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Media representations of sexuality can play a relevant role in the development of gender stereotypes and sexual learning processes. In the current pre-registered study, we examined the representation of sexuality in content on Netflix, a dominant force in global mass media consumption. We coded 271 mixed-gender sexual scenes across seven highly popular Netflix series for orgasm portrayal, depiction of sexual behaviors, including clitoral stimulation, and gendered sexual scripts (i.e., initiation, control, and expression of desires). Our results revealed a nuanced picture of women's sexual pleasure representation. Women's orgasms were depicted less frequently than men's, although orgasm portrayal was generally rare. Sexual behaviors were mostly limited to penile-vaginal intercourse, though cunnilingus was depicted more frequently than fellatio. Regarding gendered sexual scripts, women were portrayed as equally sexually agentic as men, initiating sexual encounters, taking control, and expressing their needs and desires. Our findings indicate that this content simultaneously reinforces and challenges gender stereotypes related to sexual experiences, highlighting the need for sexual educators to critically address the realism of mainstream media portrayals to foster a nuanced understanding of sexuality and pleasure. [ABSTRACT FROM AUTHOR]

Concomitant with the rupture of the cloacal membrane in the 6th week of development, the intermediate layer of the perineal‐skin epithelium thickens. We investigated its distribution and the development of the corresponding subcutaneous compartments in serial sections of female human embryos and foetuses and prepared 3D reconstructions to establish topographic relations. The thick‐skin area becomes restricted to the outlets of the genital and intestinal tracts. The clitoris and labia majora become identifiable at ~7 weeks. The mesenchymal mass inside the clitoris soon divides into the glans and the cavernous bodies. The clitoral hood forms between 10 and 14 weeks as a fold of tissue that extends from proximal to distal over the glans. Due to the caudal bending of the clitoral shaft, the labia majora gradually cover the clitoris after ~14 weeks. The labia minora form at ~8 weeks from the ridges of thick‐skin epithelium that flank the genital exit. They are continuous ventrolaterally with the clitoral hood and ventromedially with the apex of the cavernous body. Dorsally, their dense subcutaneous mesenchymal core extends to the anal canal. Between 8 and 14 weeks, the urethra lengthens axially, while the vaginal vestibule extends ventrally. In this period, the urethral plate of female embryos is mitotically active but does not increase in volume, which suggests that it contributes to vestibular growth. In conclusion, we observed a temporal correlation between the development of the thick‐skin epithelium and that of the external genitals, with a distribution that is reminiscent of the dihydrotestosterone‐sensitive skin. [ABSTRACT FROM AUTHOR]

Even tough clitoris plays a critical role in female sexuality, we lack a precise understanding of qualitative and quantitative aspects of the innervation of the human clitoris. To address this issue, we dissected human clitorides from body donors and imaged them after staining with iodine with microCT for a macroscopic analysis. To resolve innervation patterns at the microscopic level we prepared thin sections of clitorides and stained them with trichrome azan to reveal the tissue structure combined with immunocytochemistry against Neurofilament H antibodies to reveal all axons and luxol blue labeling to reveal myelinated axons. We find the clitoral branch of pudendal nerve that innervates the clitoris not as single nerve, but as number of loose bundles. In the crus of the clitoris, about 12 such bundles can be recognized while about 32 bundles are present in the clitoral hemi-body. We counted on avarage 2917 axons in the crus of the clitoris (76% of which are myelinated) and 3137 axons in the hemibody of the clitoris (71% of which are myelinated). While the human clitoris receives only one third of the number of axons that innervate the human penis, an estimate of innervation density (per surface area) revealed that clitoris has approximately 6 times denser innervation compared to the penis. Thus, our study combines histology with microCT analysis provides detailed information on the number, myelination and innervation density of dorsal nerve of clitoris. [ABSTRACT FROM AUTHOR]

The baubellum (os clitoridis) is a bone found in the clitoris of many female eutherian mammals and is homologous to the baculum in males. In contrast to the baculum, the baubellum has received very little attention regarding its morphological or interspecific diversity, or on hypotheses for its function. The presence of the baubellum in bears (Ursidae) has only been established and mentioned in the literature for the Ursus genus, and not for the other genera of bears. Moreover, no scaled photographs are available for baubella of this clade, and the sizes reported vary between sources. We hereby present and describe the baubellum of a spectacled bear (Tremarctos ornatus), providing a detailed account of baubella in a basal ursid species. The baubellum of Tremarctos is slightly bowed dorsally, with two small prominences at the distal apex. The length of the Tremarctos baubellum in this study is comparable to that of Ursus americanus (American black bear). We infer the specific shape, with longitudinal ridges, of the baubellum in Tremarctos could indicate a discrete function during copulation or sexual arousal. However, future studies, especially regarding the associated soft tissues, will be required to confirm whether this is indeed the case. Our study expands the understanding of baubella within Ursidae, providing new data (including a three‐dimensional model) that can be used to further explore the morphological diversity and function of this enigmatic extra‐skeletal bone. [ABSTRACT FROM AUTHOR]

Objectives Methods Results Conclusions To explore the dermoscopic features of lichen sclerosus in different parts of the external genitalia in children.A retrospective analysis of the dermoscopic features of 42 female children with vulvar lichen sclerosus treated in the Department of Dermatology of Shanxi Children's Hospital from January 2020 to May 2023.Among the 42 female children, aged 3–14 years (mean: 7.24 ± 2.43 years), the duration of vulvar lichen sclerosus ranged from 3 months to 2 years (mean: 9.83 ± 4.93 months). Clinical lesions occurred in the labia minora in 18 cases (42.9%), labia majora in 38 cases (90.5%), posterior fourchette in 36 cases (85.7%), perianal area in 13 cases (31.0%), anterior fourchette in 17 cases (40.5%), clitoris in seven cases (16.7%), and interlabial sulcus in 11 cases (26.2%). Dermoscopic findings common in the labia majora included follicular keratotic plugs, cloverleaf‐like structures, comedo‐like openings, and linear vessels (p < .05); however, purple–red globules and patches and white linear streaks were more common in the posterior fourchette (p < .05), whereas dotted vessels were more common in the labia minora (p < .05).Common dermoscopic findings in pediatric vulvar lichen sclerosus were yellow‐white structureless areas, white linear streaks, follicular keratotic plugs, and cloverleaf‐like structures; yellow‐white structureless areas and white linear streaks showed the highest specificity. The dermoscopic findings varied among different affected areas, which provides a basis for further understanding of the characteristics of different sites of vulvar lichen sclerosus in the pediatric population. [ABSTRACT FROM AUTHOR]

The glans clitoris has a corona; however, unlike the corona of the glans penis, the corona of the glans clitoris is practically "nonexistent" as evidenced by the noteworthy absence of its mention and depiction in anatomical and clinical sciences. Accordingly, the corona of the glans clitoris has been neglected in anatomical education and clinical practice. This report details the history regarding the anatomical terminology of the glans and identifies that descriptions of the glans penis, corona of the glans penis, and other penile structures have preceded descriptions of the homologous anatomy of the clitoris by at least a century. Today, recognition of the corona of the glans clitoris, as well as the coronal sulcus and neck of the clitoris should be commonplace. Henceforth, the corona of the glans clitoris and its related anatomy including the sulcus of the glans clitoris and neck of the clitoris should be incorporated into anatomical and clinical language, illustrations, textbooks, education, and practice. Likewise, efforts should be made to propagate knowledge regarding the corona of the glans clitoris, coronal sulcus, and neck of the clitoris to the general public. Giving names to the anatomical structures of the clitoris will undoubtedly increase the awareness of their existence which, in turn, will encourage their clinical assessment and result in decreased morbidity and mortality. Likewise, improved self-awareness of clitoral anatomy will promote self-care which is important in the prevention of disease and the promotion of optimal sexual health. [ABSTRACT FROM AUTHOR]

Introduction: Hoodplasties and labia minora reductions are some of the most requested operative procedures by women distressed with the appearance of their vulvar region. In the majority of cases, a concomitant hoodplasty (HP) is performed to achieve a better aesthetic appearance. Various surgical methods have been described for the removal of excess tissue within the clitoris hood area. Materials and Method: This study aims to describe a single surgeon's preference and results in her private practise in 630 patients who underwent labiaplasty mainly because of dissatisfaction with the aesthetic appearance. Results: Of the 630 labiaplasties performed, 303 had clitoris hood excess, 44% of cases with concomitant HP and in 7.9% of cases only a HP was performed. The study was done between September 2009 and December 2021 and the HP technique was longitudinal excision in 97% of patients and horseshoe excision in 4.95% of them. Surgeries lasted between 30 and 60 min. 98% of the patients claimed an improvement in self-esteem and 96% claimed improvement in sex life post-surgery. No major complications occurred. Discussion: An isolated labiaplasty technique in patients with hood excess results in disharmony in the area. HP can be considered as a subdivision of a labioplasty. Extended central wedge labia minora resection (V-plasty) is a commonly used procedure in LP operations but can limit the excess clitoris hood resection. Edge labia minora resection can easily be combined with longitudinal excision of the clitoral hood, and when also horizontal clitoris hood excess is present can also be addressed by converting the resection from longitudinal into a horse hose resection. Limitations in the study include lack of use of validated assessments for the satisfaction of aesthetic outcomes and that all the procedures were performed by a single senior surgeon, which can be seen as a strength but also a limitation because of the high risk of bias. Moreover, there was no comparative cohort for the study population. Furthermore, we could not find comparative cohorts in previously reported techniques in the literature either. Conclusion: Clitoris hood resections should be treated on an individualized approach and adapted according to the excess present. It is important when a patient requests a labiaplasty to always address the clitoris hood during the consultation to avoid unsatisfied patients afterwards. Many patients come just focussed on their labia minora excess and when corrected, realize the clitoris hood excess was also part of the problem. Level of Evidence III: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266. [ABSTRACT FROM AUTHOR]

Metastasis to the clitoris is extremely rare. Here, we report a highly unusual case of high-grade squamous cell carcinoma of the cervix metastasizing to the clitoris a year following surgery and chemoradiotherapy. The patient presented with a painless clitoral mass identified through physical examination. Magnetic resonance imaging (MRI) showed a diffusely enhancing clitoral mass with hyperintense signals on diffusion-weighted imaging (DWI) and fluid-sensitive T2-weighted (T2W) sequences. This malignant tumor was detected by 18fluorine-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) due to its high FDG uptake. Pathological examination confirmed clitoral metastasis. Clitoral metastasis, although exceedingly rare, should be considered in cervical cancer patients presenting with clitoral masses on physical examination and imaging, particularly in those with advanced stages. Our case report is unique because it represents a recurrence in a patient initially diagnosed with early-stage cancer.

This case study critically examines the long-term detrimental effects of female genital mutilation (FGM), specifically focusing on the development of clitoral epidermoid inclusion cysts. The study illuminates the often-overlooked post-mutilation complications that extend beyond immediate physical trauma, encompassing significant anatomical alterations with potential psychosocial implications. As a direct consequence of FGM, clitoral epidermoid inclusion cysts represent a physical manifestation of such prolonged complications, contributing to discomfort, potential sexual dysfunction, and an overall decline in quality of life. In an unusual case, a 38-year-old African woman presented with a painful clitoral tumor intermittently draining for three years. The study underscores the urgent need for comprehensive preventive measures, early diagnosis, and effective management strategies in affected populations to mitigate the enduring consequences of this harmful practice.

The clitoris is still a significantly underrepresented organ in today's society, especially in education. In light of this, the central objective of this work was to propose a didactic sequence that highlights the underrepresentation of the clitoris in science and education. To achieve this, historical and anatomophysiological aspects of the clitoris were systematized through bibliographic research in studies related to the organ. This allowed us to highlight aspects of the nature of science in this context and (re)contextualize aspects of clitoral anatomy and physiology for teaching. Furthermore, the analysis of textbooks and videos that claim to be educational materials made it evident that the (sub)representation of clitoral anatomophysiology and scientific knowledge is a prevalent issue. Based on these findings, we argue that discussing the anatomophysiological and historical aspects of the clitoris can be a means to address the nature of science in science and biology classes. Finally, we proposed a didactic sequence about the clitoris, aimed at Science and Biology teachers. [ABSTRACT FROM AUTHOR]

Objectives: This study aimed to compare women’s body image, positive effect on sexual functions and aesthetic appearance satisfaction after gynecologic cosmetic surgery especially labiaplasty. Materials and Methods: This was a retrospective study. A sample of 42 women attending the private gynecology clinic in Mersin was entered into the study. Surgeries included labiaplasty plus vaginoplasty, clitoral hudoplasty, perinoplasty, augmentation of labia majora by filler or autolog fat transfer. Women were assessed for the female sexual function inventory at two points in time: 1 and 2 months after surgery. Results: The results showed that women’s body image, sexual function and couples' sexual satisfaction improved significantly after labiaplasty. Conclusion: The findings suggest that female genital cosmetic surgery especially labiaplasty improved the body image and sexual function of women and sexual satisfaction in couples. [ABSTRACT FROM AUTHOR]

Introduction and hypothesis: Knowledge of clitoral neuroanatomy is critical to vulvar surgery. We sought to characterize the density and distribution of autonomic and somatic nerves supplying the clitoris. Methods: Pelvic tissue harvested from female cadavers was sectioned axially at three anatomic levels: the proximal aspect of the clitoral body (CB), the distal CB, and the glans. The CB, glans, and the surrounding connective tissue (dorsal, lateral, and ventral) were outlined microscopically. An area containing large nerve bundles dorsal to the CB, referred to as the dorsal nerve subregion, was analyzed separately. Double-immunofluorescent staining for beta III tubulin (βIIIT), a global axonal marker, and myelin basic protein (MBP), a myelinated nerve marker, was performed. Threshold-based automatic image-segmentation distinguished stained areas. Autonomic and somatic density were calculated as percentage of tissue stained with βIIIT alone, and βIIIT and MBP respectively. Comparisons were made using nonparametric Friedman tests. Results: Seven cadavers, aged 22–81, were examined. Somatic (mean 4.42%, SD ± 1.97) and autonomic (2.14% ± 2.42) nerve density was highest in the dorsal nerve subregion and dorsal region at the distal CB level. Compared with the CB, somatic density was higher in proximal (0.05% ± 0.03 vs 1.27% ± 0.69, p = 0.03) and distal (0.29% ± 0.25 vs 1.09% ± 0.41, p = 0.05) dorsal regions. Somatic density was greater in the glans than in the surrounding lateral (0.78% ± 0.47 vs 0.43% ± 0.23, p = 0.03) and ventral (0.78% ± 0.47 vs 0.52% ± 0.2, p = 0.03) regions. Autonomic density was greater than somatic in all areas, except for the dorsal nerve subregion. Conclusions: Somatic and autonomic nerve density were greatest in a well-defined region dorsal to the CB. Surgical preservation of this region is critical for maintaining nerve supply to the clitoris. [ABSTRACT FROM AUTHOR]

The human penile and clitoral development begins from a morphologically indifferent genital tubercle. Under the influence of androgen, the genital tubercle forms the penis by forming a tubular urethra within the penile shaft. Without the effect of the androgen, the genital tubercle differentiates into the clitoris, and a lack of formation of the urethra within the clitoris is observed. Even though there are similarities during the development of the glans penis and glans clitoris, the complex canalization occurring along the penile shaft eventually leads to a morphological difference between the penis and clitoris. Based on the morphological differences, the main goal of this study was to define the vascular and neuronal anatomy of the developing penis and clitoris between 8 and 12 weeks of gestation using laser scanning confocal microscopy. Our results demonstrated there is a co‐expression of CD31, which is an endothelial cell marker, and PGP9.5, which is a neuronal marker in the penis where the fusion is actively occurring at the ventral shaft. We also identified a unique anatomical structure for the first time, the clitoral ridge, which is a fetal structure running along the clitoral shaft in the vestibular groove. Contrary to previous anatomical findings which indicate that the neurovascular distribution in the developing penis and clitoris is similar, in this study, laser scanning confocal microscopy enabled us to demonstrate finer differences in the neurovascular anatomy between the penis and clitoris. [ABSTRACT FROM AUTHOR]

Krause's corpuscles are typical of cutaneous mucous epithelia, like the lip vermillion or the glans clitoridis, and are associated with rapidly adapting low-threshold mechanoreceptors involved in gentle touch or vibration. PIEZO1 and PIEZO2 are transmembrane mechano-gated proteins that form a part of the cationic ion channels required for mechanosensitivity in mammalian cells. They are involved in somatosensitivity, especially in the different qualities of touch, but also in pain and proprioception. In the present study, immunohistochemistry and immunofluorescence were used to analyze the occurrence and cellular location of PIEZO1 and PIEZO2 in human clitoral Krause's corpuscles. Both PIEZO1 and PIEZO2 were detected in Krause's corpuscles in both the axon and the terminal glial cells. The presence of PIEZOs in the terminal glial cells of Kraus's corpuscles is reported here for the first time. Based on the distribution of PIEZO1 and PIEZO2, it may be assumed they could be involved in mechanical stimuli, sexual behavior, and sexual pleasure. [ABSTRACT FROM AUTHOR]

To determine urethral outcomes of single-stage metoidioplasty and radial forearm free flap (RFFF) phalloplasty using the labia minora ring flap for urethral lengthening (UL). A retrospective review was performed of patients undergoing single-stage metoidioplasty and RFFF phalloplasty utilizing the labia minora ring flap technique. The ring flap consists of endodermal labia minora tissue ventral to the clitoris and surrounding the vaginal introitus. During metoidioplasty, the ring flap accounts for the entirety of UL. During RFFF phalloplasty, the ring flap becomes the pars fixa (PF) urethra. The primary outcomes measured were rates of fistula, stricture, and surgical revision. Between November 2017 and August 2023, 311 patients underwent metoidioplasty or RFFF phalloplasty (mean follow-up 37 months). Of the 69 metoidioplasties, urethrocutaneous fistulas developed in 11 patients (16%); strictures occurred in 4 (6%). Of the 242 phalloplasty patients, there were 71 fistulas (29%), 56 of which resolved spontaneously. Strictures developed in 44 patients (18%). Twenty-five patients (10%) developed both a stricture and fistula. Surgical repair was required in 8/69 (12%) metoidioplasty patients and in 46/242 (19%) RFFF phalloplasty patients for an overall revision rate of 17%. UL during metoidioplasty or RFFF phalloplasty can be accomplished in a single stage using the labia minora ring flap with comparable surgical revision rates to previously described techniques. This approach can also be applied to other phalloplasty techniques. Many fistulas of the PF urethra resolve spontaneously. Higher urethral revision rates were seen in phalloplasty compared to metoidioplasty. [ABSTRACT FROM AUTHOR]

The corona of the glans clitoris is a clinically important yet poorly understood anatomical structure. There has been longstanding confusion regarding the prevalence of the corona of the glans clitoris and, moreover, its very existence. Therefore, this anatomical study assesses the prevalence of the corona of the glans clitoris and the gross anatomy of the proximal glans clitoris. Anatomy was assessed in 104 female donor bodies ranging in age from 50 to 102 years with an average age-at-death of 78.1±10.9 years (mean±SD). All clitorises (100%; 104:104 dorsums and 100%; 208:208 sides) were found to have a well-defined clitoral corona. Three of 104 (2.9%) coronas possessed grossly visible, outward-projecting, bluntly rounded papillae. Some donors possessed a coronopreputial frenulum. Clitoropreputial adhesions were common and associated with clitoral pearls. Clitoral pearls were identified in 37.8% (14:37) of unembalmed donors and observed to create clitoral craters, structural deformations in the surface of the corona and glans. The results of this study suggest that the corona of the glans clitoris is a ubiquitous anatomical structure. The clitoral coronal papillae and coronopreputial frenulum are novel, previously undescribed, anatomical structures. This study identifies that the corona of the glans clitoris is prone to pathological processes such as clitoral pearl formation and clitoral deformation. In addition to novel anatomical findings, the results of this study call attention to the need for life-long clitoral examinations. Furthermore, the corona of the glans clitoris should be regularly included in anatomical texts and accurately depicted in anatomical illustrations. [ABSTRACT FROM AUTHOR]

This case study critically examines the long-term detrimental effects of female genital mutilation (FGM), specifically focusing on the development of clitoral epidermoid inclusion cysts. The study illuminates the oftenoverlooked post-mutilation complications that extend beyond immediate physical trauma, encompassing significant anatomical alterations with potential psychosocial implications. As a direct consequence of FGM, clitoral epidermoid inclusion cysts represent a physical manifestation of such prolonged complications, contributing to discomfort, potential sexual dysfunction, and an overall decline in quality of life. In an unusual case, a 38-year-old African woman presented with a painful clitoral tumor intermittently draining for three years. The study underscores the urgent need for comprehensive preventive measures, early diagnosis, and effective management strategies in affected populations to mitigate the enduring consequences of this harmful practice. : [ABSTRACT FROM AUTHOR]

Enfatizando las complejas interrelaciones disciplinares que se han ido tejiendo históricamente en torno al placer femenino, este texto ofrece un recorrido por algunos de los momentos clave de las mutilaciones físicas, psíquicas y textuales del clítoris, principalmente en Europa y Estados Unidos. En un primer momento exhibe que las mutilaciones genitales están presentes en muchas culturas desde la Antigüedad, solo que, bajo el cobijo de la medicina y con un afán de “curar”, se les llama clitorectomías. En un segundo momento muestra que la historia del clítoris tiene distintas aristas, y aunque la más dolorosa es la de las extirpaciones físicas, sería ingenuo pensar que las ablaciones del clítoris no tienen relación con las mutilaciones psíquicas teorizadas por Freud, y con las textuales, que van desde borrar el clítoris de las anatomías hasta la poca presencia que tiene el órgano del placer femenino en la literatura y el cine. Finalmente, se evoca la clitorrevolución, impulsada principalmente desde las artes plásticas.

Background: The clitoris has long been ignored in medical literature and teaching, with the first paper describing its anatomy only published in 1993. It is essential that those working in women's health understand the anatomy of this important female sexual organ. Aims: The aim of this study was to assess the level of knowledge of the anatomy of the clitoris across five cohorts in a busy teaching maternity hospital in Ireland. Materials and Methods: A questionnaire was devised, asking ten consultants, ten non‐consultant hospital doctors (NCHDs), ten midwives, ten midwifery students and ten medical students to name the anatomical parts of a 3D model of the clitoris. Results: None of the 50 respondents could name all five labelled parts of the clitoris, and 38 of respondents could not correctly name one anatomical part. Conclusions: It is evident that there is a lack of knowledge of the anatomical parts of the clitoris among the medical staff included in this study. This reflects a lack of adequate teaching in this area in both past and recent years. Despite this, we acknowledge that women's health and sexual health awareness is improving all of the time, and we hope that this study can highlight the need for reformed teaching in this area. [ABSTRACT FROM AUTHOR]

Introduction: Hypertrophy of the labia minora combined with a redundant clitoral hood is a common complaint among women seeking aesthetic genital cosmetic surgery for functional, psychological, and aesthetic complaints. The objective of this study was to describe the boomerang technique, a surgical treatment for labial hypertrophy that extends to the entire clitoral hood. Method: A retrospective, analytical study was conducted to evaluate the medical records of forty-eight consecutive patients who underwent female genital cosmetic surgery between July 2017 and July 2021. The same surgeon performed all surgical procedures. The technique used in the patients consisted of longitudinal resection of excess small vaginal lips associated with resection of the boomerang-shaped clitoral hood associated with clitoroplasty. Results: The average age of patients undergoing surgery was 36.25 years (range 18-59 years), among whom 94.44% had aesthetic complaints associated or not with functional complaints, and 5.56% had only functional complaints. Two patients had bruises on the labia majora in the immediate postoperative period, and one patient had suture dehiscence on the labia minora. Conclusion: The boomerang technique is reproducible and provides aesthetic and/or functional benefits to the female genitalia.

Genitourinary neurofibromatosis is an unusual autosomal dominant transmitted disorder affecting the genitourinary tract, including the bladder. We presented a case of 22-year-old female with multiple localized lesions, clitoromegaly and difficulty in conception. Clinical exome testing confirmed the anticipated diagnosis of neurofibromatosis, revealing the presence of a pathogenic variation of the NF1 gene associated with neurofibromatosis type 1; NF1. The patient was managed with oral ovulogens combined with one cycle intrauterine insemination and successfully conceived during first cycle. Pregnancy worsen NF1 symptoms, increasing maternal and foetal risks, necessitating careful monitoring. [ABSTRACT FROM AUTHOR]

This article, titled "How to Breathe," explores the author's personal experiences and reflections on the theme of breathing. The author discusses various moments in their life where breathing has played a significant role, such as encounters with a former partner, childhood experiences, the loss of their child, and their connection to nature. The author also touches on the importance of breathing for their own survival and the impact it has had on their perspective. The article is written by Court Harler, a queer freelance writer, editor, and educator based in Las Vegas, Nevada. [Extracted from the article]

Synopsis: Postoperative non‐invasive mucosal implantation of cervical adenocarcinoma on the clitoris is rare. Surgical resection is appropriate for local recurrence in the vulva. [ABSTRACT FROM AUTHOR]

The surgical construction of a vulva in transgender 'vaginoplasty' offers a unique opportunity to deconstruct the sociocultural standing of the vulva at large. Social apprehension of the vulva is broadly 'dis-eased,' in Christine Labuski's terms: profoundly and bioculturally disparaged. Synecdochically erased, and with its function effaced against the reproductive, heterosexed vagina, the vulva is situated at the paradoxical intersection of excess and lack, simultaneously invisibilised and threateningly, shamefully visible. This disparagement bears professional ramifications: medical science reflects the sociocultural context in which it is produced and (re)produces precisely this culture. Through trans 'vaginoplasty,' the trans body is surgically inscribed with this dis-eased vulvar script, manifesting as social text upon which the vulva may be read. Systematic reviews of surgical literature, analysed here with respect to the clitoris and labia minora as structures central for female sexual pleasure, reveal how surgeons (re)produce the fictitious dichotomy between vulvar appearance and vaginal function and (re)erase non-heteronormative sexuality. The trans vulva thus illustrates the sociocultural position of the vulva, literally constructed in this image: linguistically invisibilised, it is the heterosexed vagina which takes precedent, at cost of vulvar cosmesis, and in disavowal of vulvar function, the vulva relegated to an academic, surgical and otherwise afterthought. [ABSTRACT FROM AUTHOR]

Background The relationship between sexuality, or the libido, and spirituality or religion has long been debated in psychiatry. Recent studies have explored the neurophysiology of both sexual experiences and spiritual practices such as meditation or prayer. In the present study, we report changes in cerebral glucose metabolism in a unique meditation practice augmented by clitoral stimulation called, Orgasmic Meditation, in which a spiritual state is described to be attained by both male and female participants engaged in the practice as a pair. Methods Male (N=20) and female (N=20) subjects had an intravenous catheter connected to a bag of normal saline inserted prior to the practice. During the practice, men stimulated their partner’s clitoris for exactly 15 minutes (he received no sexual stimulation). Midway through the practice, researchers injected 18F-fluorodeoxyglucose so the scan would reflect cerebral metabolism during the practice. Positron emission tomography (PET) imaging was performed approximately 30 minutes later. Results In the female participants, the meditation state showed significant decreases in the left inferior frontal, inferior parietal, insula, middle temporal, and orbitofrontal regions as well as in the right angular gyrus, anterior cingulate and parahippocampus compared to a neutral state (p Conclusions These findings represent a distinct pattern of brain activity, for both men and women, that is a hybrid between that of other meditation practices and sexual stimulation. Such findings have potential psychotherapeutic implications and may deepen our understanding of the relationship between spiritual and sexual experience.

In the last two decades, genital transplants have emerged as another type of quality‐of‐life transplants. Successful allogenic transplantations of the uterus, ovary, testicle, and penis have all been reported. Yet, there is no discussion of clitoris transplantation in the medical literature, mass media, and everywhere else I searched. This surgery could be used for cisgender women who have a clitoral injury or disease or who have undergone female genital cutting. I examine the gender norms regarding sexuality and reproduction to show how they shape surgical advancements. My point in this paper is not to take a normative position on status of current genital transplantations. Rather, I highlight that their existence is due, at least in part, because they align with dominant gender norms: penis and testicle transplantations reinforce the importance of men's virility and the existence of "normal" male genitalia, whereas uterus and ovary transplantations uphold the conflation of women and reproduction and the strong valuing of women's fertility. That medical advances reflect cultural values is not a new claim. What is new in this paper is the discussion of how sexism norms—regarding the invisibility of the clitoris and the devaluing of women's sexual pleasure— has engendered various types of genital transplants, but not clitoris transplantation. [ABSTRACT FROM AUTHOR]

We investigated whether anogenital distance (AGD) is associated with adenomyosis, endometriosis and uterine leiomyomas (UL, also called uterine fibroids). We recruited 81 women with UL, 105 with ovarian endometrioma (OE), 116 with adenomyosis, 28 with both adenomyosis and UL, and 100 control subjects with other acquired gynecological conditions but not endometriosis, adenomyosis, UL, or polycystic ovarian syndrome. Measurements from the anterior clitoral surface to the center of the anus (AGDAC), from the tip of the clitoris to the center of the anus (AGDACt), and from the posterior fourchette to the center of the anus (AGDAF) were made in all subjects. Multiple regression was performed to estimate the association between AGDs and presence of OE, adenomyosis, and UL while controlling for possible confounding factors. We found that, compared with controls, women with OE and adenomyosis, but not UL, had significantly shorter AGDAF, but not AGDAC. However, the amount of variance that could be explained by the disease status is rather moderate, suggesting that factors other than disease status, bodyweight and height were also responsible for AGD. Thus, prenatal exposure to reduced levels of androgen may increase the risk of developing endometriosis and adenomyosis. However, other factors may also contribute to the pathogenesis of endometriosis and adenomyosis. [ABSTRACT FROM AUTHOR]

Introduction: Being one of the most practiced procedures in plastic surgery, it is important to foster a better understanding of the effect of anatomical changes in the pubic area after abdominoplasty on sexuality in women. Since to date no study has been performed with this purpose, our aim is to evaluate the impact of the abdominoplasty on sexual pleasure and to perform an objective evaluation of changes in clitoral position and prepubic fat area after this procedure. Materials and Methods: A prospective study has been performed in 50 women who expressed a desire to undergo abdominoplasty from January 2021 to December 2021. The primary endpoint was Sexual pleasure assessed by the "Sexuality Assessment Scale" before and 6 months after abdominoplasty in all patients. Furthermore, we evaluated the physical changes of the clitoris (clito-pubic distance, CP distance) and the prepubic fat area on magnetic resonance imaging before and 3 months after abdominoplasty. Results: Patients mean age was of 42 ± 9 years, and mean body mass index of 26 ± 2 kg/m2. A significant difference (P < 0.0001) between sexual satisfaction before and 6 months after abdominoplasty (mean difference +7.4 ± 6.452) was found. Though there was no significant difference between the clito-pubic distance before and after abdominoplasty (mean difference −3.200 ± 2.499 mm; p= 0.0832), a significant difference was found in the size of the prepubic fat area before compared to after abdominoplasty (mean difference −1.714 ± 1.010 cm2; p = 0.0426). However, no significant relationship between these anatomical changes and sexual satisfaction was found. Conclusion: Our results show that abdominoplasty is associated with an increase in sexual satisfaction. The changes in the post-operative position of the clitoris were not statistically significant, contrarily to the size of the prepubic fat area, which was significantly modified and could partially explain the improved sexual pleasure. Authors were unable to statistically demonstrate a correlation between those anatomical modifications and sexual pleasure. Level of Evidence IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266. [ABSTRACT FROM AUTHOR]

Bilateral adrenal myelolipoma is rare in clinics and patients with disorders of sex development (DSDs). One case was reported in our center. A 45-year-old patient was admitted to the hospital after discovering a left abdominal mass for more than a year and worsening abdominal pain for 18 days. An imaging examination showed bilateral adrenal masses. Physical examination showed clitoris hypertrophy with patelliform changes, thick and dense pubic hair, normal development of bilateral labia majora without labia minora, and urethral opening. After the relevant preoperative examinations, bilateral adrenal mass resection was performed under general anesthesia. The postoperative pathology confirmed adrenal myelolipoma. The incision healed well without recurrence over 10 years after the operation. Her enlarged clitoris decreased in size. This case report has a detailed diagnosis and treatment process and sufficient examination results. It can provide a reference for diagnosing and treating patients with bilateral adrenal myelolipoma and DSD and reduce the risk of misdiagnosis and mistreatment. [ABSTRACT FROM AUTHOR]

Copyright of Journal of Ankara University Faculty of Medicine / Ankara Üniversitesi Tip Fakültesi Mecmuasi is the property of Galenos Yayinevi Tic. LTD. STI and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Primary mucosal melanomas of the female genital tract account for one percent or less of all cases of melanoma with even fewer originating in the clitoris. Given the rarity of diagnosis of clitoral melanoma, there is a paucity of data guiding management. There is no supporting evidence that radical vulvectomy (with or without inguinal lymphadenopathy) is associated with improved disease-free or overall survival compared to partial vulvectomy or wide local excision. Additionally, there is no data to evaluate the role of sentinel lymph node biopsy or extensive lymphadenectomy in clitoral melanoma, however previous evidence demonstrates the utility of regional lymph node sampling in predicting survival in women with female genital tract mucosal melanoma. Adjuvant therapy considerations are often extrapolated from their use in treating cutaneous melanomas, including immune checkpoint inhibitors and other immunotherapy agents. Adjuvant radiation therapy has limited utility except in cases of bulky, unresectable disease, or when inguinal lymph nodes are positive for metastasis. The 52 year-old patient presented in this review was diagnosed with locally invasive advanced stage clitoral melanoma presenting as an exophytic clitoral mass. She underwent diagnostic primary tumor resection, which demonstrated ulcerative melanoma with spindle cell features extending to a Breslow depth of at least 28 mm. She subsequently underwent secondary wide local excision with groin sentinel lymph node biopsy, and adjuvant treatment with pembrolizumab. This article also emphasizes the importance of a multidisciplinary team involving gynecologic oncology, medical oncology, radiology, and pathology for management of this rare type of primary mucosal melanoma of the female genital tract.

To present 2 clitoroplasty techniques—the preputial skin and urethral flap—and describe our rationale for using each technique to construct the clitoro-urethral complex in gender-affirming vaginoplasty. For uncircumcised patients or circumcised patients with greater than 2 cm of inner preputial skin and at least 8 cm of shaft skin proximal to the circumcision scar, we use the preputial skin clitoroplasty, a modification of the Ghent style clitoroplasty. The entire corona is used after medial glans and urethral mucosa is excised. The corona is brought together 1 cm from midline to create the visible ovoid clitoris; the remaining coronal tissue remains lateral to the clitoris for erogenous sensation as clitoral corpora. The clitoris is anchored to the proximal tunica, positioned at the level of the adductor longus tendon. The folded neurovascular bundle is fixed in the suprapubic area. The ventral urethral is spatulated and urethral flap approximated to the clitoris. Preputial skin is sutured proximally as tension allows. The clitoro-urethral complex is inset into an opening created in the penile skin flap. For patients with less skin, we use the urethral flap clitoroplasty. More corpus spongiosum is used, as the urethra creates the clitoral hood; this is described in the literature and attributed to Pierre Brassard. The clitoris is inset following a dorsal urethrotomy, with a small collar of preputial skin sewn to the spongiosum and urethral mucosa. The urethra is transected about 1 cm distally. The ventral urethra is then spatulated and the urethroplasty completed. We prefer the preputial skin flap technique for its' greater coronal tissue volume for erogenous sensation and better esthetics, in our opinion. Circumcised patients should have at least 2 cm of skin distal to the circumcision scar. To avoid using skin graft for the introitus—a risk for introital stenosis—shaft skin proximal to the circumcision line should be at least 8 cm. We present 2 technical options for clitoroplasty and construction of the clitoro-urethral complex in gender-affirming vaginoplasty. [ABSTRACT FROM AUTHOR]

Objective: Dissection of the dorsal nerves of the clitoris (DNC) is an important step in most gender-affirming phalloplasty techniques. Understanding DNC anatomy also facilitates safe vulvar and clitoral surgery. However, the surgical anatomy of the DNC has only recently been thoroughly described in the literature, and dissection of the DNC has not traditionally been a routine part of genitourinary surgical education.1,2 With procedures involving the DNC (e.g. gender-affirming phalloplasty) increasing in frequency, surgical resources are needed to better illustrate and teach this critical dissection. In this video, we demonstrate a safe, efficient and reliable approach to dissection of the DNC. Patients and surgical procedure: This video is a demonstration of an approach to dissection of the dorsal nerve of the clitoris in a gender-affirming phalloplasty procedure. Results: The DNC is a critical structure for erogenous and sexual function and its dissection should always be approached cautiously to avoid injury. The DNC is formed from branches of the pudendal nerve and travels below the inferior public ramus along the posterior edge of the clitoral crus [3]. Inferior to the pubic symphysis, at the angle of the clitoral body, the dorsal clitoral nerves enter the deep component of the suspensory ligament of the clitoris.1,2 At the base of the clitoral body the dorsal nerves are superiorly suspended away from the clitoris before they descend inferiorly along the clitoral body. At this level, the DNC are large, approximately 2–3.2 mm, traveling at 10-11 and 1-2 o'clock positions along the clitoral body. We approach the DNC at this level by releasing the suspensory ligament of the clitoris and dissecting through the clitoral fascia. Conclusions: Dissection of the dorsal nerve of the clitoris (DNC) is a critical step in many gender-affirming phalloplasty procedures. A thorough understanding of its surgical anatomy is also necessary for safe vulvar surgery. In this video, we demonstrate a safe, efficient and reliable approach to dissection of the DNC.

Introduction: Hemangioma is usually a benign vascular tumor caused by endothelial cell proliferation and often presents in early childhood. It can occur anywhere on the body but most commonly appears on the face, scalp, chest or back. Clitoris is a rare site for it. Case presentation: A 6-year-old-female child presented with a complaint of pain and a reddish-black swelling at the tip of clitoris for last 4 months. There was a history of bleeding from it. After local examination and ultrasonography with Doppler, a collaborative diagnosis of vascular swelling of clitoris was made. Surgical excision was done under local anaesthesia. Histopathological examination confirmed it to be clitoral cavernous hemangioma. Conclusion: Vascular anomalies embody a myriad of blood vessel abnormalities. Correct diagnosis is imperative for appropriate treatment. Treatment of these hemangiomas involves multiple therapeutic options; wait and watch strategy being the most practised but sometimes surgical excision proves to be a better option depending upon the presentation and site of the lesion.

A 9-year-old, spayed female, mixed-breed dog was initially presented for evaluation of chronic dermatitis on the nasal planum, where a clitoral mass was discovered as an incidental finding during the exam. No further investigation of the clitoral mass was undertaken due to other significant dermal lesions and the lack of clinical significance of the mass at the time. However, ~1 month later, the dog was presented to the Emergency Service for bleeding from the vulva. The clitoral mass was found to have prolapsed; the mass was manually reduced back into a position within the vulvar folds and maintained with a purse-string suture. The dog was referred to the Theriogenology Service for further investigation and removal. On follow-up evaluation, the mass was noted to be multi-lobulated, ulcerated, cystic, and involving the clitoris but not the urethra. The urethra was easily catheterized, and no urinary abnormalities were found. No evidence of lymph node metastasis or hypercalcemia was noted prior to surgery. Ultrasonographic evaluation of the anal sacs was normal. The mass was removed, and histopathologic evaluation revealed a primary clitoral adenocarcinoma. On recheck evaluation, after 1 month, no evidence of metastasis or local recurrence was observed. Clitoral adenocarcinoma is a rarely reported neoplasm of the canine genital tract that shares many clinical, histopathological, and immunohistochemical features with canine apocrine gland anal sac adenocarcinoma. This case adds to the available knowledge on the condition, specifically regarding the frequency of complications such as hypercalcemia and metastasis, as previous reports suggest that these are present at least 50% of the time.

Background and objectives: We herein reported ten, female neonates with transient clitoral preputial edema, which was mistaken for clitoromegaly. Although it is well known that the clitoris is prominent in premature, female neonates, there are as of yet no reports of clitoral preputial edema in full-term neonates. The present study was conducted to clarify the clinical course of clitoral preputial edema. Methods: Seventeen, Japanese patients aged < 6 months with suspected clitoromegaly were enrolled, and their clinical course was analyzed retrospectively. Clitoral preputial edema was defined by 1) a normal clitoral glans despite edema; and 2) the absence of established differences of sexual development, such as 21-hydroxylase deficiency. Results: Ten of the 17 patients with suspected clitoromegaly had clitoral preputial edema; eight of the ten patients were full-term, and the remaining two were preterm neonates. The median age at the first visit was 8 days. Edema of the labia minora and labia majora, rugosity of the labia majora, and hymenal polyps often accompanied the clitoral preputial edema. Seven patients were examined at our division during the neonatal period, and three patients were examined in the postneonatal period. Age at reduction of the clitoral width to < 7 mmranged from8 to 74 days in four of the seven neonatal patients. In the three post-neonatal patients, age to reduction in the clitoral width ranged from 107 to 243 days. Conclusions: Transient clitoral preputial edema is often mistaken for clitoromegaly. The key to diagnosing clitoral preputial edema lies in its characteristic appearance and improvement course. [ABSTRACT FROM AUTHOR]

Simple Summary: Sugar gliders are small marsupials that are becoming quite common as pets. As patients, they are challenging for clinical veterinarians. References about exotic animals are difficult to find, especially regarding the internal anatomy of Petaurus breviceps, knowledge of which is essential to reach a correct diagnosis of pathologies. Since the reproduction of marsupials is peculiar, we focused on the female genital apparatus of this species, very different from that of the usual mammals in veterinary practices. Sugar gliders have duplicates of all the genital organs: they have two ovaries, two oviducts, two uteri and two vaginas. In addition, in pregnant females, a new conduit arises: the birth canal, through which the offspring will leave the genital tract to go outside. In this species, the urinary, genital and digestive systems flow into a small cavity called the cloaca, which receives urine, the foetus and faeces, and communicates with the outside through a single orifice. Thus, the female genital apparatus of the sugar glider fits the general schema of marsupials. We dissected carcasses of eight mature females, both parous and non-parous specimens, to study the macroscopic anatomy of the female reproductive system in the sugar glider. The genital system includes double organs, namely the right and left ones, which are completely separated. It includes two ovaries, two oviducts, two uteri and a vaginal complex. The uteri are fusiform-shaped and lack horns. The vaginal complex includes two lateral vaginae and a median vagina, also called the 'birth canal'. The cranial end of both lateral vaginae partially fuses, forming an expansion named the vaginal sinus, which is divided into two parts by a longitudinal septum, one for each vagina, where the ipsilateral uterine cervix opens. The caudal end of the lateral vaginae opens into a medial and impar duct: the urogenital sinus that serves as a common passage for the reproductive and urinary systems. In non-pregnant females, only the lateral vaginae are present. In pregnant and recently parous females, a short median vagina extends from the caudal wall of the vaginal sinus to the cranial end of the urogenital sinus. In the ventral wall of this sinus, next to its caudal opening, there is a forked clitoris. [ABSTRACT FROM AUTHOR]

Despite some efforts to enhance clitoral knowledge to increase women's sexual pleasure, a gendered orgasm gap persists. We aimed to provide contemporary data on people's knowledge about the clitoris and investigate its association with the experience of sexual pleasure. Heterosexual participants (n = 573; 64.2% women) took a quiz on clitoral knowledge and answered sexuality-related questions. Participants answered only 50% of the nine quiz items correctly. Clitoral knowledge predicted sexual pleasure and orgasm in women, mediated via reduced endorsement of gendered sexual scripts. Our results highlight the importance of clitoral knowledge and its interplay with societal barriers for the experience of pleasure. [ABSTRACT FROM AUTHOR]

To better understand how the human fetal penis and clitoris grows and remodels, we undertook an investigation to define active areas of cellular proliferation and programmed cell death spatially and temporally during development of human fetal external genitalia from the indifferent stage (8 weeks) to 18 weeks of gestation. Fifty normal human fetal penile and clitoral specimens were examined using macroscopic imaging, scanning electron microscopy and immunohistochemical localization for the cellular proliferation and apoptotic markers, Ki67 and Caspase-3. A number of hot spots of cellular proliferation characterized by Ki67 localization are present in the penis and clitoris especially early in development, most notably in the corporal body, glans, remodeling glanular urethra, the urethral plate, the roof of the urethral groove and the fully formed penile urethra. The 12-fold increase in penile length over 10 weeks of growth from 8 to 18 weeks of gestation based on Ki67 labelling appears to be driven by cellular proliferation in the corporal body and glans. Throughout all ages in both the developing penis and clitoris Ki67 labeling was consistently elevated in the ventral epidermis and ventral mesenchyme relative to the dorsal counterparts. This finding is consistent with the intense morphogenetic activity/remodeling in the ventral half of the genital tubercle in both sexes involving formation of the urethral/vestibular plates, canalization of the urethral/vestibular plates and fusion of the urethral folds to form the penile urethra. Areas of reduced or absent Ki67 staining include the urethral fold epithelium that fuses to form the penile tubular urethra. In contrast, the urethral fold mesenchyme is positive for Ki67. Apoptosis was rarely noted in the developing penis and clitoris; the only area of minimal Caspase-3 localization was in the epithelium of the ventral epithelial glanular channel remodeling.

The goal of this report is (a) to provide the first detailed description of mouse clitoral development, and (b) to compare mouse and human clitoral development. For this purpose, external genitalia of female mice were examined by wholemount microscopy, histology and immunohistochemistry from 14 days of gestation to 10 days postnatal. Human clitoral development was examined by these techniques as well as by scanning electron microscopy and optical projection tomography from 8 to 19 weeks of gestation. The adult mouse clitoris is an internal organ defined by a U-shaped clitoral lamina whose development is associated with the prenatal medial and distal growth of the female preputial swellings along the sides of the genital tubercle to form the circumferential preputial lamina. Regression of the ventral aspect of the preputial lamina leads to formation of the U-shaped clitoral lamina recognized as early as 17 days of gestation. While the adult U-shaped mouse clitoral lamina is closely associated with the vagina, and it appears to be completely non-responsive to estrogen as opposed to the highly estrogen-responsive vaginal epithelium. The prominent perineal appendage in adult females is prepuce, formed via fusion of the embryonic preputial swellings and is not the clitoris. The human clitoris is in many respects a smaller anatomic version of the human penis having all of the external and internal elements except the urethra. The human clitoris (like the human penis) is derived from the genital tubercle with the clitoral glans projecting into the vaginal vestibule. Adult morphology and developmental processes are virtually non-comparable in the mouse and human clitoris.

The common view on penile development is that it is androgen-dependent, based first and foremost on the fact that the genital tubercle forms a penis in males and a clitoris in females. However, critical examination of the complex processes involved in human penile development reveals that many individual steps in development of the genital tubercle are common to both males and females, and thus can be interpreted as androgen-independent. For certain developmental events this conclusion is bolstered by observations in androgen-insensitive patients and androgen receptor mutant mice. Events in genital tubercle development that are common to human males and females include: formation of (a) the genital tubercle, (b) the urethral plate, (c) the urethral groove, (d) the glans, (e) the prepuce and (f) the corporal body. For humans 6 of 13 individual developmental steps in penile development were interpreted as androgen-independent. For mice 5 of 11 individual developmental steps were found to be androgen-independent, which were verified through analysis of androgen-insensitive mutants. Observations from development of external genitalia of other species (moles and spotted hyena) provide further examples of androgen-independent events in penile development. These observations support the counter-intuitive idea that penile development involves both androgen-independent and androgen-dependent processes.

Erasure of the clitoris has been so profound that many people are not even aware of their own clitoris, let alone its role in their sexual wellness. The superficial clitoral vein feeds into the external pudendal vein, which then drains into the great saphenous vein, and the deep clitoral vein drains into the vesical plexus into the internal iliac vein.[6] The clitoris has dual innervation - somatic and autonomic. What we know about the anatomy and physiology of the clitoris The clitoris is a multiplanar structure made up of the internal paired clitoral bulbs, corporal bodies, and crura, which are all composed of erectile tissue. The glans clitoris is the only external structure, and it consists of nonerectile tissue that is rich with neural innervation. [Extracted from the article]

Copyright of Gaceta Médica de Caracas is the property of Academia Nacional de Medicina and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)