The initial or ischio-pubic segment of the dorsal nerve of the clitoris is the superior division branche of the pudendal nerve of which it extends the direction, thus remaining in the fibrous pudendal canal with the artery and pudendal veins. It should be noted that this dorsal nerve of the clitoris is difficult to release in this initial segment, where it is routed against the ischio-pubic branch, below the fascia of the obturator internus, above the insertions of the deep fascia (superior fascia) of the urogenital diaphragm. It provides, at this level, the nerve of the external sphincter of the urethra, which will cross the above-mentioned fascia to join the sphincter fibres in the deep space of the perineum. Beyond the pudendal canal, the dorsal nerve of the clitoris will cross the pudendal artery, which will be in the more medial position. It surfaces by crossing through the superior fascia of the urogenital diaphragm and penetrates the deep space of the perineum, where it becomes accessible for perineal dissection. It may then, depending on the situation, remain above the inferior fascia of the urogenital diaphragm or, on the other hand, resurface by crossing through this fascia (Fig. 8.1). This penetration has been the subject of recent studies (A. Vaze et al.): according to these authors, it is located, on average, at 2 cm, 7 from the external orifice of the urethra. In both cases, the nerve will continue its forward and inward diagonal route towards the inferior branch of the pubis, which shelters and protects it and to which it is closely connected. At the inferior edge of this branch, a more or less deep groove can be observed. This groove has been described by Sedy J et al. as follows: the groove of the dorsal nerve of the clitoris (nearly 70 % of cases) is more or less marked, 15.8 mm long on average and even extends, according to these authors, at the inferior part of the ventral surface of the pubis. According to Sedy, this protective groove, which contains the nerve (which is often covered with a fibrous tissue), is as important as the pudendal canal because, in some cases, such as the latter, it can be too narrow and become a site of nerve compression (for cyclists in particular!), the consequence being a “syndrome of the dorsal nerve” (slightly different from the “pudendal nerve entrapment syndrome” and involving evocative symptoms such as an erectile malfunction). In order to meet the clitoris, the nerve finally reaches the inferior edge of the body of the pubis and its very dense prepubic fibrous coating. More precisely, it appears in the lateral part of the infra-pubic region, in front of the transverse perineal ligament (Henlé’s or Krause’s ligament), below the caudal symphysis edge (inferior edge), coated with the significant fibrous layers of the arcuate pubic ligament (Lauth’s ligament). Therefore, the nerve is in a very dense fibrous atmosphere, on which no author has insisted (except for Hruby S. et al., who described it in men) and which, however, plays a major protection role. Each of the 2 nerves will be wrapped at this level, in an actual protective sheath, a fibrous sleeve (with smooth internal wall), formed by the numerous fibrous components which surround the infra-pubic region. In some cases, certain nerves are wrapped in a fibrous canal formed by the duplication of the arcuate pubic ligament or even in a tunnel duplicated from the pre-symphysis tissue. The incision of the most superficial lamina of this envelope releases the nerve, which then seems to sprout out from an actual fibrous cone (Fig. 8.2). It should be noted that the homologous pudendal artery is also well protected, inside an underlying fibrous sleeve. The above details can be perfectly well observed by slightly tilting the clitoris, released from its pubic attachments, ventrally and backwards (Fig. 8.2). The thin subpubic urethral plate, which spreads out laterally up to the 2 nerves (which can be observed by transparency) must also be resected (Fig. 13.​4).