Neural Supply to the Clitoris: Immunohistochemical Study with Three-Dimensional Reconstruction of Cavernous Nerve, Spongious Nerve, and Dorsal Clitoris Nerve in Human Fetus

Authors

  • David Moszkowicz MD,

    1. Laboratory of Experimental Surgery, EA 4122, Faculty of Medicine, Bicêtre-Paris 11 University, Le Kremlin-Bicêtre, France
    2. Department of Surgery Assistance-Publique-Hôpitaux de Paris, Ambroise Paré Hospital, Boulogne, France
    Search for more papers by this author
  • Bayan Alsaid MD,

    1. Laboratory of Experimental Surgery, EA 4122, Faculty of Medicine, Bicêtre-Paris 11 University, Le Kremlin-Bicêtre, France
    Search for more papers by this author
  • Thomas Bessede MD,

    1. Laboratory of Experimental Surgery, EA 4122, Faculty of Medicine, Bicêtre-Paris 11 University, Le Kremlin-Bicêtre, France
    Search for more papers by this author
  • Mazen Zaitouna MD,

    1. Laboratory of Experimental Surgery, EA 4122, Faculty of Medicine, Bicêtre-Paris 11 University, Le Kremlin-Bicêtre, France
    Search for more papers by this author
  • Christophe Penna MD,

    1. Department of Surgery Assistance-Publique-Hôpitaux de Paris, Ambroise Paré Hospital, Boulogne, France
    2. University PIFO UVSQ, Guyancourt, France
    Search for more papers by this author
  • Gérard Benoit MD,

    1. Laboratory of Experimental Surgery, EA 4122, Faculty of Medicine, Bicêtre-Paris 11 University, Le Kremlin-Bicêtre, France
    Search for more papers by this author
  • Frédérique Peschaud MD

    Corresponding author
    1. Laboratory of Experimental Surgery, EA 4122, Faculty of Medicine, Bicêtre-Paris 11 University, Le Kremlin-Bicêtre, France
    2. Department of Surgery Assistance-Publique-Hôpitaux de Paris, Ambroise Paré Hospital, Boulogne, France
    3. University PIFO UVSQ, Guyancourt, France
    Search for more papers by this author

Frédérique Peschaud, MD, Laboratoire de Chirurgie Expérimentale, EA 4122, Faculté de médecine Paris 11-Sud, 63 rue Gabriél Péri, Le Kremlin-Bicêtre 94270, France. Tel: +33149095589; Fax: +33149095869; E-mail: mjpeschaud@gmail.com

ABSTRACT

Introduction.  Little detailed information is available concerning autonomic and somatic nerve supply to the clitoris, potentially causing difficulties for nerve preservation during pelvic and perineal surgery.

Aim.  To identify the location and type (nitrergic, adrenergic, cholinergic and sensory) of nerve fibers in the clitoris and to provide a three-dimensional (3D) representation of their structural relationship in the human female fetus.

Methods.  Serial transverse sections were obtained from five human female fetuses (18–31 weeks of gestation) and subjected to histological and immunohistochemical investigations; digitized serial sections were used to construct a 3D representation of the pelvis.

Main Outcome Measures.  Pelvic-perineal nerve location and type were evaluated qualitatively.

Results.  The female neurovascular bundle (NVB) is the anteroinferior terminal portion of the inferior hypogastric plexus that runs along the postero-lateral then lateral face of the vagina and is rich in nNOS-positive fibers. The cavernous nerve (CN) is a thin ventrocaudal collateral projection of the NVB, and this projection does not strictly follow the NVB course. The CN runs along the lateral surface of the vagina and urethra and penetrates the homolateral clitoral crus. The CN provides adrenergic, cholinergic, and nitrergic innervation to the clitoris, but not sensory innervation. The spongious nerve (SN) is the terminal and main projection of the NVB and provides nitrergic innervation to the vestibular bulbs. The dorsal clitoris nerve (DCN), somatic branche of the pudendal nerve, runs along the superior surface of the clitoral crus and body and has a segmental proerectile nitrergic activity related to communicating branches with the CN.

Conclusions.  “Computer-assisted anatomic dissection” allowed the identification of the precise location and distribution of the autonomic and somatic neural supply to female erectile bodies, providing an anatomical basis for nerve-sparing surgical techniques, and participating to the understanding of neurogenic female sexual dysfunction. Moszkowicz D, Alsaid B, Bessede T, Zaitouna M, Penna C, Benoit G, and Peschaud F. Neural supply to the clitoris: Immunohistochemical study with 3D reconstruction of cavernous nerve, spongious nerve and dorsal clitoris nerve in human fetus. J Sex Med 2011;8:1112–1122.

Ancillary