Did you know that, like an iceberg, most of the clitoris is hidden beneath the surface? I didn’t until a couple of years ago but there was a spate of pretty pink 3D clitorises (?sp ??clitorati) on the net and it got me thinking and Googling.  I found an article by a urologist who kept failing a test because her answers didn’t match that given by the textbooks. Helen O’Connell’s paper in the Journal of Urology (2005) was a real eye opener, a mine of information on the anatomy of the clitoris – and the history of that anatomy which shows that sometimes the textbooks are just plain wrong.

According to Wikipedia (I know … but practically everyone else agrees) the function of the clitoris is to provide women with sexual pleasure. All well and good and thanks very much, but any structure that lies anywhere near the birth canal must be a candidate for a role in birth. Birth is the evolutionary bottleneck which must surely trump women’s pleasure – and, when all’s said and done, most of the time the clitoris doesn’t even provide a woman with an orgasm in the standard human mating position!

When we started to walk upright four million years ago, the standard mammalian mating position, the male entering from behind, became problematic. (Read Elaine Morgan, The Descent of Woman for more details) The practicalities of a vagina that was becoming inaccessible switched the mating position to face to face, but the clitoris was on the wrong side of the vagina to be stimulated with any ease during sex. Besides, the male had ‘lost’ his penis bone and with it the means to provide adequate stimulation (sorry chaps). These days the happy pair are indeed fortunate if he manages to hit the G spot with any accuracy and with any regularity (or perhaps I have just been unlucky).

The trouble with those pretty pink models of the clitoris is that they march across the page with no indication of quite where they are situated. Call it my inadequate female brain if you like, but an ability to manipulate 3D structures in space is not my best attribute. I struggled to sort out in my head where all those extensions and extremities fitted in (the outside button bit was the only bit I was sure about). I got there in the end.  It turns out that the two legs (crura) are attached each side of the pubic arch and the two bulbs project backwards either side of the vagina where they seem to be known as the vestibular bulbs. What might be called the main body of the clitoris lies behind the cartilage of the pubic symphysis. A portion of this root doubles back on itself and burrows through to the Mons of Venus at the apex of the pubic arch. The glans, the visible ‘button’, is at the end of this root. The legendary G spot now has an anatomical explanation, it corresponds to the corpus, the root of the clitoris, which is higher up behind the symphysis pubis. The nerves of the clitoris are huge, visible to the naked eye, and travel back to the sacrum.  So now you know.

In my book, Dynamic Positions in Birth, (Pinter and Martin, 2014) I had speculated that the G spot might be stimulated by the back of the baby’s head on the journey down the birth canal and that this could be responsible for triggering Ferguson’s reflex. Ferguson’s reflex is a nervous signal to the hypothalamus which results in a bolus of oxytocin giving the uterus a tonic contraction which assists the mother in the final pushes for the baby to be born. (More than assist – a large enough uterine contraction can do practically all the work.) Now that I knew that the G spot was part of a larger structure, everything dropped into place. (Confusion about its location is now explained, because it is stimulated at one remove through the vaginal wall and it is not so much as a spot as an area.)

Birth should be orgasmic, the fluttering vaginal contractions of orgasm initiated by the downward movement of the fetal head also ease the baby out.  The engorgement of the vestibular bulbs and the crura cushion the back of the baby’s head from the hard bones of the pubic arch. Vaginal orgasm at birth is the intended target of evolution. Orgasm by external stimulation during sex is an added bonus. (It says a lot for our birth culture that it is so rare … yes, me neither.) It probably says even more for our birth culture that textbook physiology has absolutely nothing to say on the subject. I wonder whether all that engorgement and lubrication protects women against tearing?

In Spiritual Midwifery Ina May Gaskin makes much of what partners can do to help their women give birth – loving, smooching, cuddling and sexual stimulation.  Though it grieves me to say it, there are some obstetricians who stimulate the external clitoris mechanically to ease birth, which seems to me to be a gross intrusion, verging on assault. They do at least have physiology on their side – like nipple stimulation, it releases oxytocin,  but both orgasm and oxytocin secretion are shy phenomena, failing to manifest themselves in stressful environments.

A role for the clitoris in labour would make sense of many of the things we see in birth. We might find that birth proceeds better when we adopt positions where maximal clitoral stimulation is possible, not just upright, but forward leaning, acknowledging our quadrupedal heritage. It would certainly proceed better in the same sorts of environments that facilitate sex. Anyone for sex in the lithotomy position gazed on by a posse of strangers (me neither)?