Nov. 10, 2022 – Jill Krapf’s patients are often too embarrassed to tell her about discomfort in their clitoris.
“I ask all of my patients about clitoral pain, and it is often the first time they have ever been asked about this,” says Krapf, MD, the associate director of the Center for Vulvovaginal Disorders, a private clinic in Washington DC, and New York City.
Krapf is an OBGYN who specializes in female sexual pain that involves the pelvis, vagina, and vulva.
Many of the conditions Krapf treats don’t have outward symptoms that appear abnormal, but internally, there are damaged or irritated nerves that can result in hypersensitivity, unwanted arousal, or pain.
“Most recent research indicates that even a herniated disk or tear in the spine can lead to clitoral or vulvar symptoms, just like sciatica pain that shoots down the leg is related to issues in the spine,” Krapf says.
Krapf was excited to read of a new discovery: The clitoris has more than 10,000 nerve fibers – 2,000 more than previously reported in 1976 – a medical breakthrough for a part of the body that has often been neglected by the scientific field. Krapf and other doctors in are hopeful that the attention to the clitoris will spark more interest and comprehensive education among people in their field. They also hope it will empower patients to seek medical help if they are having issues with their clitoris.
“Female sexual health has historically been underfunded, especially compared to male sexual health, like erectile dysfunction,” Krapf says. “Optimizing vulvar and vaginal health is not only necessary for sexual well-being.”
Blair Peters, MD, a plastic surgeon who specializes in gender-affirming care, led the study, which was presented at the Sexual Medicine Society of North America conference in October. Peters says he hopes that the new information decreases stigma that the clitoris is not worthy of the same medical attention that other organs of the body receive.
When the clitoris doesn’t properly function, there can be harm to a person’s physical and mental health. Paying attention to discomfort in the clitoris, and seeking medical attention, can help catch and prevent some urinary and vaginal infections.
“The fact that it took until 2022 for someone to do this work speaks to how little attention the clitoris has received,” says Peters, an assistant professor of surgery at the Oregon Health and Science University School of Medicine in Portland, OR.
What’s Inside?
Peters and his colleagues completed the study by taking clitoral nerve tissue from seven adult transgender men who had received gender-affirming genital surgery. The tissues were dyed and magnified 1,000 times under a microscope so the researchers could count nerve fibers.
Peters says the finding is important because many surgeries take place in the groin region – like hip replacements, episiotomies during childbirth, and pelvic mesh procedures – and the revived attention to the clitoris may help health care providers know where nerves are so that injuries from medical mistakes are prevented.
“Nerves are at risk of damage if it’s not understood where they are at all times,” he says.
Peters hopes the new finding will help create new surgical techniques for nerve repair and offer insight for gender-affirming phalloplasty, which is the surgical construction of a penis often for transmasculine people.
Ownership of the Body Part
If you have a heart issue, you see a cardiologist; brain issue, a neuroscientist. But when it comes to the clitoris, no one type of doctor has specialized in the sex organ.
Urologists, gynecologists, plastic surgeons, and sex therapists all address potential problems that can arise with the clitoris and its surrounding body parts. But specialists like Krapf are few and far between.
It wasn’t until 2005 that Australian urologist Helen O’Connell found the clitoris is filled with erectile and non-erectile tissues that are often hidden in anatomy drawings by fat and bone. And it wasn’t until the early 2000s that researchers began delving in earnest into the anatomy of the clitoris and how it functions.
And a 2018 study showed that if more doctors examined the clitoris, they could identify issues like adhesions or infections in the area, most of which can be treated without surgery.
A Body Part Built for Pleasure
Randi Levinson, a sex, marriage and family therapist in Los Angeles, sees patients who have less sensation in the clitoris or pain while having sex, many of whom have recently given birth or are going through menopause.
Women often become embarrassed when they can’t orgasm, or have less sensation in the clitoris, but tend to avoid seeking medical advice, she says. Normalizing discussions about women’s pleasure and the vast anatomy that supports it may help some of her patients.
“The more normal it is to talk about and explore women’s pleasure, the less shame women will have when getting help when they aren’t experiencing pleasure,” Levinson says. “I have many … clients who experience pain and discomfort with sex [after pregnancy] and no longer feel pleasure and are concerned that something is wrong with them.”
