“Anatomy of the Clitoris” (2005) by Helen E. O’Connell, Kalavampara V. Sanjeevan, and John M. Hutson

In 2005, Helen O’Connell and colleagues published “Anatomy of the Clitoris,” a review article, in The Journal of Urology. The article was one of the first to provide a complete anatomical description of the clitoris, which is the organ involved in female sexual pleasure. In addition, O’Connell and her team relay that researchers have historically misunderstood and misrepresented the anatomy of the clitoris. They point out that even though researchers began accurately describing the anatomy of the clitoris in the 1840s, most anatomy textbooks in 2005 still omitted or inaccurately described the structure. The team argues that those omissions not only hinder surgeons’ ability to perform surgery on the clitoris but also reflect a dominant culture of misvaluing the female body. “Anatomy of the Clitoris” helps correct historical misconceptions about clitoral anatomy and promotes accurate representation of female anatomy in educational textbooks and academic settings.

In “Anatomy of the Clitoris,” O’Connell and colleagues discuss various anatomical structures located near the clitoris, including the vagina, urethra, labia minora, and mons pubis. Each of those components are part of the vulva, or external female genitalia, which is roughly the shape of an oval. The vagina is a canal that leads from the internal reproductive organs to the outside of the female body, and its opening is located towards the base of the vulva. The urethra runs above the vagina, and it is the canal that carries urine from the bladder out of the body. The labia minora are the small, inner folds of skin that surround and protect the openings of both the vagina and the urethra, and, finally, the mons pubis is a rounded mass of tissue that covers the pubic bones, which are bones that help protect internal sex organs and other internal organs. The external portion of the clitoris is visible below the mons pubis and above the labia minora, and the internal components wrap around both the urethra and vagina and embed deeply within the surrounding fat and muscles.  

Additionally, the team describes the neurovascular system of nerves, blood vessels, and tissues that surround and supply the clitoris, establishing its relationship with nearby structures. Nerves are bundles of fibers that send and receive messages about physical sensations back and forth between the brain and the rest of the body. Blood vessels are small tubes that blood flows through to circulate in the body. There are many types of blood vessels that the authors mention, including arteries, or blood vessels that carry blood from the heart to the rest of the body, and veins, or blood vessels that carry blood from the body back to the heart. Finally, tissues are a collection of cells that have similar structures and function together as a unit to perform specific functions. Many of the nerves, blood vessels, and tissues surrounding and within the clitoris also surround and supply structures like the vagina and urethra, making them largely interconnected.

At the time of writing “Anatomy of the Clitoris,” all three authors practiced urology, the branch of medicine concerned with the diseases and functions of the urinary system, in the Department of Urology at the Royal Melbourne Hospital in Victoria, Australia. In 1994, O’Connell was one of the first women to become a urologist in Australia. As of 2023, Kalavampara V. Sanjeevan works as a physician in the departments of urology, surgical oncology, the Amrita Advanced Center for Robotic Surgery, and as a clinical professor in the Department of Urology at Amrita Institute of Medical Sciences, a health center and medical school in Kochi, India. Also, as of 2023, John M. Hutson is the Chair of Pediatric Surgery at The University of Melbourne in Melbourne, Australia, where he has worked since 1984. He is also one of the Consultant Pediatric Urologists at The Royal Children’s Hospital, in Melbourne.

According to a 2020 interview with O’Connell in the newspaper The Guardian, O’Connell’s personal experiences in medical school led to her eventual research on clitoral anatomy. In the interview for The Guardian, she explained that her anatomy textbooks angered her because they discussed penile anatomy in detail yet hardly mentioned clitoral anatomy. Additionally, according to the interview, when O’Connell moved on to study urology in her later medical training, she recognized that surgeons had a wide breadth of knowledge about how to preserve nerves in the penis during surgery, but researchers had not done the work necessary to understand how to preserve nerves in the clitoris during surgery. She expressed that it was as if throughout her education, her experiences reinforced the idea that there were males, and then there was another subset of people who were not whole people in the way that males were and therefore were not deserving of their body parts having a full description. O’Connell relays that her experiences pushed her to study female anatomy to help address the lack of resources about it in comparison to male anatomy. 

Prior to writing “Anatomy of the Clitoris,” O’Connell co-authored multiple publications on clitoral anatomy, which largely informed the descriptions of the clitoris that her team included in the article. For example, in 1998, O’Connell, Hutson, and two others co-authored “Anatomical Relationship Between Urethra and Clitoris,” in which they argued that based on their dissections of ten human cadavers, the prevailing anatomical descriptions of female genital anatomy were inaccurate. Primarily, they explained that the clitoris, urethra, and vagina anatomically connect and relate to one another in ways that anatomists had not previously recognized. Then, in June 2005, O’Connell co-authored another article about clitoral anatomy using magnetic resonance imaging, or MRI, on female volunteers. MRI is a medical technique that allows scientists to see detailed images of internal organs and tissues. In the 2005 article, the authors described the characteristics of the clitoris that are visible using MRI technology, which allowed them to distinguish between and more thoroughly analyze each component of the clitoris than they could using dissections. O’Connell and her team used findings from both studies to guide the descriptions of clitoral anatomy they included in “Anatomy of the Clitoris.”

O’Connell and colleagues organize “Anatomy of the Clitoris” into five sections. In the first section, an untitled introduction, the authors claim that many anatomy textbooks omit detailed descriptions of clitoral anatomy, and they share that they wrote “Anatomy of the Clitoris” to clarify human understanding of clitoral anatomy. Then, in “Modern Studies of Clitoral Anatomy,” they highlight that the clitoris consists of multiple components, and they explain that an abundance of nerves and blood vessels supply the structure. In the third section, “History of the Anatomy of the Clitoris,” O’Connell and colleagues explain that even though human understanding of clitoral anatomy increased between the sixteenth and twenty-first centuries, social and cultural values combined with unclear language spurred and worsened controversies surrounding the clitoris, stunting research on the topic. Next, in “Context of Anatomical Controversy,” they state that the clitoris, urethra, and vagina all contribute to female sexual pleasure, thus, they propose it may be clearer to adopt one term that encompasses all three of those structures. Finally, in “Conclusions,” the authors argue that textbook writers have had access to comprehensive descriptions and diagrams of the clitoris since the late 1800s, but have not incorporated them because of cultural prejudices surrounding the structure of the clitoris.

In the untitled introduction of the article, O’Connell and colleagues explain that human understanding of the clitoris varied drastically between the sixteenth and twenty-first centuries. The team explains that when anatomists first described the clitoris in the 1500s, almost everything about it was controversial, including what it was, what people should call it, and whether it was normal to have one. They explain that from the sixteenth century onwards, many anatomists claimed to have discovered the clitoris, and some of whom the authors identify as prominent individuals in the field of anatomy argued that the clitoris was not a normal or standard female body part. O’Connell and colleagues go on to explain that a lack of understanding and correct representation of the clitoris persisted into the twenty-first century.

The authors explain that at the time of publication, many new textbooks did not include accurate descriptions of clitoral anatomy, which they argue could result in difficult or unsuccessful clitoral surgeries. They emphasize that the same textbooks that omit or inaccurately describe the clitoris do provide detailed descriptions of penile anatomy. O’Connell and colleagues explain that recent research showing anatomical connections between the clitoris, urethra, and vagina suggest an important relationship between the structures, yet most textbooks do not mention that relationship or the structures’ anatomical relatedness whatsoever. To ensure that surgeons can successfully preserve anatomical structures and their function during surgery, the authors express that it is important to have accurate and accessible descriptions of its anatomy.  

Thus, to conclude the first section, the authors outline their methods and explain that they wrote “Anatomy of the Clitoris” to clarify female sexual anatomy and specifically, clitoral anatomy. They describe that they first used two databases to search for articles related to modern anatomical understanding of the clitoris, from 1966 to 2004, and then they related findings from those articles to historical literature to thoroughly clarify female sexual anatomy. The authors state that they aimed to clarify specific aspects of clitoral anatomy, including its features, relationship to other structures, nerve and blood supply, microscopic structure, and historical significance.

Then, in “Modern Studies of Clitoral Anatomy,” O’Connell and colleagues explain that the clitoris has multiple parts, which they begin discussing by defining the glans, or the highly sensitive, small, and external part of the clitoris. The glans is located above the urethral opening and has an abundance of nerve endings, thus, it is sensitive to the touch. Because it is the only part of the clitoris that one can see from outside the body, the glans is the structure that most people think of when they hear the term clitoris and that due to its visibility, researchers have spent more time studying it.  

However, they point out that the glans is only a small part of the clitoris, as the internal structures that it connects to, the corpus, crura, and bulbs, make up approximately ninety percent of the clitoris. The authors explain that the corpus, or the body of the clitoris that directly connects to the glans, is composed of two conjoined corpora, or sponge-like regions of erectile tissue and forms a boomerang shape such that its bend projects into the mons pubis. They state that a partition separates the two corpora of the corpus, and the partition continues halfway into the glans. The crura are two legs that extend off the corpus as the longest part of the clitoris, and the bulbs are masses of erectile tissue that sit between the crura and the vaginal wall. O’Connell and colleagues include three pictures that each display a different view of the components that make up the clitoris. The first two are images of the frontal and side views of a dissected clitoris, and the third contains a diagram displaying the boomerang-like shape of the corpus in relation to nearby structures.

O’Connell and colleagues then emphasize the interconnected relationship between the clitoris, urethra, and vagina, largely because of the structures’ proximity. They explain that the clitoris, urethra, and vagina form a pyramid-shape. The ends of the crura form the bottom corners, the bulbs and vagina forming the base, the urethra in the center, and the corpora and glans forming the top of the pyramid. The authors include an additional figure that displays the pyramidal structure of the clitoris, urethra, and vagina.  

After outlining how the clitoris proximally relates to the urethra and vagina, the authors explain that a complex system of nerves and blood vessels supply the clitoris and nearby structures. They explain that some parts of the clitoral neurovascular system, or system of nerves and blood vessels, are macroscopic and therefore visible to the naked eye, whereas others are microscopic and researchers need the assistance of technology to clearly see them. The authors state that multiple macroscopic neurovascular bundles, or structures in which connective tissue binds nerves and veins together so they travel together throughout the body, surround and feed into the clitoris. They describe that the bundles wrap around both sides of the pyramidal structure of the clitoris, urethra, and vagina, interconnecting the structures, and then join together to run along the corpora and into the glans like large trunks. Though researchers have defined the macroscopic components, the authors explain that doing so for the remaining network of microscopic nerves is much more difficult. They explain that the existing literature on the microscopic neural network suggests the branches of nerves are very small, supply both the urethra and the clitoris, and travel along both the urethra and vaginal wall. However, they also point out that previous studies analyzed the neural anatomy of infants rather than adults. Thus, the authors propose that researchers should conduct further studies in adult individuals to provide surgeons the information they need to preserve the neural network when they perform various surgical procedures on adults.  

Continuing in “Modern Studies of Clitoral Anatomy,” the team then explains the microscopic anatomy of the clitoris, beginning with the corpus and the glans. First, the authors state that the microscopic anatomy of the corpus is very similar to that of the penis. They describe that deep clitoral arteries rest in the corpus’s spongy erectile tissue, tough and fibrous layers of connective tissue surround its exterior, and branches of nerves, vessels, and arteries lay on its outside surface. Then, the authors explain that the glans contains an abundance of densely packed nerves, but they highlight that few are located at the very top of the glans, which has implications for surgeons when they perform procedures such as genital reconstruction surgeries, or surgeries to create a functional penis or vulva in someone who does not have one. For example, knowledge of where clitoral nerves are located can help surgeons to better construct an anatomically and functionally accurate penis with improved sexual sensation. Additionally, they include that the glans contains many sensory receptors, or nerve endings that send signals based on changes in the environment, including a special type of sensory receptor that provides deep sensation and can detect vibration.

After outlining the microscopic anatomy of the corpus and the glans, the authors explain that the microscopic anatomy of the crura and glans differ from that of the corpus and glans. Regarding the crura, they describe that microscopically, it partially resembles the corpus because both are composed of the same type of erectile tissue. However, they state that the two structures differ because the crura lacks the surrounding nerves and blood vessels and the internal vessels of the corpus. Then, the team explains that the bulbs consist of spongy, erectile tissues that have large spaces and very few nerves. They state that the tough connective tissue that surrounds the corpus and crura do not surround the bulbs, giving the bulbs a purple color that differs from the pink appearance of the corpus and the crura. Despite their analysis, the authors call for further research on the microscopic structure of the clitoris.

In their third section, “History of the Anatomy of the Clitoris,” the authors claim that in 1545, Charles Estienne, a scientist who studied anatomy and medicine in France, became one of the first people to publish on the clitoris based on a dissection. According to the authors, Estienne proposed that the clitoris has a urinary function, a presumption that, as of 2023, researchers recognize as untrue. However, the authors explain that most anatomists in the following decades ignored Estienne’s work and neglected to discuss the clitoris. Then, in the early 1560s, other anatomists, like Matteo Realdo Colombo, a professor who studied anatomy and surgery in Italy, and Gabriele Falloppio, a physician who also studied anatomy in Italy, began to claim that they were the first to discover the clitoris, reintroducing discussion of the structure.

O’Connell and colleagues describe that anatomists led by Andreas Vesalius, a physician in Belgium who was one of the first to publish work based on human dissections, spurred widespread confusion and controversy about the clitoris in the sixteenth and seventeenth centuries, setting back research on the structure. They explain that when anatomists initially began discussing the clitoris, Vesalius held and spread misconceptions about the female body that other less well-known anatomists could not combat. According to the authors, Vesalius argued that female genitalia, such as the vagina, were simply inverted versions of male genitalia, for example, the penis correlated with the vagina. Since he did not perceive there to be an anatomical equivalent for the clitoris in males, Vesalius described the structure as useless and claimed that healthy women simply do not have one. As of 2023, researchers and medical professionals reject Vesalius’s ideas about the clitoris and recognize it as a natural component of female genitalia, but at the time, many anatomists accepted his ideas.

In addition to the confusion Vesalius spurred, O’Connell and her team state that there were different terms used to refer to the clitoris, which increased societal confusion about the structure. They explain that anatomists and people researching medicine in different regions often used different terms to label the clitoris, which made it harder for people to clearly communicate about the structure. Additionally, the authors specify that some anatomists used terms that grouped the clitoris with nearby anatomical structures. For example, they explain that researchers often used the term nympha (labia minora) to refer to both the labia minora and the clitoris together because terms did not exist to clearly differentiate the two structures.  

In the same section, O’Connell and colleagues point out that the lack of knowledge on the clitoris left many individuals confused about what it was and whether it was normal to have one, which led to justification of practices like clitoridectomies, or a form of genital mutilation in which a physician surgically removes the clitoris. According to O’Connell and colleagues, in 1573, Jacques Daléchamps, a physician and botanist who worked in France, wrote the primary French surgical text of his time. The authors explain that in Daléchamps’s text, there was a procedure called nymphotomia, or a clitoridectomy, which physicians performed on people who had a clitoris that they felt was unusually large. Daléchamps claimed in his text that the large clitoris was unusual and caused hypersexual behavior, and that physicians should perform a clitoridectomy to treat such behavior. Though, as of 2023, researchers in the US do not condone the practice of clitoridectomies, the authors explain that for many years the procedure was common.

The team then claims that Regnier de Graaf, a physician who practiced in the Netherlands, reintroduced the clitoris into scientific discourse in 1672. They mention that he was one of the earliest researchers to consistently use the term clitoris in reference to the structure that anatomists call the clitoris as of 2023. According to the authors, de Graaf recognized that people needed a way to differentiate the clitoris from the nympha, which still consisted of both the labia minora and the clitoris, causing him to make a distinction between the two. Additionally, O’Connell and colleagues explain that de Graaf provided one of the first comprehensive accounts of clitoral anatomy, and it differed from past accounts because he described the bulbs when discussing the structure of the clitoris.  

The authors state that after de Graaf described the clitoris, in the 1840s, Georg Ludwig Kobelt, a professor who studied anatomy in Germany, provided an even clearer perspective of clitoral anatomy. According to O’Connell and colleagues, Kobelt performed various types of studies to inform his work, such as dissections. The authors explain that Kobelt’s description of the internal structure was impressive for his time as he described many of the macroscopic elements of internal clitoral anatomy correctly. Thus, they conclude the section by emphasizing that, by the time of publication in 2005, writers of anatomical textbooks had been able to access Kobelt’s and de Graff’s accounts of the clitoris for over a century, yet most textbooks still lacked details about the structure.

Next, in “Context of Anatomical Controversy,” O’Connell and colleagues return to the topic of clitoridectomies and claim that the history of the practice reveals a strong relationship between female genital anatomy and the predominant social and cultural frameworks. They explain that many societies across the world justified clitoridectomies for thousands of years, and they point out that even in Western countries, surgeons continued to perform the procedure in the late 1800s as an operation to treat certain medical disorders like epilepsy, as well as insanity and hysteria, which are out-of-date terms describing disordered or disrupted states of mind. They cite a statistic expressing that as of 1999, approximately 120 million living individuals worldwide had experienced a form of female genital mutilation, including clitoridectomies. Additionally, they point out that laws attempting to halt the practice typically only reduce the safety of the procedure rather than the frequency as people still seek procedures from illegal, and potentially dangerous sources. The team also quotes Elizabeth Sheehan, an anthropology teacher and researcher who studied gender in the 1980s, from an essay she wrote that emphasizes the hypocrisy of those who supported clitoridectomies. According to the quote, nineteenth century doctors claimed the clitoris was so unimportant that one will not miss it if surgeons removed it, yet the doctors also argued that the structure was a source of several severe disorders and, thus, was a huge threat to female welfare, which, Sheehan claimed, are two ideas that are unable to coexist.

The team also relays that the dominant cultural framework contributed to historical misconceptions about the role of the clitoris and vagina in orgasm. For example, they explain that until 1966, most clinicians believed that stimulation of the clitoris only produced clitoral orgasm in young girls, rather than mature women, so, if an adult was able to have a clitoral orgasm, they viewed it as a symptom of mental illness. The authors state that since the late 1960s, sex therapists and sex educators have reevaluated that adults can indeed experience orgasm through clitoral stimulation, but they emphasize that the vagina can still play a role in sexual response as well.

The authors then propose that it may be helpful to create a term that captures the clitoris, urethra, and vagina together to emphasize the interconnectedness of the three structures and reduce confusion surrounding female sexual response. They point out that research shows that the clitoris, urethra, and vagina are highly related structures that all contribute to sexual pleasure, yet there is not a word that encompasses all three structures as the general site of female sexual response. The authors argue that the lack of an all-encompassing term contributes to unnecessary harmful societal ideas, such as people unnecessarily differentiating between vaginal and clitoral orgasms. Furthermore, the popular press at the time of publication often discussed the G-spot, a sensitive area in the front vaginal wall, as if it is a distinct structure even though scientific evidence of the time suggested that it is simply the area where the urethra approaches the vaginal wall. Thus, they propose that it would be useful to have a term that encompasses the clitoris, urethra, and vagina, just like the term penis generally describes the site of sexual pleasure for males. The authors suggest that it could be useful to simply begin using the word clitoris to reference the whole cluster of structures, or, eventually, anatomists could give the cluster an entirely separate, new name.

Finally, in “Conclusions,” O’Connell and colleagues reiterate the fact that researchers have had access to accurate information about clitoral anatomy for nearly two centuries yet have not popularized it is a parable of cultural bias. They explain that anatomy textbooks writers have had access to complete and accurate descriptions and diagrams of the clitoris since Kobelt published his work in the 1840s. Yet, by 2005, most pelvic surgical texts still did not provide detailed descriptions of clitoral anatomy. Thus, the authors conclude that the clitoris reflects a broader story about culture and the fact that civilizations shape the human body to reflect the needs and values of society, not for the betterment of the people and bodies themselves.

According to Google Scholar, as of 2023, researchers have cited “Anatomy of the Clitoris” around 377 times. Since its publication, researchers have begun using various terms that encompass the urethra, vagina, and clitoris as O’Connell and colleagues proposed. For example, in 2014, researchers began using the phrase clitourethrovaginal complex to describe the entire area of the female body that one can stimulate to induce orgasm. Additionally, according to Jennifer Hayes and Meredith Temple-Smith, two professors at the University of Melbourne, both researchers and anatomy, textbook readers have become aware of O’Connell and colleagues’ point that anatomy textbooks do indeed describe female anatomy in undetailed and often inaccurate ways. In 2022, Rebecca Beni and colleagues, a group of physicians and researchers in London, England, claimed that accurately describing clitoral anatomy is essential to promoting inclusivity and representation in anatomy education.

Since O’Connell and colleagues published “Anatomy of the Clitoris,” many individuals have taken action to improve how textbooks and the media portray female anatomy, but many researchers argue that, as of 2023, representation is still problematic. In 2018, two medical students from Norway published the book The Wonder Down Under: The Insider’s Guide to the Anatomy, Biology, and Reality of the Vagina to review and correct common myths about female anatomy that the media portrays. Five years later, in 2022, Hayes and Temple-Smith wrote “New Context, New Content—Rethinking Genital Anatomy in Textbooks,” an article in which they argue that anatomy textbooks still have a long way to go and call for change to incorporate more complete descriptions and diverse representations of female anatomy. Also in 2022, Rachel E. Gross, an award-winning journalist has written about historical portrayals of vaginal anatomy, published a New York Times article called “Half the World Has a Clitoris. Why Don’t Doctors Study It?” In it, Gross details that the organ is often ignored and generally understudied, which, she argues, has had tragic surgical implications as many women have lost the ability to orgasm after having surgery on their clitoris. She discusses the message of “Anatomy of the Clitoris,” explaining that the problems that researchers like O’Connell and colleagues discussed still exist, and people must pay more attention to clitoral anatomy. Thus, researchers, doctors, and textbook writers have not resolved the issues raised in “Anatomy of the Clitoris,” however, the article led to progress as both researchers and students have since begun seeking solutions.

Additionally, researchers have since built on the understanding of the clitoris that O’Connell and colleagues put forth in “Anatomy of the Clitoris.” For example, Rachel N. Pauls, a pelvic surgeon at a hospital in Cincinnati, Ohio, wrote an article in 2015 on how the structure of the clitoris relates to its role in female pleasure and explained that the clitoris is the most important organ for sexual response and is functionally similar to the penis. Then, in 2019, another researcher relayed that in addition to its role in pleasure, the clitoris also may have a reproductive function. Specifically, they proposed that stimulating the clitoris increases vaginal lubrication and promotes other physical changes that allow sperm to travel more easily, increasing the chances of reproductive success. Both articles used the details about clitoral anatomy portrayed in “Anatomy of the Clitoris” as a guide for their work.

In “Anatomy of the Clitoris,” O’Connell and colleagues call out the historical inaccuracies and misconceptions surrounding the clitoris and argue that anatomy textbooks authors should include accurate and up-to-date descriptions of the clitoris in their works so that surgeons can successfully preserve the structure during procedures. Thus, “Anatomy of the Clitoris” and publications that followed have helped to provide new insight into the function of the clitoris and spur a push for anatomy textbook writers to increase the frequency, accuracy, and diversity of descriptions and representations of clitoral anatomy in their works.

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