This post is dedicated to the midwifery students I have had the pleasure of teaching anatomy to over the years. It serves as a reminder that anatomy is fascinating and can’t be kept separate from broader cultural influences.
The clitoris has one function, and one function only. Sexual pleasure. Myths abound about the anatomy of the clitoris, both in non-clinical circles and in the profession of obstetrics and gynaecology. The often repeated trope about men not being able to find it is, at first glance, funny. But it hides a long history of wilful ignorance and deliberate suppression of women’s knowledge through history.
Finally – we found it!
In recent years, claims that it took a woman to finally discover the correct anatomical detail of the clitoris have been common (like this one). While it makes a great story, it’s not actually true. While urologist Helen O’Connell, was the first to use MRI to demonstrate the anatomy of the clitoris (O’Connell et al., 2005a), she acknowledged her findings confirmed descriptions derived from dissections on cadavers from the 19th century (O’Connell et al, 2005b).
This is far from the first time the clitoris has been presumed missing and “discovered” again. Indeed, the history of clitoral anatomy is most notably distinguished by its repeated rediscovery between periods of denial of its existence.
The fascinating history of the discovery and rediscovery of the clitoris
The first written descriptions of the clitoris I can find reference to came from Hippocrates (he of the Hippocratic oath) from around 460 BCE (Blechner, 2017). He called it the columella or little pillar. 500 years later, the clitoris had disappeared again when Galen, a Roman anatomist, denied such a thing existed at all.
Skipping forward in time to when a systematised approach to learning about and teaching anatomy was starting to appear in Europe, we see the clitoris appear again. In 1476, Italian Pietro d’Abano wrote a description of a structure near the pubis, that if rubbed would bring women to orgasm. In 1545, the French anatomist Charles Estienne described the clitoris, but gave it a bad reputation, calling it the “shameful member”. I’m pretty sure his pet name for his own penis was far more flattering. The word clitoris appears to have been derived from an historical play on words in Greek, with similar sounding words meaning either “the little hill” or “to rub” (O’Connell, et al., 2005b).
Another Italian, Realdo Columbo, had a good eye for self promotion of his ability as an anatomist. Writing in 1559, he said of the clitoris “it cannot be said how much I am astonished by so many remarkable anatomists, that they not even have detected [it] on account of so great advantage this so beautiful thing formed by great art” (in Stringer & Becker, 2010, p. 131 – 132). It seems no one had pointed out to Columbo the importance of a good literature review before publishing.
Columbo appears to have been a fan of the clitoris. He named it the sweetness of Venus. He wrote: “and this dearest reader is that, it is the principal seat of women’s enjoyment in intercourse; so that if you not only rub it with your penis, but even touch it with your little finger, the pleasure causes their seed to flow forth in all directions, swifter than the wind, even if they don’t want it to” (in Stringer & Becker, 2010, p. 132). It seems his commitment to anatomical knowledge included direct attempts to understand the physiology of female sexual pleasure, so I’ll forgive his lack of attention to detail to literature reviewing. I’m far less pleased about his suggestion to rub a woman’s clitoris when she doesn’t want you to.
Columbo had been a student of another prominent anatomist – Vesalius. Vesalius seems to have been less than impressed by his student apparently upstaging him with his “new discovery”. He offered a backhand reply that once again condemned the clitoris, denying the existence of this “new and useless part” in healthy women, claiming it to be a structure only found in what he called “hermaphrodites”.
Colombo wasn’t the only self-promoting Italian of the era. Fallopio (he of Fallopian tube fame) claimed of the clitoris in 1561 that “it is so hidden that I was the first to discover it” (in Stringer & Becker, 2010, p. 132). Skipping forward in time, 16th and 17th century anatomists Caspar Bartholin of Denmark (the Bartholin’s gland was named after him), Jean Riolan the Younger from France (who seems to have been denied eponymous fame), and Regnier de Graaf from Holland (after whom the Graafian follicle on the ovary was named) all took a turn at saying “I found it!”.
In 1844 the German, George Cobalt published a remarkable and detailed description of clitoral anatomy. His anatomical illustrations closely mirror those of O’Connell 160 years later. But in the intervening years – the clitoris did its disappearing trick yet again. It made an appearance as a little named bump in an illustration in the 1901 edition of Grey’s anatomy, but disappeared entirely from the 1947 edition of the text (Blechner, 2017).
Have we really acknowledged the existence of the clitoris now?
Now that we have “discovered” the clitoris again with modern technology, you might be forgiven for thinking this anatomical awareness would have a place in the practice of modern medicine. In obstetric care, we continue to overlook the existence of the clitoris, and focus on describing muscular anatomy instead. A recent text, titled Perineal Trauma at Childbirth (Ismail, 2016) includes a labelled illustration of the clitoris, but names only the glans of the clitoris as “clitoris”. The vestibular bulb (also part of the clitoris) is incorrectly labelled as the bulbospongiosus muscle. This might give the appearance the clitoris is well away from where perineal surgery or trauma at birth happens.
The 28 page Women’s Healthcare Australasia and the Clinical Excellence Commission Perineal Protection Bundle “how to” guide (2019) mentions clitoral anatomy a total of zero times. The same is true of the obstetric anal sphincter injury care bundle (OASI Care Bundle Project Team, 2018) from the United Kingdom. Both these guidelines (now widely applied in both countries) advise maternity professionals to perform episiotomy at an angle of 60 degrees above the vertical at the time of crowning (assuming the woman is in the lithotomy position) in order to prevent severe perineal trauma where the anal sphincter is damaged. This typically results in an angle of 45% at the time of repair. Evidence for the advice to use a specific type of scissors to achieve this angle of incision is limited and of low quality, with only one randomised controlled trial of 63 women, and three non-experimental studies (Divakova, et al., 2020).
While preventing anal sphincter injuries is important, it is vital we understand the anatomical consequences of a wider angle of incision. Anatomical studies by Garner and colleagues (2021) found that increasing angles away from the midline increased the risk of trauma to the clitoral vestibular bulb, reaching 100% at an angle of 45 degrees or more. Injury to the deep branch of the perineal nerve (providing nerve supply to the clitoral bulbs, and the superficial transverse perineal, bulbospongiosus, ischiocavernosus, levator ani, and external anal sphincter muscles) reached 100% at an angle above 15 degrees.
It is a sign of the disregard in which we hold women’s bodies and their sexual pleasure that we simply do not know what the consequence of direct injury to the clitoral bulbs or their nerve supply is. In the rush to preserve the anal sphincter muscle for some women, we might be sacrificing clitoral function in many women. I’m confident this is a discussion childbearing women would like to be included in, but at present it is not a consideration even in professional circles.
The personal is (always) political
There is no evidence to suggest the clitoris is a new invention, so I’m going to start with the assumption that women have had a clitoris for as long as there have been homo sapiens. I’m also going to assume that, even if they didn’t have a name for it or an understanding of the internal structure of it, women knew the clitoris existed and how to make use of it. At least until a man came and told them it didn’t exist, they were doing sex all wrong (I’m looking at you Freud), and if it did exist then touching it was shameful.
What a difference there would have been if women had been permitted to study and write anatomical literature through early history. What a difference there would have been if the men who studied women’s bodies asked women what it was like to inhabit them. As women we are still playing catch-up to have our anatomy and physiology acknowledged as uniquely ours, and not as a variation on the male body seen as the ideal, or normal body.
Will the clitoris do its disappearing act again in the future, or have we finally turned an historical corner where we will acknowledge its existence and devote at least as much attention to it as other neighbouring structures and male erectile tissues currently receive?
References
Blechner, M. J. (2017). The clitoris: Anatomical and psychological issues. Studies in Gender and Sexuality, 18(3), 190-200. https://doi.org/10.1080/15240657.2017.1349509
Divakova, O., Khunda, A., & Ballard, P. A. (2020, Mar). Episcissors-60 and obstetrics anal sphincter injury: a systematic review and meta-analysis. International Urogynecology Journal, 31(3), 605-612. https://doi.org/10.1007/s00192-019-03901-4
Garner, D. K., Patel, A. B., Hung, J., Castro, M., Segev, T. G., Plochocki, J. H., & Hall, M. I. (2021, Feb 2). Midline and mediolateral episiotomy: Risk assessment based on clinical anatomy. Diagnostics, 11(2). https://doi.org/10.3390/diagnostics11020221
Ismail, K. (Ed.). (2016). Perineal trauma at childbirth. Springer.
O’Connell, H. E., & DeLancey, J. O. (2005a). Clitoral anatomy in nulliparous, healthy, premenopausal volunteers using unenhanced magnetic resonance imaging. Journal of Urology, 173(6), 2060-2063. doi: 10.1097/01.ju.0000158446.21396.c0
O’Connell, H. E., Sanjeevan, K. V., & Hutson, J. M. (2005b). Anatomy of the clitoris. Journal of Urology, 174(4 Pt 1), 1189-1195. https://doi.org/10.1097/01.ju.0000173639.38898.cd
OASI Care Bundle Project Team. (2018). Implementation guide for maternity sites in the roll-out phase 2018-2018. RCOG London. https://www.rcog.org.uk/media/rntlozz3/oasi-care-bundle-guide-final-_-050118.pdf
Stringer, M. D., & Becker, I. (2010, Aug). Colombo and the clitoris. European Journal of Obstetrics & Gynecology and Reproductive Biology, 151(2), 130-133. https://doi.org/10.1016/j.ejogrb.2010.04.007
Women’s Healthcare Australasia & Clinical Excellence Commission. (2019). The how to guide: WHA CEC perineal protection bundle. https://women.wcha.asn.au/wp-content/uploads/sites/3/2022/04/wha_national_collaborative_how_to_guide_21.1.20.pdf
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Categories: Feminism, Language, Reflections
Tags: anatomy, clitoris, Episiotomy, Perineal trauma
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Brilliant read, thank you Kirsten. I am now curious about what research there is about the mental connection to pleasure from clitoris stimulation. I certainly beg to differ with Colombo about it working even if the woman doesn’t want it!
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I haven’t looked into the central nervous system connections and pleasure pathways. It would no doubt be fascinating!
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This is a brilliant expose of the ramblings of female sexual anatomy through time.
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Thanks Lois – it’s quite the saga!
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I do so enjoy your writing, Kirsten. And yes, another example of how poor documentation and lack of engagement with the person, rather than just the part, makes for poor science.
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Thanks Kathryn!
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