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The aim of this study is to elucidate the innervation of human vagina by performing a microdissection and PGP immunohistochemistry study. Seven fresh Korean cadavers were used. In five cadavers, the site at which the nerve entered the vaginal wall was observed by microdissection. Two vaginas were stained with trichrome and protein gene product 9.5...
Citations
... Krause's corpuscles are associated with rapidly adapting LTMRs [10] and, because of PIEZO2, are related to fine touch, vibration, motion, and displacement across the skin [35]. The role of PIEZOs in clitoral Krause's corpuscles remains to be fully elucidated but is presumably related to the involvement of mechanical stimuli in sexual behavior and in sexual pleasure since genital tactile stimulation is a critical component of sexual arousal and orgasmic response [36][37][38][39][40][41]. Nevertheless, it is necessary to consider that the specialized glabrous skin from the glans clitoridis contains combinations of LTMRs that make it functionally distinct and ultimately determine orgasm pleasure sensibility, rendering it as the center for triggering the orgasmic response [24]. ...
Krause’s corpuscles are typical of cutaneous mucous epithelia, like the lip vermillion or the glans clitoridis, and are associated with rapidly adapting low-threshold mechanoreceptors involved in gentle touch or vibration. PIEZO1 and PIEZO2 are transmembrane mechano-gated proteins that form a part of the cationic ion channels required for mechanosensitivity in mammalian cells. They are involved in somatosensitivity, especially in the different qualities of touch, but also in pain and proprioception. In the present study, immunohistochemistry and immunofluorescence were used to analyze the occurrence and cellular location of PIEZO1 and PIEZO2 in human clitoral Krause’s corpuscles. Both PIEZO1 and PIEZO2 were detected in Krause’s corpuscles in both the axon and the terminal glial cells. The presence of PIEZOs in the terminal glial cells of Kraus’s corpuscles is reported here for the first time. Based on the distribution of PIEZO1 and PIEZO2, it may be assumed they could be involved in mechanical stimuli, sexual behavior, and sexual pleasure.
... Clinical studies have suggested that the anterior vaginal wall is more sensitive in women and, therefore, considered that the G-spot is located in the anterior wall of the vagina [8], but further evidence is still lacking. In 2009, Song et al. found that the nerve density and thickness of the anterior wall is higher in the distal vagina than in the proximal vagina by microanatomical and immunohistochemical studies of the vagina [9]. However, a study of 110 vaginal biopsy specimens from 21 women found no significant differences in the distribution of nerve density in the vagina [4]. ...
Aim:
Orgasm is the ultimate pleasurable sexual experience in sexual life, a phenomenon that is difficult to depict and uncertain. A satisfying sexual life plays a vital role in the physical and mental health of men and women, the relationship between husband and wife, and family harmony. In the past, it was thought that female orgasm was related to the G-spot in the vagina, but it has never been proven. In this review, we focus on the anatomy of the vaginal vestibule, vagina, Urethra, Skene gland, and clitoris to explore the origin of female orgasm.
Methods:
The published articles were reviewed, including original articles, reviews, letters to the editor, and case reports, regarding the female reproductive system.
Results:
The concept of the clitourethrovaginal complex (CUV) explains the mechanism of the female orgasm, which is not produced by a single organ acting alone, but by the synergistic action of multiple organs and tissues.
Conclusion:
The concept of CUV complex not only reveals the principle of female orgasm but also provides new ideas for the diagnosis and treatment of female sexual medicine in the future.
... 17,18 A higher density of nerves has been found in the anterior vagina compared to the posterior vagina, as well as in the distal vagina compared to the proximal vagina in human biopsies and cadaveric tissue. 22,46 However, innervation has also been found to not vary significantly along the length of the rat vagina 45 and along the length of the human anterior vagina. 34 The nerve distribution with respect to VaSM is likely to play a role in vaginal contractility. ...
Smooth muscle fibers within the vagina, as well as the nerve fibers that contribute to their control mechanisms, are important for the maintenance and alteration of vaginal length and tone. Vaginal smooth muscle (VaSM) is typically described as being arranged into two distinct concentric layers: an inner circular muscular layer and an outer longitudinal muscular layer. However, the distribution of VaSM oriented in the longitudinal direction (LD) and circumferential direction (CD) has never been quantified. In this study, tissue clearing and immunohistochemistry were performed so that the VaSM, and surrounding nerves, within whole rat vaginas ([Formula: see text]) could be imaged without tissue sectioning, preserving the three-dimensional architecture of the organs. Using these methods, the vagina was viewed through the full thickness of the muscularis layer, from the distal to the proximal regions. The VaSM orientation in the proximal and distal regions and the VaSM content along the LD and CD were quantified. Additionally, a qualitative assessment of vaginal nerves was performed. When compared using a permuted version of the Watson [Formula: see text] test, the orientation of VaSM in the proximal and distal regions were found to be significantly different in 4 of the 6 imaged rat vaginas ([Formula: see text]). While the distal vagina contained a similar amount of VaSM oriented within [Formula: see text] of the LD and within [Formula: see text] of the CD, the proximal vagina contained significantly more VaSM oriented towards the LD than towards the CD. Nerve fibers were found to be wavy, running both parallel and perpendicular to vascular and non-vascular smooth muscle within the vagina. Micro-structural analyses, like the one conducted here, are necessary to understand the physiological function and pathological changes of the vagina.
... Although the presence of a hypererogenic region in the anterior vaginal wall has been claimed to be the G-spot (1) , the histologic structure of the anterior wall should not be forgotten. The anterior wall of the vagina is thinner and richer in neural tissue than the posterior wall of the vagina (11) . Keeping in mind this anatomic information, the amplification procedures performed to the region defined as the "G-spot" in the anterior wall of the vagina may in fact cause ballooning of the anterior wall of the vagina so that penile contact of this region results in increased sexual pleasure. ...
Objective:
There is a growing debate on the existence of the G-spot. G-spot amplification by various surgical interventions has become mainstream for esthetic vaginal surgery despite a lack of conclusive proof of the G-spot. The aim of this study was to search for histologic evidence in regions of so-called hyperintense focus (HF) (considered as the G-spot) using magnetic resonance imaging (MRI) mapping and biopsied tissues.
Materials and methods:
Fifteen patients who had grade 2 or higher anterior compartment defects were enrolled in the study. All patients were subjected to MRI. When a HF was seen, its localization, dimensions, and distances to adjacent structures were measured in images. Dissections in the anterior vaginal wall were performed in accordance with the measurements derived from MRI and tissue measuring 0.5x0.5 cm was biopsied from the determined HF.
Results:
An HF was determined in MRI of three (20%) patients. However, no significant neurovascular tissue density was observed histologically in any of the biopsy specimens obtained from the surgical dissections under the guidance of MRI mapping.
Conclusion:
Our findings denote that there is no G-spot in the anterior vaginal wall.
... Furthermore, the distal part of the anterior vaginal wall has denser nerve fibers than the proximal part. Song et al. examined nerve fiber density in the anterior vaginal wall of two fresh cadavers and found more dense nerve fibers in the second fifth of the anterior vaginal wall [3]. Li et al. found increased density of nerve fibers in the distal third of the anterior vaginal wall [4]. ...
... Vaginal microvascularization and nerve innervation occur fairly regularly, with no site consistently demonstrating the highest nerve density and vascularization in our series. Reported results on vaginal innervation were inconsistent in a few studies [2][3][4][5]. Previous studies with a limited number of biopsies stained with PGP 9.5 reported that the distal part of the vagina had the most small nerve fiber density in the mucosa compared to the posterior vaginal wall or proximal part of the vagina [2][3][4]. ...
... Reported results on vaginal innervation were inconsistent in a few studies [2][3][4][5]. Previous studies with a limited number of biopsies stained with PGP 9.5 reported that the distal part of the vagina had the most small nerve fiber density in the mucosa compared to the posterior vaginal wall or proximal part of the vagina [2][3][4]. The inconsistency between our results and those of this study can be explained by the limited number of biopsies from the anterior vaginal wall and the wide, nonstandard gap between the samples. ...
Introduction and hypothesisOrgasm and other sexual responses such as pain, arousal and lubrication may be mediated by nerve fibers and vessels in the lamina propria and muscularis of the vaginal wall, in which case the number of nerve fibers and vessels would be associated with sexual functions. The aim of the study is to map the distribution of nerves and vessels in the anterior vaginal wall along the paraurethral region in a systematic fashion.Methods
Specimens were taken from women with anterior vaginal wall prolapse undergoing colporrhaphy anterior repair. All specimens were mapped in a standard way starting 15 mm proximal to the external urethral orifice. Selected blocks of samples were immunohistochemically stained: actin, smooth muscle Ab-1 and S100 Protein Ab-1. The numbers of microvessels and nerves in the lamina propria and muscularis were counted in five consecutive high-power fields of a light microscope. Pairwise comparisons of proximal, distal, right and left paravaginal microvessel and nerve fiber density were analyzed with paired-sample t-test or Wilcoxon signed-rank test.ResultsVaginal nerve fibers in the lamina propria and muscularis have a fairly even distribution in the anterior vaginal wall. Vaginal small vessel vascularization and microvascularization are also evenly distributed, with no concentrated site along the paraurethral region of the anterior vaginal wall.Conclusions
Nerve fiber, nerve bundle, microvessel and small vessel densities in the lamina propria and muscularis were fairly regular, with no concentrated site on the paraurethral region of the anterior vaginal wall.
... Although locoregional discrepancies in the innervation of the human vagina are still debated, immunohistochemical studies reported that a greater number of fibers is detectable in distal regions of the vaginal wall compared with the proximal 23 and that the distal anterior vaginal wall is markedly thicker than the proximal. 24 Furthermore, following the studies of O'Connell et al, 25 suggesting that the distal vagina and the urethra display a close spatial, morphological, and functional proximity to the erectile tissue of the bulbs and cavernous bodies of the clitoris and based on dynamic imaging techniques, Jannini et al 26 proposed the existence of a clitourethrovaginal complex, defined as a morphofunctional area stimulated by vaginal penetration and involved in triggering sexual arousal and vaginally activated orgasm. ...
Introduction
Androgens have been shown to exert beneficial effects on vaginal physiology, at least partially independent of their aromatization to estrogens. Androgen deficiency in the vagina and in the other genitourinary tissues contributes to the development of vulvovaginal atrophy and genitourinary syndrome of menopause, resulting in impaired arousal and lubrication and dyspareunia.
Objectives
To summarize the role of testosterone in modulating vaginal structure and function.
Methods
A qualitative review of the relevant literature on the topic was performed using the PubMed database. We present a summary of preclinical and clinical evidence supporting the involvement of testosterone (T) in vaginal physiopathology and discuss it in terms of the role of the vagina in female sexual response.
Results
Androgens are important in the differentiation of the vagina and in maintaining trophic and functional actions in postnatal life, as suggested by the detection of the androgen receptor and of the key enzymes involved in androgen synthesis. T is essential for the integrity of vaginal tissue structure (including non-vascular smooth muscle thickness and contractility and collagen fiber compactness) and for the complex neurovascular processes that regulate arousal and lubrication (vascular smooth muscle relaxation via the NO/cGMP/PDE5 pathway, nerve fiber density and neurotransmission). T has also been reported to modulate nociception, inflammation, and mucin secretion within the vagina. Available and potential androgen-based treatments for vulvovaginal atrophy/genitourinary syndrome of menopause and for other conditions leading to female genital arousal disorder and dyspareunia are presented.
Conclusions
The vagina is both an androgen-target and synthesis organ. Preclinical and clinical data consistently suggest that T plays an important role in maintaining vaginal health and genital sexual function.
Maseroli E, Vignozzi L. Testosterone and Vaginal Function. Sex Med 2020;XX:XXX–XXX.
... The most sensitive point to stimulus in the female body is the genital area (6) . In the vagina, the lower one-third of the anterior region has been proved to have more nerves immunohistochemically (7)(8)(9) and it is known that the response of the distal anterior vaginal wall to contact and to pressure is higher than the other part of the vagina, in penis-vagina penetration (6,10) . PRP treatment has the potential to be part of a surgical and non-hormonal approach in patients with sexual dysfunction with regenerative changes by increasing collagen formation and neovascularization in the anterior vaginal wall. ...
... The anterior wall, compared with the posterior wall and the distal part of the anterior, has been shown to have more nerves immunohistochemically (7) . In a cadaver study, it was found that the second one-fifth partition of the distal anterior wall had significantly richer innervation than the surrounding areas (8) . ...
Objective:
To investigate the effect of platelet-rich plasma (PRP) injection to the lower one-third of the anterior vaginal wall on sexual function, orgasm, and genital perception in women with sexual dysfunction.
Materials and methods:
Four sessions of PRP were administered to the anterior vaginal wall of 52 female patients with sexual dysfunction and orgasmic disorder [Female Sexual Function Index (FSFI) total score ≤26 orgasmic subdomain score ≤3.75]. Prior to the PRP administrations in each session, the FSFI validated in Turkish, the Female Genital Self-Image Scale (FGSIS), the Female Sexual Distress Scale-Revised (FSDS-R), and Rosenberg's Self-Esteem Scale were used and in the final follow-up, and the Patient Global Impression of Improvement (PGI-I) was performed and the results were analyzed.
Results:
Following the application of the PRP, the total FSFI score was observed as 27.88±4.80 and the total score was 26 and above in 50% of the patients (p<0.001). Orgasm subdomain scores were found as 2.11±1.20 before the PRP treatment and 4.48±1.14 afterwards (p<0.001). A significant change was observed in all sub-domains after PRP and it was observed that this change started after the first administration (p<0.001). A statistically significant increase was determined in FGSIS genital perception scores, which was significant between the 1st and 2nd months (p<0.001). The FSDS-R scores showed a minimal increase in stress scores as the application number increased, but a statistically significant decrease was observed in the 4th administration (p<0.001). No statistically significant difference was found in Rosenberg Scale scores before and after treatment (p=0.389). High satisfaction was found in PGI-I scores.
Conclusion:
As a minimally invasive method, PRP administration to the distal anterior vaginal wall may improve female sexuality with high satisfaction.
... Additionally, they omitted information from the in vivo MRI study that revealed the G-spot anatomical structure in 100% of cases when vaginal contrast was used (Maratos et al., 2016). Song et al. (2009) stated that the anterior-distal vaginal wall has intense innervation, which they suggested "could be called the G-spot." However, other researchers disagreed: "Innervation and vasculature were quantitatively the same along the anterior vagina" (Mazloomdoost et al., 2017;Pauls, 2006). ...
The discovery of the G‐spot and verification of its anatomy and histology paved the way to better understanding. Until 2012, the G‐spot was defined as a physiological sexual response phenomenon with no identifiable anatomical correlate. The weakness of this definition is that a physiological response cannot exist without an anatomical basis, so the question motivating the present study was formulated: Are current scientific‐clinical data sufficient to resolve the controversy about the anatomical existence of a G‐spot? It is important to stipulate that no systematic review of the G‐spot has hitherto been published. Manual and electronic searches revealed postmortem and in vivo studies describing the G‐spot and findings reported within PRISMA‐IPD guidelines. The objective of the present review was to provide evidence‐based information related to the G‐spot. Articles were quality‐assessed using validated instruments. Publications on the G‐spot from 1950 to May 2019 were reviewed. Of the 279 full‐text articles examined, 30 met the eligibility criteria. The findings indicate that there are reliable scientific‐clinical data to support the existence of an anatomical G‐spot structure. Transient anterior‐distal vaginal wall engorgement is caused by blood entrapment within the G‐spot structure. Histological examination effectively ruled out the G‐spot as the organ cannot be responsible for female ejaculation since no glandular tissue was identifiable. Finally, the results of this study could assist in developing new therapeutic, surgical interventions to treat secondary G‐spot dysfunction. Additionally, this review indicates ample opportunities for further scientific‐clinical investigations and has thereby moved the field forward. Clin. Anat. 32:1094–1101, 2019. © 2019 Wiley Periodicals, Inc.
... This may be due to the fact that in this species there is no difference, or that the measurement is not sensitive to detect it. PGP 9.5 stain was used to stain neuronal network in cadaveric human specimen observations [41] as well as in rhesus macaques [22]. ...
Background/aims:
The ewe is increasingly being used as an animal model for pelvic floor disorders. The aim was to further characterize changes in the vaginal properties during its entire lifespan.
Methods:
Vaginal tissues were collected at different stages of reproductive life (neonatal, prepubescence, nulliparous, primiparous, multiparous, and menopausal; ≥6 ewes/group). Vaginal size, as well as active and passive biomechanics, was measured. Microscopy included thickness of glycogen, epithelium, lamina propria and muscularis thickness, densities of collagen, elastin, smooth muscle, and nerves.
Results:
Vaginal dimensions increase during adolescence, peak at reproductive levels, and decrease sharply after ovariectomy. One year after first delivery, the distal vagina gets more compliant, yet this is reversed later in life. The thickness of glycogen staining epithelial layers changed with puberty and menopause. The epithelium was markedly thicker after multiple deliveries. The thickness of lamina propria and muscularis increased in puberty and in nulliparous. Semi-quantitative collagen assessment demonstrated a lower collagen and higher elastin content after first and multiple deliveries.
Conclusion:
The changes in the ovine vaginal wall during representative moments of her lifespan parallel those observed in women.
... In den Köpfen vieler Männer kann ihr Penis nicht lang genug sein (Shaeer 2012,Ghanem201.3, Nabil2013, Veale 2015, dabei verspüren viele Frauen mehr Lust beim Akt, wenn ihre Vagina optimal gedehnt wird (Hilliges 1995, Eisenman 2001, Pauls 2006, Song 2009, Villeda Sandoval 2074.Da sich die Mehrzahl der Nervenendigungen im unteren Drittel der Vagina befindet, spielt beim Verkehr die Länge des Penis eine weit geringere Rolle als sein Umfang. ...
Ein unbekannter Prozentsatz von Männern wird jedes Risiko auf sich nehmen, um einen größeren Penis zu bekommen. In der Vergangenheit wurden weltweit alle möglichen Flüssigkeiten oder Gele meist in Eigeninjektionen unter die Haut des Penis gespritzt – mit meist desaströsen Folgen. Auch alle zugelassenen injizierbaren „medizinischen Produkte“ haben bestimmte Nebenwirkungen: Sie können wandern, werden an der Basis komprimiert oder fließen der Schwerkraft folgend zur Spitze des Penis hin (Birnenform) oder werden über kurz oder lang resorbiert.
