Mapping a Danger Zone of the Dorsal Nerve of the Clitoris: Implications in Female Cosmetic Genital Surgery

Abstract

OBJECTIVE: Complications following labiaplasty procedures are understudied and underreported1 and could possibly include loss of sensation in the female pudendum.2 As the number of procedures each year increase,3 it is important to continue to explore ways to ensure positive outcomes for patients. The aim of this study was to determine variability in the course and branching of the dorsal nerve of the clitoris (DNC) and to generate a surgical safe zone. METHODS: Ninety-seven Cadavers from the University of Nebraska Medical Center, Creighton University, and Kansas City University anatomy labs were examined for this study. A shallow vertical incision was made from the pudendal cleft superiorly through the mons pubis. The glans clitoris was identified and used as a landmark while the fascia surrounding the body of the clitoris was carefully removed. The DNC was located where it pierces the perineal membrane and traced distally. The following measurements were taken: (1) from the point where the DNC pierces the perineal membrane to the urethra, (2) from the point where the DNC pierces the perineal membrane to the pubic bone, (3) from the angle of the clitoris to where the nerve branches on the dorsum of the body of the clitoris, and (4) from that branch point to the distal most portion of the glans clitoris. A subset of the population (n = 72) cadavers were examined for abnormal branching patterns, which were noted and characterized. All statistical data analyses were conducted through IBM SPSS. RESULTS: Thirty-five DNCs were characterized as anomalous in the branching pattern analysis. Type 1 was the typical DNC branching pattern (splits once into two terminal branches). Type 2 was distinguished by the presence of an early branch near where the DNC pierces the perineal membrane. Types 3–6 corresponded to the number of branches the DNC had (type 3 had 3 branches, etc). Finally, the measurements that were taken were used to generate a surgical safe zone, which can be used to avoid injury to the DNC during procedures involving the female pudendum. CONCLUSIONS: The findings of this study allowed the investigators to map out a surgical safe zone for procedures involving the female pudendum to avoid injury to the DNC and identify and classify anomalous branching patterns. This information should be useful to physicians performing procedures near the DNC to increase patient satisfaction and safety. Further research should be done into the DNC and outcomes of labiaplasties and other surgeries that could impact this nerve. REFERENCES: 1. Goodman MP. Outcomes. In: Goodman MP, ed. Female Genital Plastic and Cosmetic Surgery. First. John Wiley & Sons, Ltd.; 2016:206–211. 2. Runacres SA, Wood PL. Cosmetic labiaplasty in an adolescent population. J Pediatr Adolesc Gynecol. 2016;29:218–222. 3. Vieira-Baptista P, Almeida G, Bogliatto F, et al. International Society for the study of vulvovaginal disease recommendations regarding female cosmetic genital surgery. J Low Genit Tract Dis. 2018;22:415–434.