Surgical anatomy of the clitoris and surrounding vulvar structures.

Injury to the clitoris and its associated nerve supply has the potential to adversely impact sexual arousal and sexual response. Strategies to avoid such injuries during vulvar procedures are not well described, in part, because of the limited understanding of clitoral anatomy. In particular, resources demonstrating methods of periclitoral surgical dissection are rare. To overcome this gap, we created a surgical video tutorial describing the anatomy of the clitoris and surrounding structures using cadaveric specimens. Gross dissections were performed to examine the anatomic relationships of the clitoris, the dorsal nerve of the clitoris, and the autonomic nerve supply. Techniques to identify and follow the path of the dorsal nerve of the clitoris and strategies to avoid nerve injury when dissecting near the clitoris are highlighted. Enhanced awareness of this anatomy will improve our ability to understand and prevent disruption of the clitoral nerve supply and will improve our ability to appropriately counsel patients on the risks of vulvar surgery.