Clitoral ultrasound is a modality for imaging clitoral pathology, which can be the etiology of female sexual dysfunction. It can also be performed before and after gynecologic surgery to assess clitoral anatomy and blood flow. The exam involves a transperineal component.
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Normal ultrasound anatomy
Clitoris
(see: clitoris)
consists of glans, body (formed in the midline where the paired cavernous bodies meet), cavernous bodies (crura), vestibular bulbs
in the transverse plane, the cavernous bodies are round, hypoechoic structures lateral to the urethra
the cavernous bodies join superomedially at the body
during arousal and clitoral erection, blood flow increases to deep artery of the clitoris, supplying the cavernous bodies (homologous to the corpus cavernosum of the penis); this can be visualized with color Doppler
clitoral erection leads to an increase in length of the cavernous bodies, best measured in the sagittal plane
the paired vestibular bulbs may be difficult to detect on ultrasound (they are isoechoic to the adjacent pelvic floor muscles, and are on a more medial plane than the cavernous bodies)
Technique
Clitoral ultrasound involves a transperineal component.
Transperineal exam
A broadband linear array transducer (4-12 MHz) is often used. The transducer can be placed on the clitoral hood and fanned to visualize the rest of the clitoris. Color Doppler can be used qualitatively to assess general blood flow to the clitoris, and/or quantitatively to assess the velocity of blood flow through the deep artery of the clitoris.
Practical points
Apply light pressure with the transducer to avoid distorting the dimensions of the clitoris, and to avoid compressing the deep or dorsal clitoral arteries.
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