Let's Talk About the Clitoris

Let’s face it.  The clitoris doesn’t come up in conversation all that often.  Even in the bedroom, it can be a topic that is seldom discussed between consenting adults.  It’s become second nature to keep women’s actual sexual pleasure center under wraps - that’s what can happen after centuries of ignorance, misinformation and penis-centric ideology.

The clitoris has been ignored or misrepresented throughout history.  During the 1500s, an aroused clitoris was believed to be evidence of witchcraft.  The father of modern anatomy, Andreus Vesalius, believed that “healthy women” did not have clitorises.  And in 1948, the clitoris was removed from the pages of Gray’s Anatomy which, sadly, was not the first or only publication to play hide and seek with the hub of the female pleasure wheel. It’s actually been commonplace for the clitoris to be downplayed, described inaccurately or omitted altogether from medical texts. 

Even in our current world, the clitoris is often misunderstood.  For instance, our culture’s insistence that the vagina is the main road to female orgasm is simply counter to anatomical fact.  Most women need clitoral stimulation to reach orgasm – even though heterosexual sex is almost always portrayed as vaginal intercourse that ends in orgasm. 

WHAT'S THE BIG DEAL?
The clitoris is a big deal in the same way that the penis is a big deal.  Here are some specifics. 

• It’s the center of sexual pleasure for women
• It has no purpose other than pleasure
• It has 8,000 nerve endings give or take – double that of the penis
• It’s responsible for most orgasms
• It’s much bigger than you think
• It’s mostly internal
• With the exception of the glans, it’s made of erectile tissue
• It’s not one size or shape – everyone’s unique

ANATOMY OF THE CLITORIS
If you were taught about the clitoris during sex education, that makes one of us. Most of us didn’t learn about the reality of female sexual anatomy in class or at home or anywhere else for that matter.  And there’s a good reason for that.  Factual information about the anatomy and function of the clitoris, not to mention its status as the female sexual pleasure center, has been scarce throughout history.  In fact, misleading, inaccurate, and incomplete information persists to this day.  To prove this point, I looked at multiple online sources for descriptions of the clitoris.  I used major online medical outlets generally accepted as reliable:  Cleveland Clinic, Healthline, Medline Plus, NIH, Urology Care Foundation, and WebMD.  Only Healthline and the NIH presented current, straightforward, accurate, and complete information about the clitoris.  Two out of six.  Think about that for a minute.

Obviously, there's some work to do.  And knowledge of the actual anatomy of the clitoris is a good place to start.  Check out the following depictions of the clitoris highlighting the glans, corpora, crura, and vestibular bulbs. 

You can't have a meaningful discussion about the anatomy of the clitoris without mentioning Dr. Helen O'Connell.  She's an Australian physician who conducted and documented the entirety of the clitoris - internal and external - in the late 1990s. She describes a clitoral structure that is mostly internal, multi-faceted, sizeable, and integrated with the vagina and the urethra.  Because of her research, we now have a more complete picture of female sexual anatomy and a better understanding of female sexual pleasure.

It’s important to note that the clitoris was fully known by 1850. This fact makes the historical exclusion of the reality of the clitoris that much more perplexing and upsetting – and the work of Dr. O’Connell that much more compelling and important.

It's also important to understand the impact of systemic misinformation.  Of course, it limits our understanding of sexual pleasure - and that's a big deal.  A good example of this is the G-spot which has always been described as a specific place on the vaginal wall.  Based on Dr. O'Connell's work, it appears that it may actually be the clitoris on the other side of the vaginal canal.

“The vaginal wall is, in fact, the clitoris. If you lift the skin off the vagina on the side walls, you get the bulbs of the clitoris — triangular, crescental masses of erectile tissue."
-- Dr. O’Connell (2006 BBC interview)

Ignorance of the clitoris also poses a direct physical threat to women.  Imagine a surgical procedure by a doctor with a scalpel who doesn't understand the internal anatomy of the clitoris.  Sound outrageous? 

THE CLITORIS AS TABOO
There are reasons why the clitoris as a topic of conversation has traditionally been muted.  For one thing, it’s part of the female anatomy.  And while the penis has been documented exhaustively throughout history until now, the clitoris has been ignored, erased, and misrepresented.  It’s been “discovered” and rediscovered throughout history and it’s been the target of serious abuse -  such as the shameful history of clitoridectomies (also known as female genital mutilation) performed for such unrelated reasons as insanity, epilepsy, catalepsy, and hysteria. 

Female Genital Mutilation (FGM) became illegal in the United States in 1996.  And Congress has moved to strengthen protection for girls in the years since.  However, in 2018, a judge ruled that Congress did not have the authority to pass the federal FGM law and the DOJ did not appeal the decision.  But Congress moved to strengthen protection for girls with the Stop FGM Act - signed into aw in January of 2021.

Women and girls around the globe are still at risk

According to Emily Nagoski, author of Come As You Are, the taboo label given to the clitoris was born in shame and impaired our understanding of the clitoris.

"The Latin name for the female genital package is the pew addendum — which derives from the Latin word that means 'to make ashamed'," she explains.

"The whole thing is named after the idea that women should, and do, feel ashamed of their bodies."

Thanks to women like Helen O'Connell and Emily Nagoski, science is winning out over ignorance and shame when it comes to female sexuality.  We now know the complexities and the entirety of the clitoris.  We understand that it was always the female sexual pleasure center and is likely the reality behind the G-spot (literally!).   

A HEALTHY CLIT IS A HAPPY CLIT
Clitoral health is vital.  It’s important for both physical and mental wellbeing – not to mention its integral role in female sexual pleasure and orgasm. 



No special products are needed to keep the external part of your clitoris, the glans, clean and healthy.  Our vulvas are self-cleaning and depend on a delicate balance of bacteria to stay in good shape.  So, if you use soap, it should be very mild.  And remember that gentle is the name of the game when it comes to keeping your glans clean.  

Anything that has a negative impact on your vulva can also have a negative impact on your glans.  Here’s a list of some of the things that could have a negative impact.

• Unprotected sex can lead to sexually transmitted infection.
• Injury to the pelvic area can result in physical trauma.
• Scarring  from pelvic surgery and certain cancer treatments can cause pain.
• Antibiotics can increase your risk of getting a yeast infection.
• Barrier contraceptives like condoms and diaphragms – and the associated spermicides can cause irritation.
• Feminine hygiene products like sprays, deodorants and douches can make a bad situation worse when it comes to irritation. They can also cause problems by upsetting the delicate balance of the vulva.
• Childbirth that includes an episiotomy can result in damage, if the surgeon doesn’t understand the internal anatomy of the clitoris.
• Anxiety and depression can cause a low level of arousal and that can result in decreased natural lubrication and pain during stimulation.

There are also infections, conditions, and illnesses that can affect the glans of your clitoris. One common complaint is itching.  It typically clears up on its own or with a change to cotton panties that are not too tight, cool compresses applied to the affected area(s), and avoiding the chemicals used in bath products and douches.

Here’s a list of some of the causes of clitoral itching:

• A burning sensation while urinating
• Pain or a burning sensation in the vagina
• Vaginal discharge (grey or white)
• An unfamiliar odor – especially after sex

The exact cause of bacterial vaginosis is unknown; however, there are some factors that are believed to increase your risk. 

• Having sex (especially with a new partner)
• Having sex with multiple partners
• Vaginal douching

Antibiotics are usually prescribed to treat bacterial vaginosis.

Vaginal yeast infection (Thrush)
A yeast infection in the vagina can cause the clitoris glans to be itchy, as well as the other parts of the vulva.  Thrush, as it is sometimes called, is caused by an overgrowth of yeast called Candida.  These infections can also cause other symptoms:

• Burning sensation
• Redness and swelling
• Painful urination
• Painful sex
• Soreness
• Vaginal discharge (thick and white, resembles cottage cheese with no odor)

The following list of conditions and behaviors can put you more at risk for a vaginal yeast infection:

• Diabetes or high blood sugar
• Pregnancy
• Birth control that increases estrogen level
• Using douches or any kind of chemicals in the vagina
• Antibiotics
• A weakened immune system

Thrush is often treated with a prescription of antifungal medication.

Lichen sclerosus
Lichen sclerosus is an autoimmune disease of the skin that can affect the genitals, breasts, upper body, and upperarms. It is not contagious.  Lichen sclerosus affects women more than men and usually occurs during post-menopause.  The cause is not currently known, but experts believe that it may be related to:

• Changes in hormones
• Genetics
• Skin damage caused by injury
• An overactive immune system

 Itching is one symptom of lichen sclerosus, but there are more: 

• Blisters
• Scarring of the skin
• Bleeding
• Small white spots (may grow bigger)
• Patches of thin, wrinkled skin
• Skin that tears or bruises easily

• Red rash
• Thin cracks in the skin
• Weeping, crusty, or dry skin
• Stinging or burning sensation

 Genital eczema is typically treated with a topical steroid cream.

STDs 
Itching tops the list of symptoms that can sound the alarm on sexually transmitted disease.  Here is a list of other symptoms from Medical News Today:

• Painful urination
• Frequent urination
• Unusual vaginal discharge
• Unusual odor
• Redness (around the genitals)
• Stomach pain
• Anal bleeding
• Mouth sores
• Genital warts

If you suspect a sexually transmitted disease or if you are experiencing symptoms, it’s important to follow up with your doctor.  Treatment will be based on specific findings.

Vulvar cancer
Itching of the clitoris can be one of the symptoms of vulvar cancer. Here’s a list of some of the other symptoms that can accompany it – depending on the type of vulvar cancer:

• An area of skin on the vulva that appears different than the surrounding areas – lighter, darker, thicker
• Skin that appears red or pink compared to the surrounding area
• A painful or burning sensation
• Unusual vaginal bleeding or discharge
• An open sore that does not go away
• A lump or bump on the vulva
• A change in a mole in the genital area

These symptoms should prompt you to make an appointment with your doctor.

WHEN TO SEE A PROFESSIONAL
Consider seeking medical advice, if you experience any of the symptoms listed below – or anytime you experience a symptom that causes you concern or distress.  It’s always better to rule out something serious than to ignore symptoms that are meant to alert you.  Here are some examples:

• A change in the color, odor or amount of vaginal discharge
• Redness, itching or swelling that doesn’t go away
• Vaginal bleeding between periods, after sex or after menopause
• A mass or bulge on your vulva
• Pain during intercourse
• Unexplained pain
  
  

CLITORAL HEALTH CHECKLIST
Here are steps we can all take to keep our clitorises healthy.  You’ll notice that there’s some crossover with the vagina and the vulva due to proximity and function.

• Use a condom, if you’re not in a mutually monogamous relationship
• Vaccinate to protect yourself from HPV and Hepatitis B
• Make kegels a part of your everyday routine
• Discuss side effects of medications you’re taking with your doctor
• Limit alcohol (chronic alcohol abuse can impair sexual function)
• Don’t smoke (nicotine can inhibit sexual arousal)
• Substance abuse can affect overall physical health as well as mental health – both of which can affect sexual function
• Wash with water and mild soap
• Don't douche or use chemicals on or near your glans
• Use clitoral stimulation to orgasm on a regular basis
• Get regular check ups that include pelvic exams and pap smears, if you have a uterus

WE ARE ALL UNIQUE
You know how we tend to compare ourselves to others in ways that are not all that flattering to us?  Well, it's no different when it comes to our sexual anatomy.  We've been sold a bill of goods about the size, shape, symmetry, color, and smell of our vulvas, vaginas, and the visible part of our clitorises.  The notion that there's a perfect shade of pink, one appropriate shape, or that all vulvas are symmetrical is nonsense.  Unfortunately, it's the kind of misinformation that is harmful to women.  It's even the impetus behind unnecessary cosmetic surgery that runs the risk of causing permanent impairment to sexual function and pleasure.

But there's also good news.  Here's a link to a gallery of actual vulvas of actual women, so you can see for yourself that there is a great big range of normal when it comes to your vulva.  Click here to go there.


THE BEST FOR LAST
There's a lot to learn about the clitoris - anatomy, history, health.  But at the end of the day, the clitoris is the female sexual pleasure center.  It's where our orgasms come from, We don't have to pretend otherwise and we can move forward with the knowledge that the vaginal orgasms that some of us experience are actually due to the internal clitoral crura and bulbs that sit right behind the vaginal wall.



For detailed information about stimulating the clitoris, click on one (or all) of these links:

 The Ultimate Guide to Clitoral Stimulation
from Healthline

There Are Three Ways to Stimulate the Clitoris for Maximum Pleasure
from Hello Giggles

Betty's Rock 'n Roll Orgasm Technique
from Betty Dodson & Carlin Ross
Better orgasms.  Better world.

REFERENCES:
University of Regina Students’ Union; The History of the Clitoris; Robin Hilton; October 1, 2021
Vice; ‘Fear of the Clit’:  A Brief History of Medical Books Erasing Women’s Genitalia; Suzannah Weiss; May 3, 2017
Planned Parenthood; What Are the Parts of the Female Sexual Anatomy?; Planned Parenthood Staff; No date
Cleveland Clinic; Clitoris; Cleveland Clinic Medical Professional; April 25, 2022
Healthline; The Ultimate Guide to Clitoral Stimulation; Jennifer Chesak & Gabrielle Kassel; medically reviewed by Valinda Riggins Nwadike, M.D., M.P.H.; February 28, 2022
Medical News Today; The clitoris:  What is there to know about this mystery organ?; Maria Cohut, Ph.D.; June 22, 2018
ABC Everyday; How Well Do You Know the Clitoris?; Kellie Scott; July 29, 2020
The Journal of Urology, ANATOMY OF THE CLITORIS, Helen E. O’Connell, Kalavampara V. Sanjeevan and John Hutson, From the Department of Urology, Royal Melbourne Hospital, Victoria, Australia, 2005
Department of Surgery (Urology), the University of Melbourne, Royal Melbourne Hospital, Victoria, Australia; The Anatomy of the Distal Vagina:  Towards Unity; Helen E. O’Connell, MD, MMed, MBBS, FRACS (Urol), * Norm Eizenberg, MBBS, Marzia Rahman, Medical Student, * and Joan Cleeve, RN, BA (Hons), Grad Dip Lib and IS*
Medical News Today; What can cause clitoris itching?; Beth Sissons; medically reviewed by:  Valinda Riggins Nwadike; September 10, 2019