{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,19]],"date-time":"2026-09-19T15:35:13Z","timestamp":1789832113271,"version":"4.0.1"},"reference-count":48,"publisher":"American Medical Association (AMA)","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Surg"],"published-print":{"date-parts":[[2025,4,1]]},"abstract":"<jats:sec id=\"ab-soi240107-4\"><jats:title>Importance<\/jats:title><jats:p>Transvaginal surgery is commonly performed to treat pelvic organ prolapse. Little research focuses on how sexual function relates to clitoral anatomy after vaginal surgery despite the clitoris\u2019 role in the sexual response.<\/jats:p><\/jats:sec><jats:sec id=\"ab-soi240107-5\"><jats:title>Objective<\/jats:title><jats:p>To determine how postoperative sexual function after vaginal surgery is associated with clitoral features (size, position, shape).<\/jats:p><\/jats:sec><jats:sec id=\"ab-soi240107-6\"><jats:title>Design, Setting, and Participants<\/jats:title><jats:p>This was a cross-sectional ancillary study of magnetic resonance imaging (MRI) data from the Defining Mechanisms of Anterior Vaginal Wall Descent (DEMAND) study. The setting comprised 8 clinical sites in the US Pelvic Floor Disorders Network and included the MRI data of 88 women with uterovaginal prolapse previously randomized to either vaginal mesh hysteropexy or vaginal hysterectomy with uterosacral ligament suspension between 2013 and 2015. Data were analyzed between September 2021 and June 2023.<\/jats:p><\/jats:sec><jats:sec id=\"ab-soi240107-7\"><jats:title>Exposures<\/jats:title><jats:p>Participants underwent postoperative pelvic MRI at 30 to 42 months (or earlier if reoperation was desired) between June 2014 and May 2018. Sexual activity and function at baseline (preoperatively) and 24- to 48-month follow-up (postoperatively) were assessed using the Pelvic Organ Prolapse\/Incontinence Sexual Questionnaire, International Urogynecological Association Revised (PISQ-IR). Clitoral features were derived from postoperative MRI-based 3-dimensional models.<\/jats:p><\/jats:sec><jats:sec id=\"ab-soi240107-8\"><jats:title>Main Outcomes and Measures<\/jats:title><jats:p>Correlations between (1) PISQ-IR mean, subscale, and item scores and (2) clitoral size, position, and shape (principal component scores).<\/jats:p><\/jats:sec><jats:sec id=\"ab-soi240107-9\"><jats:title>Results<\/jats:title><jats:p>A total of 82 women (median [range] age, 65 [47-79] years) were analyzed (41 received hysteropexy and 41 received hysterectomy). Postoperatively, 37 were sexually active (SA), and 45 were not SA (NSA). Among SA women, better overall postoperative sexual function (higher PISQ-IR summary score) correlated with a larger clitoral glans width (Spearman \u03c1\u2009=\u20090.37; 95% CI, 0.05-0.62; <jats:italic>P<\/jats:italic>\u2009=\u2009.03) and thickness (Spearman \u03c1\u2009=\u20090.38; 95% CI, 0.06-0.63; <jats:italic>P<\/jats:italic>\u2009=\u2009.02). Among NSA women, sexual inactivity related to postoperative dyspareunia correlated with a more lateral clitoral position (Spearman \u03c1 =\u20090.45; 95% CI, 0.18-0.66; <jats:italic>P<\/jats:italic>\u2009=\u2009.002), and sexual inactivity related to incontinence\/prolapse correlated with a more posterior clitoral position (Spearman \u03c1\u2009=\u2009\u22120.36; 95% CI, \u22120.60 to \u22120.07; <jats:italic>P<\/jats:italic>\u2009=\u2009.02) (farther from the pubic symphysis). Shape analysis demonstrated that poorer postoperative sexual function outcomes in SA women and sexual inactivity in NSA women correlated with a more posteriorly positioned glans, anteriorly oriented clitoral body, medially positioned crura, and lateral vestibular bulbs.<\/jats:p><\/jats:sec><jats:sec id=\"ab-soi240107-10\"><jats:title>Conclusions and Relevance<\/jats:title><jats:p>Results of this cross-sectional study suggest that postoperative sexual function after vaginal surgery was associated with clitoral glans size, position, and shape. Results warrant prospective studies on surgery-induced changes in clitoral anatomy and sexual function.<\/jats:p><\/jats:sec>","DOI":"10.1001\/jamasurg.2024.6922","type":"journal-article","created":{"date-parts":[[2025,2,12]],"date-time":"2025-02-12T16:00:55Z","timestamp":1739376055000},"page":"396","source":"Crossref","is-referenced-by-count":4,"title":["Postoperative Sexual Function After Vaginal Surgery and Clitoral Size, Position, and Shape"],"prefix":"10.1001","volume":"160","author":[{"given":"Shaniel T.","family":"Bowen","sequence":"first","affiliation":[{"name":"Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge"},{"name":"Department of Bioengineering, University of Pittsburgh, Pittsburgh, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pamela A.","family":"Moalli","sequence":"additional","affiliation":[{"name":"Department of Bioengineering, University of Pittsburgh, Pittsburgh, Pennsylvania"},{"name":"Division of Urogynecology and Reconstructive Pelvic Surgery, Magee-Womens Hospital of the University of Pittsburgh, Pittsburgh, Pennsylvania"},{"name":"Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rebecca G.","family":"Rogers","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Albany Medical Center, Albany, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marlene M.","family":"Corton","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Uduak U.","family":"Andy","sequence":"additional","affiliation":[{"name":"Division of Urogynecology and Pelvic Reconstructive Surgery, University of Pennsylvania, Philadelphia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Charles R.","family":"Rardin","sequence":"additional","affiliation":[{"name":"Division of Urogynecology, Alpert Medical School of Brown University, Providence, Rhode Island"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael E.","family":"Hahn","sequence":"additional","affiliation":[{"name":"Department of Radiology, University of California, San Diego, La Jolla"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alison C.","family":"Weidner","sequence":"additional","affiliation":[{"name":"Division of Urogynecology, Department of Obstetrics & Gynecology, Duke University, Durham, North Carolina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David R.","family":"Ellington","sequence":"additional","affiliation":[{"name":"Division of Urogynecology and Pelvic Reconstructive Surgery, University of Alabama at Birmingham, Birmingham"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Donna","family":"Mazloomdoost","sequence":"additional","affiliation":[{"name":"Gynecologic Health and Disease Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amaanti","family":"Sridhar","sequence":"additional","affiliation":[{"name":"Social, Statistical, and Environmental Sciences, RTI International, Research Triangle Park, North Carolina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marie G.","family":"Gantz","sequence":"additional","affiliation":[{"name":"Social, Statistical, and Environmental Sciences, RTI International, Research Triangle Park, North Carolina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"NICHD Pelvic Floor Disorders Network","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kimberly","family":"Ferrante","sequence":"additional","affiliation":[{"name":"for the NICHD Pelvic Floor Disorders Network"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sherella","family":"Johnson","sequence":"additional","affiliation":[{"name":"for the NICHD Pelvic Floor Disorders Network"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emily S.","family":"Lukacz","sequence":"additional","affiliation":[{"name":"for the NICHD Pelvic Floor Disorders Network"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Charles W.","family":"Nager","sequence":"additional","affiliation":[{"name":"for the NICHD Pelvic Floor Disorders Network"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gouri B.","family":"Diwadkar","sequence":"additional","affiliation":[{"name":"for the NICHD Pelvic Floor Disorders Network"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Keisha Y.","family":"Dyer","sequence":"additional","affiliation":[{"name":"for the NICHD Pelvic Floor Disorders Network"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Linda M.","family":"Mackinnon","sequence":"additional","affiliation":[{"name":"for the NICHD Pelvic Floor Disorders Network"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jasmine","family":"Tan-Kim","sequence":"additional","affiliation":[{"name":"for the NICHD Pelvic Floor Disorders Network"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gisselle","family":"Zazueta-Damian","sequence":"additional","affiliation":[{"name":"for the NICHD Pelvic Floor Disorders Network"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cindy","family":"Amundsen","sequence":"additional","affiliation":[{"name":"for the NICHD Pelvic Floor Disorders Network"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yasmeen","family":"Bruton","sequence":"additional","affiliation":[{"name":"for the NICHD Pelvic Floor Disorders Network"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Notorious","family":"Coleman-Taylor","sequence":"additional","affiliation":[{"name":"for the NICHD Pelvic Floor Disorders Network"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amie","family":"Kawasaki","sequence":"additional","affiliation":[{"name":"for the NICHD Pelvic Floor Disorders Network"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicole","family":"Longoria","sequence":"additional","affiliation":[{"name":"for the NICHD Pelvic Floor Disorders Network"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shantae","family":"McLean","sequence":"additional","affiliation":[{"name":"for the NICHD Pelvic Floor Disorders Network"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nazema","family":"Siddiqui","sequence":"additional","affiliation":[{"name":"for the NICHD Pelvic Floor Disorders Network"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kathy","family":"Carter","sequence":"additional","affiliation":[{"name":"for the NICHD Pelvic Floor Disorders Network"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark E.","family":"Lockhart","sequence":"additional","affiliation":[{"name":"for the NICHD Pelvic Floor Disorders Network"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sunita","family":"Patel","sequence":"additional","affiliation":[{"name":"for the NICHD Pelvic Floor Disorders Network"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Holly E.","family":"Richter","sequence":"additional","affiliation":[{"name":"for the NICHD Pelvic Floor Disorders Network"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nancy","family":"Saxon","sequence":"additional","affiliation":[{"name":"for the NICHD Pelvic Floor Disorders Network"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Velria B.","family":"Willis","sequence":"additional","affiliation":[{"name":"for the NICHD Pelvic Floor Disorders Network"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cassandra","family":"Carberry","sequence":"additional","affiliation":[{"name":"for the NICHD Pelvic Floor Disorders Network"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brittany S.","family":"Hampton","sequence":"additional","affiliation":[{"name":"for the NICHD Pelvic Floor Disorders Network"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicole","family":"Korbly","sequence":"additional","affiliation":[{"name":"for the NICHD Pelvic Floor Disorders Network"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ann S.","family":"Meers","sequence":"additional","affiliation":[{"name":"for the NICHD Pelvic Floor Disorders Network"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Deborah L.","family":"Myers","sequence":"additional","affiliation":[{"name":"for the NICHD Pelvic Floor Disorders Network"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vivian W.","family":"Sung","sequence":"additional","affiliation":[{"name":"for the NICHD Pelvic Floor Disorders Network"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kyle","family":"Wohlrab","sequence":"additional","affiliation":[{"name":"for the NICHD Pelvic Floor Disorders Network"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gena","family":"Dunivan","sequence":"additional","affiliation":[{"name":"for the NICHD Pelvic Floor Disorders Network"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuko","family":"Komesu","sequence":"additional","affiliation":[{"name":"for the NICHD Pelvic Floor Disorders Network"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter","family":"Jeppson","sequence":"additional","affiliation":[{"name":"for the NICHD Pelvic Floor Disorders Network"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lily","family":"Arya","sequence":"additional","affiliation":[{"name":"for the NICHD Pelvic Floor Disorders Network"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lorraine","family":"Flick","sequence":"additional","affiliation":[{"name":"for the NICHD Pelvic Floor Disorders Network"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Heidi","family":"Harvie","sequence":"additional","affiliation":[{"name":"for the NICHD Pelvic Floor Disorders Network"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michelle","family":"Kinglee","sequence":"additional","affiliation":[{"name":"for the NICHD Pelvic Floor Disorders Network"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ariana","family":"Smith","sequence":"additional","affiliation":[{"name":"for the NICHD Pelvic Floor Disorders Network"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Steven D.","family":"Abramowitch","sequence":"additional","affiliation":[{"name":"for the NICHD Pelvic Floor Disorders Network"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Bonidie","sequence":"additional","affiliation":[{"name":"for the NICHD Pelvic Floor Disorders Network"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Judy","family":"Gruss","sequence":"additional","affiliation":[{"name":"for the NICHD Pelvic Floor Disorders Network"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonathan","family":"Shepherd","sequence":"additional","affiliation":[{"name":"for the NICHD Pelvic Floor Disorders Network"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gary","family":"Sutkin","sequence":"additional","affiliation":[{"name":"for the NICHD Pelvic Floor Disorders Network"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Halina M.","family":"Zyczynski","sequence":"additional","affiliation":[{"name":"for the NICHD Pelvic Floor Disorders Network"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthew","family":"Barber","sequence":"additional","affiliation":[{"name":"for the NICHD Pelvic Floor Disorders Network"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Annette","family":"Graham","sequence":"additional","affiliation":[{"name":"for the NICHD Pelvic Floor Disorders Network"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marie Fidela R.","family":"Paraiso","sequence":"additional","affiliation":[{"name":"for the NICHD Pelvic Floor Disorders Network"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cecile","family":"Ferrando","sequence":"additional","affiliation":[{"name":"for the NICHD Pelvic Floor Disorders Network"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kate","family":"Burdekin","sequence":"additional","affiliation":[{"name":"for the NICHD Pelvic Floor Disorders Network"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Ham","sequence":"additional","affiliation":[{"name":"for the NICHD Pelvic Floor Disorders Network"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amanda","family":"Shaffer","sequence":"additional","affiliation":[{"name":"for the NICHD Pelvic Floor Disorders Network"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dennis","family":"Wallace","sequence":"additional","affiliation":[{"name":"for the NICHD Pelvic Floor Disorders Network"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ryan","family":"Whitworth","sequence":"additional","affiliation":[{"name":"for the NICHD Pelvic Floor Disorders Network"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Taylor","family":"Swankie","sequence":"additional","affiliation":[{"name":"for the NICHD Pelvic Floor Disorders Network"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"10","reference":[{"issue":"5","key":"soi240107r1","doi-asserted-by":"publisher","first-page":"1455","DOI":"10.1016\/j.ajog.2006.01.060","article-title":"Women seeking treatment for advanced pelvic organ prolapse have decreased body image and quality of life.","volume":"194","author":"Jelovsek","year":"2006","journal-title":"Am J Obstet Gynecol"},{"issue":"11","key":"soi240107r2","doi-asserted-by":"publisher","first-page":"1311","DOI":"10.1001\/jama.300.11.1311","article-title":"Prevalence of symptomatic pelvic floor disorders in US women.","volume":"300","author":"Nygaard","year":"2008","journal-title":"JAMA"},{"issue":"8","key":"soi240107r3","doi-asserted-by":"publisher","first-page":"2286","DOI":"10.1111\/j.1743-6109.2009.01329.x","article-title":"Sexual function is related to body image perception in women with pelvic organ prolapse.","volume":"6","author":"Lowenstein","year":"2009","journal-title":"J Sex Med"},{"issue":"8","key":"soi240107r4","doi-asserted-by":"publisher","first-page":"919","DOI":"10.1007\/s00192-010-1141-1","article-title":"Body image in women before and after reconstructive surgery for pelvic organ prolapse.","volume":"21","author":"Lowder","year":"2010","journal-title":"Int Urogynecol J"},{"issue":"6","key":"soi240107r5","doi-asserted-by":"publisher","first-page":"1201","DOI":"10.1097\/AOG.0000000000000286","article-title":"Lifetime risk of stress urinary incontinence or pelvic organ prolapse surgery.","volume":"123","author":"Wu","year":"2014","journal-title":"Obstet Gynecol"},{"issue":"10","key":"soi240107r6","doi-asserted-by":"publisher","first-page":"1023","DOI":"10.1001\/jama.2014.1719","article-title":"Comparison of 2 transvaginal surgical approaches and perioperative behavioral therapy for apical vaginal prolapse: the OPTIMAL randomized trial.","volume":"311","author":"Barber","year":"2014","journal-title":"JAMA"},{"issue":"1","key":"soi240107r7","doi-asserted-by":"publisher","first-page":"0033","DOI":"10.1089\/gyn.2022.0033","article-title":"Transvaginal approach to surgery for pelvic organ prolapse.","volume":"39","author":"Vargas Maldonado","year":"2022","journal-title":"J Gynecol Surg"},{"issue":"1","key":"soi240107r8","doi-asserted-by":"publisher","first-page":"152","DOI":"10.1097\/01.AOG.0000297309.25091.a0","article-title":"The role of apical vaginal support in the appearance of anterior and posterior vaginal prolapse.","volume":"111","author":"Lowder","year":"2008","journal-title":"Obstet Gynecol"},{"issue":"2","key":"soi240107r9","first-page":"251","article-title":"Significance of restoration of normal vaginal depth and axis.","volume":"36","author":"Nichols","year":"1970","journal-title":"Obstet Gynecol"},{"issue":"9","key":"soi240107r10","doi-asserted-by":"publisher","first-page":"531","DOI":"10.1038\/nrurol.2014.193","article-title":"Beyond the G-spot: clitourethrovaginal complex anatomy in female orgasm.","volume":"11","author":"Jannini","year":"2014","journal-title":"Nat Rev Urol"},{"issue":"7","key":"soi240107r11","doi-asserted-by":"publisher","first-page":"1559","DOI":"10.1111\/j.1743-6109.2008.00839.x","article-title":"Magnetic resonance imaging and the female sexual response: overview of techniques, results, and future directions.","volume":"5","author":"Maravilla","year":"2008","journal-title":"J Sex Med"},{"issue":"2","key":"soi240107r12","doi-asserted-by":"publisher","first-page":"439","DOI":"10.1016\/S0022-5347(05)00168-0","article-title":"Female sexual dysfunction following vaginal surgery: a review.","volume":"175","author":"Tunuguntla","year":"2006","journal-title":"J Urol"},{"issue":"6","key":"soi240107r13","doi-asserted-by":"publisher","first-page":"622.e1","DOI":"10.1016\/j.ajog.2007.08.014","article-title":"Sexual function after vaginal surgery for pelvic organ prolapse and urinary incontinence.","volume":"197","author":"Pauls","year":"2007","journal-title":"Am J Obstet Gynecol"},{"issue":"6","key":"soi240107r14","doi-asserted-by":"publisher","first-page":"1071","DOI":"10.1097\/AOG.0000000000001442","article-title":"Quality of life and sexual function 2 years after vaginal surgery for prolapse.","volume":"127","author":"Lukacz","year":"2016","journal-title":"Obstet Gynecol"},{"issue":"3","key":"soi240107r15","doi-asserted-by":"publisher","first-page":"213","DOI":"10.1016\/j.sxmr.2016.02.002","article-title":"Surgical management for pelvic organ prolapse and its impact on sexual function.","volume":"4","author":"Thompson","year":"2016","journal-title":"Sex Med Rev"},{"issue":"2","key":"soi240107r16","doi-asserted-by":"publisher","first-page":"213","DOI":"10.1016\/j.jsxm.2015.12.006","article-title":"The Impact of sacrospinous hysteropexy and vaginal hysterectomy with suspension of the uterosacral ligaments on sexual function in women with uterine prolapse: a secondary analysis of a randomized comparative study.","volume":"13","author":"Detollenaere","year":"2016","journal-title":"J Sex Med"},{"issue":"1","key":"soi240107r17","first-page":"41","article-title":"Clitoral size in normal women.","volume":"80","author":"Verkauf","year":"1992","journal-title":"Obstet Gynecol"},{"issue":"4 part 1","key":"soi240107r18","doi-asserted-by":"publisher","first-page":"1189","DOI":"10.1097\/01.ju.0000173639.38898.cd","article-title":"Anatomy of the clitoris.","volume":"174","author":"O\u2019Connell","year":"2005","journal-title":"J Urol"},{"issue":"6","key":"soi240107r19","doi-asserted-by":"publisher","first-page":"2060","DOI":"10.1097\/01.ju.0000158446.21396.c0","article-title":"Clitoral anatomy in nulliparous, healthy, premenopausal volunteers using unenhanced magnetic resonance imaging.","volume":"173","author":"O\u2019Connell","year":"2005","journal-title":"J Urol"},{"issue":"1","key":"soi240107r20","doi-asserted-by":"publisher","first-page":"180","DOI":"10.1016\/j.ejogrb.2014.02.024","article-title":"Female sexual function and the clitoral complex using pelvic MRI assessment.","volume":"180","author":"Vaccaro","year":"2014","journal-title":"Eur J Obstet Gynecol Reprod Biol"},{"issue":"4","key":"soi240107r21","doi-asserted-by":"publisher","first-page":"1013","DOI":"10.1111\/jsm.12450","article-title":"Clitoral size and location in relation to sexual function using pelvic MRI.","volume":"11","author":"Oakley","year":"2014","journal-title":"J Sex Med"},{"issue":"5","key":"soi240107r22","doi-asserted-by":"publisher","first-page":"519.e1","DOI":"10.1016\/j.ajog.2019.06.048","article-title":"Anatomy, histology, and nerve density of clitoris and associated structures: clinical applications to vulvar surgery.","volume":"221","author":"Jackson","year":"2019","journal-title":"Am J Obstet Gynecol"},{"issue":"1","key":"soi240107r23","doi-asserted-by":"publisher","first-page":"32578","DOI":"10.3402\/snp.v6.32578","article-title":"The whole vs the sum of some of the parts: toward resolving the apparent controversy of clitoral vs vaginal orgasms.","volume":"6","author":"Pfaus","year":"2016","journal-title":"Socioaffect Neurosci Psychol"},{"key":"soi240107r24","doi-asserted-by":"publisher","DOI":"10.5402\/2011\/261464","article-title":"Anatomy of the clitoris: revision and clarifications about the anatomical terms for the clitoris proposed (without scientific bases) by Helen O\u2019Connell, Emmanuele Jannini, and Odile Buisson.","volume":"2011","author":"Puppo","year":"2011","journal-title":"ISRN Obstet Gynecol"},{"issue":"3","key":"soi240107r25","doi-asserted-by":"publisher","first-page":"376","DOI":"10.1002\/ca.22524","article-title":"Anatomy of the clitoris and the female sexual response.","volume":"28","author":"Pauls","year":"2015","journal-title":"Clin Anat"},{"issue":"4","key":"soi240107r26","doi-asserted-by":"publisher","first-page":"245","DOI":"10.1002\/smrj.61","article-title":"A comprehensive review of the clitoris and its role in female sexual function.","volume":"3","author":"Mazloomdoost","year":"2015","journal-title":"Sex Med Rev"},{"issue":"5","key":"soi240107r27","doi-asserted-by":"publisher","first-page":"506.e1","DOI":"10.1016\/j.ajog.2021.05.041","article-title":"Defining mechanisms of recurrence following apical prolapse repair based on imaging criteria.","volume":"225","author":"Bowen","year":"2021","journal-title":"Am J Obstet Gynecol"},{"issue":"11","key":"soi240107r28","doi-asserted-by":"publisher","first-page":"1054","DOI":"10.1001\/jama.2019.12812","article-title":"Effect of vaginal mesh hysteropexy vs vaginal hysterectomy with uterosacral ligament suspension on treatment failure in women with uterovaginal prolapse: a randomized clinical trial.","volume":"322","author":"Nager","year":"2019","journal-title":"JAMA"},{"issue":"4","key":"soi240107r29","doi-asserted-by":"publisher","first-page":"809","DOI":"10.1007\/s00192-020-04511-1","article-title":"Methods for the Defining Mechanisms of Anterior Vaginal Wall Descent (DEMAND) study.","volume":"32","author":"Moalli","year":"2021","journal-title":"Int Urogynecol J"},{"issue":"9","key":"soi240107r30","doi-asserted-by":"publisher","first-page":"1323","DOI":"10.1016\/j.mri.2012.05.001","article-title":"3-D slicer as an image computing platform for the Quantitative Imaging Network.","volume":"30","author":"Fedorov","year":"2012","journal-title":"Magn Reson Imaging"},{"key":"soi240107r31","doi-asserted-by":"publisher","DOI":"10.1016\/j.cmpb.2021.106175","article-title":"The establishment of a 3-D anatomical coordinate system for defining vaginal axis and spatial position.","volume":"208","author":"Sinex","year":"2021","journal-title":"Comput Methods Programs Biomed"},{"issue":"6","key":"soi240107r32","doi-asserted-by":"publisher","first-page":"1649","DOI":"10.1007\/s00192-022-05172-y","article-title":"3-D quantitative analysis of normal clitoral anatomy in nulliparous women by MRI.","volume":"33","author":"Bowen","year":"2022","journal-title":"Int Urogynecol J"},{"issue":"7","key":"soi240107r33","doi-asserted-by":"publisher","first-page":"1461","DOI":"10.1007\/s10439-023-03150-z","article-title":"Morphological variation in the pelvic floor muscle complex of nulliparous, pregnant, and parous women.","volume":"51","author":"Routzong","year":"2023","journal-title":"Ann Biomed Eng"},{"issue":"4","key":"soi240107r35","doi-asserted-by":"publisher","DOI":"10.1117\/1.JMI.11.4.045001","article-title":"Improving radiological quantification of levator hiatus features with measures informed by statistical shape modeling.","volume":"11","author":"Vargo","year":"2024","journal-title":"J Med Imaging (Bellingham)"},{"issue":"2","key":"soi240107r36","doi-asserted-by":"publisher","first-page":"122","DOI":"10.1080\/10255842.2020.1813281","article-title":"Statistical shape modeling of the pelvic floor to evaluate women with obstructed defecation symptoms.","volume":"24","author":"Routzong","year":"2021","journal-title":"Comput methods Biomech Biomed Engin"},{"issue":"7","key":"soi240107r37","doi-asserted-by":"publisher","first-page":"1091","DOI":"10.1007\/s00192-012-2020-8","article-title":"A new measure of sexual function in women with pelvic floor disorders (PFD): the Pelvic Organ Prolapse\/Incontinence Sexual Questionnaire, IUGA Revised (PISQ-IR).","volume":"24","author":"Rogers","year":"2013","journal-title":"Int Urogynecol J"},{"issue":"12","key":"soi240107r38","doi-asserted-by":"publisher","first-page":"1901","DOI":"10.1007\/s00192-017-3373-9","article-title":"Validation of a single summary score for the Prolapse\/Incontinence Sexual Questionnaire, IUGA Revised (PISQ-IR).","volume":"28","author":"Constantine","year":"2017","journal-title":"Int Urogynecol J"},{"issue":"2","key":"soi240107r39","doi-asserted-by":"publisher","first-page":"226","DOI":"10.1016\/j.jsxm.2015.12.023","article-title":"Sexual anatomy and function in women with and without genital mutilation: a cross-sectional study.","volume":"13","author":"Abdulcadir","year":"2016","journal-title":"J Sex Med"},{"issue":"5","key":"soi240107r40","doi-asserted-by":"publisher","first-page":"780","DOI":"10.1016\/j.yhbeh.2010.12.004","article-title":"Female sexual arousal: genital anatomy and orgasm in intercourse.","volume":"59","author":"Wallen","year":"2011","journal-title":"Horm Behav"},{"issue":"5","key":"soi240107r41","doi-asserted-by":"publisher","first-page":"390","DOI":"10.28982\/josam.727165","article-title":"Relationship of orgasm with measurable dimensions of clitoris and visibility of clitoral glans.","volume":"4","author":"Pulatoglu","year":"2020","journal-title":"J Surg Med"},{"issue":"3","key":"soi240107r42","doi-asserted-by":"crossref","first-page":"610","DOI":"10.1111\/j.1743-6109.2007.00739.x","article-title":"Measurement of the thickness of the urethrovaginal space in women with or without vaginal orgasm.","volume":"5","author":"Gravina","year":"2008","journal-title":"J Sex Med"},{"issue":"6","key":"soi240107r43","doi-asserted-by":"crossref","first-page":"397","DOI":"10.1002\/1098-2353(2000)13:6<397::AID-CA1>3.0.CO;2-2","article-title":"The suspensory ligament of the clitoris: connective tissue supports of the erectile tissues of the female urogenital region.","volume":"13","author":"Rees","year":"2000","journal-title":"Clin Anat"},{"issue":"1","key":"soi240107r44","doi-asserted-by":"crossref","first-page":"12","DOI":"10.1016\/j.jsxm.2021.10.002","article-title":"The suspensory ligament of the clitoris: a new anatomical and histological description.","volume":"19","author":"Botter","year":"2022","journal-title":"J Sex Med"},{"issue":"1","key":"soi240107r45","doi-asserted-by":"crossref","first-page":"84","DOI":"10.1353\/pbm.2008.0012","article-title":"From body to brain: considering the neurobiological effects of female genital cutting.","volume":"51","author":"Einstein","year":"2008","journal-title":"Perspect Biol Med"},{"issue":"5","key":"soi240107r46","doi-asserted-by":"crossref","first-page":"643","DOI":"10.1111\/j.1471-0528.2004.00517.x","article-title":"Female genital appearance: normality unfolds.","volume":"112","author":"Lloyd","year":"2005","journal-title":"BJOG"},{"issue":"2","key":"soi240107r47","first-page":"183","article-title":"The gynecology of childhood and adolescence.","volume":"136","author":"Kreutner","year":"1982","journal-title":"Am J Dis Child"},{"issue":"3","key":"soi240107r48","doi-asserted-by":"crossref","first-page":"175","DOI":"10.4274\/tjod.galenos.2020.89896","article-title":"Do external female genital measurements affect genital perception and sexual function and orgasm?","volume":"17","author":"Ellibes Kaya","year":"2020","journal-title":"Turk J Obstet Gynecol"},{"key":"soi240107r34","first-page":"3","volume-title":"Lecture Notes in Computer Science (Including Subseries Lecture Notes in Artificial Intelligence and Lecture Notes in Bioinformatics)","author":"B\u00f4ne","year":"2018"}],"container-title":["JAMA Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/jamanetwork.com\/journals\/jamasurgery\/articlepdf\/2830135\/jamasurgery_bowen_2025_oi_240107_1743603975.42747.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,4,9]],"date-time":"2025-04-09T15:01:02Z","timestamp":1744210862000},"score":1,"resource":{"primary":{"URL":"https:\/\/jamanetwork.com\/journals\/jamasurgery\/fullarticle\/2830135"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,4,1]]},"references-count":48,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2025,4,1]]}},"URL":"https:\/\/doi.org\/10.1001\/jamasurg.2024.6922","relation":{},"ISSN":["2168-6254"],"issn-type":[{"value":"2168-6254","type":"print"}],"subject":[],"published":{"date-parts":[[2025,4,1]]}}}