Was the clitoris really discovered in 1998? (spoiler alert - it wasn't) - An Article I Read
Welcome back to An Article I Read, where I summarize a scientific article relating to female orgasm (check all the past ones out HERE). This, my friends, is a long one. So, to help you some, I'm listing the sections. Sorry it took me so long to get his post out. I had fun doing it though.
Context, Background, and my Opinions about this Article (I have some strong opinions)
Article Summary of famed 1998 O'Connell study that supposedly "discovered" the full structure of the clit
A few examples of articles with incorrect claims that the inner structure of the clit was unknown until 1998 (The Guardian, Scientific American, Huffington Post - they all got it wrong, people)
A little perspective about the inner penis (for fun)
Citations
Context, Background, and my Opinions about this Article
You may have seen some memes or postings in social media or in sex-positive feminist articles that say the clitoris was only really discovered in 1998. The more responsible of these may say the whole structure of the clitoris was only discovered in 1998. It's a neat story for a headline; surprising and pretty sad, but it's a super simplistic and frankly incorrect description of what actually happened in clit anatomy research in 1998.
What did happen in 1998 was that a group of researchers, including Helen O'Connell released a research paper (the one I will be summarizing here) that claimed a structure, the vestibular bulbs (or bulbar vestibuli), that was not named as part of the clitoris, well, should be. They asserted it should be called 'bulbs of the clitoris' because the researchers found them to be so related to the clitoris. They also, I'll point out, had other more subtle and interesting insights into the details of female anatomy as a result of the cadaver dissections that were the focus of this research.
However, what I want to focus on right now is that none of that seemed to matter to the science writers and the public. Instead, something much more exciting, and ultimately false, took hold of the public imagination in relation to this paper; that a "new" inner structure of the clit was revealed or 'rediscovered.'
Even though the authors did not assert that sentiment in the paper, in articles written about this paper there is often an insinuation or outright statement that O'Connell and her team 'discovered' or 'rediscovered' for modern times that there was an inner aspect to the clitoris at all- and not simply that the researchers felt another inner organ should also be described as part of the internal clitoral structure.
The truth, however, is that it was absolutely already known before this time that there was a significant inner structure of the clitoris hidden in the body, as was the existence of the vestibular bulbs and their important role in blood flow related swelling in the female genitals during arousal. No internal parts were 'discovered' and the uses and qualities of these organs were not 'discovered' either at this time or in this paper. Granted, as the paper describes, the lack of visual resources and detail in female, but not so much male, anatomy in medical resources was and still is certainly a problem. It's also certainly true that there was and still is a a discrepancy in accurate, detailed knowledge sharing around female arousal and orgasmic anatomy and functioning in science, medicine, education, and public discussion.
I want to make it absolutely clear, though, that the large scale scarcity of information sharing about female anatomy that the authors of this paper described was not due to a void in the basic scientific physiological knowledge of clits or female arousal and orgasm. Let me say that again, because it is simply not believed.
There is no lack of basic scientific physiological knowledge of clits or female arousal and orgasm. There is an unwillingness to believe the information which exists, though.
No doubt cultural biases and norms have minimized and twisted our cultural awareness and even our willingness to include fact-based discussion of female arousal and orgasm in the spaces where it deserves to be and where fact-based understanding of male arousal and orgasm already exists. But, I find it deeply problematic to insinuate, as is often done, that the scientific and medical community has been unaware of the full aspect of the clitoris and the other erectile parts of the female sexual anatomy and their basic functioning for arousal and orgasm, because it's not true and saying so covers up the larger, more egregious problem; that even though plenty of fact-based knowledge exist out there, it is continually ignored, minimized and denounced. I think this is important to note because we as a culture could acquire all the data in the world about female arousal and orgasm physiology, but there will continue to be ignorance and erasure surrounding it until we cultivate a willingness to engage with and accept what the data is telling us (i.e. we need to stop ignoring the aggressively loud and poignant lack of data for an orgasm stimulated through the inside of the vagina)
All that to say, you could find basically accurate physiological and anatomical information in some of the most important modern sexual works, but to be honest, what these works tell us (what they actually tell us - not what people kind of believe they tell us) about female arousal and orgasm physiology is indeed ignored, minimized and denounced in important, although I don't believe always in intentional, ways to this day even by the most progressive sexual educators, researchers and activists.
The Hite Report (1) published in 1976 had the following picture that clearly showed both the internal clitoral structures and the vestibular bulbs.
From pg 181: "Think of your clitoris as just the tip of your 'penis,' the rest of which lies underneath the surface of your vulva - or think of a penis as just the externalization of a woman's interior bulbs and clitoral network."
Also from pg 181: "When fully engorged, the clitoral system as a whole is roughly 30 times as large as the external clitoral glans and shaft - what we commonly know as the 'clitoris'...The next time you are aroused notice how swollen your vulva and labia majora become. This reflects the swelling of the vestibular bulbs and other tissues which lie just below this area."
She got much of her information from Masters and Johnson and from a book by Mary Jane Sherfey published in 1973 (2) (I'm serious that these 70's feminist sex activists are OVERLOOKED...and are STILL minimized as hell, but I digress).
But also, it is clear in Masters and Johnson's 1966 ground breaking research in the book Human Sexual Response (3) (arguably the largest and most important anatomical and physiological sexual study ever), that they understood the clitoris to be not just the clitoral glans, but also inner parts of the body and legs. They also clearly knew about the vestibular bulbs (or bulbus vestibuli), and their role in the extensive blood congestion related to arousal as well as vaginal lubrication and the squeezing of the vaginal barrel. Granted, their few drawings did not include these inner parts, but their information did.
pg 70: In describing what they discovered as causing vaginal lubrication, "The bulbus vestibuli, plexus pudendalis, plexus uterovaginalis, and questionably the plexus vesicalis and the plexus rectalis externus are all involved in a fulminating vasocongestive reaction about the walls of the vagina."
pg. 76: On the physiological changes during the plateau phase level of arousal - "The entire outer third of the vagina, including the bulbus vestibuli, becomes grossly distended with venous blood. The vagocongestion is so marked that the central lumen on the outer third of the vaginal barrel is reduced by at least a third."
pg. 50: Of the physiological changes regarding the clitoral shaft (body) in relation to excitement phase arousal, "There is definitive increase in diameter of the shaft which is a constant development regardless of shaft size."
pg 51: Of the physiological changes regarding the Clitoral legs (or Crura) during Plateau level arousal, "It should be emphasized that the exact roles of crura, suspensory ligaments, and various muscle bundles in clitoral retraction have not been determined with total conviction."
Although Masters and Johnson were not able to directly observe the changes associated with arousal and orgasm for some of those more hidden elements of the female sexual organs, given the technology they were working with and the nature of their experimentation, the discoveries they made about both male and female arousal and orgasm physiology still clearly took into account the extensive inner erectile tissue in females, and their finding still hold up today in no small part to that fact.
So, in essence, one might really just see the re-naming of the vestibular bulbs part of this 1998 O'Connell paper as simply an argument of terminology. There was no revelation about the existence of or purpose for the internal clitoral structures or the vestibular bulbs - none of that was new. It was about visualizing and categorizing the clitoris as not just the clitoris organ but a structure of organs that contained erectile tissue in the female. Despite all the magical excitement over this paper, it is important to remember it was a subtle expansion of anatomical understanding based on dissecting and photographing this anatomy. It was not a revelation.
It's also important to point out that the conclusions about the 'clitoral structure' and what should be named as part of the 'clitoris' in this paper are also not uncontroversial with anatomy scholars. It's not as if this paper came out and everyone was like, "oh yeah, that makes sense!" In fact, this article in Clinical Anatomy from 2014 (4) specifically argues that O'Connell's choice of terminology doesn't make anatomical sense. I summarized that paper HERE. Also Chapter 5of the book Anatomical Study of the Clitoris and Bulbo-Clitoral Organ (5) from 2014 (which I recently found/am super excited about and you can read online- seriously the pics on this are amazing. check them out) speaks directly to the O'Connell paper saying, "The Unicist Theory, rehabilitated by O’Connell, corresponds to reality (see the histological dissections and sections…). However, the fact of referring to the two structures as the clitoris does not correspond to “nomina anatomica” and does not make sense; it is therefore a source of confusion."
My point is that this 1998 O'Connell paper in and of itself is an interesting and useful investigation and discussion of female genital anatomy, but it like so many other papers in so many other disciplines, is just that - a piece of the discussion, a piece that other scientists play off of or criticize in order to get closer to understanding. I do have respect for this work and for these authors. It's just that what this paper has symbolized in the larger culture is incorrect and incredibly problematic.
Unfortunately, there is a feeling that
1. this study discovered a before-unknown (at least in contemporary times) inner part of the clitoris, and
2. that this discovery in some way helps explain something about how the 'inner' clit actually works for female pleasure and orgasm (the more far fetched and egregious assumption about this paper)
It in fact did neither of these and the paper never claimed to them either. First, like I've already shown, those structures were not recently discovered. Second, contrary to popular belief, this article did not teach us anything about the the g-spot or the vaginal orgasm (or inner orgasm or vaginally stimulated orgasm or inner clitoral orgasm, or whatever name it's being called in the moment). Which brings me back to the point I always come back to...because frankly I always have to, given that it's always utterly ignored. No matter what the supposed cause (G-spot, inner clitoral legs, spongey tissue around Koebelt Plexus, whatever), there. is. no. physical. evidence. that women can orgasm from stimulation inside the vagina alone. That was true in the 60's when Master and Johnson did their extensive orgasm research. It was true in the 80's when the "G-spot" was "discovered" and touted (without any actual evidence of course) as a cause of 'vaginal orgasm,' and it's still true today when now the inner clit/inner erectile tissue is being touted as the cause of 'vaginal orgasms' (or inner clit orgasms - but same thing) due to some yet unspecified quality of penises/dildos/fingers stimulating the inner erectile tissue through the walls of the vagina.
If I could only communicate 1 thing in this blog post it would be this:
If you have an idea in your head that scientist learning about the large amount of inner female erectile tissue, including the clitoral legs, the vestibular bulbs, or the venous and spongy tissue generally around the area where the vagina, urethra, clitoral crura and vestibular bulbs are closest...if you have any feeling that scientists learning about these sparked a recent renaissance in lady-gasm research/knowledge - including a better understanding of how women orgasm from intercourse and about the g-spot, then please shake that right out of your head because it's straight up not true.
Yet, as there has been for decades, there is still a constant pull towards anything that will make the idea of vaginal orgasm seem like it might be physically, scientifically validated. The desperation for finding vaginal orgasm validity is so strong that some will grab for anything they can to muddy the truth; there is no actual physical evidence for it. The very best we have as evidence (and believe me researchers cling dearly to this) is that a small percentage of women (depends on who you ask, but I stick to a around 30% to be quite generous) claim to have vaginal orgasms. Problem is, these claims, when they are made, always stay just that - claims. Despite ample opportunity to physically verify it over the decades, it has never happened.
Make what conclusions you will from that, but if an orgasm can happen from an object stimulating something inside the vagina, then scientist over the last, oh...all of history should have found physical evidence to back that, but have not. Masters and Johnson said outright that the vagina does not cause orgasms. And, Masters and Johnson, let's be honest, were kinda desperate to find a way to say that men could give women orgasms with their penis, and to be fair some of the most shitty parts of their work were because they were bent with that bias, but do you know what they found? A whole lotta nothing-much except that stimulating the externally accessible parts of the clit/vulva area or the penis is what caused orgasms.
Nothing since Master's and Johnson's foundational work has done much better or disproved their work in any significant way. But dear lord of all things insane, they. have. tried. oh have they tried. You have dudes (I'm looking at you Dr. Stuart Brody- but not only at you) that are out there getting actual studies published in actual scientific journals that say they can determine if a woman can vaginally orgasm by how she walks. Mother fucker, please. You can't even tell me what a vaginal orgasm is, physically, or the mechanism for how it happens, or if one has ever even actually happened, and your ass is telling me that you can discern this made up shit from how a woman walks? Piss off straight to hell with that. But he's just one of the most flamboyant and obviously egregious of what I like to call the vaginal orgasm research flunkies. They're like the ambulance chasers of sex research, desperately flying down the road towards any sniff of a lead that might put them in the spotlight for finally giving the world an actual piece of evidence that vaginally stimulated orgasms are real (Giving rejoice to all that wish women could just come while penises masturbate inside their vagina instead of 'needing extra'!). It's kind of a racket out there to try and find any way to sneak in some room in your research to claim...'and this is maybe how vaginal orgasms happen' or 'and this is maybe the actual g-spot' or some desperate, scientifically hollow shit like that.
Sadly the lore and assumptions that have risen from the so-called clitoral anatomy revelation in this 1998 paper, I would argue, ended up extending the life of these vaginal orgasms research flunky shenanigans and set the orgasm equality movement back quite a few paces - unintentionally, I think, but back a few paces none the less. Why? Because suddenly women having orgasms due to nothing more than getting banged, a notion which was rightly (but super slowly) getting beaten down because there is literally no physical evidence for it, well, that notion of vaginal orgasm suddenly got a facelift that progressives, feminists, and sexperts could get behind simply because it uses the feel-good, progressive, lady-gasm relevant word, "CLITORIS."
I'll wrap up my long-winded 2-cents about this paper and begin my long-winded summary by reminding you that both before and after this study, the inner parts of the female arousal system were basically understood in relation to their role in arousal and orgasm and it was also known that the part of the clit that can be stimulated from the outside of the body is what can cause orgasm. That is physically substantiated all throughout scientific literature, and none of that changed in 1998. There were no actual scientific revelations about the clit's structure or its role in orgasm. The fact that the general public assumes there was has helped to extend the life of toxic lies about how female orgasm works and how female orgasm happen.
So, on that note, if are wanting to know more detail, here's the summary of this 1998 paper.
Article Summary
To my great happiness, you can actually go and read this full article, and I would suggest anyone with questions or who want to see the pictures, please check it out.
Everything I say below will be my best summary of the the authors' words - with an eye towards using more down-to-earth wording, expressing concepts more accessibly, but still trying to be comprehensive. I do my best, but certainly succeed and fail at this to different degrees throughout. Also - I'm no anatomist, and I truly don't understand this deeply. I spend a lot of time looking things up, and I try to link words and concepts that have helped me, so please use those as you need.
I won't add in my own thoughts unless they are are clearly marked with a title or in these brackets [Me:...]. All quotes are from this article.
Background
The male erectile structures were well known and pretty accurate, not so much for the female structures. Past anatomy books and research tended to brush over these lady parts or speak of them only in relation to what is known of male anatomy. There was just plain less research for female junk.
The original aim of this research was to investigate the nerves related to clitoral erection and determine if they are comparable to the same nerves in the male anatomy - which is related to penile erection. They began this by doing dissections on 10 female infants that had passed from Sudden Infant Death Syndrome. They started with this because there had been a similar study using dissections on male infants with which to compare.
"While performing these dissections it became apparent that the end organ erectile tissue was surprisingly different than the description of it in anatomy publications."
However, they wanted to broaden the scope of their study and also make sure their findings weren't age dependent, which brings us to the study being summarized here. In this study they intend to determine and describe through visual inspection, the placement and size (the gross anatomy generally) of "the urethra and its surrounding erectile tissue complex, the clitoris." They are also reviewing the "appropriateness of current anatomical terminology describing these tissues."
Materials and Methods
The perineum and pelvis of a total of 10 female cadavers were dissected. The researchers used these dissections along with photographs taken along the way to determine anatomy of the female erectile tissue and its relationship to the urethra.
"The dissections were compared to anatomy and pelvic surgery texts, and historical anatomy literature."
The researchers were able to determine the age range but not the menopausal status (although they had pretty good guesses for most based on age) for the cadavers . They were: 22 and 51 year old fresh (not embalmed) cadavers, 6 that were over 70 years old plus a 36 and 55 year old fixed (standard embalmed) cadavers. The 2 cadavers where menopausal status was unclear due to age, the 51 and 55 year olds, were suspected to be post menopausal. 3 of the 6 oldest showed signs of a hysterectomy, but there were no signs of any other other pelvic surgery.
Below are some of the steps taken in the dissection process.
The 8 Embalmed Cadavers
The lower limbs were amputated and the abdomen was cut a few inches above the pelvic region of interest. "All pelvic viscera except for the uterus, vagina, bladder, and urethra were removed"[Me: so I believe that means other organs in there, like the rectum, were removed].
The adductor muscles were carefully cut to avoid injury to adjacent tissue and musculature [Me: so I believe this mean the large muscles kind of between the thigh and pelvis]
"The suspensory ligaments were dissected in detail in 4 specimens" - which means they were not in the other 4. [Me: these suspensory ligaments, I believe, are basically just a grouping of structures that support the internal organs in the female pelvis]
The labia majora (the outer lips) were dissected, and the researchers noted that they had a highly vascular adipose tissue (a kind of specialized fat-rich tissue).
The bulbospongiosus and ischiocavernosus, along with the fat covering them were removed.
The bony pelvis was removed after cutting the pubic symphysis (cartilage that connects 2 sides of the pelvis bones), and also after separating the soft tissue from the bone starting from the the outside of the body working in towards the midline of the body. "Extreme care was taken to avoid injury to the neurovascular bundle observed to run adjacent to the ischiopubic ramus." This, plus another removal of a ligament, revealed the body and crura (legs) of the clitoris.
"The flimsy capsule surrounding the bulbs of the vestibule was removed to expose the underlying erectile tissue, and the relationship between the bulbs and the urethra was noted in each specimen."
Ischioanal fossa fat (fat in space next to the anal canal) and levator ani (the main pelvic floor muscle that contracts rhythmically during orgasm in both sexes - including the well-known PC muscle) were removed to reveal the internal pudendal and cavernosal neurovascular bundles. These were dissected and their course was noted.
Non-Embalmed Cadavers
"The fresh tissue obtained post-mortem involved a much more limited dissection after a standard post-mortem evaluation had been performed. An en bloc dissection of the uterus, vagina, bladder, urethra, small segment of the pubic symphysis, surrounding erectile tissue, and associated musculature and fat was performed, and a more detailed dissection was performed using an operating microscope in the laboratory. All specimens are described according to their anatomical position"[Me: I believe this means the parts listed up there were removed from the body as one and then dissected in more detail outside the body]
Results
"The erectile tissue complex (clitoris) consists of a midline body (corpora) giving rise to bilateral crura and separate bulbs which sit posterior to the body...The urethra lies surrounded by this complex." They go on to say that this means the urethra is embedded in the vaginal wall (the wall towards the front of the body), but is surrounded on all other sides by the erectile tissue described above. [Me: This is an important statement. The researchers take this moment to subtly, but quite radically redefine clitoris as an "erectile tissue complex" instead of the structure that includes the 'glans' you see on the outside, the 'body or corpora' that dips inside the body and the 'legs or crura' that split in 2 from the corpora down further into the body. This is what has traditionally been known as the clitoris. These researchers are lumping in the bulbs of vestibule (they just say 'separate bulbs'), which is a different erectile organ.]
"In anatomy texts the bulbs are referred to as the bulbs of the vestibule and appear as if they form an erectile core of the labia minora. However, our dissections reveal that the bulbs relate most closely to the clitoris and urethra, and do not have a consistent relationship with the vaginal vestibule." [Me: the vaginal vestibule is the opening of the vagina, and the bulbs have been largely associated in the past to how they fill with blood and swell the outer lips of the vulva during arousal as well as puts pressure on the vaginal opening. However, these researchers say that its closeness to the clitoris and urethra is more important - so important in fact that the clitoris should be redefined as including the separate structures of the urethra and the bulbs.]
The paper has several pictures - not super easy to see, but useful none the less. They reference and discuss these from time to time, and I recommend going to the full article and checking them out. I will summarize the rest of their findings as best I can here minus the references to these pictures.
The erectile tissue of the clitoral legs and body are the same deep pink vasculature with a thick tough capsule. This is different from the deep blue vasculature surrounded by a delicate membrane seen in the bulbs.
In a premenopausal specimen, the researchers describe the bulbs as extensive, lying deep underneath the bulbospongiosus muscle and almost completely surrounding the distal vaginal wall, or the part closest to the outside of the body. It is said to be somewhat different in post-menopausal specimens, however. The researchers add, "In other specimens from postmenopausal cadavers, the bulbs related more exclusively to the clitoris or to the urethra."[Me: This sounds a bit like the researchers found that the conclusion about the bulbs being more 'related to the clitoris and the urethra' (which was their reasoning for calling it bulbs of the clitoris instead of bulbs of the vestibule) was more true in postmenopausal women than in premenopausal women, although they don't elaborate further on that.]
The clitoris is described as tri-planer. The corpora or body is lying on the sagittal plane (imagine a vertical plate of glass through the middle of the body dividing it into right to left. The corpora is on that plane of glass). The body/corpora is 1-2cm wide and made up of paired crura that are 2-4 cm long. [Me: The clitoral glans (or the outer nub that's packed full of nerves, the part we all most think of as the clit and the part that causes orgasm when stimulated) is on one side of the corpora/body and sticks outside the vulva. On the other side of the body/corpora it Vs out and becomes the crura or legs].
The crura or legs are described as parallel to the ischiopubic ramus. So, think of that glass plate again and imagine the legs are sticking out on either side of it somewhere between perpendicular and parallel to the glass plate and somewhat towards the front of the body. They are 5-7 cm long and slightly narrower than the corpora/body.
The bulbs [Me: and here notice again that they are including the bulbs when they say 'clitoris'] partially or completely fill in the gap on either side of the vagina and urethra between the labia minora (the inner folded up lips of the vulva - so basically the bulbs are up against the outside of the vulva) and the corpora and crura (body and legs) of the clitoris. The bulbs are 3-7cm long, crescent or triangular in shape. "Thus the clitoris is not flat against the bone as is shown in anatomy and surgery texts."
The glans of the clitoris, however, they found is "usually accurately described in textbooks."
"Our dissection revealed no structure consistent with the greater vestibular (Bartholin's) glands. "[Me: this is a gland on either side of the vaginal opening. It is said to add some lubrication (although most lubrication comes from the vaginal walls). This article doesn't discuss further why they didn't find it or what implications that has.]
Although the male dorsal neurovascular bundle (of the penis) is clearly described in standard textbooks, the female dorsal neurovascular bundle of the clitoris is "usually absent or inaccurate." The researchers described the placement of the dorsal neurovascular bundle of the clitoris and noted the dorsal nerve of the clitoris runs along the top of the corpora (or body) of the clitoris "to enter the deep aspects of the glans clitoris" (the outer part of the clit that we can see). They also pointed out an anatomy text that called the female version of this nerve very small. However, they "found the dorsal nerve of the clitoris to be noticeably large. In most dissections greater than 2mm in diameter."
"In previous studies a cavernosal neurovascular bundle has been observed lateral to the urethra and lying directly on the pelvic aspect of the anterior vaginal wall. Careful excision of the endopelvic fascia and bladder facilitates exposure of this bundle. [Me: basically they identified the known cavernosal neurovascular bundle, which is related to penile and clitoral erection, sitting just to the side of the urethra which sits along the outside of the vaginal wall closest to the front of the body.]
Discussion
"Since the studies of Masters and Johnson there has been surprisingly little investigation of basic female sexual anatomy or physiology." The authors go on to describe some later discussions on male and female sexual function that describe the clitoris as merely the outer nub and later state that the neuropathways have not yet been mapped out with precision.
The authors then note that although there were some illustrations from foreign historical anatomy works that seem to look like what this study has found, most modern anatomy works have reduced descriptions for female, but fairly full descriptions for male anatomy. The authors describe several major shortcomings in current anatomy literature including that: "The bulbs are either omitted or, if described, their relationship to other cavernous tissue is not observed. The urethra is not shown to relate to the clitoris.The erectile tissue complex is displayed as if it were flat against the pubic symphasis and not shown in 3-dimensional (D). The clitoris is pictured as minute or not represented at all, and it's neurovascular supply is rarely described."
The researchers believe that their use of photography and the view of the anatomy from different angles helps to reveal its 3-D nature, and acknowledge that it is difficult anatomy to display because of its 3-D nature.
"The bulbar erectile tissue is intimately related to other components of the clitoris and urethra, and our research indicates that it has been inappropriately named the bulbs of the vestibule. For clarity and completeness it makes more sense to refer to the bulbs by their constant relationship to the clitoral components and call them the bulbs of the clitoris." [ME: this is the big headline grabber statement here - that the vestibular bulbs should be called the bulbs of the clitoris.]
"While local vasocongestion of the corpora cavernosa and spongiosum of the penis are said to produce male erection, 'the bulbs of the vestibule which surround the introitus, produce vaginal lubrication and the swelling which creates the orgasmic platform.' Although there is a paucity of accurate clinical investigation assessing the specific function of the bulbar erectile tissue, it appears that this tissue is likely to have a significant sexual role. We hypothesize that the bulbs add support to the distal vaginal wall to enhance its rigidity during penetrations." The quote within this quote is from Kaplan, H.S. The New Sex Therapy. 1974.
The authors go on to talk about the urethra, saying it is intimately connected to each component of the clitoris, but that it's uncertain whether it has a sexual role. "In a recent French ultrasonographic study of female sensitivity, the site of the external sphincter of the urethra was identified as the the most sensitive area along the anterior vaginal wall. In that study, the urethra sphincter was referred to as the 'G point' and the perineal urogenital tissue referred to as the 'ensemble uretro-clitorido-vulvaire.' Our study leads us to suspect that role of the urethra in sexual function is related to the position of the surrounding erectile tissue rather than the erectile sphincter."
The authors go on to say that whether the urethra has a sexual function is one issue but of likely greater concern is whether tissue related to sexual function around the urethra could be damaged during pelvic surgery. They note that an extensive review of the literature indicates that this concern is rarely considered in the outcome of such medical operations.
They also noted that they found through this research that there is age related variation in the amount of erectile tissue, with pre-menopausal cadavers showing more erectile tissue, and certainly more than was expected from anatomy textbooks. They considered the possibility that typical dissections of female anatomy were done on older cadavers than were male dissections. They also noted that the male anatomy is simply easier to access than the more interior female anatomy.
Conclusion
"A dissection based study of female cadavers suggests that current anatomy textbooks do not accurately display female perineal anatomy. Cadaveric dissection has facilitated an increased understanding of the gross anatomy of the urethra and surrounding erectile tissue as well as its neurovascular supply. We found the clitoris to be intimately related to the perineal urethra and more extensive than typical diagrams indicate. The bulbs of the vestibule appear to be inappropriately named because of their constant relationship to the urethra and clitoris, and we recommend they be referred to as the bulbs of the clitoris."
[ME: that is the whole conclusion in its entirety]
A few examples of articles with incorrect claims that the inner structure of the clit was unknown until 1998
I'm adding this here simply to prove that there really is an idea out there that this 1998 research article by O'Connell et al.
1. discovered a before-unknown (at least in contemporary times) inner part of the clitoris, and
2. that this discovery in some way helps explain something about how the 'inner' clit actually works for female pleasure and orgasm (the more far fetched and egregiously incorrect assumption about this paper).
I don't want you thinking I'm railing against something that doesn't exists. It does, and it's not just with fringe media. It's an idea boldly touted by high end media outlets. It baked so quickly into our cultural understanding that, as I've said before, even the most progressive, well-intended, feminist sexual educators, writers, and advisors seem to believe it, so I certainly wouldn't blame anyone for doing their research and still thinking this 1998 article really did do those things.
Anyway, here's a small sampling from the Guardian, Babe, Huffington Post, The Bustle, and Scientific American, and also an important, well-intentioned and largely positive art series that I think really helped propel this article into this limelight. And truly, this is just a few. I could get plenty more, but I think this is more than enough to get the point across.
This Guardian article: "The sole function of the clitoris is female orgasm. Is that why it’s ignored by medical science?" by Calla Wahlquist from Oct. 2020. It heavily features an interview with Dr. O'Connell.
Wahlquist writes: "The first comprehensive anatomical study of the clitoris was led by O’Connell and published in 1998. A subsequent study in 2005 examined it under MRI. It was not, O’Connell discovered, just a small nub of erectile tissue, described in some texts as the “poor homologue” of the penis. Instead it was an otherworldly shape, with the nerve-rich glans merely the external protrusion of an organ that extended beneath the pubic bone and wrapped around the vaginal opening, with bulbs that become engorged when aroused. It looked like an orchid. It was beautiful."
I'm totally down for many of the points in this article including how insane it is to assume intercourse causes female orgasm (right on, but I will say O'Connell, as with most/almost all sexperts, stops short of actually saying that there are no known 'vaginal orgasms,' only that 'most' women need clitoral stimulation). However, I don't appreciate the insinuation that O'Connell's work was where we learned that the clitoris was more than just the external nub. That's an insane and patently incorrect insinuation. People have LONG known and discussed both the hidden parts of the clit and the vestibular bulbs, and their functions have been largely understood. Of course O'Connell's and other recent work have illuminated understanding further, but to say we were in the dark ages on this stuff until 1998 is a HUGE overstatement if not outright lie.
This Babe article: "The clitoris was only fully discovered in 1998" by Daisy Bernard.
It starts out with a simple exasperated, "1998!!!!!!!!!!!!!!!" Bernard tells us, "it wasn’t until 1998 when the clitoris was discovered in its full structure,"(not actually true), and then quickly she moves to the deeply problematic slip into connecting the (not actually newly understood) inner parts of the clit to new understandings of how getting banged in the vagina causes orgasms (it doesn't actually cause orgasm), when she references an article by Drs. Buisson and Foldes et al., that I summarized HERE to (very incorrectly) say, "This research was revolutionary – explaining how what we once considered to be a vaginal orgasm is actually an internal clitoral orgasm."
That research article does not do that. It doesn't even claim to do that.
I mean, it was a cool use of ultrasound to look at lady bits in a way they hadn't been looked at before, so maybe that's revolutionary, and I respect that, but there are no discussions or conclusions about the cause for vaginal orgasms/internal clitoral orgasms. There is no physical scientific proof that either of those 'orgasms' even exist, and even if they did, there is nothing in either of those articles that gives a mechanism for how they would actually happen.
This Huffington Post piece: Cliteracy is an online series. I'm specifically looking at the "Anatomy" Section. You can find the contributors in the
credits sections (including story editors Johanna Barr, Noah Michelson and Zoë Triska and Production by Carina Kolodny with Amber Genuske).
Speaking again about this O'Connell article, it says, "In 1998, she published her findings. She revealed to the world that the clitoris had an internal and external structure..."
She did not, in fact, 'reveal' the inner structure of the clitoris. It was absolutely known. She just proposed the renaming of 1 (already known) internal structure...and that renaming is controversial - in the anatomy community.
This Art Piece: This brings me not to the Huffington series Cliteracy that I just discussed but to the 2012 project, Cliteracy 100 Natural Laws by artist Sophia Wallace that inspired that series.
I overall LOVE Sophia Wallace's work because it focuses on the erasure, minimization, and ignorance about the clitoris and female orgasm in our sexual culture. Much needed, smart, powerful work. I write my longer-form thoughts on it HERE. However, one of her many pieces in this project was a sign that said "1998 Dr. Helen O'Connell proved the clitoris is exponentially larger and more complex than once believed." (Cliteracy Natural Law #9).
I mean, O'Connell just plain didn't do that, and saying that she did erases the rich and too often marginalized history of particularly 70's feminist scholars that were trying to shout accurate clitoral and female orgasm knowledge from the roof tops. It also plays to the idea that there was an inner clitoral anatomy knowledge renaissance starting in 1998, which in turn plays to the idea that recent learnings about the inner clit suddenly showed us something new about how women can orgasm from getting banged.
Anyway, I understand the good intentions behind this, but this and all the excitement over the 'discovery' that "The clitoris is not a button it is an iceberg" (that's actually Cliteracy Natural Law #4) ended up strengthening the idea that women could get banged into orgasm through their vagina given that now we 'know' it's the inner clit and not the vagina that was responsible for the orgasm (obviously, it's actually not the inner clit or the vagina, and actually there is no scientific proof that an orgasm from just getting banged even exists at all).
My point is, this work (below) by Sophia Wallace was very popular and shared widely - particularly among the progressive sexually-educated types. Despite the other incredibly correct and poignant things in the 100 Laws series, these 'inner clit' related ones stuck in an unforeseen way, I think, in the public eye, and unfortunately, I think it actually helped to widen and strengthen the very incorrect idea that "vaginal orgasms" (which don't exist) were actually "inner clitoral orgasms," (which also don't exist) and that's a step backwards for orgasm equality.
This The Bustle article: Emma McGowan at The Bustle wrote an article called, "Do You Know The Shape Of This Important Body Part?"
She writes, "Turns out, the clitoris is more complicated than even the most sex-positive parent could have known in the mid-90s." (Actually, everything understood to be part of the Clitoris today was absolutely known well before the 90s). "That’s because the full shape of the clitoris wasn’t “discovered” until 1998, when urologist Helen O’Connell drew a diagram of the full internal clitoris for a paper in the Journal of Urology."
Actually she discovered no new parts to the clit - just asserted that the vestibular bulbs should be called the bulbs of the clitoris. And, there were no drawings in that article, so I don't even know where that came from.
Respect to the Bustle's McGowan because she at least acknowledged that this was not completely new. "However, it turns out that Dr. O’Connell was only the first contemporary researcher to sketch out the shape of the clit: Edward Clint writes that an OB/GYN named R.L. Dickinson made a sketch of the internal clitoris in 1949 and someone named G.L Kobelt did the same in 1844."
And you know, also lots of other people knew about it, wrote about it and researched with it in mind. These 'new parts' of the clitoris that were 'discovered' were already in some of the most important and known sex research and writings available, including Masters and Johnson (3) and The Hite Report (1).
Then, it goes down hill. We see the unfortunate slip into using the idea that the clit has inner elements to insinuate we now have some kind of new window into how 'vaginal orgasms' happen. "When a person with a vagina is turned on, these crura fill with blood and become “erect,” similar to a penis. Because they’re bigger, they squeeze closer to the walls of the vaginal canal, bringing clitoral nerves and tissue close the vagina. More and more research suggests that the old idea of a purely vaginal orgasm is untrue because clitoral tissue is both internal and external."
I assure you more and more research is not suggesting that - largely because the idea of a 'vaginal orgasm' or an orgasm caused only by stimulation inside the vagina, is completely unfounded - like, there's no physical recording of this 'type' of orgasm in all of scientific literature.
So yes, the old idea of a vaginal orgasm is untrue, but because it's not a thing...not because O'Connell's 1998 'discovery' of the inner clit 'enlightened' us to the possibility that vaginal orgasms are actually just 'inner' clitoral. That would be convenient and nice, and that is, I think, why the idea has caught on so strongly, but it's bunk and generally harmful because it's just a new, hipper way to keep the false idea of vaginal orgasm alive and well.
This Scientific American article: "The Clitoris, Uncovered: An Intimate History" By Rachel E. Gross on March 4, 2020. This is both an article and a widely shared video piece you can find with this article. The 1st quote below is from the article and the rest are from the video.
About the clitoris still not being adequately displayed in most anatomy textbooks, Gross says, "Fortunately, a few anatomical pioneers are working to change that. In 2005 Australian urologist Helen O’Connell thrust the full anatomy of the clitoris into the public eye. She used microdissection of cadavers and magnetic resonance imaging of living women to reveal what only a few brave anatomists had ever dared to point out."
As I've said 100 times, O'Connell didn't thrust the full anatomy of the clit into the public eye, she just suggested an anatomically controversial idea that the vestibular bulbs be further identified as part of the clit. Granted, Gross is using a 2005 article of O'Connell's not the 1998 one, but this 2005 one is not a new study. It's a review study, pulling together previous work done on clitoral anatomy, including her own past work. So, still, there is nothing revolutionary or new. All the parts were already known and their use understood. O'Connell and her team, as before, were merely suggesting the clitoris be identified as including other things like the vestibular bulbs, and distal urethra; something other anatomists disagree with on anatomical terms.
The article is short, but the video is over 8 minutes and quickly slips into suggesting that the discovery of the "inner clit" enabled us to finally understand how vaginal orgasms actually work. Quickly the narrator says, "The shape of the clitoris explains many things, including how female orgasm works and what the G-spot actually is, but you'll have to wait to the end of the video to figure that one out." (No it doesn't. I'm kinda bored of explaining this and you're probably bored of reading it, so I'm gonna leave it at that.)
Towards the end, we get this, "The clitoris is not just an isolated island in your anatomy. It's intimately connected to all the rest of your reproductive parts. This has some really important implications. Survey's find that only 18% of woman have orgasms through vaginal intercourse alone, and studies like these indicate that actually, it's not a 'vaginal orgasm,' that's just the stimulation of the clitoris through the walls of the vagina, and in the same way, what we call the G-spot, it's really just the back of the clitoris. It's not some new organ."
Uggghhh forever! This is what I'm talking about here. Yes, a small amount of women claim to have vaginal orgasm but none have ever been physically recorded doing so. There is no physical evidence that orgasm from stimulation inside the vagina exists. This is just true. The lack of evidence despite decades of looking for it is loud, clear and in your face. But, instead of recognizing and accounting for that, we ignore it and try to find the cause for this non-existent phenomenon anyway because we believe it should exist soooo much.
Let me put it into perspective. The idea that something in the vagina itself just caused 'vaginal orgasm' was discredited pretty heavily over the years. It hasn't been in vogue for a while now, particularly not after the g-spot was suggested in the early 80's and reignited vaginal orgasm hope. Prior to that Masters and Johnson had po-pooed the idea of vaginal orgasm in 1966 based on their extensive research and those pesky 70's feminists were calling out the BS behind vaginal orgasms like mother fucking bosses. But then around 1980... the G-spot. It was the golden child and the focus of all the vaginal orgasm research and advice for much of the 80's, 90's and early 2000's, but it has also been largely discredited as something that could be stimulated into orgasm over the years . However, the desperate vaginal orgasm researchers didn't really let the g-spot go until it started being suggested that maybe, it's the inner parts of the clit. And the storyline, false as it may be, of the inner clit being "discovered" during this time, only made this seem more exciting and plausible.
However, just like with the vagina and the g-spot, there's tons of speculation but no real agreement on where or how this inner clitoral stimulation should take place to cause orgasm. Yet, it's clung to anyway as if it's tried and true scientific fact instead of a bunch of random mostly hollow hypotheses. As you can see from the quote up there, this new and completely unfounded hope in the inner clit is so strong it can not only explain the years of being wrong about "vaginal orgasms" but also about "g-spot orgasms." It's the newest golden child catch all for explaining away how women can get banged into orgasms, and it will continue to be that despite no real evidence to back it up until another vague but hip explanation comes along or until we finally acknowledge the lack of evidence for a vaginal/inner-clitoral/g-spot orgasm and thus don't have to desperately chase reasons to justify our blind belief in it anymore.
And further to my point, the narrator does the bidding for all the vaginal orgasm research chasers out there and sweeps all the misaligned, inconclusive data out there that reaches for but cannot prove anything about an inner clitoral orgasm into a pile that looks like it might be something even though it is not, and says, "but what all these people were saying in different ways was that all orgasms are clitoral. No matter where you feel the sensation, it all comes from this one organ."
Talk to me in another 30 years when this currently hip inner clitoral orgasm research has become as tired and dead-ended as the g-spot and vaginal orgasm research and then we'll talk.
*btw, I want to be clear that I don't blame any of these writers. It's terrible information about the clit and female orgasm, but it's also the state of the information currently. It's what is being taught to progressive sexperts, and it's what you would come up with if you stared poking around about it. It's not really them. It's the whole state of sexual education and research.
The Inner Penis (just for fun)
On a final note - just for fun and to maybe give you a different perspective. Did you know that at least 1/3 of the penis is buried inside the body as well? You might hear it called the "Root of the Penis" but it, like the outer parts of the penis, are made up of the analogous structures to the female's clitoris and vestibular bulbs. This picture housed on Wikipedia from "An anatomical illustration from An atlas of anatomy/by regions 1962" shows these inner parts.
Just like the inner parts of the clit, these inner parts fill with blood when aroused, are kind of hard to see in medical drawings (from my Googling at least), aren't really discussed in sex ed, and aren't included in what people think of as 'the penis,' but they have been anatomically known and understood for decades. I'm only drawing attention to this to point out that just because regular ol' people didn't know about these inner parts of our genitals doesn't also mean that scientists didn't know about them or how they relate to arousal and orgasm. And also, we know how to make a male orgasm even if we didn't know that 1/3 of their penis was inside their body.
Citations
(1) Hite, Shere. The Hite Report: A National Study of Female Sexuality. Dell. NY, 1976
(2) Sherfey, Mary Jane. The Nature and Evolution of Female Sexuality. Random House. NY, 1972
(3) Masters, W. and Johnson, V. Human Sexual Response. Little, Brown and Company. Boston, 1966.
(4) Vincenzo Puppo and Giulia Puppo. "Anatomy of Sex: Revision of the New Anatomical Terms Used for the Clitoris and the Female Orgasm by Sexologists." Clinical Anatomy 28:293-304 2015
(5) Di Marino, Vincent, Lepidi, Hubert. Anatomic Study of the Clitoris and the Bulbo-Clitoral Organ. Chapter 5. 2014. Online https://www.springer.com/gp/book/9783319048932