people were around, while drivi
it was too dangerous to com

guilty about ‘infantile’ level of

-- looking in
with clothes
ng once, but
plete. Then I got married (feeling

orgasms) and never had had vaginal
orgasms. After lots of fucking, I found that my best experience

with men revolved around cunnilingus and manual play ... hus-
band good at oral sex and manual play with which I could have
multiple orgasms. Then I began having ‘vaginal’ orgasms in wom-
an-astride position. Whenever I was bored with fucking I would

masturbate. I did a lot while pregnant ... he would, too. It turned

me on to watch, and he watched (more uptight, though). I love to
excite a man by masturbating. I began using dildoes vaginally and
anally while masturbating, or I would masturbate while being
fucked in vagina and with a finger in my ass (very good). I would
get uterine contractions while masturbating and pregnant. Too in-
tense. Also have good orgasms in sleep (dreaming) if not having
orgasms awake. I’m no longer with my husband.

“Last boyfriend uptight about most sex; no oral sex (which I
loved when astride the man’s mouth) and he felt morally uptight
about masturbating. He used me for release... then I taught him
to do me manually, only one orgasm per time. I find I am more
uptight about masturbating now. I’m very stiff, and don’t move
around to make noise... masturbated once in front of him ... it
wasn’t too great... I once tried in bed while he was asleep...
the tension of holding still and ‘orgasming’ almost made me pass
out... too heavy. I like to sleep alone to masturbate, but it
wastes my sexual desire for men... which is much less than I
used to have... still like to have multiple orgasms, they’re O.K.
but not as good as before. Have new boyfriend, hope he’s into
masturbation, oral sex; also hope to rediscover erotic fantasies.
Thanks, I had a great time remembering all this.”’

DISCUSSION

247

The women who have provided these histories may not be
Statistically typical. In Kinsey’s sample of 5,000 women, by age
twenty, forty per cent of women had had at least one masturba-
tory orgasm. The mean age at which our ten women learned
effective self-stimulation was 19.6 years. Our group may be
slightly ahead of the norm, but when compared with the or-
8asmic experience and facility of men, it is easy to see that
women start the fifty yard dash with a hundred yard handicap!

is inside and hand outside. ;
Pi re I remember is feeling good when washing in bee
first orgasm when trying to do that again by washing, eer
legs together, then rubbing with handle of the back scrub pe
ing multiple orgasms.... trying to hold out as long as Pare
but sometimes missing if I did that. Also having lots ° oe
| sies.... sometimes of being seen, sometimes of being exam oe
sometimes of being made love to by women, a ee ee
) sex. Always rub entire vulva, one middle finger on clitoris,

—

248 CLITORIS

This sample probably has a higher percentage of homosexual
and bisexual experience than the general population and has 4
smaller proportion of ongoing marriages than other women of
the same age. Nevertheless, their struggles are not unlike the
struggles of women everywhere.

Some of the women we know began masturbation (and teach-
ing it to others) by age six, but it’s not rare at all for women to
be well past voting age before they begin to own their own
bodies.

In counseling non-orgasmic women, we have found the writ-
ings of Hite (2) and Dodson (3) helpful. The former describes
the developmental and sexual struggles of many women, while
the latter is more the personal saga of a gifted radical thinker.
Many women find solace and encouragement in these writings;
we hope that similar comfort will be provided by the stories we
have presented here.

REFERENCES

1. Barbach, L.G.: For Your Self. Doubleday, New York, 1975.

2. Hite, S.: Sexual Honesty By Women For Women. Warner Paperback, New York,

1974
3. Dodson, B.: Liberating Masturbation. Goddess Books, San Francisco, 1973 (pamph-

let).

Chapter XVI

STEREOSCOPIC ILLUSTRATIONS

Dr. David L. Bassett’s Stereoscopic Atlas of Human Anat

published fifteen years ago, set a new standard f mick

) or medical illus-
tration, as the Sawyer’s Viewmaster Reel format provided a
three dimensional, color picture unequalled in the field of bio-
logical photography. Since then, atlases for ophthalmology,
ophthalmoscopy and orthopedics have appeared, and others are
in preparation.

Like most other parts of the human body, the clitoris is not
adequately represented on a two dimensional printed page. The
following stereoscopic illustrations show some of the range and
variety of the size, pigmentation, mobility and preputial cover-
ings of the clitoris, as well as the complex interfoldings where
prepuce and labia minora join.

Most of the views were taken by John W. Binckley, M.D.,
using a Canon 35 mm camera, mounted on a rack-and-pinion
bar, which provided for horizontal motion between the two ex-
posures. Lighting was by electronic flash. The film is Koda-
chrome II.

The clitorides shown here are all within the range of normal.
The captions comment on the natural variation which is visible,
but it should be clear that none of the sizes, shapes or pigmenta-
tions shown are abnormal, except view 28.

lA 36-year-old fair-skinned Caucasian woman. The darker-pigmented

labia minora merge gradually into the prepuce, which entirely conceals

the clitoral glans. The ruler indicates size.
2. Same case as 1. Vertical and lateral traction have retracted the prepuce,
revealing the glans. The veins visible above the prepuce suggest parity.
3. Same case as 1. The anterior end of the vestibule is visible between the

labia minora and below the clitoris.
4. Same case as 1. Vertical traction alone has retracted the prepuce, while

the labia remain in apposition.

249

250

10.

11.

12.

13.

14.

15.

16.

17.

. Same case as

. Same case a

CLITORIS

1. Lateral traction shows details of preputio-labial junc.
tion, which is not bilaterally symmetrical. ;
s 1. Stronger vertical and lateral traction fully opens the

vestibule and reveals most of the glans. The urethral meatus appears at

the lower margin of the photo.

. A 37-year-old Caucasian woman with light-brown hair. The glans js

concealed. The clitoral shaft appears longer than in case 1. Labial pig-
mentation and corrugation are both less prominent. There appears to

be a dorsal slit in the prepuce.

. 30-year-old Spanish woman, with olive complexion. The clitoris is

slightly larger than average and is seen in its natural, unretracted state.
40-year-old Caucasian woman with fair complexion. The shaft of the
clitoris is buried under the cylindrical fold of tissue which projects
forward and towards the viewer’s right, terminating in the prepuce. The
glans is largely hidden under the prepuce, where the upper margins of
the labia minora terminate.

Same case as 9, with the mons tissues retracted laterally and upward,
revealing the glans. The labia minora join and terminate on the lower
surface of the glans, forming the frenulum of the clitoris. Parity is
indicated by the veins above the prepuce. There are signs of mild
vaginitis and irritation.

$2-year-old Caucasian woman with darker than average pigmentation.
The labia minora, extending from below, are in apposition, while the
prepuce covers the glans.

Same case as 11. With upward traction, the glans becomes visible. The
prepuce and labia minora appear mildly edematous. The urethral
meatus is visible between the labia; below that is the beginning of the
vaginal opening, coated with a moderate vaginal discharge.

A fair-complexioned redhead. The clitoris is more hooded than usual
and perhaps a little larger than average. Mild irritation in the folds of
the skin.

28-year-old Caucasian woman of average pigmentation. The clitoris is
larger and more hooded than usual. The upper labia minora wing out
anteriorly much more than usual. The urthral meatus is visible.
Caucasian woman. The clitoral shaft is unusually long. The glans i
visible, being covered by prepuce above and labial lips below. The
vestibule is in shadow behind the lips.

The labia minora touch throughout most of their length, completely
obscuring the vestibule; the prepuce covers the glans.

Same case as 16. Even with lateral traction, the glans remains con-
cealed. This view illustrates the Gray’s Anatomy description of the
anterior termination of the labia minora:

The upper division passes above the clitoris to meet its fellow of the
opposite side, forming a fold which overhangs the glans clitoridis, 2?
is named the preputium clitoridis; the lower division passes beneath the

s not

_— ww

19.

20.

21.

22.

23.

2a,

25.

26.

27.

28.

Publisher’s note:

. Postpartum state illustrated by recently shaved

clitoris. Pposite side, the frenulum of the

Clearly, this description does not fit every woman
public hair. The glans

on. The labia are aver-
they are shorter than

appears average size and is visible without tracti
age in length, in contrast to view 16, where
average.

Same case as 18. Slight traction shows : ;
between the two fingers. The urethral aoe oe ge
the vestibule.

The shaft appears longer than average. The glans is hidden beneath the
prepuce. The skin of the vulva appears dry, flaking and irritated.
bin hay Several fold, with divine ee Rees ae
; S merging in the mons area, un-
like the textbook description.

Same case as view 21. With later traction, the vestibule lies open and
the prepuce retracts slightly, but the glans remains largely concealed.
There is a moderate vaginal discharge.

A fair-complexioned redhead. The clitoris is totally obscured by labia,
prepuce and pubic hair.

Same case as view 23. With upward traction, the shaft is outlined
under the preputial skin, between the fingers. The labia are somewhat
longer than usual; one remains folded centrad, largely obscuring the
glans. There are signs of skin irritation, with moderate vaginal dis-
charge.

The clitoral area lies deep in the furrow between the labia majora,
obscured by shadow and pubic hair. This is a frequently encountered
phenomenon, and one which requires retraction of surrounding tissues
in order to visualize the clitoris.

Same case as view 25. With upward traction, the glans is exposed,
including the termination of the lower division of the anterior labia
minora, which join the under surface of the glans. There appears to be
a surgically made dorsal slit in the prepuce.

Generally light pigmentation in a postpartum woman. The structures
are of average size. The glans lies beneath the prepuce; the labia minora
Overhang the vaginal opening.

A case of clitoral agenesis. The vagin ied
appear bright pink. On either side are the pigmented labia eae
larger than the other. Above the vagina is an area nciting wanise Os
where the clitoris would normally be. (Case PEA e 1288. TENTS eet

stereo view.)

appears as a dimple in

al orifice and hymeneal area
one

Additional or replacement reels are available from the

Publisher.

Adhesions, 5, 106, 107
Age-grading, 141

Agenesis, 100, 251

Akkadian, 171, 172

Algeria, 185

Alkaline phosphatase, 87
Alpha waves, 219

Amharic, 173

Anal stimulation, 214, 240, 245, 247
Anatomy, 9, 249

Anatomy, comparative, 23ff
Anorgasmia, 207, 208, 227
Anthropology, 111

Appetite, 60

Arabian Nights, 188

Arabic, 183

Artiodactylia, 26

Arousal, sexual, 60, 64
Asaorta, 119

Australia, 150

Bagishu, 145

Bartholin gland, 12

Bestiality, 242

Blood vessels, clitorial, 15, 79, 80
Body image, 59

Bone, clitorial, see Os clitoridis
Buddhism, 214

Bulbs, vestibular, 9, 70
Carcinoma, 100

Cat, 28

Celtic, 168

Cerebral laterality, 236
Chauvinism, medical, 2
Chinese, 176

Cholinesterase, 87
Circumbustion, 117
Circumcision, 106, 113ff
Cleopatra, 124
Clitoridectomy, 105, 114, 126
Clitoris, function, 24

Corpora cavernosa, 75ff
Cow, 26

Culture diffusion, 156
Cunnilingus, 190, 242
Cunnus, 168
Cytochemistry, 87
Danish, 167
Diencephalon, 46

Dog, 28

Dorsal slit, 250, 251
Egypt, 113

Egyptian, 174
Electroencephalogram, 213, 219
Electron microscope, 91
Elephant, African, 32
Embryology, 17, 36, 194
Erection, clitoral, 65, 81, 83
Ethiopia, 119
Etymology, 162

Ewe, 26

Faking, 225

Family therapy, 196
Fears, orgasmic, 232
Feedback, positive, 61, 63
Femininity, 233
Feminism, 35

Fiber size, nerve, 37ff
Fibroma, 100

Flemish, 167

Galla, 119

Genital corpuscles, 20
Glans clitoris, 13, 14, 23
Glomus tumor, 100
Gorilla, 32

Guinea pig, 27

Hamster, 27

Hebrew, 173
Hemangioendothelioma, 100
Herodotus, 123

Horse, see mare

254. CLITORIS

Hyena, spotted, 28
Hypertrophy, 99, 107
Hyperventilation, 219
Hypothalamus, 54
Indian (American) languages, 180
Indo-european Languages, 167
Indonesia, 178
Infibulation, 113ff
Innervation, clitoral, 18, 24, 37, 94, 96
Innervation, penile vs. clitoral, 41
Iraq, 185
Irish, 220
Intersex, 98, 99
Introcision, 117
Japanese, 177
Javanese, 179
Jazz, 165
Kegel exercises, 211ff
Kikuyu, 135
Krause bulbs, 91, 94
Latin, 168
Learning, and sexuality, 62
Leiomyosarcoma, 100
Lemur, 29
Libya, 185
Lipoma, 100
Male-female differences, 225
Man in the boat, 165
Maori, 154
Mare, 25
Masturbation, 64, 128, 130-132, 147, 201,
239-247.
Meissner touch corpuscle, 91, 94
Melanoblastoma, 100
Melanosarcoma, 100
Menstrual cramps, 216
Merkel tactile disc, 91, 94
Micronesia, 155
Monkey; New world, 29
Old world, 31
Spider, 29
Moro, 149
Mouse, 27
Mucocutaneous end organ, 89, 93
Muscles:
pelvic, 10ff
bulbospongiosus, 10
constrictor vestibuli, 23
constrictor vulvae, 23

corpus cavernosum clitoridis, 23
ischiocavernosus, 10
pubococcyseus, 21 1ff
retractor clitoridis, 23
transversus perinei superficialis, 23
Myoblastoma, 100
Myo-epithelial cells, 82
Nandi, 144
Native American languages, 18
Neurilemmoma, 100
Neurophysiology 35ff, 204, 213, 218-220
Oedipus complex, 197
Orgasm:
baseline contractions in, 68, 71
“‘clitoral’’, 203, 209, 210
female, 194, 199, 206-208, 210,
214-217, 244 ff.
multiple, 215
muscles in, 66-71
pubococcygeus in, 68
physiology, 65ff
“vaginal’’, 199, 203, 209, 210
Orgasmic platform, 213
Os clitoridis, 24, 28, 29, 30, 31
Pacinian corpuscles, 19, 37, 40, 60, 87,
91,94
Paleoanthropology, 122
Paleolithic era, 224
Palestine, 148
Pano indians, 118
Papyamentu, 168
Pathology, 98
Pelvic congestion, 216
Perfumed Garden, The, 187
Perineum, 10
Perissodactylia, 25
Persian, 169, 186
Petit mort, 205
Pharaonic circumcision, 113
Playboy, 196
Politics, sexual, 216, 217
Polynesia, 153
Potential, electrical, 42ff
Prepuce, 14
Psychoanalysis, 197, 206
Psycholinguistics, 162
Psychosexual ethos, 144
Puberty rites, 142ff
Rabbit, 28

Racial differences, 112

Rat, 27

Rectalgia, 212

Reflexes, spinal, genital, 41
Reichian psychology, 199, 216
Rites of passage, 142

Ruffini end-organs, 91, 92, 94
Sanskrit, 169-171

Semitic, 171

Sex technique, 203

Social class, 195

Sociology, 195

Somali, 119

Sow, 26

Smegma, 5

Spanish, 169

Spinal cord, 48 ff

Sudan, 113

Sunna circumcision, 115ff

Surgery, 105 —

Syria, 184

Tarsier, 29

Thalamus, 53, 55, 57

Therapy, 239

Toilet training, 234

Trauma, 109

Triangle, urogenital, 10

Truk, 155

Turner’s syndrome, 99

Urdu, 170

Urethra, clitorine, 23, 29

Vagina, sensitivity of, 95, 96
Vaginitis, 250

Vater-Pacini, see Pacinian corpuscle
Velocity, conduction, 49
Vibrator, 65, 242, 243, 244

Von Recklinghausen’s disease, 100
Whale, 32

University of British Columbia Library

DUE DATE

JUN - 1 1998

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