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Cavernous Erectile System in Women and the Hypereroticism Area (H Area)

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Cavernous Erectile System in Women and the Hypereroticism Area (H Area) Journal of Clinical Sexology - Vol. 3; No.3: July- September 2020 121 CAVERNOUS ERECTILE SYSTEM IN WOMEN AND THE HYPEREROTICISM AREA (H AREA) 1*Vasile NIȚESCU 1.*Medical Centre for Obstetrics-Gynaecology and Sexology The erectile organs of the vulva, through their structure and functionality, participate directly in determining the state of arousal and erection, necessary for sexual interc urse. The command to trigger an erection is given by the brain and is transmitted through the medullary pathways and/or the sacral spinal cord S2-S4, through the reflex arch. The direct connection between the cavernous erectile organs containing a venous ple- xus (vestibular bulbs) with the erectile tissue of the clitoris, the suburethral tissue, respec- tively the cavernous venous plexus of the urethra which constitutes the Vaginal Area of Hypereroticism (”H”), stimulates the receptors of any of the above structures in order to increase the local congestion and the vulvo-vaginal erectile sensitivity, thus activating the desire to mate (the ”libido”). It has to be mentioned that the erectile tissue covered by albuginea has a special func- tionality compared to the tissue with a simple local hyperemia (Niţescu). Parasympathetic impulses dilate the arteries of erectile tissue due to acetylcholine, to nitric oxide and to VIP (Vasoactive Intestinal Polypeptide) released at the nerve endings, local hyperemia highlighting the vulvo-vaginal erectile tissue. The connections between the corpora cavernosa of the clitoris and the corpora caver- nosa of the urethra are also explained by the drainage of venous blood, that is mainly and directly to the circumflex veins, which is another proof of the direct link between the clitoris and H area, all considered by women as being the most important vulvo-vaginal erogenous zones. *Correspondence: 1*Professor Nițescu Vasile, MD,PhD, E-mail [email protected], phone +40723151804. 122 Journal of Clinical Sexology - Vol. 3; No.3: July- September 2020 Hypervascularization of the H area, deter- erectile formations through tactile corpus- mined by the existence of the urethro-vaginal cles, including the glans, determining the cavernous structure, appears as an additional congestion of all segments of the clitoris, thus stimulating factor on the cavernous structure preparing the genitals for copulation, ejacula- of the vaginal wall congested by Gussenbau- tion and orgasm. er erectile tissue, during the period of local Clitoral vasodilation occurs much faster excitation of the trapezoidal “H” area. in young women and more difficult in the el- Morphophysiologically, erection is an re- derly. The size and proximity to the vaginal action based on a complex vascular-nervous introitus of the clitoris easily allow its mecha- mechanism, in which the relaxation of the nical arousal, being the most efficient structu- cavernous spaces is the result of blood flow, re in obtaining a number of orgasms. in response to arousal stimuli recorded by tis- Investigations and clinical observati- sue and central nervous receptors (brain), the ons have confirmed the direct link between erection being perceived by the woman as an hyperclitoridia and hyperandrogenism with ”erotic state”. the state of hypereroticism and in the increase of the orgasms number. In addition to the exciting visual appea- The clitoris rance of the much-enlarged clitoris (as in the case of the enlarged penis seen by a woman From an anatomical point of view, in its on her sex partner), it has an increased num- anterior region, the body of the clitoris is co- ber of receptors on its surface, which gives it vered by the foreskin, which leaves visible a special sensitivity, so that the longer it is the the clitoral gland with erectile spongy struc- more the arousal surface is larger and there- ture and which is very sensitive through tac- fore the woman’s erotic state is stronger. tile corpuscles; the clitoral erectile structures are considered similar to the corpus caverno- According to our statistics, the clitoris sum of the penis. provides the woman with the strongest ero- genous support, followed by the Vaginal Area Structurally, the clitoris consists of two of Hypereroticism (H). cavernous bodies of low volume, consisting of erectile tissue wrapped in a fibroelastic The sensory innervation of the clitoris is membrane, slightly extensible, called albugi- given by the dorsal nerve of the clitoris, the nea, which fixes the roots of the clitoris to the terminal branch of the internal pudendal ner- ischio-pubic bone branches. In its constituti- ve, which enters the body of the clitoris. on, there are two small muscles, that are the The dorsal nerve of the clitoris innerva- erector muscles of the clitoris, inserted on its tes the hood and clitoral mucosa, the upper root. part of the labia minora and the integuments The blood influx into the cavernous struc- of the anterior region of the labia majora, ex- tures, delimited by albuginea, increases the plaining the erogenous reaction of the labia local congestion and also the sensitivity of (as well as H area) to clitoral excitation, and vice versa. The dorsal nerve of the clitoris is Journal of Clinical Sexology - Vol. 3; No.3: July- September 2020 123 distally a nerve plexus. erectile tension. The body of the foreskin and the bulbo- The inner part of the vestibular bulbs has vestibular muscles also contain vegetative- upward relations with the terminal part of the vascular branches. The sympathetic fibers go urethra, then downwards with the inner face along with the pudendal nerve and the inter- of the labia minora and of the Bartholin’s nal pudendal artery that gives rise to the su- glands. The two vestibular bulbs join in front perficial and profound bulbar perineal bran- of the urethra through their anterior extre- ches, cavernous arteries and the dorsal artery mities, taking on the general appearance of of the clitoris which are analogous to the dor- a „horseshoe” with the concavity posteriorly. sal artery of the penis (Testut/Latarjet). The bulbar venous plexus anastomoses The parasympathetic fibers run parallel to with the veins of the clitoris. In the anteri- the pudendal artery, causing the erection of or region, a small venous plexus is formed structures, especially of the erectile tissue. between the vestibular bulbs and the clitoral gland called the „pars intermedia” (Kobelt). From the internal pudendal artery emer- ges the clitoral artery, then the cavernous and The vestibular bulbs, especially through dorsal artery of the clitoris (from the internal their posterior extremities which are more pudendal artery). voluminous, increase their size during erec- tion, participating in the determination of or- The venous system consists of the deep gasm together with the constrictor muscle of dorsal veins of the clitoris that go into the the vagina. bladder vascular plexus. The erectile tissue that forms the vestibular bulbs is connected to that of the vulvar erecti- le organs, forming an increased intensity ero- The vestibular bulbs tic area (clitoris, vestibular bulbs, inner face of the labiae, urethra and sub-urethral tissue They are cavernous erectile organs that with H area), explaining why the involvment contain a venous plexus covered by a thin of one of these elements determine the erecti- fibrous membrane. The vestibular bulbs are le tension of all of them. located on the sides of the opening of the vagina and urethra, which surround the base of the labia minora (Fig.1). On their exter- nal face, these structures are covered by the bulbous-cavernous muscles which, together The tactile corpuscles of volup- with the one on the opposite side, constitute tuousness the constrictor muscle of the vagina, which These structures are located on the inside narrows the vaginal ostium. part of the labia minora and near the vaginal entrance. In copulation, the excitability of the vul- va and the penis increases due to the greater On the hypertrophied vulva, performing adhesion of the two surfaces (penis-vulva, re- stimulating manual maneuvers on the sensi- spectively penis-vagina), by increasing their tive receptors of the internal surface of the 124 Journal of Clinical Sexology - Vol. 3; No.3: July- September 2020 Fig. 1 The vestibular bulbs (Adapted after Jamieson’s illustrations of regional anatomy) labia minora, which have a high sensitivity, (S2-S3-S4), to the vulvo-vaginal organs. respectively on the lubricated vulvar surface, The nervous impulse, through the pa- produces the orgasm, as it also occurs in the rasympathetic system, determines the vasodi- clitoral gland, respectively in the Hypererotic lation of the erectile vessels, by the discharge Zone of the Vagina (H). of nitric oxide from the epithelium, as well as The cavernous tissue of the clitoris is also by VIP release, through which the vasodilati- evident in the vascular system of the labia on is mediated (Netter). Acetylcholine blocks minora in women (Benson), explaining the noradrenergic vasoconstrictor mechanisms. rapidity of the zonal erection, necessary for Nitric oxide is the main neurotransmitter res- the existence of libido and copulation. ponsible for the vulvar congestion. The direct implication of the labial tacti- le corpuscles potentiates the state of vulvar The vaginal area of eroticism. hypereroticism (H area) In this context, the direct connection The vulvar erectile tissue and that of the between the erectile tissue of the clitoris, ves- Vaginal Area of Hypereroticism are control- tibular bulbs, urethral tissue, urethro-vaginal led by parasympathetic nerves, which reach, tissue and vascular plexus of H area determi- through the pelvic nerves of the sacral plexus Journal of Clinical Sexology - Vol. 3; No.3: July- September 2020 125 nes that the receptors of any of these above Hypervascularization of H area appears as mentioned structures stimulation to cause an additional factor for the utero-vaginal ca- the rapid erection of all the cavernous vul- vernous structure functionality, which acts on var structures, i.e.
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