Is the Clitoris a Tiny Penis?
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woman in an MRI tube has few secrets. The man at the control console knows the size of her heart and the contents of her womb. He knows if she’s had her breasts enlarged or her stomach stapled. He can see into her bladder and knows whether she’s wishing she’d stopped by the restroom before climbing onto the exam table.
Ken Maravilla, a University of Washington radiology professor, knows all these things about Meg Cole[62] (bladder contents: half a cup). Very soon, he will also know how stimulating she finds the X-rated video that he has arranged for her to watch while she gets an MRI. Before you too arrange to have your next MRI done at UW you should know that not everyone gets the Maravilla treatment. Only study subjects.
Maravilla has a side interest in sex research. His work has shown that MRI can provide an unambiguous measure of how much blood is in the tissues of a woman’s clitoris. As it does with men, sexual excitement ushers more blood to a woman’s genitals. Clitoral blood volume, then, should yield a simple, dramatic portrait of what Masters and Johnson oh-so-appealingly called “mounting readiness.” Maravilla has found that, on average, women’s clitorises hold twice as much blood while they are watching porn than when they are watching, say, footage of a Space Shuttle launch.
“Mary, we don’t use the term ‘porn,’” Maravilla says quietly. “We say ‘erotic videos.’” (Or, when we’re feeling especially defensive, “VES,” for visual erotic stimulation.) Maravilla, sixty, is a slim, gracious man. His hair is cleanly cut and contoured. He speaks easily about sex, but is sensitive about the porn thing. This is understandable: His proposal was originally turned down by the university’s human subjects review board. Maravilla had to sit down with them, convince them that “it was above-board, that there was nothing voyeuristic going on.”
Of the many ways to quantify a woman’s sexual fires, MRI is the least intrusive, in that nothing need be inserted, suction-cupped, or otherwise affixed. This is sexological measurement at its most demure. Cole lies on her back with a radio frequency coil laid lightly, like a heating pad, over her hips. She is given a pillow and a blanket, and the lights are turned down. It’s like first class on a British Airways flight to Europe: downright comfortable under the circumstances.
Cole has what the Diagnostic and Statistical Manual of Mental Disorders calls female sexual arousal disorder (FSAD): She is regularly in the mood for sex, but her body doesn’t respond to the preliminaries. To be more precise, it doesn’t respond the way she’d like it to. If it wasn’t a problem in Cole’s eyes, it wouldn’t be a problem in the eyes of the DSM. Part of the diagnosis is that the condition causes “marked distress or interpersonal difficulty.”
FSAD is the ladies’ edition of ED (erectile dysfunction). It is distinct from FOD (female orgasmic disorder) and HSDD (hypoactive sexual desire disorder, or low libido).[63] Confusingly, there is also female sexual dysfunction, or FSD, but this is simply the catch-all term for anyone who has one—or a combination—of these conditions. Lack of desire (HSDD) is the most common of women’s sexual complaints, and we will get to this later. (Monkeys will be involved. Do not change the channel.)
Female sexual arousal disorder is the least common. Women with FSAD and nothing but FSAD are difficult to find. The coordinator of tonight’s study, Joanna Haug, had to interview 140 women to find the volunteers who comprise the study’s subject group. Unexpectedly, Haug finds many of her subjects by running ads in the sports section of the Seattle Times. “I used to run them in the food section,” she says, “but I kept hearing women tell me they heard about the study from their husband.” Men are often more troubled by their wife’s sexual responses, or lack thereof, than are the women themselves.
Cole is not a stereotypical “nonresponder.” She is not conservative or inhibited. She is the opposite of these things. When I came in, she was chatting with Haug about the best Seattle sex shops. A friend of hers teaches a bondage safety class sponsored by a local police department. “People kept getting hurt,” she is saying. “I guess it was monopolizing too much of the officers’ time.” If a woman like Cole is having trouble getting aroused, it seems reasonable to look for a physiological explanation.
Haug sits beside Maravilla in the MRI control room, which is actually labeled “Control Room,” just like in a James Bond movie. She is a likable, no-nonsense Englishwoman in pinstripe pants and a ponytail. At Maravilla’s signal, she presses a button to activate a conveyor that will move Cole into the MRI machine. The conveyor carries her toward the magnet feet-first and cinematically slowly.[64] James Bond inching toward the spinning saw blade.
Haug selected the sexually explicit clips for the study. I ask her where she got them, thinking, I don’t know, that there’s a supply catalog of explicit video clips produced specially for sex researchers. Haug blinks at me. “Sex shop.” Joanna Haug has more interesting business receipts than the rest of us.
Maravilla centers an image of Cole’s clitoris on the screen. The image bears no resemblance to the vague nub one generally pictures. This is because we’re looking at the whole organ, not just the one-tenth of it that is visible to the eye. Maravilla takes me on an underground tour. “Here
are the crura,” he says, pointing to a pair of matched arms that branch away from the tip like halves of a wishbone. “And this is the glans,” he says, as though Cole has a penis. In a sense, she has. Time out for a short primer.
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can recall, many years ago, being told that a clitoris[65] is a vestigial penis. The feminist in me, who is small and sleeps a lot but can be scrappy when provoked, took umbrage at this description. I resented the implication that men have the real deal, while women make do with a sort of miniaturized, wannabe rendition.
But it is true. Male and female fetuses both begin life with something closer to a clitoris. The male’s expands into a penis, while the female’s remains more or less as is.
Even in their adult forms, the two organs have much in common. The clitoris, like the penis, ends in a sensitive, nerve-dense, pleasure-yielding bulb of tissue called a glans. Like the penis, the clitoris has a shaft, and that shaft contains a pair of expandable chambers called corpora cavernosa. It also has a prepuce, or foreskin, just like the penis does, and if you draw it back you may, just as with the penis, discover a wee cache of smegma. Robert Latou Dickinson, a pioneer in the field of female smegma, described it in his Atlas of Human Sex Anatomy as “tiny, hard pellets, white and glistening.” The text includes a thumbnail illustration of three such pellets, placed alongside a clitoris, for scale. The drawing is dated 1928 and labeled, in Dickinson’s neat, boyish calligraphy, “Smegma.”
And yes, a clitoris expands when its owner is aroused— though not as quickly or extravagantly as does a penis. Masters and Johnson filmed dozens upon dozens of clitoral erections: Responses to vibrators, to fingertips, to “stimulative literature,” to intercourse. (Filming the clitoris during a missionary position coupling was of course problematic, as the male missionary is in the way. In this case, the artificial coition machine was called in to pinch-hit.)
Masters and Johnson focused on the glans—the touchy little bean that is the visible portion of the clitoris. The pair found that although the glans occasionally gets much bigger, expanding to as much as twice its normal size, fewer than half the clitorises enlarged to a degree that could be detected by the unaided eye.
MRI tells a different story. Maravilla’s work has shown that when you factor in the blood volume of its hidden portions, the aroused clitoris routinely doubles in size.[66]
Given the anatomical parallels between penises and clitorises, it might seem reasonable to think of women’s arousal problems, like men’s, as a blood-flow issue. Indeed, if you look in the sexual medicine journals, you will find papers on clitoral priapism, nocturnal clitoral erections,[67] and, yes, “clitoral erectile insufficiency” The team of researchers who coined this term are, unsurprisingly, urologists. They theorized that when older women have trouble getting aroused, the culprit might be—as it sometimes is in older men—clogged arteries. To test their theory, they induced atherosclerosis in a small group of female rabbits and then compared their vaginal and clitoral blood flow before and afterward. As theorized, the animals with the atherosclerosis had a lukewarm response when the researchers stimulated their bunny rabbit genitals.
Along these same lines, exercise has been shown to
Chemical analyses of female “ejaculate” have differed. Two labs concluded the samples were the same as urine; four found significant differences. At least one reported the presence of PAP, an enzyme found in the prostatic component of semen. It is true that women have a vestigial prostate, a scattering of ducts and glandular material surrounding the urethra, in the G-spot vicinity on the vagina’s front wall. It’s possible some women expel urine, others a prostatic fluid, and some a mixture. The debate drags on.
improve a woman’s ability to get aroused. Which makes sense: Exercise makes the body more efficient at pumping blood. “So when you get into a sexual situation,” says Cindy Meston, who ran the study, “the response is both quicker and more intense.” (Though it’s also possible, Meston allows, that women in better shape simply feel less self-conscious. With less attention devoted to worrying about what their body looks like, there’s more to apply to the sensations of arousal.)
If clitoral erectile insufficiency is for real, then you might imagine that the same remedies that work for erectile dysfunction in men might work for women (and, heck, rabbits). And you would not be alone. In the wake of Viagra’s monster success in treating ED, Pfizer turned its gaze to women. Partnering with urologists and sex researchers around the country, the pharmaceutical behemoth commenced a massive research venture to see whether genital blood flow was as critical to women’s sexual well-being as it is to men’s. Or, on a cruder level, to see ifViagra could be marketed to the other half of the planet.
Eight years and 3,000 subjects later, the answer appeared to be no. Viagra did in fact increase blood volume in the nethers, but most women seemed not to notice it. The researchers confirmed what most of them suspected all along: that women’s arousal, much more so than men’s, rests in the psychological as well as the physiological. And that is why a visit to Cindy Meston’s Female Sexual Psychophysiology Laboratory will be coming up.
Before we get there, I feel I must address the female penis pump: as of this writing, the only Food and Drug Administration-approved treatment for female sexual arousal disorder.
The Eros Clitoral Therapy Device is its formal name. Available by prescription, it consists of a small motor inside a plastic housing the size of a bar of soap. Attached to this is a clear flexible cup that fits over the clitoris. Switch on the motor, and you have a handheld suction device. The idea behind a male penis pump is, of course, to pull blood into a limp penis (and keep it there by means of a stretchable band placed around the organ’s base). You are making it stiff enough for sex. To get inside a lubricated vagina, a penis needs to be hard enough to push against the opening with one to two pounds of force.[68] That is approximately the amount of force required to open a swinging kitchen door. A woman does not need to penetrate anything with her clitoris, any more than a man needs to open kitchen doors with his penis. So why would she use a clitoris pump?
My apologies in advance, but this was something that begged checking into.
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