Cliteracy: Meaning and Sexual Help
Cliteracy: clit-er-uh-see
“The quality or state of being cliterate, especially the ability to navigate the clitoris based on an understanding that it is fundamental to the female orgasm”.
This definition, described by artist Sophia Wallace (@sophiawallaceartist), who creates conceptual art and objects d'art inspired by the ever-elusive clitoris, and I think it’s fantastic!
Why has the clitoris been so mysterious? In 2005, Helen O’Connell and colleagues published “Anatomy of the Clitoris,” a review article, in The Journal of Urology. The article was one of the first to provide a complete anatomical description of the clitoris.
Yes, you read that right.
2005
In one article from Arizona State University discussing the paper, O’Connell states “That even though researchers began accurately describing the anatomy of the clitoris in the 1840s, most anatomy textbooks in 2005 still omitted or inaccurately described the structure”.
She also comments that this “reflects a dominant culture of misvaluing the female body”.
That’s one way to put it. I call it plain old sexism.
Finally, we have information about basic clitoral anatomy. What else can help our cliteracy?
In 2022 Dr. Blair Peters, MD presented at the Sexual Medicine Society of North America’s annual meeting. He, along with others, sliced nerve sections, magnified them, and suggested that the clitoris has over 10,000 nerve fibers.
Yes, you read that right.
2022
Before that, it was assumed to be 8,000 nerve endings based on a book from the 70’s studying cow anatomy. No one bothered to figure out if this was correct or not until Dr. Peter’s research.
Because, you know, we’re talking about a woman’s anatomy.
Sigh
Besides the anatomy and nerve endings, what else do we know about this miraculous organ?
It is the only organ in the body whose sole purpose is pleasure. During the sexual arousal phase, for those who have a vulva, this happens:
Clitoral Tumescence: a vasodilation and increased blood flow leading to vasocongestion at around 3 minutes, with a peak at 9 minutes. The clitoris engorges by 50-300% and the labia 2-3x its resting size
Vaginal lubrication: Transudative lubricant production peaks during arousal
Vaginal elongation and uterine tenting
Questions you might be asking yourself:
What are some ways we can help people who have pain with sex? Here are some ideas:
If caused by increased friction after the vaginal lubrication has peaked, use a longer-lasting lubricant with quality ingredients may be helpful
If there is pain with deep thrusting, try increasing the time for foreplay/stimulation, therefore increasing vaginal elongation prior to penetration.
Different positions: aiming for less depth (ex: penetration from behind in side-lying)
Use of an Ohnut to reduce the depth of deep thrusting may be helpful for improving comfort with penetrative activity.
How do hormones affect things?
The clitoris is estrogen and testosterone dependent and both levels decrease with menopause, taking oral birth control or spironolactone, breastfeeding, and early postpartum. In one study by Battaglia et al, women who took oral birth control had:
decreased estradiol, testosterone, free androgen, free estrogen, clitoral volume, orgasm frequency, number of episodes of intercourse/week
and
increased pain with sex, SHBG (sex hormone binding globulin, which decreases free androgen and estrogen utilization)
Having a hormonal assessment or vulvar work-up by a sexual medicine specialist may be greatly beneficial for improving imbalances
Other things to consider if you are a provider and work with pelvic floor patients:
Neurologic Control: Orgasm requires coordination of the sympathetic T12-L2 and parasympathetic S2-4 spinal areas and the somatic nervous system via the pudendal nerve S2-S4. Consider assessing mobility restrictions at T12-L2.
Pelvic floor muscle contractions correlate with the intensity and duration of the orgasm - are they lacking in force generation of the pelvic floor muscles?
Are there orthopedic factors influencing sexual function, such as hip, low back, or SIJ pain/dysfunction?
For pelvic health providers, when doing a subjective assessment, it can be difficult to narrow down what the biggest driver is for their complaints. Consider using the FSFI - Female Sex Function Index for your cisgender women patients, which is a 19-item, validated questionnaire assessing 6 domains:
>Desire
>Arousal
>Lubrication
>Orgasm
>Global and relationship satisfaction
>Pain
Using their answers you can improve the efficiency and specificity of your subjective assessment.
Now that you fully understand cliteracy meaning and how to help with sexual health issues, it’s time to:
Build the O-team!
Medical provider (MD, PA, CNP) who specializes in sexual health - check out the directory at ISSWSH (International Society for the Study of Women’s Sexual Medicine) to find someone in your local area
Mental health: certified AASCECT (American Association of Educators, Counselors, and Therapists) members (directory)
Pain management - if you are lucky enough to have providers specialize in pelvic health in your area
Resources to check out
Sex Without Pain: A Self-Treatment Guide to the Sex Life You Deserve by Heather Jeffcoat, DPT
Becoming Clitorate - Why Orgasm Equality Matters - And How To Get It by Laurie Mintz
Come As You Are: Revised and Updated: The Surprising New Science That Will TrNsform Your Sex Life By Emily Nagoski
She Comes First: The Thinking Man’s Guide to Pleasuring a Woman by Ian Kerner
Wanna work with me? If you live in the greater Minneapolis, Minnesota area, my clinic is in Edina, MN. Let’s work together to create an action plan to overcome your pelvic health issues and reach your goals.
Reference:
Based, in part, on information learned by me from The Female Orgasm: Understanding Function to Better Treat Dysfunction by Health Jeffcoat, DPT; Pelvicon 2022.
Rosen R, Brown C, Heiman J, Leiblum S, Meston CM, Shabsigh R, Ferguson D, D’Agostino R., Jr The Female Sexual Function Index (FSFI): A multidimensional self-report instrument for the assessment of female sexual function. Journal of Sex & Marital Therapy. 2000;26:191–208.
Battaglia C, Morotti E, Persico N, Battaglia B, Busacchi P, Casadio P, Paradisi R, Venturoli S. Clitoral vascularization and sexual behavior in young patients treated with drospirenone-ethinyl estradiol or contraceptive vaginal ring: a prospective, randomized, pilot study. Journal of Sexual Medicine. 2014;11(2):471-480.
Disclaimer: These self-care suggestions are for general use only and are not intended to be used as medical advice, diagnosis, or treatment. Refer to your medical provider for all questions and concerns regarding your individual care.
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