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![1 Anatomy of the CUV complex. Schematic representation of the external and internal clitoris and the vaginal opening. The insert, an anterior vaginal wall obtained from a cadaver [15, 21], represent the intimate relationships between all the different anatomical structures involved in the female sexual pleasure. (See plate section for color representation of the figure)](profile/Barry-Komisaruk/publication/324578379/figure/fig1/AS:631991238160384@1527689861367/Anatomy-of-the-CUV-complex-Schematic-representation-of-the-external-and-internal.png)
1 Anatomy of the CUV complex. Schematic representation of the external and internal clitoris and the vaginal opening. The insert, an anterior vaginal wall obtained from a cadaver [15, 21], represent the intimate relationships between all the different anatomical structures involved in the female sexual pleasure. (See plate section for color representation of the figure)
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![Table 13 .1 Histological findings in clitoris and vagina [8].](profile/Barry-Komisaruk/publication/324578379/figure/tbl1/AS:668540227026957@1536403819857/1-Histological-findings-in-clitoris-and-vagina-8_Q320.jpg)
The clitoris and the clito‐urethro‐vaginal complex are responsive to ovarian hormones and are the main peripheral structures that, with significant individual differences, provide the genital peripheral afferent component of female sexual pleasure. In the central nervous system during orgasm, essentially all of the major brain systems are activated...
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To provide baseline data for the anatomy of the external female genitalia and to investigate the correlation between those measurements and sexual function and genital perception.
Materials and methods:
This prospective cohort study consisted of 208 healthy premenopausal women. The Female Sexual Function index (FSFI) and the Female Ge...
This chapter will give more insights into the anatomical, endocrinological and physiological aspects of (female) sexual functioning. And, although less extensively, also on aspects of relevant male sexual functioning. There are many similarities between (elements of) female sexuality and pregnancy. The physical expressions of female sexual arousal...
Background
Surgery for clitoral reduction has been practised for over half a century. The aim of clitoral surgery is to achieve normal clitoral morphology without compromising sexual function. To achieve these purposes, many techniques were developed since Young first reported reduction clitoroplasty in 1937. As the importance of the neurovascular...
Background:. Current male-to-female (MtF) sex-reassignment-surgery techniques have not been fully successful to achieve the ideal objectives. The ordeal of multiple procedures, associated complications, and suboptimal results leads to high rate of dissatisfaction. We have tried to overcome functional inadequacy and address the esthetic issues for o...
Citations
... Concerning the urethra and its surrounding exocrine glands, it is purported to be responsible for the secretions released during the peak of female arousal states. Specifically, the microscopic distal urethral glands, also known as Skene's or paraurethral glands, are the claimed source for this milky fluid, which is then released by the small and short ducts that drain via the urethra; the finding of specific markers of prostatic tissue such as prostate-specific antigen (PSA), type 5 phosphodiesterase (PDE5) [53] and other markers such as chromogranin and nitric oxide (NO) synthases (NOS) [54,55] in this "milky fluid" seem to have confirmed this theory, although the recognition of the "prostate foeminina" [2] is still not unanimously accepted. Nevertheless, a sort of vestigial "prostatic" tissue was found in around 90% of women [56], localized in the urethra, approximately 10% of it around the area of the bladder sphincter but the main part of the tissue being in the more distal urethra in 66% of women [57]. ...
In the field of female sexuality, the existence of the so-called “G-spot” represents a topic still anchored to anecdotes and opinions and explained using non-scientific points, as well as being overused for commercial and mediatic purposes.
Purpose of Review
The scope of this review is to give an update on the current state of information regarding the G-spot and suggesting potential future directions in the research field of this interesting, albeit controversial, aspect of human sexual physiology.
Recent Findings
From evolutionary, anatomical, and functional points of view, new evidence has rebutted the original conceptualization of the G-spot, abandoning the idea of a specific anatomical point able to produce exceptional orgasmic experiences through the stimulation of the anterior vaginal wall, the site where the G-spot is assumed to be. From a psychological perspective, only few findings to date are able to describe the psychological, behavioral, and social correlates of the pleasure experience by G-spot-induced or, better, vaginally induced orgasm (VAO).
Summary
Recent literature suggests the existence of a G-spot but specifies that, since it is not a spot, neither anatomically nor functionally, it cannot be called G, nor spot, anymore. It is indeed a functional, dynamic, and hormone-dependent area (called clitorourethrovaginal, CUV, complex), extremely individual in its development and action due to the combined influence of biological and psychological aspects, which may trigger VAO and in some particular cases also female ejaculation (FE).
... Coital orgasm without the direct stimulation of the clitoris (often named vaginal orgasm) and is a matter of controversy. Unlike previously thought, recent studies show physiological differences between vaginal and clitoral orgasm (Brody, 2017;Jannini et al., 2019;Jannini et al., 2012). Many women report to not attain vaginal orgasm at all or on a regular basis, which makes it an intriguing subject. ...
Associations between Big Five personality traits and sexual function
have been reported by many studies. Additionally, temporary alterations of consciousness influence sexual functioning. The present study examined how sexual responsiveness is independently associated with Big Five Personality traits and intensity
of awareness of body, time, and surrounding space. One hundred thirty six heterosexual Portuguese women answered an online survey. Big Five personality traits were measured by the NEO-FFI-20. To assess responsiveness during the last sexual intercourse, participants completed measures on sexual satisfaction, desire, arousal, and
orgasm occurrence, as well as awareness of body, space and time. Satisfaction and orgasm were associated to higher extraversion, higher conscientiousness, and lower neuroticism. Desire and arousal correlated with higher extraversion and lower neuroticism. Greater body awareness and lesser time awareness correlated with satisfaction, desire, and arousal. Body awareness was inversely related to time awareness. Satisfaction was independently predicted by body awareness, being in a relationship, extraversion, openness to experience, and conscientiousness. Desire was independently predicted by body awareness and lower neuroticism. Arousal was
independently predicted by body awareness, openness to experience, and lower neuroticism. The findings provide knowledge on how sexual responsiveness might be independently influenced by stable personality factors and transient changes of consciousness.
... Vaginal orgasm is a controversial subject with many women reporting that have difficulties attaining orgasm by penile-vaginal intercourse alone (Jannini et al., 2012). More recent research has been suggesting that there are physiological differences between orgasm by vaginal penetration and orgasm by stimulating the clitoral gland (Brody, 2017;Jannini et al., 2012;Jannini et al., 2019). Future research is need to clarify if vaginal orgasm is more likely to happen during exceptional states of consciousness, and this makes it more infrequent. ...
... Future research is need to clarify if vaginal orgasm is more likely to happen during exceptional states of consciousness, and this makes it more infrequent. According to a study almost all women (95%) reports that clitoral stimulation contributes to their orgasms, while only 65% report that vaginal stimulation contributes to orgasm, and even less (35%) report that cervical stimulation contributes to orgasm (Jannini et al., 2019). Interestingly, orgasms elicited by cervical stimulation were described in more abstract manners that are reminiscent of ASC, such as provoking "showers of stars" or "images of universal spaciousness" (Jannini et al., 2019) In the study by Costa and colleagues (2016a), occurrence of vaginal orgasm was related to greater changes in the perception of time than noncoital orgasms or coital orgasms with clitoral masturbation. ...
... According to a study almost all women (95%) reports that clitoral stimulation contributes to their orgasms, while only 65% report that vaginal stimulation contributes to orgasm, and even less (35%) report that cervical stimulation contributes to orgasm (Jannini et al., 2019). Interestingly, orgasms elicited by cervical stimulation were described in more abstract manners that are reminiscent of ASC, such as provoking "showers of stars" or "images of universal spaciousness" (Jannini et al., 2019) In the study by Costa and colleagues (2016a), occurrence of vaginal orgasm was related to greater changes in the perception of time than noncoital orgasms or coital orgasms with clitoral masturbation. ...
Sexual intercourse alters normal waking consciousness. Altered states of consciousness (ASC) refer to marked deviations from usual waking consciousness, and include alterations in the sense of self, attention, thought processes, time awareness and sensory perception. Sex can induce ASC, as indicated by states of attentional absorption in bodily sensations concomitant with loss of time awareness. The present study aimed at testing if, during sexual relations, higher sexual responsiveness relates to higher intensity of dimensions of ASC that can occur in other contexts, such as meditation or use of psychoactive substances. The personality trait of absorption appears to reflect individual differences in the proclivity to experience ASC; thus, a second aim was to examine if trait absorption relates to intensity of ASC during sex. The international sample consisted of 448 participants (303 women, 145 men). Sex-induced ASC were measured with four sub-scales of The Altered States of Consciousness Rating Scale (OAV): Experience of Unity, Spiritual Experience, Blissful State and Insightfulness. Trait absorption was measured by the Modified Tellegen Absorption Scale (MODTAS). Sexual responsiveness during the last intercourse was assessed by the sum of measures of arousal, desire, and satisfaction, as well as by questions on the occurrence of orgasm from different sexual activities. Trait absorption and sexual responsiveness predicted independently all dimensions of ASC among women and men. In women, vaginal orgasm (during vaginal intercourse without concomitant clitoral masturbation) was an additional independent predictor of ASC. Male orgasm related to ASC, but not independently from other aspects of sexual responsiveness.
... La amígdala proporciona el componente emocional al orgasmo y, además, conjuntamente con el hipotálamo posterior activa al sistema nervioso autónomo, que induce el aumento de la frecuencia cardíaca y del flujo sanguíneo, característicos del orgasmo. Sin embargo, el hipocampo es el responsable del papel de la fantasía en el orgasmo, mientras que el núcleo paraventral del hipotálamo es indispensable para la liberación de oxitocina y la eyaculación (Jannini et al, 2018). ...
... El cerebelo también se activa, tanto en el orgasmo de la hembra como del varón, incrementando la tensión muscular, Por otra parte, la corteza de la cíngula se activa fuertemente en el orgasmo y presenta dos funciones importantes: una simulación para activar el sistema nervioso autónomo y, además, generar los sentimientos intensos del orgasmo (Jannini et al, 2018). ...
... 3ª época. Año 11 N° 30, 2020 Andrés Reyes et al. /// Biopsicosociología del orgasmo en el varón y en la hembra …396-414 406 actividad en la corteza orbitofrontal, lo cual representaría la desinhibición conductual, como también del córtex temporal inferior, que está asociado con el incremento de la excitación sexual (Jannini et al, 2018;Georgiadis et al, 2016). Debido a la activación exagerada de la cíngula anterior, las manifestaciones autonómicas del orgasmo en la hembra se presentan con doble magnitud, debido a una intensa activación de la vía simpática (Jannini et al, 2018). ...
La respuesta sexual se encuentra mediada por factores anatomo-hormono-neuro-vasculoendoteliales. Ha sido explicada a través de varios modelos como el tetrafásico (Masters y Johnson, 1966), el trifásico (Kaplan, 1979), y el pentafásico (Bancroft, 1983), entre otros. El orgasmo se ubica como una de estas fases en estos modelos. Éste se define como un conjunto de sensaciones corporales sumamente placenteras y de excitación intensa, que libera tensiones y que produce satisfacción. Existen pocas diferencias entre el orgasmo del varón y de la hembra; desde un punto de vista funcional, el orgasmo del varón está estrechamente relacionado con la eyaculación, mientras que en la hembra no existe una conexión tan obvia y directa. En este estudio se recopilaron las semejanzas y diferencias presentes en el orgasmo del varón y de la hembra, referidas a los fundamentos anatómicos, fisiológicos, neuroendocrinos, neurológicos, psicológicos, socioculturales y espirituales.
... Tantric practices involving orgasmic movements of subtle energy can foster experiences of transformative transcendence and spiritual bliss (Barratt, 2019). Western research into the neurological and subjective impact of orgasms has charted the neural bases of orgasm (Jannini et al., 2018), developed a scale to measure intensity (Elfers, 2019), has revealed that orgasms in some circumstances are unpleasant rather than blissful (Chadwick et al., 2019) and suggests spiritual experiences are common outcomes of extended sexual orgasms (Costa et al., 2017(Costa et al., , 2016a(Costa et al., , 2016bSayin, 2019aSayin, , 2019bSayin, , 2019cSayin, , 2017aSayin, , 2017bSayin, , 2011Sayin and This research, together with western typologies of altered states (Berkovich-Ohana and Wittmann, 2017), suggests that neuroscience could provide a map for orgasm state, the fourth state of consciousness on the Tibetan Buddhist Tantric tradition. Increased knowledge of the orgasm state of alternative consciousness could have undoubted spiritual, emotional, and therapeutic benefits in Buddhist and non-Buddhist contexts. ...
... There is a possibility that pain, and orgasm may be using similar or the same spinothalamic pathways, a neurophysiological mechanism which can explain why some women and men enjoy mild pain and pleasure/orgasm together in BDSM sessions. Also, it is shown that female orgasm is analgesic [63][64][65][66], probably due to the release of oxytocin, which has also analgesic effects, and endogenous opioids. This can also explain how mild pain and orgasmic pleasure can be interchangeable with each other. ...
CORRECTED PROOF:
In sexuality research and sex therapy, it is generally very difficult to define “the normal” and to
differentiate variations, mild and harmless fantasies, sexual games and fantasy role play from paraphilia.
In DSM classifications, there are still dilemmas, misinterpretations, contradictions and controversies to
define paraphilias and what pathology is and what is not. There are new definitions and terminology
in sexuality research, such as “Expanded Sexual Response” (ESR), “status orgasmus” “Never Ending
Orgasms (Super Orgasms)”, “Deep Vaginal Erogenous Zones” (DVZ),”Sexual Pleasure Objects” (SEPOs),
“Hypersexuality” “Non-genital orgasms” and “soft-non-pathological BDSM” etc. In this review novel
definitions of some new notions are given and it is discussed why those sexual behaviors cannot be
regarded as a pathology or paraphilia, such as “Hypersexuality” and soft-BDSM; a unified definition of
paraphilias is proposed. Sometimes, ESR women are often confused with pathological hypersexuality.
ESR is defined as: “being able to attain long lasting and/or prolonged and/or multiple and/or sustained
orgasms and/or status orgasmus that lasted longer and more intense than the classical orgasm patterns
defined in the literature”. Lately a research performed in United Kingdom revealed that the research team
had discovered more than 500 women who were having more than 30 to 50 orgasms in one or two hours
(see: You Tube, “Never Ending Orgasm” documentary). We have concluded in many publications that
during an ESR orgasm and status orgasmus, some women can have trains of tens of orgasms in a given
love making session. Women can be trained to achieve ESR orgasms and it is a learned phenomenon.
Although defined recently in medical literature, the notion of ESR is as old as history, starting from the
Dionysus Cult Era and Far Eastern sexual traditions descending from Early Ages and Tantra and Taoist
cultures. At the turn of 21st Century, Female Orgasm is still a mystery and we only know the tip of the
Orgasmic Iceberg of Females.
Keywords: Sexual pleasure objects; Fantasy; Variations; Soft-BDSM; ESR; Hypersexuality; Nymphomania;
Paraphilia; DSM-5; Normal; EQ; Sexual intelligence; SEPO
... Today it is even possible to detect the centers that are activated or inactivated during sexual pleasure and orgasm (Komisaruk, 2006;Wise, 2017;Jannini, 2018). New horizons have been discovered in the area of sexual physiology by fMRI. ...
... • orbitofrontal cortex These brain areas are often called "hedonic hotspots". The experiments and observations claim that either the electrical (using micro electrodes) or chemical stimulation (amphetamines or cocaine) of these brain structures can induce pleasure or positive emotions (Kringelbach, 2009;Berridge, 2007Berridge, , 2008Berridge, , 2015Koob, 1997Koob, , 2009Koob, , 2010Volkow, 2007;Komisaruk, 2006;Wise, 2017;Jannini, 2018;Funahashi, 2011;Kim, 2015). ...
Hedonism and pleasure are one of the main goals of human life. Pleasure can be accepted as a reward for the brain, while the major reward neurotransmitters are dopamine, norepinephrine, oxytocin and gluta-mate. Boost of dopamine in the "hedonic hot spots" creates euphoria, delight, pleasure, contentment and is associated with happiness. The reward circuitry and pleasure centers in the brain involve the ventral teg-mental area (VTA), nucleus accumbens (NA), substantia nigra (SN), ventral pallidum, insula, lateral thala-mus, cingulate cortex, hippocampus, amygdala, medial prefrontal cortex and orbitofrontal cortex. Pleasure is a learned enjoyable phenomenon and pursuing the pleasure principle is one of the crucial goals of human life. However, to some extent of pleasure, due to the release of dopamine and glutamate and the activation of D1-like excitatory dopamine receptors and NMDA receptors, may induce different forms of psychological addiction. Sexual motivation, sexual drive and orgasm also use the same reward circuitry and similar neuro-chemicals in the brain. The experience of "getting high on dopamine" has been one of the primary longstanding goals for human beings, as well as for other higher primates and animals during the normal course of evolution. Today, it is known that pleasure and sexual hedonism may even alter synaptic plasticity , and may influence a variety of psychological responses and the personality of individuals, as Sigmund Freud had pointed out a century ago.
... Love, sexual pleasure and orgasm in H. sapiens are far more complicated phenomena compared to the "mating" of the laboratory animals, although the same neurochemicals participate in the induction of sexual pleasure, such as dopamine (DA) and oxytocin (OXT), similar to animals [26,28]. Komisaruk., et al. reported, from some fMRI studies, that during the orgasms induced by vaginal-cervical stimulation or clitoral stimulation, hypothalamic paraventricular nucleus (where oxytocin is initially released), amygdala, hippocampus, nucleus accumbens (NA), nucleus Caudatus (NC), insula, preoptic area (where oxytocin is released), some basal ganglions, cerebellum, anterior cingulate gyrus, insularparietal and prefrontal cortices were activated [29][30][31][32][33]. By means of sophisticated technology and imaging techniques, now, we are able to see how human data, fits with the findings emerging from animal experiments. ...
... In regional cerebral blood low studies (rCBF), Georgiadis., et al. have found that during clitoral stimulation, blood flow was increased at the right somatosensorial cortex; during clitoral orgasm, rCBF was decreased at the left orbitofrontal cortex, inferior temporal gyrus and anterior temporal lobe; an increase of rCBF, was detected at the caudate nucleus (NC) and cerebellar nuclei [34,35] (Figure 1). The results coming from animal studies (mostly rats), have been tested in live human subjects by using very sophisticated imaging techniques, such as fMRI, show that, when there is pleasure the following areas of the brain may become activated [24][25][26][27]29,[30][31][32][33][34][35][36][37][38][39][40][41][42][43][44][45] (Table 1 ...
... Neuroimaging studies during sexual stimulation and orgasm Komisaruk., et al. have done extensive research on the activation of brain regions, during stimulation of nipple, clitoris, vagina and cervix, arousal and orgasm by using fMRI technique [30][31][32][33]46]. By self-stimulation of clitoris, vagina and cervix, the corresponding of sensory cortex and cortex region overlapping with the innervation of pudental, pelvic and hypogastric nerves, were activated [30][31][32][33]. ...
Pleasure principal" is one of the most important driving forces of the human psyche. Kinds of pleasure in human beings include various satisfactions, such as food intake for the survival, satisfaction of the ego and higher cortical cognitive functions, sexual satisfaction and orgasm, satisfaction of basic physiological needs and peak experiences, such as love, satori-like experiences, and some mystical-like experiences. Pleasure phenomenon has some neural correlates, circuitries and neurotransmitter systems involved. Some pleasure centers have been defined in both animals and humans, such as ventral tegmental area (VTA), nucleus accumbens (NA), prefrontal cortex, hypothalamus, cingulate cortex, insula, while amygdala, hippocampus and some structures of the temporal lobe may have an auxiliary role. Mainly neurotransmitters dopamine (DA) and oxytocin (OXT) are the mediators of pleasure experiences in humans. During love, sexual pleasure and orgasm, those hedonic hot spots are activated, as also shown by fMRI techniques. Recently it was proposed that sexual pleasure can be expanded and there were reports on expanded orgasms (EO or ESR). Also, some researchers have reported that there are erogenous zones other than clitoris, while some non-genital orgasms have also been reported. Pudental, pelvic, hypogastric nerves and vagus control the orgasmic reflex in females. OXT, which is also a pleasure molecule, just like DA, also has some separate pleasure pathways. The limits and extents of female pleasure and orgasms have not been investigated thoroughly until recently. One of the extremes of female pleasures, ESR, has some specific neurological mechanisms which can be explained by using current data on female sexuality. There are different types of female orgasms: clitoral, vaginal, blended orgasms, EO and status orgasmus, which are still debated in the academic circles. This review discusses the possible neurological and neuropharmacological mechanisms of EO and ESR, using the informatics theory, as well.
... The results coming from animal studies (mostly rats), have been tested in live human subjects by using very sophisticated imaging techniques, such as fMRI. It was shown that, when there is pleasure the following areas of the brain may become activated, like experimental animals [8,[10][11][12][13][14][15] ...
Abuse of methamphetamine, cocaine and morphine is an increasing global problem. According to 2018 UNODOC report between 2012 and 2016, 151 millions of people used cannabis; 146 millions of people consumed cocaine; 275 millions of people used opioids and opiates; 131 millions of people consumed amphetamines. According to another Global Drug Survey-2017, the figures of addiction may be much worse than the expected. People use cocaine and amphetamines because these drugs increase the dopamine release in ventral tegmental area (VTA), nucleus accumbens (NA) and prefrontal cortex, brain regions which take part in the reward-pleasure circuitry. They also play major roles in the development of addiction. In the review the mechanism of action of amphetamines, cocaine and morphine are explained in a very clean schematic way; explaining why people get addicted to these drugs. Cocaine binds strongly to the dopamine-reuptake transporter, preventing the reuptake of dopamine into the nerve terminal. Because of this blocking effect, dopamine remains at high concentrations in the synapse and continues to affect adjacent neurons, producing the characteristic cocaine "high." Activated D1 receptor activates the PKA signaling pathway, and this pathway plays a critical role in mediating the behavioral responses to cocaine administration. Cocaine-induced neuroadaptations, including dopamine depletion, may underlie craving and hedonic dysregulation. Acute administration of amphetamine induces phosphorylation of cAMP response element-binding protein (CREB) and expression of a number of immediate early genes (IEGs), such as c-fos. The IEGs is likely to initiate downstream molecular events, which may have important roles in the induction and maintenance of addictive states. Chronic exposure to amphetamine induces a unique transcription factor delta FosB, which plays an essential role in long-term adaptive changes in the brain. Morphine can cause indirect excitation of VTA dopamine neurons by reducing inhibitory synaptic transmission mediated by GABAergic neurons. The chronic use of morphine is characterized by adaptive changes in neurons and neuronal communication; such adaptations (e.g., 'super-activation' of adenylyl cyclase) must underlie altered behaviour associated with morphine dependence and withdrawal syndrome, as well as drug-induced craving and relapse to drug use.
During pregnancy, maternal brain neuroplasticity indicates vast neurofunctional and neuroanatomical changes. Recent findings documented a similarly massive readjustment after pregnancy. Currently, these brain changes are interpreted as preparation for and adjustment of the maternal brain to motherhood. Yet, this perspective leaves many questions unsolved. Neuroscientific studies have not yet been conducted to determine the brain areas that function during natural childbirth even though physiological birth is the natural process of women who have reproduced successfully throughout two million years of evolution of the genus Homo. It is rational to believe that the female brain is an active and crucial actor during birth and that birth, itself, is a process that requires brain neuroplasticity. Lack of studies of the birthing brain and brain preparation for birth is a significant lacuna in neuroscience research. I demonstrate theoretically that a new hypothesis for complementary interpretation of maternal brain neuroplasticity is reasonable: Certain maternal brain changes during pregnancy can be interpreted as brain preparation for birth and certain maternal brain changes after birth can be interpreted as brain recovery after the tremendous event of birth. This essay can be a starting point for new directions in neuroscience studies.
