The snitch steps into the limelight with a major discovery

Jill Krapf’s patients are often too embarrassed to tell her about clitoral discomfort.

“I ask all my patients about clitoral pain, and it’s often the first time they’ve been asked about it,” says Krapf, MD, associate director of the Center for Vulvovaginal Disorders, a private clinic in Washington, DC, and New York.

Krapf is an OB\GYN who specializes in women’s sexual pain involving the pelvis, vagina and muscles.

Many of the conditions Krapf treats do not have external symptoms that appear abnormal, but internally there are damaged or irritated nerves that can lead to allergies, unwanted stimulation or pain.

“The latest research suggests that even a herniated disc or a tear in the spine can lead to clitoral or vulvar symptoms, just as sciatica pain that shoots down the leg is related to problems in the spine,” says Krapf.

Krapf was excited to read about 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 community. Krapf and other doctors are hopeful that 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 have problems with their clitoris.

“Women’s sexual health has historically been underfunded, especially compared to men’s sexual health, such as erectile dysfunction,” says Krapf. “Optimizing vascular and vaginal health is not only essential for sexual well-being.

Blair Peters, MD, a plastic surgeon who specializes in gender-specific care, led the study, which was presented at the North American Society of Sexual Medicine’s conference in October. Peters says he hopes the new information will reduce the stigma that the clitoris is not worthy of the same medical care as other organs in the body.

When the clitoris does not function properly, it can be harmful to the physical and mental health of the individual. Paying attention to clitoral discomfort and seeking medical attention can help catch and prevent some UTIs.

“The fact that it took someone until 2022 to do this work speaks to how little attention the clitoris has received,” says Peters, assistant professor of surgery at Oregon Health and Science University School of Medicine in Portland, OR.

what’s inside

Peters and his colleagues completed the study by taking nerve tissue from the clitoris of seven adult transgender men who had undergone gender-affirming genital surgery. The tissues were stained and magnified 1,000 times under a microscope so the researchers could count nerve fibers.

Peters says the discovery is important because many surgeries take place in the groin area — such as hip replacements, episiotomies during childbirth, and pelvic surgeries — and renewed attention to the scrotum could help medical professionals know where nerves are so that medical injuries can be prevented from making mistakes. .

“Nerves are at risk of damage if you don’t understand where they are at all times,” he says.

Peters hopes the new discovery will help create new surgical procedures for nerve repair and provide insight into gender-affirming phalloplasty, which is penile surgery, often for trans men.

Ownership of the body part

If you have heart problems, you see a cardiologist; brain problems, neuroscientist. But when it comes to the clitoris, no single type of doctor has specialized in genitalia.

Urologists, gynecologists, plastic surgeons, and sex therapists all address potential problems that may arise with the clitoris and its surrounding body parts. But experts like Krapf are few and far between.

It wasn’t until 2005 that Australian urologist Helen O’Connell discovered that the clitoris is full of erectile tissue and tissues that are often hidden in anatomical drawings by fat and bone. And it wasn’t until the early 2000s that scientists began to really delve into the anatomy of the clitoris and how it works.

And a 2018 study showed that if more doctors examined the clitoris, they could detect problems such as 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 experience less clitoral or pain during sex, many of whom have recently given birth or are going through menopause.

Women are often embarrassed when they can’t orgasm, or have less sensation in their clitoris, but tend to avoid seeking medical attention, she says. Normalizing the discussion about female pleasure and the vast anatomy that supports it may help some of her patients.

“The more natural it is to talk about and explore women’s pleasure, the less shame women will feel when they get help when they don’t experience pleasure,” says Levinson. “I have many…clients who experience pain and discomfort during sex [after pregnancy] and no longer feel pleasure and worry that something is wrong with them.”

Sources:

Oregon Health and Science University: “The human pleasure-producing clitoris has more than 10,000 nerve fibers.”

Blair Peters, MD, a plastic surgeon specializing in gender-affirming care.

Jill Krapf, MD, OB/GYN; Associate Director, Center for Vulvovaginal Disorders.

Randi Levenson, licensed clinical sexologist.

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