Departments of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, TX.
Pathology, University of Texas Southwestern Medical Center, Dallas, TX.
Am J Obstet Gynecol. 2023 Jun;228(6):720.e1-720.e8. doi: 10.1016/j.ajog.2023.02.011. Epub 2023 Feb 23.
Although recent studies have enhanced our understanding of the anatomy of the clitoris and its somatic innervation, less emphasis has been placed on the anatomic relationships of the clitoris to its surrounding structures.
This study aimed to further characterize the gross and histologic relationships of the clitoris, vestibular bulbs, and urethra.
Detailed dissections were performed in 30 unembalmed female cadavers. In 23 specimens, gross dissections were performed, and relationships of the clitoris, vestibular bulbs, and urethra were annotated. Histologic evaluation was performed in 7 specimens, in which tissues were harvested within 24 hours from death. Descriptive statistics were used for data analyses.
The clitoral body consisted of 2 components, the proximal body and the distal body. The distal body was oriented ≤90° from the proximal body, forming an outer and inner angle at the inflection point. A "septumlike" arrangement of fibroconnective and vascular tissues was noted between the inner angle of the clitoral body and the urethra. Neurovascular bundles coursed laterally along the clitoral body and the surfaces of the crura and vestibular bulbs. The vestibular bulbs approached each other over the ventral surface of the urethra, at the commissure of the vestibular bulbs. Each bulb was separated by fibrous tissue and did not merge along the midline. The vestibular bulbs approximated the clitoral body, but the erectile tissue of the vestibular bulbs was separated from the corpora cavernosa of the clitoral body by the tunica albuginea. The erectile tissue of the vestibular bulbs abutted the ventrolateral walls of the urethra but was separated from the urethral mucosa by an indiscrete layer of erectilelike tissue with dense stroma.
This study provided gross and histological confirmation of the relationships of the clitoris, vestibular bulbs, and urethra. Detailed knowledge of the anatomy of the clitoris is crucial for reducing surgical complications associated with periclitoral and distal urethral procedures, which may adversely affect sexual arousal and sexual function.
尽管最近的研究增强了我们对阴蒂解剖结构及其躯体神经支配的理解，但对阴蒂与其周围结构的解剖关系的重视程度较低。
本研究旨在进一步描述阴蒂、前庭球和尿道的大体和组织学关系。
在 30 具未经防腐处理的女性尸体中进行了详细的解剖。在 23 个标本中，进行了大体解剖，并对阴蒂、前庭球和尿道的关系进行了标注。在 7 个标本中进行了组织学评估，其中组织是在死亡后 24 小时内采集的。使用描述性统计数据进行数据分析。
阴蒂体由 2 个部分组成，即近端体和远端体。远端体与近端体成 ≤90°角，在拐点处形成内角和外角。在阴蒂体的内角和尿道之间，观察到纤维结缔组织和血管组织的“隔状”排列。神经血管束沿阴蒂体和阴唇系带的表面向外侧走行。前庭球在尿道的腹面靠近，在前庭球的联合处相互接近。每个球都被纤维组织隔开，没有在中线处融合。前庭球接近阴蒂体，但前庭球的勃起组织与阴蒂体的海绵体被白膜隔开。前庭球的勃起组织毗邻尿道的腹外侧壁，但与尿道黏膜之间有一层不连续的、富含基质的勃起样组织。
本研究提供了阴蒂、前庭球和尿道关系的大体和组织学证实。详细了解阴蒂的解剖结构对于减少与阴唇周围和远端尿道手术相关的手术并发症至关重要，这些并发症可能会对性唤起和性功能产生不利影响。
