3D quantitative analysis of normal clitoral anatomy in nulliparous women by MRI

Bowen, Shaniel T.; Dutta, Arijit; Rytel, Krystyna; Abramowitch, Steven D.; Rogers, Rebecca G.; Moalli, Pamela

doi:10.1007/s00192-022-05172-y

Cited by 3 publications

(4 citation statements)

References 29 publications

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“…Models were exported to Blender v2.83.2 (Blender Foundation, Amsterdam, the Netherlands) to remove aliasing (sharp edges) by interpolating segmentations between adjacent slices via a smoothing algorithm. As validated in a previous work, 16 the smoothing algorithm allows unbiased, global smoothing of aliased geometries while preserving their original shape and volume-resulting (on average) in a <1.3 mm surface distance, 0.1% volume loss and <1 mm difference in model-based anatomical measurements between the smoothed and unsmoothed models. 16 Hence, this 3D reconstruction technique (Figure 1A) does not significantly impact-or introduce error into-vaginal geometry, or measurements.…”

Section: Vaginal Segmentation and 3d Reconstructionmentioning

confidence: 68%

Vaginal morphology and position associated with prolapse recurrence after vaginal surgery: A secondary analysis of the DEMAND study

Bowen

Moalli

Abramowitch

et al. 2023

BJOG

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ObjectiveTo identify vaginal morphology and position factors associated with prolapse recurrence following vaginal surgery.DesignSecondary analysis of magnetic resonance images (MRI) of the Defining Mechanisms of Anterior Vaginal Wall Descent cross‐sectional study.SettingEight clinical sites in the US Pelvic Floor Disorders Network.Population or SampleWomen who underwent vaginal mesh hysteropexy (hysteropexy) with sacrospinous fixation or vaginal hysterectomy with uterosacral ligament suspension (hysterectomy) for uterovaginal prolapse between April 2013 and February 2015.MethodsThe MRI (rest, strain) obtained 30–42 months after surgery, or earlier for participants with recurrence who desired reoperation before 30 months, were analysed. MRI‐based prolapse recurrence was defined as prolapse beyond the hymen at strain on MRI. Vaginal segmentations (at rest) were used to create three‐dimensional models placed in a morphometry algorithm to quantify and compare vaginal morphology (angulation, dimensions) and position.Main outcome measuresVaginal angulation (upper, lower and upper–lower vaginal angles in the sagittal and coronal plane), dimensions (length, maximum transverse width, surface area, volume) and position (apex, mid‐vagina) at rest.ResultsOf the 82 women analysed, 12/41 (29%) in the hysteropexy group and 22/41 (54%) in the hysterectomy group had prolapse recurrence. After hysteropexy, women with recurrence had a more laterally deviated upper vagina (p = 0.02) at rest than women with successful surgery. After hysterectomy, women with recurrence had a more inferiorly (lower) positioned vaginal apex (p = 0.01) and mid‐vagina (p = 0.01) at rest than women with successful surgery.ConclusionsVaginal angulation and position were associated with prolapse recurrence and suggestive of vaginal support mechanisms related to surgical technique and potential unaddressed anatomical defects. Future prospective studies in women before and after prolapse surgery may distinguish these two factors.

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Section: Vaginal Segmentation and 3d Reconstructionmentioning

confidence: 68%

Vaginal morphology and position associated with prolapse recurrence after vaginal surgery: A secondary analysis of the DEMAND study

Bowen

Moalli

Abramowitch

et al. 2023

BJOG

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“…In total, clitoral structures from 2432 biological females ( n ) aged 18–84 years‐old were recorded (Table 1). Four studies (Suh et al, 2003 ( n = 18); Abdulcadir et al, 2016 ( n = 15); Vaccaro et al, 2014 ( n = 20); Bowen et al, 2022 ( n = 22) were performed through MRI ( n = 87), two studies (Buisson et al, 2008 ( n = 5); Aydin et al, 2021 ( n = 108) were performed using US ( n = 113), four studies (O'Connell et al, 1998 ( n = 10); Jackson et al, 2019 ( n = 27); Kelling et al, 2020 ( n = 10); Blayney et al, 2021 ( n = 7) measured cadaveric clitoral structures ( n = 54), whereas 11 studies (Lloyd et al, 2005 ( n = 50); Basaran et al, 2008 ( n = 100); Mendiola et al, 2021 ( n = 100); Cao et al, 2015 ( n = 319); Köşüş et al, 2016 ( n = 35); Kreklau et al, 2018 ( n = 557); Gyftopoulos et al, 2019 ( n = 56); Chinkangsadan et al, 2020 ( n = 155); Ellibeş Kaya et al, 2020 ( n = 208); Agrawal et al, 2021 ( n = 400); Ekmez & Ekmez, 2021 ( n = 210) measured clitoral structures in living patients ( n = 2190). No significant difference ( p > 0.05) was observed between each clitoral structure and the experimental modality utilized.…”

Section: Resultsmentioning

confidence: 99%

Beyond the tip of the iceberg: A meta‐analysis of the anatomy of the clitoris

Longhurst,

Beni,

Jeong

et al. 2023

Clinical Anatomy

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An understanding of ranges in clitoral anatomy is important for clinicians caring for patients including those who have had female genital mutilation, women seeking genital cosmetic surgery, or trans women seeking reconstructive surgery. The aim of this meta‐analysis is to investigate the ranges in clitoral measurements within the literature. A meta‐analysis was performed on Ovid Medline and Embase databases following the PRISMA protocol. Measurements of clitoral structures from magnetic imaging resonance, ultrasound, cadaveric, and living women were extracted and analyzed. Twenty‐one studies met the inclusion criteria. The range in addition to the average length and width of the glans (6.40 mm; 5.14 mm), body (25.46 mm; 9.00 mm), crura (52.41 mm; 8.71 mm), bulb (52.00 mm; 10.33 mm), and prepuce (23.19 mm) was calculated. Furthermore, the range and average distance from the clitoris to the external urethral meatus (22.27 mm), vagina (43.14 mm), and anus (76.30 mm) was documented. All erectile and non‐erectile structures of the clitoris present with substantial range. It is imperative to expand the literature on clitoral measurements and disseminate the new results to healthcare professionals and the public to reduce the sense of inadequacy and the chances of iatrogenic damage during surgery.

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“…In this regard, Ostrzenski's work is extremely convincing. However, O' Connell and Delaney (2005), also supported their rationale for the name change of the vestibular bulbs on an MRI study of healthy women (more recent but similar MR images are found in Yang et al, 2005;Hosseinzadeh et al, 2012;Bowen et al, 2022) that highlights highly vascular tissue (see Figure 1C). This work does indeed support the presence of highly vascularized tissue in the anterior wall of the distal female urethra, but the bulbs seem much smaller than suggested by the illustrations in Figure 1A,B.…”

mentioning

confidence: 81%

“…This proposed change did not result in a change in terminology in current anatomy textbooks and is not in the Terminologica Anatomica (2nd edition). Puppo and Puppo (2015) in this journal argued that “vestibular” is the correct name based on anatomy and embryology; nevertheless, “clitoral bulbs” has been used in the clinical literature (e.g., Bowen et al, 2022; Pauls et al, 2015; Vaccaro et al 2014; Yang et al, 2005).…”

Section: Introductionmentioning

confidence: 99%

Clitoral Anatomy in the Feminist Literature: Vagina obscura: An anatomical voyage (2020) and Clitoral Conventions and Transgressions: Graphical representations in anatomy texts, c1900‐1991 (1995)

Vilensky

2022

Clinical Anatomy

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O'Connell et al. proposed that the vestibular bulbs be renamed the "clitoral bulbs" because of their consistent relationship to the clitoris and inconsistent relationship to the vestibule. Normally such proposed esoteric changes in anatomical nomenclature would get little notice by anatomists, yet alone the general public; however, many subsequent articles and books placed this change in the context of centuries of male anatomists and physicians downplaying female sexual anatomy and sexuality. Most prominent is a 2022 book by Rachel Gross, Vagina Obscura: An Anatomical Voyage.Here we review this "Anatomical Voyage" and find author bias in omitting/including erroneous facts in this book. We also present a critique of a 1995 article that appeared in Feminist Studies; Graphical Representations in Anatomy Texts, c1900-1991. This article, which has been repeatedly cited in the clinical literature, asserts that between circa 1950-1980 anatomy textbooks purposely eliminated depicting/labeling the clitoris in illustrations because the authors of the textbooks were reflecting societal norms that de-emphasized the importance of the clitoris.Unfortunately, the methods used by Moore and Clarke are not replicable; and further, their conclusions were not justified because of clear bias in their description and depiction of the anatomy sources they review.

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3D quantitative analysis of normal clitoral anatomy in nulliparous women by MRI

Cited by 3 publications

References 29 publications

Vaginal morphology and position associated with prolapse recurrence after vaginal surgery: A secondary analysis of the DEMAND study

Vaginal morphology and position associated with prolapse recurrence after vaginal surgery: A secondary analysis of the DEMAND study

Beyond the tip of the iceberg: A meta‐analysis of the anatomy of the clitoris

Clitoral Anatomy in the Feminist Literature: Vagina obscura: An anatomical voyage (2020) and Clitoral Conventions and Transgressions: Graphical representations in anatomy texts, c1900‐1991 (1995)

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