Andrew Siegel, MD 11/7/15
The clitoris is the female version of the penis. However, the clitoris is a much more subtle and mysterious organ, a curiosity to women and men alike. It is similar to the penis in that it becomes engorged when stimulated and because of its concentration of nerve fibers, is the site where most orgasms are triggered. On rare occasions, the clitoris can become rigidly engorged for a prolonged time, a painful condition known as clitoral priapism.
Clitoral Anatomy and Function 101
The clitoris is an organ that has as its express purpose sexual function, as opposed to the penis, which is both a sexual, urinary and reproductive organ. This erectile organ is the hub of female sensual focus and is the most sensitive erogenous zone of the body, playing a vital role in sensation and orgasm.
Similar to the penis, the clitoris is composed of an external visible part and internal, deeper, “invisible” parts. The inner parts of the clitoris are known as crura (legs), which are shaped like a wishbone with each side attached to the pubic arch as it descends and diverges. The visible part is located above the opening of the urethra, where the inner labia join together. Like the penis, it has a glans (head) and shaft (body), and is covered by a hood of tissue that is the female equivalent of the prepuce (foreskin). The glans of the clitoris, typically only the size of a pea, is a dense bundle of sensory nerve fibers, thought to have greater nerve density than any other body part. Much the same as the penis, the clitoris houses paired erectile chambers that contain spongy sinuses that engorge with blood at the time of sexual stimulation, resulting in a clitoral erection.
With the increase in genital and pelvic blood flow that occurs with sexual stimulation, the penile and clitoral shafts thicken and lengthen accompanied by swelling of the glans. Two of the superficial pelvic floor muscles—the bulbocavernosus and ischiocavernosus –-engage and compress the crura of the clitoris and penis, fundamental to maintaining engorgement and clitoral and penile blood pressures that are in excess of systemic blood pressures.
The word priapism is derived from Priapus, the name of the Greek and Roman mythological God of fertility. He is commonly portrayed in classical artwork as having a disproportionately huge penis.
Engorgement and rigidity—whether penile or clitoral—is an ingenious hydraulic design and feat of nature. On occasion the system fails and the engorgement/erection does not subside. This condition is known as priapism— an unwanted, persistent, painful engorgement that is not on the basis of sexual stimulation. It has the potential risk of damaging the anatomy such that future engorgement and erectile function can be compromised.
Although priapism is much more commonly a male problem, it occasionally involves the female clitoris. Clitoral priapism is an emergency situation in which there is clitoral shaft engorgement and swelling resulting in clitoral, vulvar and perineal pain. Similar to penile priapism, there are many different underlying causes including blood and nerve disorders or side effects from prescribed or recreational medications.
Doppler ultrasound can be useful to check the flow in the arteries to the erectile chambers. Treatment may involve injection of a blood vessel constricting medicine directly into the erectile chambers. Surgical treatment sometimes becomes necessary, usually “shunting” techniques to promote drainage of blood. In one such shunting procedure, a surgical opening is made between the head of the clitoris and the erectile chambers to create an avenue for the exit of the blood.
Bottom Line: Clitoral priapism is a rare occurrence in which there is prolonged clitoral engorgement/erection resulting in swelling and pain. Like penile priapism, this is not s problem that should be ignored. Prompt medical attention can manage the situation and help prevent the possiblity of sexual dysfunction resulting from scarring and impaired erectile capacity.
Wishing you the best of health,
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Author of Male Pelvic Fitness: Optimizing Sexual and Urinary Health: available in e-book (Amazon Kindle, Apple iBooks, Barnes & Noble Nook, Kobo) and paperback: www.MalePelvicFitness.com. In the works is The Kegel Fix: Recharging Female Pelvic, Sexual and Urinary Health.
Co-creator of Private Gym, a comprehensive, interactive, FDA-registered follow-along male pelvic floor muscle training program. Built upon the foundational work of Dr. Arnold Kegel, Private Gym empowers men to increase pelvic floor muscle strength, tone, power, and endurance: www.PrivateGym.com or Amazon.