Anatomy and physiology of the clitoris

The clitoris is a remarkable and unique organ in the human anatomy. It is the only human organ solely associated with sexual arousal and sensation, its sole physiological function being to stimulate female libido and pleasure. As the erogenous center for both afferent and efferent sexual stimuli, it possesses the dual role of being both the most sensitive receptor and the most powerful sensor.
The clitoris is located at the anterior junction of the labia majora and labia minora, somewhat resembling the penis in men; in fact, it is a homologous organ of the penis. The clitoris consists of a pair of erectile corpora cavernosa, divided into three parts: the glans, body, and crura, all encased in a dense membrane primarily composed of elastic fibers and smooth muscle bundles. The central surfaces of the two corpora cavernosa fuse to form a comb-like septum. The small, pea-sized glans clitoris extends forward from the labia minora and merges with them, emerging from the clitoral hood—the only visible part of the clitoris.
Below it is the frenulum of the clitoris. In many women, the clitoral glans remains hidden in a long and tight clitoral foreskin until a strong sexual arousal is felt. Only when a considerable degree of sexual arousal is achieved can the clitoral glans be clearly exposed.
The diameter and length of the clitoral glans are both around 2.5 mm, but their size varies considerably from person to person; even a glans as thick as 10 mm is considered normal. The clitoral body is always covered by the clitoral hood. After leaving the lower part of the anterior border of the pubic symphysis, it bends almost at a right angle to the front and downward, protruding into the pendulous part, the free end of which is the clitoral glans. When you touch and press a certain area through the clitoral hood, you can feel the clitoral body, which is about the thickness of a matchstick. It swells after sexual arousal and becomes more noticeable to the touch.
The clitoral body divides posteriorly into a pair of cylindrical clitoral crura, which are much larger than the glans and body, about 40 mm long. They resemble two wings extending laterally from the clitoral body, firmly anchoring the clitoris to the pubic and ischial ramusees of the pelvis. The clitoral crura are important tissues that swell and become engorged during female sexual arousal. Like the penis, the clitoris has a suspensory ligament attached to the anterior superior surface of the clitoral cavernous septum. A pair of ischiocavernosus muscles cover the surface of the clitoral crura. The position of the clitoris is related to the distance between the origin of the clitoral crura at the anterior border of the pubic symphysis and the urethral orifice, reportedly averaging 25 mm.
The length of the clitoral body varies greatly. From an anatomical perspective, it is impossible to pinpoint the exact attachment point of the clitoral crura on the anterior border of the pubic symphysis, nor is it possible to accurately describe the precise distance between the attachment point of the clitoral crura and the urethral orifice. As a general rule, a slender clitoral body usually results in a smaller clitoral glans, while a short and thick clitoral body usually results in a larger clitoral glans. However, the opposite can also be observed.
The clitoris contains abundant sensitive nerve endings, with a density 6 to 10 times higher than that of the surrounding tissue or the glans penis. The clitoris is innervated by the dorsal clitoral nerve, a small terminal branch of the pudendal nerve that terminates in the nerve endings of the glans and body of the clitoris. Irregularly distributed within the larger bundles of the dorsal clitoral nerve are ring-shaped corpora related to proprioceptive stimuli, playing a crucial role in transmitting afferent impulses induced by somatic stimuli.
The clitellum corpuscles are responsible for deep pressure sensation and proprioception. Their quantity and quality vary considerably, which explains the significant differences in stimulation techniques and intensity required by women during masturbation. The clitoris is also rich in free nerve endings that are highly sensitive to touch. This explains why the clitoris is so sensitive to touch; skillful stimulation of the clitoris can easily arouse a woman's sexual desire and often lead to orgasm without intercourse.
Generally, stimulating the clitoral body is more effective than directly stimulating the clitoral glans. Furthermore, the clitoris often requires prolonged, continuous, and strong stimulation. Because it's separated by the foreskin, it has good tolerance, especially near orgasm where it needs more force and intensity. Clitoral stimulation is a crucial moment for arousing a woman's initiative and libido, and also a time for her to quickly transition from the excitement phase to the plateau phase. The woman must actively participate, acting as a guide and director, clearly indicating her most sensitive areas and preferred stimulation methods to her partner, and communicating fully to correct any deviations or deficiencies in the man's stimulation techniques. Otherwise, allowing the man to haphazardly follow instructions will not only waste time and energy but also lead to disappointment and frustration for the woman.
Statistics show that 2/3 of women prefer clitoral stimulation, while only 1/3 prefer vaginal stimulation. Women who prefer clitoral stimulation believe that the pleasure derived from clitoral stimulation is far stronger than that derived from vaginal stimulation. Although sex experts have clearly confirmed the important role of clitoral stimulation in female sexual response, many women still do not accept this practice.
In most sexual positions, the penis cannot directly stimulate the clitoris. Furthermore, when the sexual response reaches the plateau phase, due to the contraction of the female perineal muscles, the clitoris retracts from its usual hanging position deep into the clitoral hood, close to the anterior border of the pubic symphysis, thus moving away from the vaginal opening. This retraction makes it even more difficult for the penis to make direct contact with the clitoris. In fact, during simple vaginal intercourse, the thrusting of the penis within the vagina indirectly stimulates the clitoris by pulling back and forth on the labia minora and the connected clitoral hood. Especially when the penis is withdrawn outwards, the foreskin returns to the glans or coronal sulcus, increasing the penis diameter by a few millimeters, thus making indirect stimulation of the clitoris more likely.
●Changes in the clitoris during the sexual response cycle
Due to long-standing taboos surrounding sex and various misconceptions about the sex and reproductive systems, research into the true nature of the sexual response process has been severely hampered. In addition, technical difficulties, such as interference with or inability to conduct clinical observations in certain sexual positions or during female self-stimulation, have resulted in the latest reports on the anatomical and physiological changes of the clitoris during the sexual response cycle.
Sexual stimulation can take two forms: physical and psychological. The clitoris can respond appropriately to both types of stimulation. Although stimulation sources can be physical or psychological, and the clitoris plays a dual role as both a receptor and a sensor, this does not mean that any form of stimulation is purely physical. All stimuli must be identified, transmitted, and categorized by higher cortical centers. Somatic stimulation refers solely to physical activity; this form of clitoral stimulation is highly variable, ranging from intersexual caressing or other forms of stimulation to self-stimulation using pressure from bedding or legs. Therefore, the term "physical stimulation" or "sensor action" is used generally, not specifically referring to any particular initiation method. In any method of female sexual stimulation, the inherent overlap of psychological factors is always crucial and cannot be ignored.
The first perineal response to sexual stimulation is increased vaginal secretions, creating the necessary lubrication. From the start of stimulation to the appearance of a "sweating" response in the vaginal walls, it takes only 10-30 seconds. The clitoris, however, does not respond as quickly. It's a common misconception that since the clitoris and penis are homologous tissues with similar anatomical structures, their response times to similar stimuli should be similar. Therefore, it's assumed that the clitoris, like the penis, should rapidly achieve an "erection" response upon sexual arousal. However, this assumption is incorrect.
The speed at which a clitoral response occurs depends on whether the sexual stimulation is direct or indirect. The only direct stimulation methods are manual or mechanical stroking and pressing of the clitoral body or the entire mons pubis area, while indirect stimulation techniques are diverse, including stimulation of the breasts (especially the nipples) or vagina (without touching the clitoris), caressing of other erogenous zones of the body, various sexual fantasies or audiovisual stimulation, various non-contact sexual positions involving the clitoris, and artificial intercourse experiments.
在对妇女性反应周期的数千次直接观察中发现，只有不到半数的情况下能见到阴蒂头肿胀反应的临床证据，而且其血管充血的程度也不尽相同，有的勉强可以辨认出来，有的可使原来的体积增大一倍。阴蒂勃起组织主要是靠由支配它的副交感神经来调节的。曾把这一反应与阴茎的勃起相混淆，并称之为阴蒂的“勃起”，但在实际调查中发现，除非存在着病理性的增生肥大，否则是看不到所谓的阴蒂勃起的。阴蒂的肿胀是与小阴唇的血管充血相平行的，阴蒂的血供来自阴蒂深动脉和背动脉。
阴蒂头的肿胀反应一旦出现，并使女性达到兴奋期状态的性刺激得以继续维持的话，那么这一反应就可持续存在于整个性反应周期中。肿胀反应的出现与否无法在事先就能预见。肿胀反应体积增加的程度和出现速度的快慢，存在显著的差异，如在直接刺激时，反应迅速而强烈；而在间接刺激时，反应明显延迟且微弱。
在未受刺激时，阴蒂包皮可以稍微皱缩但不后退，其自由活动的程度显然不及阴茎包皮或阴囊皮肤。当阴蒂头肿胀体积增加之后，它将紧紧固定于原先松弛但现已充血的阴蒂包皮与其下方的阴蒂系带之间。
阴蒂体也会经历兴奋的充血反应而增粗及增长，这些反应与阴蒂头肿胀出现的时间是同步的，它们的出现与否与刺激来源或类型无关。不论是能连续达到多次高潮的妇女还是不能达到高潮的妇女都有可能在性活动中出现上述的阴蒂头和体的反应，这些反应的出现与性能力和性反应程度无关。
阴蒂对有效性刺激的主要反应发生在性反应周期的平台期。阴蒂头和体将因阴蒂脚、悬韧带和坐骨海绵体肌等多种肌肉束的收缩而从正常的阴部悬垂位置向后退缩并紧靠在耻骨联合的前界。特别是在高潮即将来临之际，整个阴蒂头和体深藏于保护性的阴蒂包皮之下，根本无法再对它们进行临床观察。在这一时刻，整个阴蒂主体的长度至少有５０％的减少。
在平台期，阴蒂主体退缩反应的发生与性刺激的方式和有效性有关。在性交或乳房手法刺激时，阴蒂的退缩发生在平台期之末，作为性紧张已达到高潮期前水平的一个指征。对阴阜区域采取手法刺激时，阴蒂主体退缩的发生将会更加迅速，通常发生在平台早期，这往往表明它是对触觉刺激的感觉反应，而不是表明高潮即将来临。
在平台期出现的阴蒂主体的退缩反应是可逆性的，如果有意减弱或者中止刺激手段，性紧张水平将立即下降，退缩的阴蒂干和头将返回到正常的阴部悬垂位置。当重新开始有效性刺激时，阴蒂主体的退缩将再度出现。当平台期长期维持时，阴蒂的这种反应顺序将会反复发生。
由于阴蒂在平台后期的严重退缩，无法在高潮期对阴蒂进行直接观察，所以人们尚不能确定阴蒂在高潮期将有哪些特别反应。
在消退期开始之际高潮平台的收缩停止后５°１０秒钟内，阴蒂就会返回正常的阴部悬垂位置，它的发生与小阴唇性皮肤颜色的消退是同步进行的。但阴蒂头肿胀（如果兴奋期中确实发生的话）的消退则是一个缓慢的过程，肿胀程度越是严重，其消退也越缓慢。一般来说，阴蒂头和阴蒂体的充血与肿胀常常在高潮表达之后持续５°１０分钟或更久。至于没有获得性高潮的女性，在终止全部性刺激活动之后，阴蒂主体的静脉充血肿胀往往要维持数小时之久。
值得提醒人们的是，阴蒂头在性高潮过后将对任何触觉或压力觉变得极其敏感，因此，渴求多个高潮的妇女要注意在重新开始新的刺激时避免直接触摸阴蒂头，而应该把注意力转移到整个阴阜区域。尤其是经ｇ点刺激引起终止性性高潮后，阴蒂及其周围组织均拒绝任何形式的进一步刺激。所以也有人提出，女性也有不应期，但一般来说，这段时间比男性短得多。
●有关阴蒂的错误认识
种种临床谬误一直主宰了人们对女性性紧张度增强过程中阴蒂功能变化的说明，根据临床实验研究的结果有必要对此予以澄清，在探讨这一问题时必须详细考虑阴蒂作为性刺激的感受器和传感器的双重功能角色，这对有效治疗女性性功能障碍具有重要的的指导意义。
错误认识之一︰历史上一直认为，阴蒂的大小与女性的性行为能力有直接关联。但实验室和临床观察研究都没有得到明确证据来支持这一观点，所以妇女不必为其阴蒂的大小而担。
错误认识之二︰过去总把阴蒂在耻骨联合前界上的位置看作是影响女性性反应的重要因素。人们往往认为阴蒂坐落的位置如果较低，性交时它与阴茎发生直接接触的机会也就会增多。事实上，其位置再低也无济于事，何况在平台期还要发生阴蒂的退缩反应呢！这就进一步消除了即使是理论上的两器官直接碰撞的可能性。
错误认识之三︰过去总说如果妇女长期手淫可以使阴蒂头变大，阴蒂体增粗增长。在具有几十年手淫史的妇女中确实可以见到阴蒂肥大的情形，但追问其性历史往往可以了解到她们广泛采用了一种或多种机械刺激方法。当然，首先要排除持续的雄激素的影响（无论是体内肾上腺过度分泌的还是经口服或肌肉注射得到的外源性的）。原则上讲，阴蒂只具有弹力纤维等结缔组织和平滑肌纤维，所以各种机械或手法刺激不会产生在横纹肌上很容易见到的增生反应，通过身体锻炼可以使胳膊、腿部的肌肉发达，但决不能使平滑肌增生。这正如男性的阴茎一样，很难通过所谓负压吸引器之类的仪器使阴茎增长增粗，丰乳器之不可相信的道理也在于此。
错误认识之四︰各种婚姻手册、指南中不厌其烦地老调重弹，强调在夫妻性生活中应如何如何以阴茎直接刺激阴蒂云云。实际上，除非男性作出特别努力使阴茎干直接紧贴在女方的整个阴阜上，否则不可能产生阴茎与阴蒂的直接摩擦。在性紧张高度增强时，很难再令男方保持这种高位重叠式的性交体位，特别是女方的阴道口较紧尚未达到经产妇般的松弛程度时就更困难了。女方往往会抱怨阴道外口或直肠的不适。这时阴茎也不可能充份插入阴道深处，所以男方阴茎应感受到的阴道扩张作用全会消失贻尽的。因此，为了更好刺激阴蒂以便更快激发女性性欲，也可采用在性交之前以勃起的阴茎轻轻摩擦女方阴蒂的方法，它是一种很理想、很巧妙、很受女方欢迎的切实可行的方法。
此外，在采用女上位、侧位、坐位等体位性交时，双方都可在阴茎抽动的同时以手直接刺激阴蒂，这种双管齐下的方法无疑会加快性高潮的到来和增强性快感的强度，也是治疗女性性高潮障碍的一个重要技术手段。
有的婚姻手册中不惜篇幅地讨论对阴蒂的抚摸，并讨论为什么和在什么时候刺激阴蒂，但是对于远远更为重要的指导，即如何抚摸阴蒂及需要多大量的刺激则很少有人问津。研究发现每个妇女在这方面的差异很大，很少有两个妇女会要求完全一样的操作方法，但绝大多数妇女具有一个共同的倾向，即她们都避免在性活动一开始时就直接抚摩阴蒂。此外，即使这样做也只是很短时间的事。这一活动通常只限于兴奋期，而且要使用润滑剂。
在大多数情况下，取而代之的做法往往是集中力量刺激整个阴阜区域，虽然这样收效较慢，但同样能获得满足，同时还不致使阴蒂因过重过久的刺激而出现疼痛或烧灼感。假如刺激过久地集中在某一区域或刺激时所给的压力太大时，都会造成该部位的某种程度的淋痺状态，从而丧失对触觉的敏感反应。通过对阴蒂切除术后手淫活动的观察可以得出有力证据，以支持阴阜作为另一个性敏感区的观点。术后单独刺激阴阜区域的效果与术前同样有效，手淫往往主要集中在阴阜区，只有很少时间集中于术后的瘢痕上。
Most women who actively masturbate are not satisfied with just one orgasm during clitoral stimulation. They control their sexual response to experience multiple orgasms until they reach complete physical and mental satisfaction and experience physical exhaustion. However, some women maintain or develop increasingly strong desires for the opposite sex. If circumstances do not allow for this, they often fall into an uncontrollable state of irritability or frustration, causing significant emotional and physical distress.
The clitoral retraction during the plateau phase often confuses men, leading them to stop stimulation and try to recapture it. This incorrect approach by men is another common reason for significant frustration for women in a state of heightened arousal, as they struggle to regain their focus and attention. Consequently, the sexual tension of the plateau phase dissipates, rendering all previous efforts futile. The lack of orgasm exacerbates the frustration, and the congestion in the pelvic organs cannot dissipate. The correct approach is for the man to continue actively and effectively stimulating the entire mons pubis area until orgasm is achieved.

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Anatomy and physiology of the clitoris

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