Q: Are my tissues shrinking down there?

What you ask about specifically is your clitoris, which, along with other genital tissues, does typically shrink with the loss of estrogen—whether through menopause or some other medical event. Because you're under 40, which is young for what you're describing, I'd encourage you to express your concern to your health care provider and have a thorough pelvic exam. The exam will be helpful in finding out whether there's another vulvar condition causing the tissue changes—or whether you're experiencing normal changes.

As we lose estrogen, we do face something of a "use it or lose it" proposition. That is, circulation and stimulation keep our genital tissues healthier; left to their own devices, they'll atrophy. If you don't have a partner right now, a vibrator is a great choice to provide stimulation and increased blood supply to the area. Maintaining your health means you'll be ready for intimacy when—just when you least expect it—a relationship emerges!

Ringing the Love Button

Maybe you gathered from last week's post that the clitoris is command central of the female orgasm. Perched atop the labia minora, its sole purpose and function is sexual pleasure. It has more nerve endings than the penis, and—although affected by conditions that reduce blood supply—it can retain sensitivity as you age.

Most of the clitoris is out of sight, extending deep within and around your vagina and labia. “The most recent anatomical research suggests that the clitoris is perhaps better described as the 'clitoral complex,' where the vagina, urethra, and clitoris all function as a unit rather than as individual parts," says Dr. Debby Herbenick, in this article for Men’s Health.

Unlike the penis, the clitoris can orgasm repeatedly without a refactory (rest) period. Clitoral orgasms also last from between 10 to 30 seconds and involve from 3 to 15 contractions, which can reach from the abdomen to the vagina.

So, rather than creating artificial divisions and hierarchies between whether an orgasm is vaginal or clitoral, why not view the whole area as one big erogenous zone? Clitoral orgasms involve the vagina and vice versa, so neither is “better” or more desirable. Every orgasm is right on the money. Use what works, rather than focusing on the vagina, which as you know, can get a little cranky right about now.

And if you can coach your partner on some clitoral finesse, lovemaking could take on a whole new dimension.

Let’s return to the fact that the clitoris, as we mentioned before, is “homologous” to a penis—it has the same biological features. Thus, it has to be treated gently. Too much or too rough and it’ll either hurt or go numb. So start slow and gentle.

To begin, use lube on your fingers. (Your partner’s tongue is great.) Start a vibrator on low. The glans (head) is usually too sensitive to touch directly, so stroke the hood over the top of the glans, stroke around the labia minora and the vaginal vestibule. Stroke inner thighs, breasts, nipples. Use round and round and over the top motion on the clitoris.

For the partner: Tongue action on and around the clitoris is very erotic. Done well, it can make her “come” all by itself. Don’t jump into action. Get things warmed up with your best foreplay action.

Then, with lubed fingers begin a gentle, playful massage downtown—gently stroke her inner labia, across, over and around her clitoris. As your partner becomes aroused, slide between her legs and begin using your tongue, licking firmly up the tiny shaft of the clitoris, using separate strokes at first. Vary the action with quick darting motions on the exposed glans or by flicking her clitoris with your tongue. Begin using a firmer, continual stroke without breaking contact until she begins to orgasm.

You can then quickly move to penis-in-vagina action until you orgasm, or you can cup her “mound” with the palm of your hand, applying gentle pressure to her clitoris, which feels very comforting.

You don’t have to go crazy with the tongue action (how exhausting that would be!). Set the scene well with foreplay; keep the action gentle and varied, increasing both the frequency and firmness as she becomes aroused. Some handwork on her breast and nipples helps. And remember, practice makes perfect!

Good positions to increase clitoral contact during sex include the faithful missionary but with the partner pressing down to engage the clit. Either partner can reach the clitoris if she’s on top or in the rear entry position. “There's no need to be overly fancy during sex—the very best positions are the ones that focus on the clitoris,” says author and sexologist Dr. Logan Levkoff.

Finally, the clitoris needs good blood flow to be its best orgasmic self—and orgasms boost the immune system, support a healthy sleep cycle, and help keep your hormones balanced. You can keep clitoral blood flow through:

  • Exercise. “Twenty minutes of moderate exercise increases a woman's genital engorgement by 168 percent—and the effect persists for hours,” writes Weed. Go for a walk with your partner, she suggests.
  • Sex and masturbation. It’s the whole “use it or lose it” dichotomy. You have to keep the tissues plumped and primed or they atrophy, especially as you age.
Clitoral stimulation techniques of your own? Please share.

10 Things You [Maybe] Didn't Know about Your Clitoris

Let’s start with anatomy and etymology, shall we?

The clitoris is a small button-like protuberance located at the top of the labia minora (the “little lips” inside the vulva). Clitoris comes from the Greek word kleitoris, which may mean “key” or “latch” or “hook” or from a word meaning “side of a hill.”

The clitoris, as it turns out, is a tremendously important organ for sexual pleasure in females, but because its anatomy is so hidden and its purpose so inscrutable, only recently have imaging techniques begun to reveal the breadth and depth of the clitoris.

  1. The clitoris and the male penis are “homologous,” which means they have similar biological structures. They’re made of the same stuff. Like the penis, the clitoris has a very sensitive head or glans (that’s the part you can see peeking out), a shaft that extends into a woman’s body, an external hood that is like the foreskin. But there’s also a whole bunch of stuff inside, and that’s now referred to as the “clitoral network”—a complicated internal structure that winds around the vulva and into the vagina and is composed, like the penis, of erectile and other tissues.
  2. The clitoral network has perhaps twice as many nerve endings as the penis (about 8,000 vs. 4,000), and when aroused, may affect 15000 more, making it extremely sensitive and critical sexual pleasure. In fact, some sources suggest that the G-spot is really part of the clitoral network.
  3. Genetic makeup, steroid overdose, and testosterone use can cause clitoral enlargement, which is called clitoromegaly.
  4. The clitoris becomes larger after childbirth, and it stays sensitive throughout the lifespan, including after menopause, although both Dr. Barb and Dr. Oz say you have to use it or lose it. (Hear that, gals!)
  5. The clitoris is the only human organ that has no function other than sexual pleasure.
  6. Other female mammals also have clitorises of various sizes. (That of the female bonobo is big enough to “waggle” when she walks, according to this article.)  Female spotted hyenas are the only mammal whose clitoris is used for urination, sex, and birthing young (ye gads!), making both sex and birth quite challenging and acrobatic for hyenas.
  7. In cultures that practice female genital mutilation (FGM), the clitoris and sometimes all or part of the labia minora is ritually cut off, often unhygenically and without anesthetic. The practice is rooted deeply in some Middle Eastern and North African cultures and has to do with ideas about purity, modesty, and female sexual desire.
  8. As you might imagine, the clit has accrued a lot of colorful names: rosebud, cherry pit, love bud, nubbin, doorbell, bald man in a boat. In some Middles Eastern countries, it may be called a sesame seed, lentil, or chickpea, depending on its size.
  9. During sexual arousal, the entire clitoral network becomes engorged, just like a penis. This includes tissue within the vagina and labia minora. Everything swells.
  10. Most women (something like 70 percent) can’t orgasm with vaginal stimulation alone, which leads us to the necessity of clitoral stimulation to dependably orgasm. There are lots of tricks to help this along.
Stay tuned. We'll follow up with another installment.

Female Anatomy 101

Writing for my gynecologist friend has included a lot of Aha! moments. I admit some of this learning makes me blush. It's not just because I blush when talking about sex—though I do. It's because I’m embarrassed when I’m caught not knowing things I think I should have known a long, long time ago.

So, I’m reading along in Dr. Barb’s enormous textbooks on female sexuality, when I come across an illustration of the clitoris, sort of like the one below. I nearly passed it over, because, what’s to know at my age? I've lived with this equipment for 50 years. I'd like to think I know my way around it.

But this illustration colored in the entire structure of the clitoris. Not just the glans, but also the shaft and the crus clitoris, or crura.

Excuse me… the shaft?... and the crura?

No.. please picture me picking my head up like a prairie dog, looking around my office, and asking the air...

“The shaft?!"

"And the crura!?!”

Somehow in all my curious, bookish, research-happy past, I never learned more about the clitoris than about the little buttonthe glansthe part that sticks out from the prepuce at the top of the labia.

Who knew my clitoris had legs? And a shaft, even?

But yes, indeed. It's practically a little penis under that hood. With long, long legs that extend waaay back toward the perineum, which fill with blood when I’m aroused.

Now, of course, the cool, rational part of my mind tells me I have enjoyed my crura—and possibly even the shaft—because they’ve been there all along. But I would have liked to know about them from the start. I can’t help but wish for a few years back in which I could quite clearly visualize my long, leggy crura.

What can we do with this information? Well, with age, the clitoris loses some sensitivity. We may find it useful to use warming oils and gels or vibrating sex aids to increase stimulation to the clitoris as we prepare for or engage in sex.

And of course, to do that, it really does help to know where it is.

Back to the books...