This retrospective MRI study examined age-related differences in clitoral-vestibular bulb anatomy (dimensions, position, and shape) in 134 women aged 19–80 years, grouped as Young Adult (18–34), Early Midlife (35–49), and Older Adult (≥50), excluding those with pelvic floor disorders or abnormal pelvic anatomy.
Older Adult women had shorter clitoral body length vs. Early Midlife (24.1 mm vs. 27.9 mm; P=.006), smaller vestibular bulb volume with age (P=.04), and more caudal displacement of the clitoral-vestibular bulb complex vs. both younger groups (−21.0 mm vs. −17.6 mm and −17.9 mm; P<.001). Clitoral volume itself did not change with age (ρ=−0.03; P=.73). Vestibular bulbs became more medially positioned and proportionally smaller relative to the clitoris (both ρ=−0.28; P=.001).
- Retrospective design using MRI obtained for other medical indications, limiting generalizability. - Menopausal status was not independently controlled for, making it difficult to separate aging from hormonal effects (71% of Older Adults were postmenopausal). - Correlations were weak to moderate (ρ range: −0.20 to −0.43), suggesting age explains only a portion of anatomical variance.
Clinicians counseling women about age-related sexual or pelvic symptoms should be aware that the vestibular bulbs—not the clitoral glans volume—appear most vulnerable to atrophy and descent with aging. This structural shift may inform evaluation and treatment strategies for female sexual dysfunction across the lifespan.
