[The dorsal nerve of the clitoris: surgical applications].
OBJECTIVE
To describe the course of the dorsal nerve of the clitoris (DNC) to better define its anatomy in the human adult and to help surgeons to avoid iatrogenic injury during surgical procedures.


METHODS
An extensive review of the current literature was done on Medline via PubMed by using the following keywords: "anatomie du clitoris", "anatomy of clitoris", "nerf dorsal du clitoris", "dorsal nerve of clitoris", "réparation clitoridienne", "transposition clitoridienne", "surgery of the clitoris", "clitoridoplasty". This review analyzed dissection, magnetic resonance imaging, 3-dimensional sectional anatomy reconstruction and immuno-histochemical studies.


RESULTS
The DNC comes from the pudendal nerve. He travels from under the inferior pubis ramus to the posterosuperior edge of the clitoral crus. The DNC reappears under the pubic symphysis and enters the deep component of the suspensory ligament. He runs on the dorsal face of the clitoral body at 11 and 1 o'clock. Distally, he gives many nervous ramifications, runs along the tunica and enters the glans.


CONCLUSIONS
The NDC might be surgically injured (i) under the pubic symphysis, at the union of the two crus of clitoris and (ii) on the dorsal surface of the clitoral body. The pathway of the DNC on the dorsal face of the clitoris permits to approach the ventral face of the clitoris without risk of iatrogenic injuries. The distance between the pubic symphysis and the DNC implies that the incision should be done just under the pubic symphysis. Distally, the dissection of the DNC next the glands appears as dangerous and impossible, considering that the DNC is too close to the glandular tissues.
URDIA EA 4465, université Paris Descartes, 45, rue des Saints-Pères, 75006 Paris, France; Service d'obstétrique et de chirurgie gynécologique, hôpital de la Pitié-Salpétrière, 47, boulevard de l'Hôpital, 75013 Paris, France.
V
V
Balaya
Laboratoire d'anatomie, faculté de médecine, université de Nantes, 1, rue Gaston-Veil, 44035 Nantes cedex, France.
A
A
Aubin
Laboratoire d'anatomie, faculté de médecine, université de Nantes, 1, rue Gaston-Veil, 44035 Nantes cedex, France.
J-M
JM
Rogez
URDIA EA 4465, université Paris Descartes, 45, rue des Saints-Pères, 75006 Paris, France; Service de chirurgie générale et digestive, hôpital Avicenne, 125, rue de Stalingrad, 93000 Bobigny, France; UFR SMBH, université Paris-Nord, 74, rue Marcel-Cachin, 93017 Bobigny, France. Electronic address: richard.douard@avc.aphp.fr.
R
R
Douard
URDIA EA 4465, université Paris Descartes, 45, rue des Saints-Pères, 75006 Paris, France; Service d'urologie, hôpital Bichat-Claude-Bernard, 46, rue Henri-Huchard, 75018 Paris, France.
V
V
Delmas
D005260:Female; D006801:Humans; D060525:Pudendal Nerve / Q000033:anatomy & histology* / Q000601:surgery*
Anatomie du clitoris; Anatomy of clitoris; Clitoridoplasty; Dorsal nerve of clitoris; Nerf dorsal du clitoris; Réparation clitoridienne; Surgery of the clitoris; Transposition clitoridienne