Neurourology & Female Urology

Abstract

Objectives: To describe the course and variation of the dorsal nerve of the clitoris (DNC) to better define its anatomy in the human adult before embarking on therapeutic strategies in this region of the body and as an aid to surgeons to help avoid iatrogenic injury to the DNC during vaginal surgical procedures. Methods: Six human female cadavers of variable body weights were sectioned. A vertical midline incision from the base of the clitoris extending toward the direction of the umbilicus was made. The DNC was identified by dissecting out the fascia, fat, and muscles around it. The anatomy of the nerve was noted bilaterally. Results: Distally, the DNC pierced the perineal membrane lateral to the external urethral meatus. It traversed along the bulbospongiosus muscle before traversing posterior to the crura. The DNC reappeared, hooking over the crura to lie on the anterolateral surface of the body of the clitoris, before dividing into 2 cords and terminating short of the tip of the glans clitoris. Conclusions: The results of this study have demonstrated the unique anatomy of the distal part of the DNC. Knowledge of the anatomy of the DNC, which was consistent for all the cadavers, is important so that surgeons can avoid potential iatrogenic injuries to this structure. Editorial CommentThe authors describe the anatomy of the dorsal nerve of the clitoris with emphasis on its exit point from the perineal membrane to its end point bifurcation. Of note is that the authors found that the course of the dorsal nerve of the clitoris was in a position that would not be affected by traditional retropubic suburethral sling operation or a transobturator suburethral sling. In addition, they noted that the nerves ended on the lateral positions of the body of the clitoris at approximately 11 and 1 o'clock with no innervation noted at the dorsal position (12 o'clock) and the nerve did not reach the tip of the clitoris but terminated approximately 1cm short of the end.This article is well worth reviewing prior to the performance of a transvaginal urethrolysis, especially when considering the suprameatal technique (1). It will be interesting to see if there is any affectation of this nerve with the increasingly popular non-surgical transurethral radiofrequency treatment for female stress urinary incontinence (2). The illustrations are excellent in quality and impart good recollective information. In addition to considerations for surgical technique, their anatomic description may impart valuable information to those physicians counseling couples with sexual dysfunction (especially with regard to the second phase female sexual function, arousal, as described in the commentary of the manuscript) and potential optimal sites for clitoral nerve stimulation.