Dr. AK: Thank you for joining me today – I’m sure you’re pretty busy.
C: Not really. Not nearly as much as I’d like to be, if we’re being honest. It’s been a bit of a dry spell, literally and figuratively.
Dr. AK: Well, I’d love to talk about that, but can I start by saying what a fan of yours I am. I mean, everyone is a fan, right?
C: Wrong. The whole “everybody loves the clitoris” thing really just started in the last few decades. We had a rocky start. When the clitoris was first described in the medical literature, the French guy who named it called it “the shameful member.” In the Middle Ages, they called it the “Devil’s Teat.”
Then, Freud made a big deal of how vaginal orgasms were the mark of full female development, whereas clitoral orgasms were immature and less than. That women who relied on the clitoris to orgasm were neurotic or abnormally masculine.
Dr. AK: Wow. I feel bad for that guy’s patients. And his wife. Especially since we now know that 75% of women need direct clitoral stimulation to orgasm. Well, okay, so things started slow, but it’s gotten better for you, yes?
C: Sure. We were all pretty excited in 2005 when Helen O’Connell used MRI and microdissection to reveal the complete anatomy of the clitoris for the first time. First time! Can you imagine if doctors had just discovered that penises had internal structures in 2005? I mean, yeah, that wasn’t that long ago, but it’s better than people thinking we’re just this tiny nubbin for all of eternity.
In the 20 years since then, we’ve been standing taller – get it? Because we’re supported by our legs, which were just discovered despite everyone knowing that men’s penises have the same legs deep under the skin, but they didn’t seem to care that we did too.
Dr. AK: For readers who don’t know, tell us about these legs of yours. Where are they hidden? What do they do?
C: Only about 10% of me is visible from the outside. The rest is tucked neatly inside. I’ve got a wishbone shape, and my two legs (crura) sit up next to the pelvic bones and hug the vagina. It’s like we’re the wishbone at Thanksgiving dinner, except instead of breaking us for luck, we bring the luck ourselves.
Dr. AK: The anatomy of the clitoris really is impressive. And, I’ve heard you have 8000 nerve endings?
C: Nah. It’s more than 10k at this point. That’s twice as many as the penis, in case anyone is asking.
Dr. AK: Incredible. So, you mentioned earlier that you’ve been a bit bored lately – what’s going on?
C: Well, my Clitoris-Owner (C.O.) is in her early 50s, and estrogen has taken a dive. Testosterone too. All of a sudden, she’s not interested in sex. And, when she makes herself try to be interested, I’m not always up to the task.
Dr. AK: What task?
C: You know – the filling up with blood, getting all swole and sensitive and sexy. For some reason, the blood is not flowing my way as much anymore. And I don’t feel things like I used to. It’s just kinda … blah. Like, yeah, you can rub against me if you want – I’m not going to file a complaint – but also… maybe you’d prefer to reorganize your spice rack? Or fall down a TikTok rabbit hole about sourdough starters?
Dr. AK: Oh no. That’s not good.
C: Not good at all. And, it gets worse. I’ve started to become concerned about the possibility of shrinking. I’ve had friends who just withered away into shadows of themselves after menopause.
Dr. AK: Yes. Unfortunately, that estradiol that is waving its final goodbye is not only crucial for blood flow, it’s also vital for keeping you nourished, responsive, and plump. It’s needed to keep the entire vulva and vagina healthy, in fact.
C: I’ve heard that. And I’ve heard some ladies take estrogen vaginally to keep things thriving down below. But does that low-dose vaginal estrogen or DHEA make my C.O. more interested in having sex? Because her whole “I’d be fine if he never touched me again” attitude is not helping my vibe.
Dr. AK: Unfortunately, low-dose vaginal estrogen won’t help her libido, but she can likely take both estrogen and testosterone therapy systemically, and both can be fantastic for improving libido.
C: Testosterone? I’ve heard good things about testosterone. My friend, Clitty Jane, said that her C.O. took testosterone for six months and that the lady was horny as hell – it was “Bring your Clitoris to Work Day” every day – sometimes multiple times a day.
Dr. AK: Ha! Testosterone can indeed be a Clitoris Owner’s best friend. Think of testosterone as her personal hype woman – she shows up and suddenly the woman remembers how fabulous she is. In women with symptoms of hypoactive sexual desire disorder (HSDD), testosterone is an amazing therapy to improve desire, arousal, pleasure – all the things.
The problem is that there’s no FDA-approved testosterone available for women in the U.S., so some women have a hard time getting it. Many doctors don’t know that they can simply prescribe “men’s testosterone” at about 1/10th to 1/20th the dose for women. Or, better yet, get it compounded so it’s precisely the dose she needs.
C: Love that. Testosterone and estrogen for the whole body. Low-dose vaginal estrogen to keep me from withering away. What else ya got? What else can my C.O. do to keep me all perky and whatnot?
Dr. AK: Well, she could get herself a vibrator. In a fascinating 2024 pilot study, they found that regular vibrator use significantly improved sexual function, decreased pain and symptoms of pelvic organ prolapse, reduced depression scores, and reduced the severity of vaginal atrophy. Why? Orgasms provide a fun mix of neurochemicals, and the boost in blood flow helps keep the tissues of the vulva and vagina healthy. Good for her. Good for you.
C: But, I’ve heard that vibrators can permanently desensitize the clitoris. I don’t want that! I’m barely scraping by these days as it is!
Dr. AK: There is no scientific evidence that using vibrators or sex toys causes permanent clitoral desensitization or damage. The “dead vagina syndrome” myth has been debunked more times than a celebrity death hoax.
C: Okay, what else do I need to know that I should?
Dr. AK: Hopefully, by this point in your life, you know about the benefits of lube. Like, your C.O. needs to keep it in her nightstand, carry it in her travel bag, maybe put some in a vial around her neck. But does she know about the difference between vaginal lubricants and vaginal moisturizers? Because she can use both.
Moisturizers are applied most days and keep the tissue … moist. Think: skincare for your down-there. Lubricants are more of an as-needed for sexy time. Both can be very beneficial.
C: Let’s see if I’ve gotten all of this… Systemic estrogen and testosterone for full-body benefits (including improved libido), low-dose vaginal estrogen or DHEA for pelvic-floor-specific benefits, vaginal moisturizers and lubricants as needed. Sex toys as needed (no shame in that game).
And most importantly, don’t ignore your clitoris, because I’m literally the only organ designed purely for pleasure. I’m not trying to be modest here; I’m just stating facts. Did I miss anything?
Dr. AK: Nope. I think you’ve got it. Thank you for your time with me today, Miss Clitoris. You were just exactly as memorable as I imagined you would be. Though I have to say, it’s pretty remarkable that with over 10,000 nerve endings and the ability to expand by 300%, you’re still somehow invisible to half the population.
C: Right? I’m literally right there. It’s not like I’m playing hide and seek. Maybe they need to invest in a new GPS, but this time it’s CPS (Clitoris Positioning System)? Though honestly, at this point, I’m thinking about just getting my own neon sign.
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