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Magnetic Resonance Imaging of Sexual Intercourse: Initial Experience

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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 position, before penetration, the vagina was parallel to the pubococcygeal 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.
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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 nération et le mécanisme des fonctions
intimes.
Collection Château de Windsor, Paris: Rouveyre.
Zwang, G.
(
1990
)
.
Abrégé de Sexologie.
Paris: Ed Masson.
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... Furthermore, any potential movement of the penis relative to the pelvis via intrinsic musculature remains unquantified. Future in vivo studies of vertebrate copulation using imaging modalities such as magnetic resonance imaging [43] and X-ray reconstruction of moving motion may future illuminate the loading regimes to which genitals are subjected. ...
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... There are few studies examining partner stimulation in the lab. These studies have focused on individual case examples or small numbers of participants and have used imaging technologies to visualize the engagement of the penis in the vagina during coitus [65][66][67]. Although initial studies examined coitus through magnetic resonance imaging (MRI), technical difficulties with measuring movement limit the applicability of this instrument with partner stimulation. ...
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IntroductionPostcoital nonobstetric vaginal lacerations due to consensual sexual act are generally minute mucosal tears. In some cases, the vaginal mucosa is lacerated deeper and the bleeding may require suturing of opened vessel ends or even transfusion. AimThe aim of this case report is to present a rare case of acute fistula formation by penile penetration through the full thickness of the rectovaginal wall after consensual vaginal intercourse and to its management in emergency settings. Methods We report a rare case of isolated rectovaginal laceration sparing anal sphincters and perineum in a 24-year-old woman following her second consensual vaginal intercourse with her new partner. Speculum examination demonstrated a 4cm laceration on the left posterior vaginal wall forming a fistula between the rectum and vagina, 2cm above the hymenal ring and not extending to the posterior fornix or perineum. Three layer suturing of rectal, vaginal mucosa, and rectovaginal septum was enough to treat the acute fistula in this case. ResultsAfter 2 months follow-up, we observed the complete healing of the rectovaginal laceration with no fistula formation and the patient resumed her sexual activity. Long term follow-up of patients is necessary to observe complete healing and to ensure the absence of a chronic fistula formation. Conclusion Simple suturing of rectal and vaginal mucosa, appropriate antiseptic precautions, and antibiotic coverage are enough to treat acutely formed low rectovaginal fistulas resulting from coitus. Decision to form colostomy and diversion of feces in the repair of such injuries should be taken cautiously. Uurel V, ozer DP, and Varol F. A rare case of rectovaginal fistula following consensual vaginal intercourse. J Sex Med 2014;11:1345-1348.
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Introduction: Women describe at least two types of orgasms: clitoral and vaginal. However, the differences, if any, are a matter of controversy. In order to clarify the functional anatomy of this sexual pleasure, most frequently achieved through clitoral stimulation, we used sonography with the aim of visualizing the movements of the clitorourethrovaginal (CUV) complex both during external, direct stimulation of the clitoris and during vaginal stimulation. Method: The ultrasounds were performed in three healthy volunteers with the General Electric® Voluson® sonography system (General Electric Healthcare, Vélizy, France), using a 12-MHz flat probe and a vaginal probe. We used functional sonography of the stimulated clitoris either during manual self-stimulation of the external clitoris or during vaginal penetration with a wet tampon. Main outcome measures: Functional and anatomic description, based on bidimensional ultrasounds, of the clitoris and CUV complex, as well as color Doppler signal indicating speed of venous blood flow, during arousal obtained by external or internal stimulation. Results: The sagittal scans obtained during external stimulation and vaginal penetration demonstrated that the root of the clitoris is not involved with external clitoral stimulation. In contrast, during vaginal stimulation, because of the movements and displacements, the whole CUV complex and the clitoral roots in particular are involved, showing functional differences depending on the type of stimulation. The color signal indicating flow speed in the veins mirrored the anatomical changes. Conclusions: Despite a common assumption that there is only one type of female orgasm, we may infer, on the basis of our findings, that the different reported perceptions from these two types of stimulation can be explained by the different parts of the clitoris (external and internal) and CUV complex that are involved.
Abrégé de Sexologie. Paris: Ed Masson. Downloaded by [Dalhousie University
  • G Zwang
Zwang, G. (1990). Abrégé de Sexologie. Paris: Ed Masson. Downloaded by [Dalhousie University] at 14:14 12 November 2014
Imagerie de la vessie et de la dynamique pelvienne de la femme
  • Copyright
Copyright © 2001 Brunner-Routledge 0092-623X/01 $12.00 +.00 REFERENCES Lapray, J. F. (1999). Imagerie de la vessie et de la dynamique pelvienne de la femme. Paris: Ed Masson.
Notes et dessins sur la génération et le mécanisme des fonctions intimes
  • L Vinci
Vinci, L. (1901). Notes et dessins sur la génération et le mécanisme des fonctions intimes. Collection Château de Windsor, Paris: Rouveyre.