The role of clitoral topography in sexual arousal and orgasm: transperineal ultrasound study

Abstract

The clitoris has a critical pivotal role in female orgasm and arousal. The aim of this cross-sectional study was to evaluate topographic measurements of the clitoris, as well as to explore potential relationships between the clitoral complex and the orgasm domain of female sexual function, combining transperineal ultrasound with morphometric measurements. In sexually active, heterosexual, premenopausal women, three-dimensional transperineal ultrasound imaging was used to measure the subpubic angle, the anterior triangle area (ATA) of the genital hiatus, the levator urethra gap, and the anteroposterior and transverse diameters of the genital hiatus. Mons pubis thickness, clitoris-urethra distance (CUD), clitoris-fourchette distance, and fourchette-perineal body distance were measured using a caliper. Comparison of measurements and correlation with orgasm score were performed. Among the 108 sexually active women, 30 (27.7%) reported a low orgasm domain score. There were statistically significant differences between the low orgasm group and the control group in the ATA (4.05 vs 3.64cm2 respectively; p = 0.03), CUD (21mm; p = 0.04 vs 16.1mm; p = 0.04), and volume of the glans clitoris (947.7mm3 vs 1081mm3; p = 0.02). There was a moderate and inverse correlation between clitoris-urethra distance and orgasm (r = -0.53, p < 0.001), and arousal (r = -0.42 p < 0.001). Broader ATA (OR = 0.47; 95% CI = 0.23-0.99; p = 0.04) and longer CUD (OR = 0.57; 95% CI = 0.44-0.73; p < 0.001) were identified as the only independent predictors of orgasm problems. Longer glans clitoris-urethra distance and broad space for the deep structures of the clitoris is related to difficulty in reaching orgasm and arousal problems.