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Journal of Sex & Marital Therapy, 27:475–482, 2001
Copyright © 2001 Brunner-Routledge
0092-623X/01 $12.00 + .00
475
Address correspondence to A. Faix, M.D., Department of Urology and Radiology, CMC
Beausoleil, 119 Avenue de Lodeve, 34070, Montpellier, France.
Magnetic Resonance Imaging of Sexual
Intercourse: Initial Experience
A. FAIX, J.F. LAPRAY, C. COURTIEU, A. MAUBON,
and KERRY LANFREY
Department of Urology and Radiology, CMC Beausoleil, Montpellier, France
The objective of this study was to investigate sexual intercourse with
magnetic resonance imaging
(
MRI
)
. A volunteer couple
(
30 year-
old male, 27-year-old female
)
with a normal sex life, had face-to-
face sexual intercourse
(
reversed missionary position
)
under MRI.
Static and dynamic T2-weighted sagittal sequencies were acquired
on the midline before and during vaginal penetration. In this posi-
tion, before penetration, the vagina was parallel to the pubococ-
cygeal line and had normal anterior convexity. After penetration,
accentuation of the vaginal convexity was observed, produced by
the penile gland reaching the anterior cul-de-sac and contact with
the anterior vaginal wall. The posterior bladder wall was pushed
forward and upward, the uterus upward and backward. In this
initial experience, we observed a preferential contact of the penis
in erection with the anterior vaginal wall and the anterior cul-de-
sac in the face-to-face sexual position. MRI allows a noninvasive
assessment of sexual intercourse.
INTRODUCTION
The anatomy of sexual intercourse has never previously been investigated
using modern imaging techniques. In the 15th century, Leonard de Vinci
(
1901
)
attempted to reproduce a schema of sexual intercourse. He hypoth-
esized that the axis of the penis was in a straight line during coitus. Anatomi-
cal studies of cadavers have found that there is a slight posterior curve of the
vagina with an open backwards angle of about 140°
(
Zwang, 1990
)
. Theo-
retically, in the “missionary” position
(
face-to-face position
)
, the anterior wall
of the vagina is preferentially stimulated; it is the reverse in the posterior
A. Faix et al.
476
position. Zwang
(
1990
)
showed these preferential contacts in theoretical dia-
grams. Because these descriptions were merely theoretical, interest grew in
studying the anatomy of sexual intercourse using magnetic resonance imag-
ing
(
MRI
)
. MRI has been demonstrated to be a useful tool for the radiological
assessment of the female pelvis and the penis
(
Lapray, 1999
)
.
MATERIAL AND METHODS
The MRI utilized is a General Electric 1 Tesla. Other specifications include:
Single-shot fast spinecho
(
SSFSE
)
Static T2-weighted sagittal sequencies
TE
(
time echo
)
of 180
TR
(
time repetition
)
of 6000 ms
Matrix of 256–192
Diameter of 60 centimeters
Three 15–minute sessions were utilized, with 30 minute intervals between
the sessions.
Couple
The subjects were volunteers with a normal sex life together. The male was
30 years old, was 180 cm, and 80 kgs, with an normal penis and an erection
of 16 cm. The female was 27 years old, 167 cm, and 52 kgs, with no gyneco-
logical problems and one birth in 1995.
Sexual Intercourse Sessions
Only one position was used—the male lying flat on his back and the female
on top of the male with legs slightly open. The MRI tube was very narrow,
allowing a space of 3 to 5 cm between the back of the female and the tube
when the couple was in position.
First Session
This session occurred without penetration in order to initialize parameters. A
sheet was draped on the window between the medical team and the couple
as a means of respecting privacy, but permanent audio contact.
Second Session
The couple initiated sexual intercourse outside the MRI. Laying down on the
ramp in position, they were then moved into the tube. During a 15-minute
First Experience of Sexual Intercourse MRI
477
check of the position on the midlne, there was a partial detumescence of the
penis.
Third Session
The female had to urinate before the last session.
Radiological Evaluation
We examined the pubococcygeal line which links the pubis and the coccyx
together, the axis of the vagina, the penis inside the vagina, and the anatomi-
cal connections between the penis and the female anatomical structures.
RESULTS
First Session
The axis of the vagina was roughly parallel to the pubococcygeal line and it
had a moderated anterior convexity which was parallel to the elevator ani
(
see Figure 1
)
. The bladder and the area of the bladder neck, the two pubes,
FIGURE 1. Line drawing of first session, before penetration, showing pubococcygeal line
(
a
)
, vagina axis
(
b
)
, and elevator ani
(
c
)
.
a
b
c
A. Faix et al.
478
and the female elevator ani were visible in the imaging. The female is lower
than the male by 14 cm
(
see Figure 2
)
.
Second Session
The penis
(
corpus cavernosum
)
had a high signal in T2-weighted sequence.
There was a posterior shift of the uterus and a preferential contact of the
penis with the anterior wall of the vagina, the anterior cul-de-sac, the urethra
(
which was not really seen
)
, Halban’s fascia, and the posterior bladder
(
see
Figure 3
)
. Because of a partial detumescence of the penis, the study was
stopped 30 minutes before the third and last session to allow the male to
obtain a better erection.
Third Session
There was an increase in the convexity of the anterior vagina with the in-
crease in the contact with the anterior cul-de-sac and the bladder
(
almost
1a
1b
2a
2b
FIGURE 2. MRI photograph of first session, showing female bladder
(
1a
)
and pubis
(
1b
)
,
and male bladder
(
2a
)
and pubis
(
2b
)
.
First Experience of Sexual Intercourse MRI
479
empty
)
which was pushed forward and upward
(
see Figure 4
)
. The angle of
the penis was 60° between the perineal and the vaginal parts and the length
inside the vagina was about 10 cm
(
because part was outside the vagina and
because of partial detumescence
)
(
see Figure 5
)
.
Geometric and Comparative Analysis
There was a modification of the vaginal axis from 140° to 90° and a shifting
of the uterus
(
see Figure 6
)
. There also was a raising of the bladder neck and
the urethra through the anterior wall of the vagina.
FIGURE 3. MRI photograph of second session, following penetration, showing penis
(
gland
)
with high signal in T2 weighted sequencie in the anterior cul-de-sac
(
a
)
, penis
(
perineal
part
)
(
b
)
, and female bladder
(
c
)
.
c
a
b
A. Faix et al.
480
DISCUSSION
One could question whether this coital experience in a laboratory is repre-
sentative of the physiology of sexual intercourse. It was very difficult to
move in the MRI tube and the man had difficulty maintaining an erection.
The ideal future objective is to examine dynamic sessions, other positions,
other couples and maybe the use of an open MRI.
CONCLUSION
This appears to be the first anatomical study of sexual intercourse by MRI. In
the reverse missionary position, the preferential areas stimulated by the pe-
nis seems to be the anterior wall of the vagina and the anterior cul-de-sac.
FIGURE 4. MRI photograph of third session, showing gland and anterior cul-de-sac
(
a
)
,
female bladder
(
b
)
, cervix
(
c
)
, uterus
(
d
)
, and central node of the perineum
(
e
)
.
d
c
b
a
e
First Experience of Sexual Intercourse MRI
481
FIGURE 5. Line drawing of third session, showing penis-vagina axis
(
a
)
, fornix
(
b
)
, uterus
(
c
)
, puboccocygeal line
(
d
)
, angle of pubis
(
e
)
, and bladder neck
(
f
)
.
c
b
a
e
f
d
e
FIGURE 6. Geometric and comparative analysis: Modification of the vaginal axis; Shifting of
the uterus; and Raising of the bladderneck.
A. Faix et al.
482
Additional sessions are planned to help further the understanding of the
anatomical aspects of sexual intercourse. MRI could be a new tool to assess
the physiology of sexual intercourse.
REFERENCES
Lapray, J. F.
(
1999
)
.
Imagerie de la vessie et de la dynamique pelvienne de la femme.
Paris: Ed Masson.
Vinci, L.
(
1901
)
.
Notes et dessins sur la génération et le mécanisme des fonctions
intimes.
Collection Château de Windsor, Paris: Rouveyre.
Zwang, G.
(
1990
)
.
Abrégé de Sexologie.
Paris: Ed Masson.
