This transcript has been edited for clarity.
Rachel S. Rubin, MD: Welcome back to Sex Matters. I'm Dr Rachel Rubin. I'm a urologist with fellowship training in sexual medicine, and I practice in the Washington, DC, area. I'm thrilled to introduce Dr Shaniel Bowen and to talk about her very exciting research that was recently published. Dr Bowen, go ahead and introduce yourself.
Shaniel Bowen, PhD: I'm Dr Shaniel Bowen. I'm a second-year postdoctoral researcher at MIT in the Edelman Lab, and my research primarily focuses on female pelvic anatomy and health. I'm currently specializing in sexual anatomy and health.
Rubin: I love your scientific background. Can you explain your background prior to MIT?
Bowen: I have a bachelor's degree and master's degree in biomedical engineering from the University of Connecticut, and I recently acquired my PhD in bioengineering from the University of Pittsburgh. During my PhD, I performed bioimaging analyses of women after pelvic organ prolapse surgery. I investigated the relationship between clitoral anatomy and postoperative sexual function.
Rubin: I'm so grateful that you are looking at clitoral anatomy because this is a topic that has been really understudied. In our anatomy textbooks, there's almost nothing on clitoral anatomy, even though the clitoris is the homologue of the penis — which we have lots of research on.
Dr Bowen just published a fabulous paper in JAMA Surgery titled Post Operative Sexual Function After Vaginal Surgery and Clitoral Size, Position, and Shape. Dr Bowen, what did you investigate in this paper?
Bowen: This paper was a supplementary study of an NIH-sponsored national research network called the Pelvic Floor Disorders Network.
We had access to postoperative images of women after prolapse surgery. I was brought in to segment the 3D clitoral anatomy and correlate it with sexual questionnaire data that were obtained from the primary clinical study. We were trying to determine whether there was a relationship between anatomy and function in these patients.
It was a great learning experience — prior to this, I didn't really know what a clitoris looked like! Learning what the clitoris actually looks like, how it can vary from person to person, and seeing how it relates to functional outcomes was super cool to see.
Rubin: Why don't you take us through and explain the modeling process. I think a lot of doctors watching this don't truly know much about the specifics of clitoral anatomy.
Bowen: I was really inspired by Dr Christine Vaccaro's work. Dr Vaccaro previously looked at clitoral anatomy from MRI and a lot of the measurements were obtained in 2D. I sought to expand the analysis to 3D, which involved creating a custom program to obtain dimensional measurements of each component of the clitoris.
By fitting bounding boxes around each structure and looking at the volume enclosed by the 3D models, we can take length, width, and thickness measurements of each clitoral component, such as the glans, body, and crura, and the volume of the vestibular bulbs.
Another interesting aspect that hasn't really been described before is the position of the clitoris with respect to the bony pelvis. Using an anatomical coordinate system based on the bony landmarks of the pelvis, we can quantify the position of the clitoris for each individual in an objective and systematic manner.
Rubin: How easy was it to get these measurements from the MRIs? Is this just an MRI without contrast? And were there any certain sequences that you had to find?
Bowen: These patients had vaginal contrast to make the vaginal borders easier to see. The contrast didn't actually enhance our ability to see the clitoris, but it was a pretty simple process of segmenting the clitoral anatomy from axial MRIs and then defining the anatomical coordinate system. However, it was a very long process, given the volume of imaging data we had access to.
Rubin: You looked at quite a few of these MRI studies, so tell us more about what you found.
Bowen: We had some exciting findings. We found that the size of the clitoral glans — a crucial component of the clitoral complex — was associated with function. Smaller overall dimensions of the clitoral glands were linked to poor sexual function outcomes among sexually active women.
We also found that the position of the clitoris was correlated to sexual function. Women with a clitoris that was more posterior and inferior more frequently experienced sexual avoidance and dyspareunia.
Lastly, I don't think (to my knowledge) clitoral shape has previously been quantified. In our paper, we quantify shape differences in the clitoral complex by sexual function outcome. The largest shape differences included attachment sites of clitoral supportive structures, like the ischiocavernosus muscles and the clitoral suspensory ligament — which are not often talked about. Looking into those structures and looking into the pelvic bone shape, which can dictate the shape of the clitoris, would be great avenues to explore going forward.
Rubin: As someone who frequently treats patients with sexual dysfunction, we have a huge need for more objective measures of sexual dysfunction. I can think of so many circumstances where we need information about clitoral anatomy both prior to and following surgery. We also know the clitoris is a hormone sensitive structure, so further research could help us understand how menopause, testosterone therapy, puberty — all these periods of clitoral development — could affect anatomy and in turn function. And what affects position? Is it just the luck of the draw? It's all so fascinating.
Where would you like to see the research go from here? And how do we increase awareness about these imaging protocols?
Bowen: There are a few different directions I'd like to explore. Right now, we're looking to evaluate how the type of relapse surgery can affect clitoral position. Does native tissue repair vs mesh repair have distinct effects on clitoral morphology and position? We're excited to publish those findings at a sooner date.
Providing empirical evidence of the relationship between clitoral anatomy and sexual function will hopefully encourage others to look beyond just psychosocial factors as determinants of sexual function outcomes and begin looking at the anatomy itself.
I also think it would be fascinating to see how formation of the neoclitoris during gender-affirming surgery can affect sexual function outcomes after surgery.
Rubin: Is there anything you wish you had looked at and didn't get a chance to? And where are you most excited to see this research go?
Bowen: I wish we had access to a more diverse patient pool. For that particular study, it was primarily White, middle-aged to elderly women who had pelvic organ prolapse. Looking at different sexual dysfunction disorders or having access to postoperative imaging data from cosmetic surgeries or other general surgeries could potentially provide us with a more direct link between anatomy and surgical outcomes related to sexual function.
Rubin: You know, the data shows that orgasm with penetration really only happens in about 15% of women— it's kind of the rare way to have an orgasm. When women tell me they do orgasm from penetration, it's often a certain position they're in; they are on top and they are getting a certain stimulation of that pubic bone. So, I would love to correlate this research with those 15% of women who can orgasm from penetration. Do they have a different size and shape of the entire clitoris?
I think there are so many avenues that this research can take, which is why I wanted to introduce you to the world. There are so many people watching this who will say, "We can't even get anyone to read an MRI that talks about the clitoris." Yet, here we are looking at the size of the glans, the size of the crura, and the position of the clitoris in relation to the pubic bone.
You have really elevated this research to the next level, and I think we're going to be talking about this pivotal study — probably until the end of time. It is so important that we are finding new ways to study sexual biology, anatomy, physiology, and hormones, because as you said, it's not all psychosocial and there is a biopsychosocial nature to sexual health.
Dr Bowen, thank you so much for joining our audience today. Where can people find you?
Bowen: I'm on X and LinkedIn. My handle is my first and last name, Shaniel Bowen, on all socials. I really appreciate this opportunity to speak with you. It means the world to me to feel visible within this space.
Rubin: Welcome. We look forward to many more research projects ahead.
COMMENTARY
We Know Nothing About the Clitoris. That Needs to Change
DISCLOSURES
| April 07, 2025This transcript has been edited for clarity.
Rachel S. Rubin, MD: Welcome back to Sex Matters. I'm Dr Rachel Rubin. I'm a urologist with fellowship training in sexual medicine, and I practice in the Washington, DC, area. I'm thrilled to introduce Dr Shaniel Bowen and to talk about her very exciting research that was recently published. Dr Bowen, go ahead and introduce yourself.
Shaniel Bowen, PhD: I'm Dr Shaniel Bowen. I'm a second-year postdoctoral researcher at MIT in the Edelman Lab, and my research primarily focuses on female pelvic anatomy and health. I'm currently specializing in sexual anatomy and health.
Rubin: I love your scientific background. Can you explain your background prior to MIT?
Bowen: I have a bachelor's degree and master's degree in biomedical engineering from the University of Connecticut, and I recently acquired my PhD in bioengineering from the University of Pittsburgh. During my PhD, I performed bioimaging analyses of women after pelvic organ prolapse surgery. I investigated the relationship between clitoral anatomy and postoperative sexual function.
Rubin: I'm so grateful that you are looking at clitoral anatomy because this is a topic that has been really understudied. In our anatomy textbooks, there's almost nothing on clitoral anatomy, even though the clitoris is the homologue of the penis — which we have lots of research on.
Dr Bowen just published a fabulous paper in JAMA Surgery titled Post Operative Sexual Function After Vaginal Surgery and Clitoral Size, Position, and Shape. Dr Bowen, what did you investigate in this paper?
Bowen: This paper was a supplementary study of an NIH-sponsored national research network called the Pelvic Floor Disorders Network.
We had access to postoperative images of women after prolapse surgery. I was brought in to segment the 3D clitoral anatomy and correlate it with sexual questionnaire data that were obtained from the primary clinical study. We were trying to determine whether there was a relationship between anatomy and function in these patients.
It was a great learning experience — prior to this, I didn't really know what a clitoris looked like! Learning what the clitoris actually looks like, how it can vary from person to person, and seeing how it relates to functional outcomes was super cool to see.
Rubin: Why don't you take us through and explain the modeling process. I think a lot of doctors watching this don't truly know much about the specifics of clitoral anatomy.
Bowen: I was really inspired by Dr Christine Vaccaro's work. Dr Vaccaro previously looked at clitoral anatomy from MRI and a lot of the measurements were obtained in 2D. I sought to expand the analysis to 3D, which involved creating a custom program to obtain dimensional measurements of each component of the clitoris.
By fitting bounding boxes around each structure and looking at the volume enclosed by the 3D models, we can take length, width, and thickness measurements of each clitoral component, such as the glans, body, and crura, and the volume of the vestibular bulbs.
Another interesting aspect that hasn't really been described before is the position of the clitoris with respect to the bony pelvis. Using an anatomical coordinate system based on the bony landmarks of the pelvis, we can quantify the position of the clitoris for each individual in an objective and systematic manner.
Rubin: How easy was it to get these measurements from the MRIs? Is this just an MRI without contrast? And were there any certain sequences that you had to find?
Bowen: These patients had vaginal contrast to make the vaginal borders easier to see. The contrast didn't actually enhance our ability to see the clitoris, but it was a pretty simple process of segmenting the clitoral anatomy from axial MRIs and then defining the anatomical coordinate system. However, it was a very long process, given the volume of imaging data we had access to.
Rubin: You looked at quite a few of these MRI studies, so tell us more about what you found.
Bowen: We had some exciting findings. We found that the size of the clitoral glans — a crucial component of the clitoral complex — was associated with function. Smaller overall dimensions of the clitoral glands were linked to poor sexual function outcomes among sexually active women.
We also found that the position of the clitoris was correlated to sexual function. Women with a clitoris that was more posterior and inferior more frequently experienced sexual avoidance and dyspareunia.
Lastly, I don't think (to my knowledge) clitoral shape has previously been quantified. In our paper, we quantify shape differences in the clitoral complex by sexual function outcome. The largest shape differences included attachment sites of clitoral supportive structures, like the ischiocavernosus muscles and the clitoral suspensory ligament — which are not often talked about. Looking into those structures and looking into the pelvic bone shape, which can dictate the shape of the clitoris, would be great avenues to explore going forward.
Rubin: As someone who frequently treats patients with sexual dysfunction, we have a huge need for more objective measures of sexual dysfunction. I can think of so many circumstances where we need information about clitoral anatomy both prior to and following surgery. We also know the clitoris is a hormone sensitive structure, so further research could help us understand how menopause, testosterone therapy, puberty — all these periods of clitoral development — could affect anatomy and in turn function. And what affects position? Is it just the luck of the draw? It's all so fascinating.
Where would you like to see the research go from here? And how do we increase awareness about these imaging protocols?
Bowen: There are a few different directions I'd like to explore. Right now, we're looking to evaluate how the type of relapse surgery can affect clitoral position. Does native tissue repair vs mesh repair have distinct effects on clitoral morphology and position? We're excited to publish those findings at a sooner date.
Providing empirical evidence of the relationship between clitoral anatomy and sexual function will hopefully encourage others to look beyond just psychosocial factors as determinants of sexual function outcomes and begin looking at the anatomy itself.
I also think it would be fascinating to see how formation of the neoclitoris during gender-affirming surgery can affect sexual function outcomes after surgery.
Rubin: Is there anything you wish you had looked at and didn't get a chance to? And where are you most excited to see this research go?
Bowen: I wish we had access to a more diverse patient pool. For that particular study, it was primarily White, middle-aged to elderly women who had pelvic organ prolapse. Looking at different sexual dysfunction disorders or having access to postoperative imaging data from cosmetic surgeries or other general surgeries could potentially provide us with a more direct link between anatomy and surgical outcomes related to sexual function.
Rubin: You know, the data shows that orgasm with penetration really only happens in about 15% of women— it's kind of the rare way to have an orgasm. When women tell me they do orgasm from penetration, it's often a certain position they're in; they are on top and they are getting a certain stimulation of that pubic bone. So, I would love to correlate this research with those 15% of women who can orgasm from penetration. Do they have a different size and shape of the entire clitoris?
I think there are so many avenues that this research can take, which is why I wanted to introduce you to the world. There are so many people watching this who will say, "We can't even get anyone to read an MRI that talks about the clitoris." Yet, here we are looking at the size of the glans, the size of the crura, and the position of the clitoris in relation to the pubic bone.
You have really elevated this research to the next level, and I think we're going to be talking about this pivotal study — probably until the end of time. It is so important that we are finding new ways to study sexual biology, anatomy, physiology, and hormones, because as you said, it's not all psychosocial and there is a biopsychosocial nature to sexual health.
Dr Bowen, thank you so much for joining our audience today. Where can people find you?
Bowen: I'm on X and LinkedIn. My handle is my first and last name, Shaniel Bowen, on all socials. I really appreciate this opportunity to speak with you. It means the world to me to feel visible within this space.
Rubin: Welcome. We look forward to many more research projects ahead.
Any views expressed above are the author's own and do not necessarily reflect the views of WebMD or Medscape.
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