The Clitoral Truth: The Secret World at Your Fingertips (5 page)

Missing,” Carol Downer says. “Although it is clearly analogous to the spongy tissue which surrounds the urethra in men, it hasn’t been considered a part of the clitoris for several hundred years. Since it had no name in women, we decided to name it the urethral sponge.”

The urethral sponge is a very significant part of the clitoral system. Embedded in its spongy erectile tissue are up to thirty or more tiny prostatic-like glands that produce an alkaline fluid similar in its constitution to the male prostatic fluid. Two of the largest, called Skene’s glands, are near the urethral opening, where the urine comes out, but numerous others are buried in the spongy tissue surrounding the urethra. All of these glands together are referred to as paraurethral glands, meaning “around the urethra,” and they are the source of female ejaculation. Normally, the sponge is collapsed and is difficult to feel, but during sexual response, if you or your partner puts a finger in your vagina and presses toward the pubic mound, you can feel a rough nugget about the length of the first one or two finger joints; that is the urethral sponge. When the sponge is filled with blood, i.e., erect, many women find that it is extremely sensitive to stroking, thrusting, or vibration inside of the vagina. The “G spot” is located on the part of the urethral sponge that can be felt through the vaginal wall. We’ll look at this intriguing part of the clitoris in detail in chapter 3.

Inside the inner lips, just below the vaginal opening, there are the all-but-invisible ducts for two bean-sized glands called the

vulvovaginal, or Bartholin’s glands. During sexual response, these small glands produce a few drops of rather thick viscous fluid, which contributes to lubrication of the vaginal opening. The amount of fluid produced can vary from woman to woman, but it is usually so small that it goes unnoticed.

Underneath the perineum, the short bridge of tissue between the fork, which marks the bottom boundary of the clitoris and the anus, is a dense network of blood vessels, often labeled in anatomy texts if it is labeled at all—as the “perineal body.” During sexual response, this tightly packed tangle of blood vessels fills with blood like the other erectile tissues do, becoming hypersensitive to touch, pressure, and vibration. Many women and men find that the perineum is intensely sensitive during sexual response and that stimulation or pressure on this area can often be felt deep inside the abdomen. Since this structure was rarely shown or labeled in anatomy texts, the FFWHCs named it the perineal sponge.

THE PELVIC FLOOR MUSCLES

The clitoris has several layers of muscles often referred to as the “vaginal muscles;’ but they are more correctly referred to as the “pelvic floor muscles.” (See Figure 5.)

The oval-shaped bulbocavernosus muscle lies between the inner lips and the bulbs of the clitoris, which are composed of cavernosus erectile tissue, and it mimics their shape; hence its name. Both the

vagina and urethra pass through this muscle. At its bottom, the bulbocavernosus muscle is interwoven with the anal sphincter muscle, which encircles the anus. Together, these muscles form a figure eight. Knowing that muscles surrounding the clitoris and the anus are connected to one another helps us to understand why anal stimulation feels good, and that it is an integral part of sexual response.

Underneath the glans, the ischiocavernosus muscles flare out on either side, sandwiched between the legs of the clitoris and the bulbs, like an upside-down “V.” The bottom ends are attached to the ischium bones (the bones that we sit on). The transverse perineal muscle stretches like a fat rubber band from side to side, attached to the ischium bones on both ends and interwoven with the bulbocavernosus and anal sphincter muscles at the center. This wide band of muscle is so named because it transverses beneath the perineum, the short bridge of skin that separates the vagina and the anus.

The urogenital diaphragm is a flat, triangle-shaped muscle that is outlined by, and lies underneath, the ischiocavernosus and transverse perineal muscles. Both the urethra and vagina pass through this muscle.

Underneath everything lies the broad, flat, funnel-shaped sheet of muscle, the levator ani. The levator ani, better known as the

FIGURE 5: THE PELVIC FLOOR MUSCLES

pubococcygeus or “PC” muscle, is a part of the pelvic diaphragm. The urethra, vagina, and anus all pass through this muscle, which forms the absolute bottom of the pelvic floor.

There are two ligaments that play a role in sexual response. One end of the suspensory ligament is attached to the glans; at the other end it branches and attaches to the ovaries. During sex this ligament, which is like a big rubber band, tightens, pulling the glans back underneath its hood. This is why the glans is often harder to see or feel as you become more sexually excited. The ends of the round ligament are woven into the soft tissue underneath the inner lips, and the other ends are firmly attached to the uterus. This is why the uterus is affected by and is involved in sexual response.

Sensory messages are carried from the clitoris up the spinal cord to the brain and back by the pudendal nerve. Pudendum means “shame” in Latin. I would appeal to anatomists to come up with a more positive and descriptive name for this major nerve—something like, for example, the genital nerve, or the primary genital nerve, if research confirms that there is more than one major nerve complex serving the genitals.

Last, but far from least, are the blood vessels. In response to normal stimulation, arteries bring an increased blood supply to the clitoris, engorging the erectile tissues, causing erection, and setting the stage for orgasm. Veins then carry blood out of the clitoris. A study by Italian anatomists has suggested that erection may be

somewhat different in men than in women. In men, the blood rushes into the penis, trapped by the contraction of the pelvic muscles until it is released through a dense network of veins called a venous plexus and by the spasms of orgasm. Blood also rushes into the clitoris, and it too greatly increases in size, but, these researchers found, there is no concentrated venous plexus, so the blood flows out more readily. According to these researchers, this explains women’s ability to experience multiple orgasms. It doesn’t take such an explosive force to flush the blood out of the erectile tissues, and it refills again quickly, allowing for that second, tenth, or nth orgasm. Certainly erection does occur in women, but perhaps not as dramatically as it does in men. During full-blown sexual response, clitoral tissues expand enormously. The erectile tissues fill with blood, causing the clitoris to protrude enough, as one woman put it, “to fill my cupped hand.”

DURING childbirth the perineum, perinea] sponge, clitoral muscles, and vaginal floor are routinely cut a procedure known as an episiotomy—to facilitate the passage of the baby through the vagina, and to avoid tearing. This cut to enlarge the birth canal goes through clitoral structures, most often the pubococcygeus (PC) muscle and the perineal sponge, but sometimes through others as well. Some women find a decrease in sexual

sensation after an episiotomy. Certainly more episiotomies are required today because of the use of painkillers and other practices designed to speed up birth, but we know from countries such as Holland and Germany where most births are still done by midwives that most episiotomies are unnecessary if childbirth is allowed to take its natural course and the perineum is properly prepared to stretch by warming and massage. Since clitoral tissues are cut, some midwives and childbirth educators believe that the episiotomy might be more properly be termed “clitorotomy.” Perhaps obstetricians would cut less often and he more careful where they cut if they were aware that they are cutting through genital tissues, and that this may have a negative impact on a woman’s sexual function afterward.

THE COMPLETE CLITORIS

All of the parts of the clitoris function together to provide sexual pleasure and orgasm, but the clitoris is certainly more than the sum of its parts. Women can experience sexual pleasure and/or orgasm without knowing anything about their anatomy, or indeed, without

touching any part of it. But knowing that there is so much more to the clitoris than just the glans should lead us to the path of discovery about our potent sexual potential.

WHAT HAPPENS DURING SEXUAL RESPONSE AND ORGASM

Once, at a workshop on the clitoris that I had organized, Carol Downer was describing the various parts of the clitoris and how they all function to cause orgasms. As the slide showing the whole clitoris came on the huge screen, one woman in the audience let out an audible “ahhhhhhhhh!” After a few moments of dead silence, the entire room, crammed with more than three hundred people, erupted into applause and sympathetic laughter. When the laughter subsided, I realized that the proverbial light bulb had flashed on in her brain, and she finally understood what must have previously mystified her, and so many women through the ages: where all of those exquisitely pleasurable sensations come from and how orgasm occurs.

As a prelude to sexual response, the senses make a subtle but profound and ultimately transformative shift from normal everyday cognitive function into the rarefied sphere of sexuality. Whereas moments before, the mind may have been occupied with the requirements, pleasures, or minutiae of daily life, the pleasure agenda suddenly demands to be fulfilled. Fantasies may invade the consciousness. We may touch our partner in ways and places that a

scant minute ago would have been considered inappropriate, or we may reach for a vibrator. In response to this change in consciousness, the brain floods the bloodstream with more than a dozen feel-good hormones and sexual chemicals. While this phenomenon is largely unconscious, how we choose to act from this point forward determines what happens next. If, for example, we are in class or on the job, we might enjoy the promise of pleasure and surreptitiously masturbate, or save it for another time. If the time is right, however, the sequence of pleasure unfolds. Blood rushes to the pelvis and fills the erectile tissues. Nerve cells in the genitals become excited. The breasts may also increase noticeably in size and stimulation of the nipples causes the production of the potent hormone oxytocin, which causes urgent tingling sensations in the genitals.

The skin on various parts of the body becomes hypersensitive. The glans pokes its enlarged head from beneath the hood. The shaft now feels like a big round rubber band. The legs stiffen and elongate. The eggplant-shaped bulbs puff up like thirsty sponges, tightly cuffing the vaginal opening and causing the vulva to expand outward. The rough ridges of the urethral sponge can now be felt easily through the roof of the vagina, and if nothing is in the way, its tip may become easily visible through the vaginal opening. Pressure from dilated clitoral blood vessels (congestion in the veins, or vasocongestion) surrounding