Clitoris Research Articles

Relationship of orgasm with measurable dimensions of clitoris and visibility of clitoral glans

Aim: The clitoris is the dominant sexual organ in the female, varies in size and plays an active role in genital sensation and orgasm. Since the importance of clitoral glans visibility is known, surgeries of clitoris are increasing day by day. However, there is insufficient literature on the subject. The aim of this study is to determine the effect of measurable dimensions of clitoris and the clitoral glans visibility on female sexual function.Methods: Seventy-seven patients included in this cross-sectional study were examined in the lithotomy position and the measurable dimensions of the clitoris, the visibility of the clitoral glans and the length of the prepuce were noted. The Female Sexual Function Index (FSFI) was applied to all participants, which were divided into two groups, as those with normal orgasmic function and orgasmic dysfunction. One researcher made all measurements.Results: There were no statistically significant differences in clitoral glans width, length, or prepuce length (P=0.11, P=0.63, P=0.35, respectively). Clitoral glans was visible in 41 of 51 patients in the normal orgasmic function group, which was significantly higher than the group with orgasmic dysfunction (P<0.001).Conclusion: Since there is a significant relationship between clitoral glans visibility and orgasm, genital surgeries performed to increase clitoral glans visibility can facilitate sexual satisfaction and/or increase orgasm intensity. The fact that the relationship between measurable dimensions of clitoris, length of prepuce and orgasm cannot be shown suggests that clitoral glans visibility is more important than clitoral size for sexual stimulation.

Anne Koedt: Politics of the Vaginal Orgasm and Female Sexuality

Abstract: This paper focuses on Koedt’s main discourse of female sexuality that develops out of the traditional phallocentric assumption in her critical essay “The Myth of the Vaginal Orgasm.” She argues that the centre of female orgasm is the clitoris, not the vagina. The paper examines how the nature of female sexuality is constructed and misrepresented by male hegemonic structure to subjugate and control women. The analysis uses a qualitative methodology in the form of the close reading of the text. It is a multidisciplinary study cutting across the disciplines of lesbian feminism, psychology, physiology, sexology, and psychiatry and attempts to investigate as to how female orgasm has previously been considered in an inadequate way. It tries to vindicate how female sexuality has politically been treated and how there exists a relationship between female sexuality and male domination. The paper also offers a very candid critique of female orgasm, female sexuality, the meaning of sexual pleasure, the vaginal orgasm, the clitoral orgasm, and different other forms of female orgasm. In the postmodern era, the main issue of gender equality is replaced by a category of sexuality. This paper provides an overview that sex in society revolves around the pleasure of men and women’s sexual desire is constructed according to the male interests. The result of the study reveals that extreme gender bias never lets women speak about their own sex lives. The analysis is intended to create awareness and education for both men and women about sexual pleasure and counter the previous misconceptions and doubts about female orgasm and female sexuality.

Distance Between Reproductive Structures and the Insertion Point of the Retrograde Pubic Ramus Screw.

To identify the distance between the guidewire for a retrograde pubic ramus screw and critical reproductive structures in men and women. Twenty hemipelves from 10 fresh-frozen cadavers (pelvis to distal femur) were studied. The mean (±SD) age was 77 ± 6 years for the 5 male cadavers and 71 ± 9 years for the 5 female cadavers. A 2.8-mm guidewire for a cannulated screw was inserted from the parasymphyseal bone using fluoroscopic guidance. The soft tissue was dissected and measurements performed by the first author. In men, we measured the closest distances from the guidewire entry point to the contralateral spermatic cord and corpus cavernosum. In women, we measured the closest distances from the guidewire entry point to the base of the clitoral body and clitoral glans. In male cadavers, mean distances were 8.8 ± 4.2 mm to the spermatic cord and 13 ± 6.7 mm to the corpus cavernosum. The guidewire did not penetrate these structures in any specimen. In female cadavers, mean distances were 12 ± 5.7 mm to the base of the clitoral body and 40 ± 8.2 mm to the clitoral glans. The guidewire also did not penetrate these structures. The contralateral spermatic cord and corpus cavernosum in men and the base of the clitoral body in women are close to the pathway of the retrograde ramus screw guidewire. Careful identification of the entry point and avoidance of multiple attempts of guidewire insertion may reduce the risk of injury to these structures.

Clitoromegaly diagnosis and treatment

Clitoris lesion is most readily classified into hormone-dependent and hormone-independent cause. It can also be characterized as congenital or acquired nature. Clitoromegaly is the most common presentation of clitoral lesions clinically. Hormone-dependent clitoromegaly is mainly attibuted to the increase of androgen, while the most comomon cause of hormone-independent clitoromegaly is neurofibromatosis. Except that, there are so many other disorders which can cause clitoromegaly, leading to the difficulty for diagnosis. However, the literature concerning the management of clitoromegaly is scarce.The present study summarized the lesions of clitoromegaly from the etiology, diagnosis, and differential diagnosis to treatment. This may help clinicians to make a reasonbale management when facing this kind of disease. Key words: Clitoromegaly; Hormone-dependent; Hormone-independent; Diagnosis; Treament

Tracing the Route of the Dorsal Nerve of the Clitoris

OBJECTIVELiterature indicates an increasing number of complications following the labiaplasty procedure which is a surgery with a known problem of underreported and understudied long‐term outcomes and complications such as loss of sensation in the female pudendum. The aim of this study was to determine the course and any variations of the dorsal nerve of the clitoris (DNC) after it pierces the perineal membrane to generate a surgical safe zone for procedures involving the female pudendum.METHODSCadavers from the University of Nebraska Medical Center, Creighton University, and Kansas City University anatomy labs were dissected 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. Any anomalous branching patterns were noted.RESULTSSpecific branching patterns were identified, mapped out and characterized into individual types. In addition to the patterns, the measurements described above were used to generate a surgical safe zone which can be used to avoid injury to the DNC during procedures involving the female pudendum. The variance was also calculated for each point of measurement to describe how much variation there is within a specific measurement to identify where the most caution is needed during surgery. Furthermore, it was determined if there were statistically significant differences between the right and left sides with regards to the nerve.CONCLUSIONSThe findings of this study have allowed the investigators to map out a surgical safe zone for procedures involving the female pudendum to avoid injury to the DNC. Furthermore, multiple anomalous branching patterns were identified and the frequency of those patterns were reported. This information should be useful to physicians performing procedures near the DNC. Some of the specimens displayed anomalous branching patterns which did not fit any of the other types identified and physicians performing procedures should be aware of those patterns as well.Support or Funding InformationThere is no support or funding information.

Anatomical Dissection of the Dorsal Nerve of the Clitoris.

The clitoris is the primary somatosensory organ of female sexual response. Knowledge of its neural anatomy and related landmarks is essential for safe genital surgery. The aim of this study was to describe the distal course of the dorsal nerves of the clitoris and associated structures. Clitorises of 10 fresh cadavers were dissected. Measurements of the dorsal nerves, suspensory ligament, clitoral body, clitoral hood, and clitoral glans were obtained. The course of the dorsal nerves was examined. The dorsal nerves of the clitoris were larger than expected, ranging from 2.0 to 3.2 mm in diameter, on average, along their course in the clitoral body. In 9 of 10 specimens, the dorsal nerves could be traced to within 6 mm of the glans. They traveled deep to a superficial clitoral fascia but superficial to the tunica albuginea, were variably located between 10 and 2 o'clock, and were separated by the deep suspensory ligament (DSL) of the clitoris. The mean length of the descending clitoral body, from the angle to the base of the glans, was 37.0 mm. The mean distance from the pubic rim to the DSL was 37.7 mm. The clitoral body is substantial in length, mostly lying superficially under the clitoral hood and mons pubis. The dorsal nerves of the clitoris are large and superficial, terminating at or near the base of the clitoral glans. Knowledge of this anatomy is critical prior to performing surgery near the clitoris.

Clinical characteristics and correlates of vulvar high-grade squamous intraepithelial lesion involving the clitoris

Clinical characteristics and correlates of vulvar high-grade squamous intraepithelial lesion involving the clitoris

Clitoral development in the mouse and human

The goal of this report is (a) to provide the first detailed description of mouse clitoral development, and (b) to compare mouse and human clitoral development. For this purpose, external genitalia of female mice were examined by wholemount microscopy, histology and immunohistochemistry from 14 days of gestation to 10 days postnatal. Human clitoral development was examined by these techniques as well as by scanning electron microscopy and optical projection tomography from 8 to 19 weeks of gestation. The adult mouse clitoris is an internal organ defined by a U-shaped clitoral lamina whose development is associated with the prenatal medial and distal growth of thefemale preputial swellings along the sides of the genital tubercle to form the circumferential preputial lamina. Regression of the ventral aspect of the preputial lamina leads to formation of the U-shaped clitoral lamina recognized as early as 17 days of gestation. While the adult U-shaped mouse clitoral lamina is closely associated with the vagina, and it appears to be completely non-responsive to estrogen as opposed to the highly estrogen-responsive vaginal epithelium. The prominent perineal appendage in adult females is prepuce, formed via fusion of the embryonic preputial swellings and is not the clitoris.The human clitoris is in many respects a smaller anatomic version of the human penis having all of the external and internal elements except the urethra. The human clitoris (like the human penis) is derived from the genital tubercle with the clitoral glans projecting into the vaginal vestibule. Adult morphology and developmental processes are virtually non-comparable in the mouse and human clitoris.

The same-stage reduction plasty for labia minora hypertrophy with redundant praeputium clitoridis

Objective To evaluate the clinical outcome of reduction plasty for labia minora hypertrophy with redundant praeputium clitoridis. Methods A total of 84 cases were included from June 2013 to December 2016. Arc-shaped resection of labia minora and crescent resection of redundant praeputium clitoridis were the two essntial surgical procedure, and 5-0 VICRYL Rapide was used for suturing the incision. Results The 84 cases were operated with this mothod with satisfactory aesthetic result. Complications, such as hematoma, infection and poor wound healing, were not observed. Edema was resoluted after one to two weeks. After the reduction plasty of the labial labia, the vagina and perineum were completely covered in the natural state, without scar, also the sensitivity of clitoris was improved due to the better expoure post-operationally. Conclusions The same-stage reduction plasty for labia minora hypertrophy with redundant praeputium clitoridis is a reliable and effective method. Both satisfactory aesthetic result and improved sexual sensitivity are achived, without hematoma, infection and poor wound healing. Key words: Clitoris; Reconstructive surgical procedures; Labia minora hypertrophy; Reduction plasty

021 The Role of Office-Based Somatic and Autonomic Neuro-Genital Testing of Persistent Genitourinary Numbness in Women

In women with sexual dysfunction, a bothersome/distressing symptom is persistent numbness in the genitourinary region, the clitoris, vagina and urethra. Women with persistent numbness often find it difficult to feel their clitoris when touched, or feel objects placed within their vagina, or feel urine flowing in their urethra. This symptom often leads to orgasmic dysfunction and limited sexual pleasure. Using office-based neuro-genital testing, we examined the integrity of the somatic and autonomic neurologic pathways of genitourinary sensation to better understand the etiology of female genitourinary sensory impairment. Office-based neuro-genital testing includes quantitative sensory testing, sacral and foot dermatome testing, bulbocavernosus reflex latency testing, vaginal pelvic afferent nerve testing and urethral pelvic afferent nerve testing. Quantitative sensory testing measures somatic vibration, cold, and heat perception threshold values in the glans clitoris, right and left inner surface of labia minora, and uses the right pulp index finger threshold values as the control. Sacral and foot dermatome testing measures somatic vibration perception in the right and left gluteal, thigh, calf, heel, arch, medial and lateral aspects of the foot, using the right pulp index finger threshold values as the control. Bulbocavernosus reflex latency testing with electromyographic monitoring of the external anal sphincter muscle contraction measures the integrity of the somatic sensory and motor neural pathways in response to mechanical stimulations of the glans clitoris. The vaginal pelvic afferent neural pathway test measure visceral awareness of distension of an anorectal (up to 60 ml) balloon within the vagina. The urethral pelvic afferent neural pathway test measure visceral awareness of distension of a Foley catheter (up to 0.4 ml) balloon within the urethra.

115 Exploring Pain-related Anxiety in Pudendal Neuralgia

Pudendal neuralgia (PN), a chronic form of vulvar and pelvic pain, is defined as pain in the distribution of the pudendal nerve. The pudendal nerve Results in 3 terminal branches: the perineal nerve, the dorsal clitoral nerve, and the inferior rectal nerves. Of these branches, injury to the dorsal clitoral nerve (DCN) has been associated with longer duration of pain. Pain-related anxiety, an independent variable in models of chronic pain, has been postulated to exacerbate and extend chronic pain. Additionally, posttraumatic stress symptoms (PTSS), which are highly prevalent in chronic pain patients, have been shown to also have significant impact on psychosocial components of pain. This study was conducted to explore pain-related anxiety in pudendal neuralgia patients via analysis of patient scoring on pain anxiety symptoms scale (PASS20) questionnaire. The effect of dorsal clitoral nerve (DCN) involvement and/or posttraumatic stress on scoring was also investigated. Patient anxiety symptom scale questionnaire (PASS20) was collected from new patients who visited two vulvovaginal specialty clinics in DC and NY between January 1, 2017 and December 31, 2017 (n=352). Data from patients clinically diagnosed with pudendal neuralgia was analyzed further (n=26). Pudendal neuralgia diagnosis was confirmed by diagnostic pudendal nerve block. DCN involvement was assessed by testing allodynia of the glans clitoris during physical exam. Patient subjective PTSS was recorded. Cut off score for anxiety was PASS 20 score greater than 30. Pairwise Mann-Whitney U test was performed between DCN, PTSS, and PASS 20 total and subscale (cognitive, escape/avoidance, fear, and physiological anxiety) scores.

Clitoral Pain and Dyspareunia after Female Genital Mutilation/Cutting: A Case Report

Background: Current evidence has focused on the complications of female genital mutilation/cutting (FGM/C) types 2 and 3, and there is a gap in the knowledge of the complications of FGM/C types 1 and 4, which are often considered milder forms of cutting. Case Presentation: A 23-year-old Somali woman with FGM/C was referred for chronic clitoral pain and superficial dyspareunia after several inconclusive gynecological examinations. Her clitoris was found to be entrapped under the scar of the cut clitoral hood. We surgically lysed the scar and reconstructed a prepuce. At the two-month follow-up, the patient reported no pain and physiologic sexual response. Conclusion: Clitoral pain and dyspareunia after FGM/C can be due to the incarceration of the clitoral glans. Treatment is surgical lysis of the scar.

A study of congenital lipoid adrenal hyperplasia in two pedigrees

The clinical features and laboratory data of two patients with congenital lipoid adrenal hyperplasia(CLAH)were collected. The genomic DNA was extracted from the peripheral blood white cells in the two patients and their family members and the STAR gene was screened for mutations by PCR and Sanger sequencing. Patient 1 was a girl aged 2 years and 8 months, and she visited us because of continual cyanosis for more than two years. Physical examination showed no obvious pigmentation or clitoral hypertrophy, and Tanner stage was B1P1. Clinical examination revealed serum ACTH 1 284.1 pg/ml and 17α-hydoxyprogesterone(17-OHP)0.54 ng/ml, with Karyotype 46, XX. Genetic analysis showed compound heterozygous mutations of c. 201_202delCT and c. 229C>T in the STAR gene. Her father carried heterozygous c. 201_202delCT mutation, and her mother showed heterozygous c. 229C>T mutation. Patient 2 was a girl aged 22 years and referred to us because of dark skin for more than 21 years. Physical examination revealed generalized hyperpigmentation, with Tanner stage B5P2. Hormone examination showed ACTH>2 000 pg/ml and serum cortisol 0.77μg/dl. Karyotype analysis revealed 46, XX. Genetic analysis found compound heterozygous mutations of c. 64+ 1G>C and c. 707_708delinsCTT in the STAR gene, which descended from her father and mother respectively. Of note, c. 64+ 1G>C is a novel splicing mutation of STAR gene. (Chin J Endocrinol Metab, 2018, 34: 308-311) Key words: Congenital lipoid adrenal hyperplasia; Steroidogenic acute regulatory protein

Retrospective Study of the Prevalence and Risk Factors of Clitoral Adhesions: Women's Health Providers Should Routinely Examine the Glans Clitoris.

IntroductionThe glans clitoris is covered by a prepuce that normally moves over the glans surface and can be retracted beyond the corona. Clitoral adhesions, ranging from mild to severe, occur when preputial skin adheres to the glans. Physical examination consistent with clitoral adhesions is based on the inability to visualize the entire glans corona. In this closed compartment, the space underneath the adherent prepuce and clitoris can become irritated, erythematous, or infected and can result in sexual dysfunction.AimTo determine the prevalence of clitoral adhesions in a sexual medicine practice and assess risk factors associated with clitoral adhesions.MethodsThis research involved retrospective examinations of vulvoscopy photographs taken from August 2007 to December 2015. Clitoral adhesions were considered absent when preputial retraction enabled full glans corona visualization. The study group consisted of women with mild, moderate, or severe clitoral adhesions based on more than 75%, 25% to 75%, or less than 25% glans clitoris exposure without full corona visualization, respectively. 2 independent reviewers evaluated photographs; a 3rd analyzed study group health record data.Main Outcome MeasurePrevalence of severity of clitoral adhesions.ResultsOf the 1,261 vulvoscopy photographs, 767 (61%) were determined adequate for assessment and 614 photographs represented individual patients. The study group with clitoral adhesions consisted of 140 women (23%) of whom 44%, 34%, and 22% demonstrated mild, moderate, and severe clitoral adhesions, respectively. In the study group, 14% presented with clitorodynia. Risk factors included a history of sexual pain, yeast infection, urinary tract infection, blunt perineal or genital trauma, lichen sclerosus, low calculated free testosterone, and other sexual dysfunctions including persistent genital arousal disorder.ConclusionWomen with sexual dysfunction should routinely undergo clitoral physical examination. If the glans corona is not fully visualized, then clitoral adhesions should be suspected. Education, counseling, and/or referral for sexual pain management should be considered.Aerts L, Rubin RS, Randazzo M, et al. Retrospective Study of the Prevalence and Risk Factors of Clitoral Adhesions: Women's Health Providers Should Routinely Examine the Glans Clitoris. Sex Med 2018;6:115–122.

Clitoroplasty: A variant of the technique by Acimi

ObjectivesTo evaluate the mid-term results of clitoroplasty through the reduction of the length and diameter of the corpus cavernosum, as well as the volume of the glans. Patients and methodsFrom October 2003 to July 2015, we performed 29 clitoroplasties using the described procedure. The median (range) age of the patients was 18 (3–47) months. After surgery we evaluated the volume of the clitoris, the appearance of glans, and its sensitivity to light touch, pressure, and pain. ResultsThe length of the apparent part of the glans remained large (>10 mm) in four patients (14%), was an average size (between 5 and 10 mm) in 11 (39%), and small (<5 mm) in 13 (46%). The length of the corpus cavernosum was <20 mm and its diameter <5 mm in all cases. The sensitivity of the reduced clitoris to touch, pressure and pain seemed normal in all patients. In addition, we never found the circumflex arteries and nerves of the penis (on histological examination of excised pieces of corpus cavernosum) in all children operated on during the first 3 years of life. The circumflex arteries of the penis begin to develop, only after the fourth year. This anatomical finding is an argument for performing clitoroplasty at an early age to avoid any risk of intraoperative and postoperative bleeding. ConclusionsThe sensitivity of the clitoral glans appeared to be normal in all cases, with a good cosmetic appearance of the external genitalia in most patients.

146 Standardization of Vulvoscopy: A Step-Wise Approach

In the medical evaluation of a woman with sexual dysfunction, there is no standard methodology for physical examination. The purpose of this was to develop a standardized technique of magnified examination of the vulvar, vestibular and vaginal region by vulvoscopy. The technique of medical healthcare providers in our facility who perform vulvoscopy using regularly, was reviewed. Options for examination are a standard colposcope with an attached camera to project the image onto a flat screen for viewing, or a tripod mounted smart phone with blue tooth remote, connected to the flat screen wirelessly. Photographs are taken at each step of the examination. Maximal diagnostic information was gained using a step-wise approach to vulvoscopy, beginning from lateral to medial, external to internal, conducted in a standardized manner. The vulvoscopy protocol begins with examination of right and left labia majora, followed by sulci, and then labia minora, assessing for pathology, and followed by cotton swab (Q-tip) palpation used to assess for pain. Labia minora width (cm) is then measured and degree of resorption from posterior fourchette assessed. The glans clitoris is examined via cephalad retraction of the prepucial hood so the corona can be visualized to assess for presence of clitoral adhesions. Glans size is compared to size of the cotton swab. Lateral retraction of labia minora enables visualization of Hart's line and close inspection of the vestibule and urethral meatus. The ostia of minor vestibular glands are observed for erythema and Q-tip testing performed at 1:00, 3:00, 5:00, 6:00, 7:00, 9:00, 11:00 to evaluate for pain on a scale of 0-10. Speculum exam is then performed by rotating the speculum 90 degrees to evaluate presence of vaginal rugae, vaginal pathology, as well as quality of the anterior vaginal wall periurethral tissue.

148 Retrospective Study of the Prevalence and Risk Factors of Clitoral Adhesions: Why Women's Health Providers Should Routinely Examine the Glans Clitoris

148 Retrospective Study of the Prevalence and Risk Factors of Clitoral Adhesions: Why Women's Health Providers Should Routinely Examine the Glans Clitoris

Complete duplication of bladder, urethra, clitoris and vagina associated with bilateral ureteral reflux in an old female patient: unique case.

Complete duplication of the bladder, urethra, vaginal and clitoris is an extreme- ly rare congenital anomaly that is usually diagnosed at pediatric age. We report an unusu- al case of a complete bladder, vaginal, clitoris and urethra duplication occurred in an old female patient (81 years old). This case highlighted the fact that an anatomical anomaly should be considered in all patients with persistent urinary tract problems, especially in old women, due to patients' reluctance to consult physicians for this kind of problem. (Urologia 2009; 76: 258-9)

Reduction Clitoroplasty by Ventral Approach: Technical Refinement.

Aesthetic alteration of the genitalia is increasingly sought by women who are unhappy about the size, shape or overall appearance of their vulva. Clitoral hypertrophy is usually seen in congenital malformations, specifically in intersexual stages of hormonal expression. A large clitoris has an appearance of a small penis, is psychologically disturbing and interferes in sexual activity. Clitoral reduction surgery has evolved over the years. Total clitorectomy, clitoral recession and neuro-vascular pedicle sparing clitoroplasty can be considered as three major milestones in its evolution. In nerve sparing clitoroplasty, earlier dorso-lateral approach was challenged by ventral approach, which is establishing itself as the approach of choice by its own merits. Clitoral reduction surgery being not a very commonly performed surgery, demands refinements in its technique to improve its results and particularly the aesthetic outcome, which is gaining more importance in recent years. An adult case of late onset congenital adrenal hyperplasia (CAH) with clitoromegaly underwent nerve sparing reduction clitoroplasty by ventral approach under moderate magnification. We present key points of the preoperative anatomic evaluation. Technical refinements planned and executed step wise during the procedure resulted in satisfactory outcome. Patient now has normal appearing genitalia, a small clitoris nicely covered by skin hood and very well preserved sensation to light touch. Preservation of sensation in the glans clitoris is of paramount importance during clitoral reduction surgery. Knowledge of the anatomy of the neurovascular supply to the glans clitoris gives us freedom from not isolating it in order to preserve it. In fact a deliberate attempt to dissect it can prove detrimental particularly when operating on a smaller organ during childhood. A ventral approach with refined technique proves safe and gives satisfactory result. Moderate degree of magnification eases dissection. A component-based detailed preoperative planning improves the overall aesthetic appearance of the female genitalia.

Expression and distribution of the transient receptor potential cationic channel A1 (TRPA1) in the human clitoris-comparison to male penile erectile tissue.

The transient receptor potential cationic channel ankyrin 1 (TRPA1) is a channel protein assumed to act in various human tissues as mechano- and pain sensor and play a role in neurotransmission. The expression of TRPA has already been investigated in the human prostate and urethra, however, only very few studies have addressed the expression and distribution in the male and female genital tract. The present study aimed to investigate by means of immunohistochemistry (double-labeling technique, laser fluorescence microscopy) in the human clitoris and penile erectile tissue the localization of TRPA1 in relation to nNOS, the vasoactive intestinal polypeptide (VIP) and vesicular acetylcholine transporter (VAChT). In the clitoral tissue, TRPA1 was observed in basal epithelial cells and slender nNOS-positive nerve fibers transversing the subepithelial space. To a certain degree, in the clitoral epithelial cells, TRPA1 was found co-localized with vimentin. In human corpus cavernosum, immunoreactivity for TRPA1 was seen in nerves transversing the cavernous sinusoidal space and running alongside small arteries, these nerves also displayed expression of the vesicular acetylcholine transporter protein (VAChT). Varicose nerves containing nNOS or VIP were not immunoreactive for TRPA1. It seems likely that TRPA1 is involved in nitric oxide-mediated afferent sensory transmission in the clitoris while, in penile erectile tissue, a role for TRPA1 in cholinergic signaling might be assumed.