Abstract
Introduction and hypothesis
The clitoris has a critical pivotal role in female orgasm and arousal. The aim of this cross-sectional study was to evaluate topographic measurements of the clitoris, as well as to explore potential relationships between the clitoral complex and the orgasm domain of female sexual function, combining transperineal ultrasound with morphometric measurements.
Methods
In sexually active, heterosexual, premenopausal women, three-dimensional transperineal ultrasound imaging was used to measure the subpubic angle, the anterior triangle area (ATA) of the genital hiatus, the levator urethra gap, and the anteroposterior and transverse diameters of the genital hiatus. Mons pubis thickness, clitoris–urethra distance (CUD), clitoris–fourchette distance, and fourchette–perineal body distance were measured using a caliper. Comparison of measurements and correlation with orgasm score were performed.
Results
Among the 108 sexually active women, 30 (27.7 %) reported a low orgasm domain score. There were statistically significant differences between the low orgasm group and the control group in the ATA (4.05 vs 3.64 cm2 respectively; p = 0.03), CUD (21 mm; p = 0.04 vs 16.1 mm; p = 0.04), and volume of the glans clitoris (947.7 mm3 vs 1081 mm3; p = 0.02). There was a moderate and inverse correlation between clitoris–urethra distance and orgasm (r = −0.53, p < 0.001), and arousal (r = −0.42 p < 0.001). Broader ATA (OR = 0.47; 95 % CI = 0.23–0.99; p = 0.04) and longer CUD (OR = 0.57; 95 % CI = 0.44–0.73; p < 0.001) were identified as the only independent predictors of orgasm problems.
Conclusions
Longer glans clitoris–urethra distance and broad space for the deep structures of the clitoris is related to difficulty in reaching orgasm and arousal problems.
Similar content being viewed by others
References
Shifren JL, Monz BU, Russo PA, et al. Sexual problems and distress in United States women: prevalence and correlates. Obstet Gynecol. 2008;112:970.
Laumann EO, Paik A, Rosen RC. Sexual dysfunction in the United States: prevalence and predictors. JAMA. 1999;281:537.
Baskin LS, Erol A, Li YW, Liu WH, Kurzrock E, Cunha GR. Anatomical studies of the human clitoris. J Urol. 1999;162(3 Pt 2):1015–20.
Jannini EA, Buisson O, Rubio-Casillas A. Beyond the G-spot: clitourethrovaginal complex anatomy in female orgasm. Nat Rev Urol. 2014;11:531–8.
O’Connell HE, Anderson CR, Plenter RJ, Hutson JM. The clitoris: a unified structure. Histology of the clitoral glans, body, crura and bulbs. Urodynamics. 2004;14:127–32.
Pauls RN. Anatomy of the clitoris and the female sexual response. Clin Anat. 2015;28(3):376–84.
O’Connell HE, Eizenberg N, Rahman M, Cleeve J. The anatomy of the distal vagina: towards unity. J Sex Med. 2008;5:1883–91.
O’Connell HE, DeLancey JOL. Clitoral anatomy in nulliparous, healthy, premenopausal volunteers using unenhanced magnetic resonance imaging. J Urol. 2005;173:2060–3.
Wiegel M, Meston C, Rosen R. The female sexual function index (FSFI): crossvalidation and development of clinical cutoff scores. J Sex Marital Ther. 2005;32:1–20.
Dietz HP, Abbu A, Shek KL. The levator-urethra gap measurement: a more objective means of determining levator avulsion? Ultrasound Obstet Gynecol. 2008;32(7):941–5.
King R, Belsky J, Mah K, et al. Are there different types of female orgasm? Arch Sex Behav. 2011;40:865–75.
Pryor JL, LeRoy SC, Nagel TC, et al. Vibratory stimulation for treatment of anejaculation in quadriplegic men. Arch Phys Med Rehabil. 1995;76:59–64.
Sarkarati M, Rossier AB, Fam BA. Experience in vibratory and electro-ejaculation techniques in spinal cord injury patients: a preliminary report. J Urol. 1987;138:59–62.
Halata Z, Munger BL. The neuroanatomical basis for the protopathic sensibility of the human glans penis. Brain Res. 1986;371:205–30.
Ingelman-Sundberg A. The anterior vaginal wall as an organ for the transmission of active forces to the urethra and the clitoris. Int Urogynecol J Pelvic Floor Dysfunct. 1997;8(1):50–1.
Aydin S, Bakar RZ, Arioglu Aydin C, Ates S. Correlation between transperineal 3-dimensional ultrasound measurements of levator hiatus and female sexual function. Female Pelvic Med Reconstr Surg. 2017;23(6):433–7.
Costa RM, Miller GF, Brody S. Women who prefer longer penises are more likely to have vaginal orgasms (but not clitoral orgasms): implications for an evolutionary theory of vaginal orgasm. J Sex Med. 2012;9(12):3079–88.
Foldes P, Buisson O. The clitoral complex: a dynamic sonographic study. J Sex Med. 2009;6(5):1223–31.
Suh DD, Yang CC, Cao Y, Garland PA, Maravilla KR. Magnetic resonance imaging anatomy of the female genitalia in premenopausal and postmenopausal women. J Urol. 2003;170:138–44.
Wallen K, Lloyd EA. Female sexual arousal: genital anatomy and orgasm in intercourse. Horm Behav. 2011;59(5):780–92.
Landis C, Landis A, Bowles M. Sex in development. New York: P.B. Hoeber Inc; 1940.
Acknowledgements
The authors would like to thank the participants in the study.
Author information
Authors and Affiliations
Contributions
S. Aydın: project development, data collection, manuscript writing, data analysis; N. Bademler: project development, data collection, data analysis; E.A.S Yardımcı: project development, data collection, data analysis. A. Çağrı: manuscript writing, data analysis, investigation; A.F.G. Karasu: data collection, manuscript writing, investigation.
Corresponding author
Ethics declarations
Conflicts of interest
None.
Additional information
Publisher’s note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations
Rights and permissions
About this article
Cite this article
Aydın, S., Bademler, N., Yardımcı, E.A.S. et al. The role of clitoral topography in sexual arousal and orgasm: transperineal ultrasound study. Int Urogynecol J 33, 1495–1502 (2022). https://doi.org/10.1007/s00192-021-04830-x
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00192-021-04830-x