Posts Tagged ‘clitoral erection’

Are You “Cliterate”? (Do You Have A Good Working Knowledge Of The Clitoris?)

March 18, 2017

Andrew Siegel MD  3/18/17

The clitoris—possessed by all female mammals—is a complex and mysterious organ. Even the word itself–and the way it rolls off the tongue as it is pronounced–is a curiosity.  Many men (and women as well) are relatively clueless (“uncliterate”) about this unique and fascinating female anatomical structure.  The greatest challenge of achieving cliteracy is that so much of this mysterious lady part is subterranean–in the nether regions, unexposed, under the surface, obscured from view–and therefore difficult to decipher.  

The intention of this entry is to enable understanding of what is under the (clitoral) hood, literally and figuratively. Regardless of gender, a greater knowledge and appreciation of the anatomy, function and nuances of this special and unique biological structure will most certainly prove to be useful.  In general terms, proficiency and command of geography and landmarks on the map is always helpful in directing one to arrive at the proper destination.  Consider this entry a clitoral GPS.



The clitoris is mostly subterranean–what you see is merely the “tip of the iceberg.”  The white lines indicate the “rest of the iceberg.”

(By Remas6 [CC0], via Wikimedia Commons)

Mountainous and Hilly Female Terrain

The vulva (the external part of the female genital anatomy) consists of hilly terrain. It is well worth learning the “lay of the land” so that it can be traversed with finesse. The mons pubis (pubic mound) is the rounded and prominent mass of fatty tissue overlying the pubic bone, derived from the Latin “mons,” meaning “mountain.” Located beneath the lower part of the mons is the upper portion of the clitoris.  The word clitoris derives from the Greek “kleitoris,” meaning “little hill.”


Lower abdomen, mons pubis and pudendal cleft

By Wikipicturesxd (Own work) [CC BY-SA 4.0 (, via Wikimedia Commons

The Epicenter of Female Sexual Anatomy

The clitoris is arguably the most vital structure involved with female sexual response and sexual climax. It is the only human organ that exists solely for pleasure, the penis being a multi-tasker with reproductive and urinary roles as well as being a sexual organ. However, I would argue that nature had much more than simply pleasure in mind when it came to the design of the clitoris, with the ultimate goal being reproduction and perpetuation of the species.  If sex was not pleasurable, there would little incentive for it and pregnancies would be significantly fewer. Think about non-human mammals—what would be their motivation to reproduce if sex were not pleasurable? (Male chimps and female chimps do not sit down together and plan on having a family!)  So, pleasure is the bait and reproduction is the switch in nature’s clever scheme.

The clitoris, like the penis, consists largely of spongy erectile tissue that is rich in blood vessels. The presence of this vascular tissue results in clitoral swelling with sexual arousal, causing clitoral fullness and ultimately a clitoral “erection.”


Comparison of penis (left) and clitoris (right), each largely composed of spongy, vascular, erectile tissue

By Esseh (Self-made. Based on various anatomy texts.) [GFDL (, CC-BY-SA-3.0 ( or CC BY-SA 2.5-2.0-1.0 (, via Wikimedia Commons

Clitoral size is highly variable from woman to woman—certainly as much as penile size. A very large clitoris can resemble a very small penis.

Interesting trivia: The female spotted hyena, squirrel monkey, lemur, and bearcat all have in common a very large clitoris referred to as a “pseudo-penis.”  When erect, it appears like the male’s penis and is used to demonstrate dominance over other clan members.  

The most sensitive part of the clitoris is the “head,” which is typically about the size of a pencil eraser and located at the upper part of the vulva where the inner lips meet. Despite its small size, the head has a dense concentration of nerve endings, arguably more than any other structure in the body. Like the penis, the head is covered with a protective hood known as the “foreskin.”

The head is really the “tip of the iceberg” because the vast majority of the clitoris is unexposed and internal. The clitoris (again like the penis) has a “shaft” (although it is internal) that extends upwards towards the pubic bone. The extensions of the shaft are the wishbone-shaped “legs” that turn downwards and attach to the pubic arch as it diverges on each side. Beneath the legs on either side of the vaginal opening are the clitoral “bulbs,” sac-shaped erectile tissues that lie beneath the outer vaginal lips. With sexual stimulation, these bulbs become full, plumping and tightening the vaginal opening.

One can think of the legs and bulbs as the roots of a tree, hidden from view and extending deeply below the surface, fundamental to the support and function of the clitoral shaft and head above, comparable to the tree’s trunk and branches.


Image above by OpenStax College – Anatomy & Physiology, Connexions Web site., Jun 19, 2013., CC BY 3.0,, no changes made to original

The Clitoral Response

With sexual arousal and stimulation, the clitoris engorges, resulting in thickening of the clitoral shaft and swelling of the head. With increasing clitoral stimulation, a clitoral erection occurs and ultimately the clitoral shaft and head withdraw from their overhanging position (clitoral “retraction”), pulling inwards against the pubic bone (like a turtle pulling its head in).

Interesting trivia: The blood pressure within the clitoris at the time of a clitoral erection is extremely high, literally at hypertensive (high blood pressure) levels. This is largely on the basis of the contractions of the pelvic floor/perineal muscles that surround the clitoral legs and bulbs and force pressurized blood into the clitoral shaft and head. The only locations in the body where hypertension is normal and, in fact, desirable are the penis and clitoris.

Why The Pelvic Floor Muscles Are Vital To Female Sexual Health And Clitoral Function

During arousal the pelvic floor muscles help increase pelvic blood flow, contributing to vaginal lubrication, genital engorgement and the transformation of the clitoris from flaccid to softly swollen to rigidly engorged.  The pelvic floor muscles enable tightening of the vagina at will and function to compress the deep roots of the clitoris, elevating clitoral blood pressure to maintain clitoral erection. At the time of climax, they contract rhythmically.  An orgasm would not be an orgasm without the contribution of these important muscles.



Bulbocavernosus muscle (pelvic floor muscle that supports and compresses the clitoral bulbs)



Ischiocavernosus muscle (pelvic floor muscle that supports and compresses the clitoral legs)

(Above two images are in public domain, originally from Gray’s Anatomy 1909)

During penetrative sexual intercourse, only a small percentage of women achieve enough direct clitoral stimulation to achieve a “clitoral” orgasm, as this is usually restricted to women with larger clitoral head sizes and shorter distances from the clitoris to the vagina. Depending on sexual position and angulation of penetration, the penis is capable of directly stimulating the clitoral head and shaft, typically in the missionary position when there is direct pubic bone to pubic bone contact. However, vaginal penetration and penile thrusting does directly stimulate the clitoral legs and bulbs and the thrusting motion can also put rhythmic traction on the labia, which can result in the clitoris getting pulled and massaged.

Interesting trivia: Magnetic resonance (MR) studies have shown that a larger clitoral head size and shorter distance from the clitoris to the vagina are correlated with an easier ability to achieve an orgasm.

The clitoris plays a key role in achieving orgasm for the majority of women. An estimated 70% of women require clitoral stimulation in order to achieve orgasm. Some women require direct clitoral stimulation, while for others indirect stimulation is sufficient. Only about 25% of women are capable of achieving orgasm via vaginal intercourse alone.

With increasing sexual arousal and stimulation, physical tension within the genitals gradually builds and once sufficient intensity and duration of sexual stimulation surpasses a threshold, involuntary rhythmic muscular contractions of the pelvic floor muscles, the vagina, uterus and anus occur, followed by the release of accumulated erotic tension and a euphoric state. Thereafter, the genital and clitoral engorgement and congestion subside, muscle relaxation occurs and a peaceful state of physical and emotional bliss and afterglow become apparent.

Clitoral orgasms are often described as a gradual buildup of sensation in the clitoral region culminating in intense waves of external muscle spasm and release. In contrast, vaginal orgasms are described as slower, fuller, wider, deeper, more expansive and complex, whole body sensations. The truth of the matter is that all lady parts are inter-connected and work together, so grouping orgasm into “clitoral” versus “vaginal” is an arbitrary distinction. Most women report that both clitoral and vaginal stimulation play roles in achieving sexual climax, but since the clitoris has the greatest density of nerves, is easily accessible and typically responds readily to stimulation, is the fastest track to sexual climax for most women.

There is a clitoral literacy movement that is gaining momentum. Please visit: for more information on the clitoris and this campaign to foster awareness of this curious organ.

Wishing you the best of health,

2014-04-23 20:16:29

A new blog is posted every week. To receive the blogs in the in box of your email go to the following link and click on “email subscription”:

Dr. Andrew Siegel is a practicing physician and urological surgeon board-certified in urology as well as in female pelvic medicine and reconstructive surgery.  Dr. Siegel serves as Assistant Clinical Professor of Surgery at the Rutgers-New Jersey Medical School and is a Castle Connolly Top Doctor New York Metro Area, Inside Jersey Top Doctor and Inside Jersey Top Doctor for Women’s Health. His mission is to “bridge the gap” between the public and the medical community that is in such dire need of bridging.

Author of MALE PELVIC FITNESS: Optimizing Sexual & Urinary Health

Author of THE KEGEL FIX: Recharging Female Pelvic, Sexual and Urinary Health (much of the material from this entry was excerpted from this book)


The Clitoris and Clitoral Priapism

November 7, 2015

Andrew Siegel, MD    11/7/15


(Fresco of PriapusCasa dei VettiiPompeii, in public domain)

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 priapisman 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,

2014-04-23 20:16:29

A new blog is posted every week. To receive the blogs in the in box of your email go to the following link and click on “email subscription”:

Author of Male Pelvic Fitness: Optimizing Sexual and Urinary Health: available in e-book (Amazon Kindle, Apple iBooks, Barnes & Noble Nook, Kobo) and paperback: 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: or Amazon.

What’s Your Favorite Nerve?…How ‘Bout The Pudendal?

September 26, 2015

Andrew Siegel MD   9/26/15


(Image above is public domain illustration of the human nervous system)

We all have favorite colors (I’m partial to blue and green) and numbers (3 does it for me), but favorite nerves? Who has a favorite nerve? I submit that you have a favorite nerve, but just don’t know it!

There are many nerves within the human body and there are quite a few of vital importance. They do their jobs quietly, diligently, efficiently, behind the scenes. They are usually taken for granted and most of us have no awareness of them unless their function becomes impaired–as might happen when they become inflamed, traumatized, injured or diseased–giving rise to a host of neurological symptoms.

The system of nerves is essentially a massive network of “wires” that conduct and transmit electro-chemical impulses from the brain and spinal cord to and from every cell in the body. In order for nerves to work effectively, they need some “breathing room” so that they can function unimpeded.

We often become aware of our nerves when they are compressed, temporarily altering their function and giving rise to numbness, pins and needles sensation, etc. It happens to me when I sleep with my arms folded across my chest (ulnal nerve compression from arm flexion) causing me to wake up with a funny sensation involving the outside of my hand and pinky finger and the outer part of the ring finger. It occurs when I go out on a long bike ride, causing a tingly sensation in my right hand (ulnal and radial nerve compression from wrist hyperextension), despite wearing padded gloves. Similarly, I experience genital numbness (pudendal nerve compression from the bike seat), even though I wear padded bike shorts and have a fitted saddle. It also tends to happen when I sit for a lengthy period of time on the “porcelain throne” engaged with reading material, causing my lower legs and feet to “go to sleep” (sciatic nerve compression). Driving for a long period of time also irritates my sciatic nerve, causing an achy sensation in my butt, which runs down the back of my thigh, a good reason to periodically stretch out.

So What Is Your Favorite Nerve?

The cranial nerves are good candidates—those that derive directly from the brain and are responsible for sight, hearing, smell, balance, swallowing, smiling, etc. Most every medical school learns the following cranial nerve mnemonic: On Old Olympus Towering Tops, A Fin And German Viewed Some Hops— the first letter of each word representing the first letter of the 12 cranial nerves: Olfactory, Optic, Oculomotor, Trochlear, Trigeminal, Abducens, Facial, Auditory Vestibular Nerve, Glossopharyngeal, Vagus, Spinal Accessory, Hypoglossal. The 31 spinal nerves are certainly contenders as well—they originate directly from the spinal cord and provide sensation and the ability to use our muscles, indisputably key functions.

How About The Pudendal Nerve?

The pudendal nerve should be considered one of our dearest and fondest. It is the main nerve of the perineum—that valuable, but often unappreciated bit of human real estate located between the scrotum and the anus in the male and the vagina and the anus in the female. This nerve provides sensation to the penis and scrotum of the male and the clitoris, vulva and vagina of the female. In both males and females it provides sensation to the perineum and anal area and enables contraction of the pelvic floor muscles and voluntary continence muscles–the external urinary and anal sphincters. Its function is imperative for sexual arousal, clitoral and penile erection, ejaculation and orgasm.

Who Knew? The term pudendal derives from the Latin “pudenda,” meaning “the shameful parts.” Sadly, our culture has strong puritanical roots.

Who Knew? In the early 19th century, Benjamin Alcock, a prominent Irish anatomist, first described the existence of the pudendal nerve and the channel in which it travels, known as “Alcock’s canal.”  Alcock sure is a fitting name for the man who discovered the nerve responsible for penile sensation, ejaculation and orgasm!

The Human Sexual Response

In accordance with Masters and Johnson’s classic findings, the human sexual response can be can be distilled down to increased genital and pelvic blood flow (the primary reaction) and muscle tensioning (the secondary reaction). Orgasm is the release from the state of increased blood flow and tensioned muscles. It is pudendal nerve stimulation that initiates the process of increased genital/pelvic blood and pelvic muscle tensioning. At the time of orgasm the pudendal nerve is what drives the rhythmic contraction of the pelvic floor muscles.

With sexual stimulation of the genitals, sensory nerves that form the pudendal nerve relay to spinal cord centers, which reflexively relay the electrochemical message to increase genital and pelvic blood flow, resulting in female lubrication and clitoral engorgement and male penile erection. The nervous system also relays directly to sexual centers in the brain, including the hypothalamus, hippocampus, amygdala, thalamus, brainstem etc., enhancing this reflex response. Brain-induced erotic stimulation (visual cues, sounds, smells, touch, thoughts, memories, etc.) leads to further genital stimulation via excitatory pathways that descend down from the brain to the genitals.

The bulbo-cavernosus reflex (governed by sensory and motor branches of the pudendal nerve) is important in initiating and maintaining erection: with stimulation of the head of the penis or clitoris,  a reflex contraction of the pelvic floor muscles increases genital blood flow, enhancing penile rigidity and clitoral engorgement.

Bottom Line: Nerves are required for all body functions and some are indispensible. Although there are more important nerves than the pudendal nerve–such as the vagus nerve, which commands unconscious body processes such as heart rate and digestion–the pudendal nerve just might be your favorite! Without a functioning pudendal nerve, your genitals would be numb, sex would be impossible, your pelvic organs would hang unsupported and you would be diapered because of absent bladder and bowel control.

Wishing you the best of health,

2014-04-23 20:16:29

A new blog is posted every week. To receive the blogs in the in box of your email go to the following link and click on “email subscription”:

Author of Male Pelvic Fitness: Optimizing Sexual and Urinary Health: available in e-book (Amazon Kindle, Apple iBooks, Barnes & Noble Nook, Kobo) and paperback: 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: or Amazon.

Erectile Rigidity: “A Perfect Storm”

December 13, 2014


Andrew Siegel MD   12/13/14

**Note: Although the following blog is written primarily for men, it is equally relevant to females. Since the penis and clitoris are homologous organs, whenever you see “penis” you can substitute “clitoris.”

Last week’s blog reviewed how the penis is one of the most “magical” of organs—how it is uniquely capable of transforming its shape, size and constitution in a matter of nanoseconds. The take home message was that the remarkable upsurge is possible because inflow of blood to the penis is maximized while outflow is minimized, resulting in penile blood pressures that far exceed arterial blood pressure.

Rigid erections can only occur when there is a “perfect storm” of events. First, the arterial blood flow to the penis needs to increase substantially (pre-penile event). Second, smooth muscle within the arteries and the spongy sinuses of the erectile chambers of the penis must relax to allow engorgement with blood (penile event). Third, the pelvic floor muscles must engage to turn the swollen penis into a rigid penis (post-penile event). The blood pressure in the penis resulting from the inflow of blood alone–in the absence of the contribution from the pelvic floor muscles–cannot exceed systolic blood pressure, so the pelvic floor muscles play a vital role with respect to penile rigidity and durability of erections.

So, when erections go south, it comes down to failure in one or more of the three events,  pre-penile, penile, or post-penile.


Pre-penile ED

The problem lies within the arterial blood supply to the pelvis, which is not capable of delivering enough blood flow to fill the penis. Typically, the pelvic arteries are clogged with fatty plaque (atherosclerosis), which is often due to an unhealthy lifestyle: poor diet, physical inactivity, being overweight and use of tobacco. Diabetes is a very common cause of impaired blood flow (although it also affects the nerve supply in an adverse way). Insufficient blood flow may also occur because of the blood pressure lowering effect of blood pressure medications.

Solution to Pre-penile ED: Lifestyle “angioplasty”— getting down to “fighting” weight, adopting a heart-healthy (and penis-healthy diet), exercising regularly, drinking alcohol moderately, avoiding tobacco, minimizing stress, getting enough sleep, etc.—all common sense measures to improve all aspects of health in general and blood vessel health in particular.


Penile ED

The problem lies within the penis itself. Because of poorly functioning smooth muscle within the arteries and spongy sinuses of the erectile chambers, the penis cannot properly swell up with blood. This smooth muscle cannot relax enough to allow blood flow to inflate the penis and pinch off the venous drainage. This failure of relaxation of the smooth muscle in the penile arteries and spongy sinuses parallels the failure of relaxation of smooth muscle in our arteries that causes high blood pressure (“essential” hypertension). Loss of this smooth muscle and scarring can also happen with aging, following prostate cancer surgery, from Peyronie’s disease or because of disuse atrophy.

Solution to Penile ED: Age-related malfunctioning smooth muscle and scarring is a difficult issue to manage. However, lifestyle measures can be helpful as well as adopting a “use it or lose it” attitude towards erectile function—exercising the penis via regular sexual activity will actually help its continued functioning and health of the smooth muscle of the penile arteries and spongy sinuses.


Post-Penile ED

 The problem is weakened pelvic floor muscles. These feeble muscles are incapable of compressing the roots of the penis sufficiently to increase the blood pressure in the penis to the levels needed for full erectile rigidity.

Solution to Post-Penile ED: Pelvic floor muscle training to improve the strength, tone and endurance of the pelvic floor muscles will optimize erectile rigidity and durability.


Wishing you the best of health,

2014-04-23 20:16:29


A new blog is posted every week. To receive the blogs in the in box of your email go to the following link and click on “email subscription”:

Author of Male Pelvic Fitness: Optimizing Sexual and Urinary Health:

Co-creator of Private Gym pelvic floor muscle training program for men