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At least 199 records · Page 11Linked to original sources
PubMed2002

Clitoral priapism: a rare condition presenting as a cause of vulvar pain.

BACKGROUND: Priapism of the clitoris is a rare condition associated with prolonged erection of the clitoris causing engorgement, swelling, and pain to the clitoris and immediate adjacent area. CASE: A 47-year-old woman presented complaining of vulvar and clitoral pain. Self-reported findings of a swollen and tender clitoris had been confirmed by physical examination during an episode of priapism, otherwise there were no abnormal findings on routine evaluation. The history and findings of prolonged clitoral swelling, tenderness, and pain of the clitoris and adjacent area were considered consistent with clitoral priapism, and discovered to be attributed to the use of trazodone hydrochloride, a heterocyclic antidepressant. The patient was initially treated with imipramine hydrochloride; however, it was the withdrawal of the medication instigating the condition that was the focal point in its management. CONCLUSION: Priapism of the clitoris is a condition that may develop during therapy with certain medications, specifically those possessing a strong alpha-adrenergic blockade. Conditions altering blood flow to the clitoris may also predispose to developing this condition. Familiarity with this condition and a high index of suspicion are paramount in establishing a diagnosis.

Antidepressive Agents, Tricyclic↗
PubMed2005

Clitoral anatomy in nulliparous, healthy, premenopausal volunteers using unenhanced magnetic resonance imaging.

PURPOSE: We determined the magnetic resonance imaging (MRI) characteristics of normal clitoral anatomy. MATERIALS AND METHODS: A series of MRI studies of 10 healthy, nulliparous volunteers with no prior surgery and normal pelvic examination was studied and the key characteristics of clitoral anatomy were determined. A range of different magnetic resonance sequences was used without any contrast agent. RESULTS: The axial plane best revealed the clitoral body and its proximal continuation as the paired crura. The glans was seen more caudal than the body of the clitoris. The bulbs of the clitoris had the same signal as the rest of the clitoris in the axial plane and they related consistently to the other erectile structures. The bulbs, body and crura formed an erectile tissue cluster, namely the clitoris. In turn, the clitoris partially surrounded the urethra and vagina, forming a consistently observed tissue complex. Midline sagittal section revealed the shape of the body, although in this plane the rest of the clitoris was poorly displayed. The coronal plane revealed the relationship between the clitoral body and labia. The axial section cephalad to the clitoral body best revealed the vascular component of the neurovascular bundle to the clitoris. The fat saturation sequence particularly highlighted clitoral anatomy in healthy, premenopausal, nulliparous women. CONCLUSIONS: Normal clitoral anatomy has been clearly demonstrated using noncontrast pelvic MRI.

Adult↗
PubMed1999

[Feminizing genital plasty in patients with intersexuality].

Feminizing genitoplasty (FGP) involves modification of a hypertrophic clitoris, vaginoplasty, and modelling of the labia. FGP is performed during childhood and usually in one stage. In 1996-1999 30 patients with intersex were operated on. 25 girls with female pseudohermaphroditism caused by congenital adrenal hyperplasia (CAH), 3 patients with mixed gonadal dysgenesis (MGD), 1 patient with male pseudohermaphroditism and one female patient with true hermaphroditism (HFV). Seventeen patients were between the ages of 3 and 6 years, 13 patients (all female with CAH) were 13 to 21 years old. One-stage FGP, i.e. partial resection of the clitoris and vaginoplasty (VP) was performed in 11 patients. A two-stage operation, i.e. partial resection of the clitoris and subsequent vaginoplasty, was done in 3 patients (all with VHN with a high-orifice vagina). Vaginoplasty after excision of the clitoris was made in 13 patients (all with CAH, 5 of them with a high-orifice vagina). Three female patients (2 VHN, 1 HFV) had partial resection of the clitoris and wait to have VP. Fourteen patients with partial resection of the clitoris healed p.p. Healing p.s. was recorded in 5/27 patients with vaginoplasty (all CAH). Three of them were older, menstruating and obese. In 4/14 patients after partial resection of the clitoris both modelling and fixation of the glans clitoridis was necessary. Urinary incontinence was not recorded. Stricture of the vaginal orifice was found in one 6-year-old patient with CAH after reconstruction of a high-orifice vagina. Thirteen older patients have a normal vaginal orifice, two of them have sexual intercourse. FGP can be performed already at toddler age, the cosmetic effect is favourable, the glans clitoridis is preserved and the psychosexual development of patients is not impaired. FGP can be used also in adults, severely virilized patients.

Child↗
PubMed2003

Vardenafil enhances clitoral and vaginal blood flow responses to pelvic nerve stimulation in female dogs.

The relaxation of the smooth muscle in the vagina and clitoris and the increase of blood flow into these organs is thought to be essential in the female sexual response. Vardenafil is a type 5 phosphodiesterase (PDE5) inhibitor that potentiates the nitric oxide (NO)/cGMP pathway facilitating penile smooth muscle relaxation and improving penile erection in men. Although the potentiation of the NO/cGMP pathway through PDE5 inhibitors can clearly enhance blood flow into the penis and is used in the therapy of male sexual dysfunction, there is controversy about the efficacy of these agents in improving female sexual function. The aim of this work was to evaluate the effects of vardenafil on the increase of blood flow into the vagina and clitoris induced by pelvic nerve electrical stimulation (PNES) in a female dog model. Application of PNES produced consistent and frequency-related increased blood flow into the vagina and clitoris of anesthetized female dogs. The magnitude and duration of the blood flow responses to PNES were variable among the different animals but remained stable over time within the same animal. The intravenous administration of vardenafil (1 mg/kg) significantly potentiated the increases in blood flow produced by PNES into the vagina (381.4 and 206.2% of control response at 5 and 10 Hz, respectively, P<0.01, n=6) and clitoris (379.4 and 238.5% of control response at 5 and 10 Hz, respectively, P<0.01, n=6) 20 min after administration. The significant enhancement of PNES-induced responses was maintained 50 min (224.5 and 181.0%, P<0.01 in vagina; 294.8 and 258.9%, P<0.05 in clitoris) and 80 min after vardenafil administration (209.5 and 156.9%, P<0.05 in vagina; 268.9 and 194.9%, P<0.05 in clitoris). Here we present a feasible model for research into female sexual function. Our results show that vardenafil effectively potentiates the blood flow responses to PNES in the genitalia of female dogs. These results emphasize the role of the NO/cGMP pathway in the local vasodilatory response in female sexual organs and provide a rationale for testing PDE5 inhibitors, such as vardenafil, as a treatment for certain forms of female sexual dysfunction.

3',5'-Cyclic-GMP Phosphodiesterases↗
PubMed2004

Self-assessment of genital anatomy, sexual sensitivity and function in women: implications for genitoplasty.

OBJECTIVE: To assess the perceptions of healthy women of their genital anatomy and sexual sensitivity, and to provide suggestions for genitoplasty based on this information, as the success of genitoplasty has historically relied upon the surgeon's perception of the patient's anatomy and function, rather than the patient's perception of outcome in terms of appearance and erotic sensitivity. SUBJECTS AND METHODS: Fifty healthy, sexually active, adult women (aged 20-56 years) with no history of genital surgery completed the female version of the Self-Assessment of Genital Anatomy and Sexual Function. This self- report questionnaire comprises written text and images enabling women to rate the appearance, size and position of clitoris and vagina, as well as the intensity of orgasm and effort required for achieving orgasm in specified areas around the clitoris and within the vagina. Anatomical locations were compared for these ratings by repeated-measures analysis of variance. RESULTS: Anatomically, 46% of women described their clitoris as 'moderate-sized and raised', 42% as 'small and raised', and 78% reported that their vaginal opening was adequate for sexual penetration. The women reported the strongest orgasm and least effort to obtain an orgasm with stimulation of the area on and above the clitoris. For vaginal sensitivity, scores for orgasm intensity increased, and for orgasm effort decreased, with increasing vaginal depth, and they indicated less sexual sensitivity for the vagina than for the external genitalia. CONCLUSION: The skin above the clitoris, and the clitoris itself, appeared to be the most sexually sensitive. During genitoplasty, attention to preserving skin-flap integrity in this area seems appropriate.

Adult↗
PubMed2006

A neuroanatomical comparison of humans and spotted hyena, a natural animal model for common urogenital sinus: clinical reflections on feminizing genitoplasty.

PURPOSE: Surgical treatment of the common urogenital sinus phallus has been one of the most challenging areas in pediatric urology. To better understand the neuroanatomy of the common urogenital sinus phallus, we evaluated an animal model naturally having this condition, the spotted hyena, Crocuta crocuta. We compared the neuroanatomy of male and female humans and spotted hyenas using anatomical, immunohistochemical and 3D reconstruction techniques. We also examined the implications of the pattern of clitoral innervation for the unique challenges faced by female spotted hyenas, the only extant species of mammal that mates and gives birth through the clitoris. MATERIALS AND METHODS: Three adult male and 3 female spotted hyenas were studied. With the animals under anesthesia gross anatomical examination was performed before and after artificial erection. Histological analysis was performed on one 95-day fetal male and female spotted hyena specimens, and on 18 human male and female fetal external genitalia specimens using antibodies raised against the neuronal marker S-100. Three-dimensional computer reconstruction using serial sections allowed analysis of the neuroanatomy of the penis, clitoris and common urogenital sinus of the fetal spotted hyena and human. RESULTS: Compared to other mammals, the clitoris and penis of spotted hyenas were remarkably similar in size and configuration in the flaccid and erect states. Male and female hyenas had a single opening on the tip of the glans penis/clitoris. The basic anatomical structures of the corporeal bodies in both sexes of humans and spotted hyenas were similar. As in humans, the dorsal nerve distribution was unique in being devoid of nerves at the 12 o'clock position in the penis and clitoris of the spotted hyena. Dorsal nerves of the penis/clitoris in humans and male spotted hyenas tracked along both sides of the corporeal body to the corpus spongiosum at the 5 and 7 o'clock positions. The dorsal nerves penetrated the corporeal body and distally the glans in the hyena. In female hyenas the dorsal nerves fanned out laterally on the clitoral body. Glans morphology was different in appearance in both sexes, being wide and blunt in the female and tapered in the male. CONCLUSIONS: The neuroanatomy of the male and female external genitalia in the spotted hyena, Crocuta crocuta, although grossly similar, has distinct anatomical and functional characteristics. The clitoris of the spotted hyena is a classic example of a natural animal model of a common urogenital sinus. The neuroanatomical characteristics of the spotted hyena may be a useful model to simulate the anatomy of common urogenital sinus anomaly in humans.

Animals↗
PubMed2003

Urogenital system of the spotted hyena (Crocuta crocuta Erxleben): a functional histological study.

The unique urogenital anatomy and histology of female spotted hyenas (Crocuta crocuta Erxleben) was reexamined to identify adaptations of "structure" that enable/facilitate urination, mating, and parturition through the clitoris. Unusual features of penile anatomy required for meeting ceremonies and successful mating through a clitoral point of insertion were also examined. As reported previously, the upper urogenital tract of the female spotted hyena is typical of other carnivores and consists of the oviducts, uterine horns, uterine body, and vagina. An anatomically defined cervix is absent, even though a histologically defined transition zone between the uterine body and vagina was demonstrated. Adaptive features of the upper genital tract were a helical-shaped uterine cavity, extensive smooth muscle in the uterus and vagina, and a newly discovered submucosal mucous urogenital gland (SMUG) located immediately caudal to the vagina. The extensive smooth muscle facilitates the expulsion of the large pups at parturition through the recurved birth canal. Secretions of the SMUG provide lubrication and protection for the urogenital mucosa during mating and parturition. Two types of "erections" are suggested by behavioral observations: the common hemodynamic erection required for insertion and thrusting by the male, and phallic "flipping" that commonly occurs earlier in the mating sequence and is sometimes seen during meeting ceremonies. Phallic "flipping" appears to be accomplished by the coordinated contractions of the large ischiocavernosus and retractor muscles acting on the semirigid organ. The extremely thick tunica albuginea and interstitial collagen of the common corporal body of the penis and clitoris gives the flaccid phallus some degree of rigidity even in the resting state in males and nulliparous females. Phallic "flipping" implies a hinge region in which flexibility is the key feature. Such a proximal hinge region of the male and female phallus was defined and was notable for its diminished collagen content. The urogenital sinus traversing the clitoris was specialized for distensibility, thus facilitating receipt of the penis during mating and for passage of the infant to the tip of the glans clitoris, where it emerges at parturition. The morphology of the glans penis is notable for the tapered common corporal body that extends to the distal tip of the glans. This adaptation is suggested to be required for a clitoral (as opposed to a vaginal) point of insertion during mating. Finally, additional segments of erectile tissue devoid of a thick collagenous capsule were demonstrated in the glans penis and glans clitoris, which appear to account for the "partially-locking" of the male into the female during the late stages of a mating sequence. Taken together, it is evident that the unusual sexual behaviors of the male and female spotted hyenas are facilitated by unique structural modifications of the relevant organs.

Animals↗
PubMed1985

Predictive factors with reference to low-risk of metastases in squamous cell carcinoma in the vulvar region.

Among 122 patients operated upon for squamous cell carcinoma in the vulvar region 14 variables were investigated by a logistic regression analysis to determine their predictive value as to the presence/absence of metastases to the inguinal nodes. Factors of predictive value proved to be hyperchromasia, polymorphism, involvement of the clitoris, depth of invasion, and tumor size. On the basis of these variables, three different models of low-risk groups were set up. Model I comprised patients whose tumors showed slight hyperchromasia and did not involve the clitoris [metastatic rate: observed 0, estimated 2.1% (0.4-9.8%)]. Model II comprised patients whose tumors showed slight hyperchromasia, did not involve the clitoris, and measured less than 4 cm [metastatic rate: observed 0, estimated 1.6% (0.3-7.8%)]. Model III comprised patients whose tumors showed slight hyperchromasia, did not involve the clitoris, and had an invasion depth of less than or equal to 5 mm [metastatic rate: observed 0, estimated 1.3% (0.2-7.1%)].

Aged↗
PubMed2002

Clitoral electromyography.

PURPOSE: The clitoris has several histomorphological and functional similarities to the penis. In this study we evaluated spontaneous and evoked electromyography activity in the clitoris. MATERIALS AND METHODS: We evaluated 11 healthy female volunteers with clitoral electromyography using a concentric needle electrode placed intracorporeally. The hand, foot and genital sympathetic skin responses, and spontaneous electrodermal activity were simultaneously recorded with silver surface electrodes. Another concentric needle electrode was placed subdermally on the mons pubis to differentiate clitoral activity from possible artifact. After recording spontaneous electromyography and electrodermal activity the left median nerve was stimulated to record evoked clitoral activity, and the sympathetic skin response in the hand, foot and genital regions. RESULTS: There was spontaneous electromyography activity in the corpus clitoris. All dermal sites, including the hand, foot and genital regions, showed spontaneous electrodermal activity. No spontaneous activity was recorded from the subdermal needle electrode. Distraction of attention and coughing increased the amplitude and frequency of spontaneous clitoral electromyography and electrodermal activity at all sites. After stimulating the left median nerve all sites except that of the subdermal needle electrode showed evoked activity. CONCLUSIONS: The demonstrated evoked and spontaneous clitoral electromyography activity seems to indicate a sympathetic tonus of the corpus clitoris, as recorded from the corpus cavernosum of the penis in human males. Clitoral electromyography may be a useful objective assessment tool for evaluating female sexual dysfunction as well as genital autonomic innervation.

Adult↗
PubMed2006

Pseudo-clitoromegaly associated with congenital prepubic sinus.

We operated on a 12-year-old girl who had clitoromegaly and a sinus on the midline prepubic area congenitally. The prepubic sinus appeared to point to the clitoris on the preoperative magnetic resonance image, but the relation between the sinus and clitoromegaly was unclear. Gray-brown discharge was emitted at the site of dissection between the prepuce and clitoris and the size of the clitoris became normal. The sinus was excised, revealing a tract 1.5 cm long that extended to the retropubic sinus, and ended in a fibrous tract that was linked to the clitoris. This suggested pseudo-hypertrophy because of the discharge collected in the end of the prepubic sinus.

Adrenal Hyperplasia, Congenital↗
PubMed2004

Genital sensation after feminizing genitoplasty for congenital adrenal hyperplasia: a pilot study.

OBJECTIVE: To assess sensation in the clitoris and vagina in women with congenital adrenal hyperplasia (CAH) who have previously had genital surgery, and to evaluate sexual function in this group as the latter, and particularly the experience of orgasm, appear to be closely related to sensitivity. PATIENTS AND METHODS: Six women were recruited from a multidisciplinary clinic specialising in intersex conditions, and representing an initial cohort from a larger ongoing study. The patients were asked to complete a postal questionnaire with a specialized sexual function assessment. Thermal, vibratory and light-touch sensory thresholds were assessed in the clitoris and vagina using a genito-sensory analyser and Von Frey filaments. RESULTS: All six women had highly abnormal results for sensation in the clitoris. Only three of them had an introitus capable of admitting the vaginal probe, and the vaginal sensory data of all three were within the validated ranges. A self-administered sexual function assessment was completed by the five women who were sexually active. The scores indicated sexual difficulties, particularly in the areas of infrequency of intercourse and anorgasmia. CONCLUSIONS: The sensory data for all six women were outside the normal range for the clitoris. The results for the upper vagina, which had not had surgery, were within normal ranges. These findings suggest that genital surgery may disrupt sensory input. Sexual function also appears to be impaired and this may relate to the compromised sensitivity and restricted introitus. The possibility that women with CAH have deficient clitoral sensation ab initio cannot be excluded. These striking findings must be evaluated further in the light of the controversy about the issue of genital surgery in children with CAH.

Adrenal Hyperplasia, Congenital↗
PubMed2006

Identification of neural circuits involved in female genital responses in the rat: a dual virus and anterograde tracing study.

The spinal and peripheral innervation of the clitoris and vagina are fairly well understood. However, little is known regarding supraspinal control of these pelvic structures. The multisynaptic tracer pseudorabies virus (PRV) was used to map the brain neurons that innervate the clitoris and vagina. To delineate forebrain input on PRV-labeled cells, the anterograde tracer biotinylated dextran amine was injected in the medial preoptic area (MPO), ventromedial nucleus of the hypothalamus (VMN), or the midbrain periaqueductal gray (PAG) 10 days before viral injections. These brain regions have been intimately linked to various aspects of female reproductive behavior. After viral injections (4 days) in the vagina and clitoris, PRV-labeled cells were observed in the paraventricular nucleus (PVN), Barrington's nucleus, the A5 region, and the nucleus paragigantocellularis (nPGi). At 5 days postviral administration, additional PRV-labeled cells were observed within the preoptic region, VMN, PAG, and lateral hypothalamus. Anterograde labeling from the MPO terminated among PRV-positive cells primarily within the dorsal PVN of the hypothalamus, ventrolateral VMN (VMNvl), caudal PAG, and nPGi. Anterograde labeling from the VMN terminated among PRV-positive cells in the MPO and lateral/ventrolateral PAG. Anterograde labeling from the PAG terminated among PRV-positive cells in the PVN, ventral hypothalamus, and nPGi. Transynaptically labeled cells in the lateral hypothalamus, Barrington's nucleus, and ventromedial medulla received innervation from all three sources. These studies, together, identify several central nervous system (CNS) sites participating in the neural control of female sexual responses. They also provide the first data demonstrating a link between the MPO, VMNvl, and PAG and CNS regions innervating the clitoris and vagina, providing support that these areas play a major role in female genital responses.

Afferent Pathways↗
PubMed2005

The incidental orgasm: the presence of clitoral knowledge and the absence of orgasm for women.

Women report anorgasmia and other difficulties achieving orgasm. One approach to alleviating this problem is to teach women about the clitoris. This assumes that women lack information about the clitoris and that knowledge about the clitoris is correlated with orgasm. Using a non-random sample of 833 undergraduate students, our study investigates both assumptions. First, we test the amount of knowledge about the clitoris, the reported sources of this knowledge, and the correlation between citing a source and actual knowledge. Second, we measure the correlation between clitoral knowledge and orgasm in both masturbation and partnered sex. Among a sample of undergraduate students, the most frequently cited sources of clitoral knowledge (school and friends) were associated with the least amount of tested knowledge. The source most likely to correlate with clitoral knowledge (self-exploration) was among the most rarely cited. Despite this, respondents correctly answered, on average, three of the five clitoral knowledge measures. Knowledge correlated significantly with the frequency of women's orgasm in masturbation but not partnered sex. Our results are discussed in light of gender inequality and a social construction of sexuality, endorsed by both men and women, that privileges men's sexual pleasure over women's, such that orgasm for women is pleasing, but ultimately incidental.

Clitoris↗