NEUROUROLOGY
& FEMALE UROLOGY
Determining
the course of the dorsal nerve of the clitoris
Vaze A, Goldman H, Jones JS, Rackley R, Vasavada S, Gustafson KJ
Glickman Urological Institute, Cleveland Clinic, Cleveland, Ohio, USA
Urology. 2008; 72: 1040-3
- Objectives:
To
describe the course and variation of the dorsal nerve of the clitoris
(DNC) to better define its anatomy in the human adult before embarking
on therapeutic strategies in this region of the body and as an aid to
surgeons to help avoid iatrogenic injury to the DNC during vaginal surgical
procedures.
-
Methods:
Six human female cadavers of variable body weights were sectioned. A
vertical midline incision from the base of the clitoris extending toward
the direction of the umbilicus was made. The DNC was identified by dissecting
out the fascia, fat, and muscles around it. The anatomy of the nerve
was noted bilaterally.
-
Results:
Distally, the DNC pierced the perineal membrane lateral to the external
urethral meatus. It traversed along the bulbospongiosus muscle before
traversing posterior to the crura. The DNC reappeared, hooking over
the crura to lie on the anterolateral surface of the body of the clitoris,
before dividing into 2 cords and terminating short of the tip of the
glans clitoris.
-
Conclusions:
The results of this study have demonstrated the unique anatomy of the
distal part of the DNC. Knowledge of the anatomy of the DNC, which was
consistent for all the cadavers, is important so that surgeons can avoid
potential iatrogenic injuries to this structure.
- Editorial
Comment
The authors describe the anatomy of the dorsal nerve of the clitoris
with emphasis on its exit point from the perineal membrane to its end
point bifurcation. Of note is that the authors found that the course
of the dorsal nerve of the clitoris was in a position that would not
be affected by traditional retropubic suburethral sling operation or
a transobturator suburethral sling. In addition, they noted that the
nerves ended on the lateral positions of the body of the clitoris at
approximately 11 and 1 o’clock with no innervation noted at the
dorsal position (12 o’clock) and the nerve did not reach the tip
of the clitoris but terminated approximately 1cm short of the end.
This article is well worth reviewing prior to the performance of a transvaginal
urethrolysis, especially when considering the suprameatal technique
(1). It will be interesting to see if there is any affectation of this
nerve with the increasingly popular non-surgical transurethral radiofrequency
treatment for female stress urinary incontinence (2). The illustrations
are excellent in quality and impart good recollective information. In
addition to considerations for surgical technique, their anatomic description
may impart valuable information to those physicians counseling couples
with sexual dysfunction (especially with regard to the second phase
female sexual function, arousal, as described in the commentary of the
manuscript) and potential optimal sites for clitoral nerve stimulation.
References
1. Petrou SP, Brown JA, Blaivas JG: Suprameatal transvaginal urethrolysis.
J Urol. 1999; 161: 1268-71.
2. Juma S, Appell RA: Nonsurgical transurethral radiofrequency treatment
of stress urinary incontinence in women. Women’s Health. 2007; 3:
291-9.
Dr.
Steven P. Petrou
Associate Professor of Urology
Chief of Surgery, St. Luke’s Hospital
Associate Dean, Mayo School of Graduate Medical Education
Jacksonville, Florida, USA
E-mail: petrou.steven@mayo.edu |