ArticleLiterature Review

Does the G-spot exist? A review of the current literature

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Abstract

In 1950, Gräfenberg described a distinct erotogenic zone on the anterior wall of the vagina, which was referred to as the Gräfenberg spot (G-spot) by Addiego, Whipple (a nurse) et al. in 1981. As a result, the G-spot has become a central topic of popular speculation and a basis of a huge business surrounding it. In our opinion, these sexologists have made a hotchpotch of Gräfenberg's thoughts and ideas that were set forth and expounded in his 1950 article: the intraurethral glands are not the corpus spongiosum of the female urethra, and Gräfenberg did not report an orgasm of the intraurethral glands. G-spot amplification is a cosmetic surgery procedure for temporarily increasing the size and sensitivity of the G-spot in which a dermal filler or a collagen-like material is injected into the bladder-vaginal septum. All published scientific data point to the fact that the G-spot does not exist, and the supposed G-spot should not be identified with Gräfenberg's name. Moreover, G-spot amplification is not medically indicated and is an unnecessary and inefficacious medical procedure.

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... Clitoral anatomy has been well-studied and it is described in human anatomy textbooks. Female sexual function was first described by Dickinson, by Masters and Johnson, and subsequently by Puppo [2][3][4][5]. ...
... The clitoris, in the free part of the organ, is composed of the body and the glans located inside of the prepuce. The crura or roots represent the hidden part of the clitoris located in contact with the ischiopubic ramus, covered by the ischiocavernosus muscle [2][3][4][5]. The vagina is an internal organ and has not anatomical relation with the clitoris: the clitoral glans and root have no anatomical relation with the vaginal lumen and with the anterior vaginal wall. ...
... "Clitoral complex" definition has no embryological, anatomical, and physiological support. In addition, clitoral bulbs is an incorrect term: the vestibular bulbs do not develop from the phallus and they do not belong to the clitoris [2][3][4][5]. The distance from glans and body of the clitoris to the anterior vaginal wall cannot predict that women will experience orgasm during intercourse (Fig. 1). ...
Data
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FREE full text (with 30 figures) of: G-spot does not exist: the claims published by Beverly Whipple, Emmanuele Jannini, Odile Buisson, Helen O’Connell et al. have no scientific basis. Journal sexual medicine and Irwin Goldstein vs women sexual health. G-spot is only a business: is it a scientific fraud?
... Les racines du clitoris sont attachées aux branches ischiopubiennes et sont couvertes par les muscles ischiocarverneux, pour cela ils ne peuvent pas être en contact avec la paroi antérieure vaginale : le vagin n'a pas de relation anatomique avec le clitoris ; l'urètre est complètement entouré par le corps spongiosum de l'urètre féminin et il n'y a pas de partie clitoridienne ni de bulbe vestibulaire dans le septum urétrovaginal. Le clitoris interne et le complexe clitoris-urètre-vagina (CUV) n'existent pas : il n'y a pas de bases embryologique, anatomique, physiologique, prouvant l'existence d'un « complexe clitoro-urétéro-vaginal » chez la femme [2][3][4][5][6][7][8][9]. ...
... L'urètre périnéal féminin, situé devant la paroi vaginale antérieure, est d'environ un centimètre de longueur et la zone du point G est dans la paroi pelvienne de l'urètre (avec une échographie il n'est pas possible de visualiser les glandes qui forment la prostate féminine), le pénis masculin ne peut être en contact avec le plexus veineux de Kobelt ou avec les racines du clitoris (qui n'ont pas de récepteurs sensitifs ni de sensibilité érogène) pendant le rapport sexuel [2][3][4][5][6][7][8][9]. ...
... En outre, le vagin n'a pas de relation anatomique avec le clitoris ! Dans le septum entre la vessie et la paroi antérieure du vagin se trouve le triangle de Pawlick (qui correspond au triangle de Lieutaud de la vessie) qui a une muqueuse lisse vaginale et est un espace de résistance mineure [2][3][4][5][6][7][8][9]. ...
Article
Les déclarations de Whipple, Jannini, Buisson, O’Connell, Brody, Ostrzenski, et al. n’ont aucun fondement scientifique. La stimulation clitoridienne est importante pour atteindre l’orgasme: le clitoris existe chez toutes les femmes, pourquoi donc ne pas le stimuler simplement pendant le rapport sexuel avec pénétration pénienne, avec le doigt?
... The G-spot as a distinct erotogenic zone on or under the anterior vaginal wall about halfway between the back of the pubic bone and the cervix, along the course of the urethra, has been accepted by many sexologists and women. However, there are conflicting data about the existence of the G-spot in the vagina [3][4][5][6][7][8][9][10][11][12]. Defined as a ''modern gynecologic myth'', the hypothesis that the G-spot is located <1 cm from the surface of the vaginal anterior wall and one-third to one-half the way from the vaginal opening is weakly supported by behavioral, anatomical, and biochemical evidence [9,[13][14][15]. ...
... However, there are conflicting data about the existence of the G-spot in the vagina [3][4][5][6][7][8][9][10][11][12]. Defined as a ''modern gynecologic myth'', the hypothesis that the G-spot is located <1 cm from the surface of the vaginal anterior wall and one-third to one-half the way from the vaginal opening is weakly supported by behavioral, anatomical, and biochemical evidence [9,[13][14][15]. Thabet [16] confirmed that the G-spot was actually present in all women, localized spot in 58% and diffuse in 42% of cases. ...
Article
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Background The presence of the G-spot (an assumed erotic sensitive area in the anterior wall of the vagina) remains controversial. We explored the histomorphological basis of the G-spot. Methods Biopsies were drawn from a 12 o’clock direction in the distal- and proximal-third areas of the anterior vagina of 32 Chinese subjects. The total number of protein gene product 9.5–immunoreactive nerves and smooth muscle actin–immunoreactive blood vessels in each specimen was quantified using the avidin-biotin-peroxidase assay. Results Vaginal innervation was observed in the lamina propria and muscle layer of the anterior vaginal wall. The distal-third of the anterior vaginal wall had significantly richer small-nerve-fiber innervation in the lamina propria than the proximal-third (p = 0.000) and in the vaginal muscle layer (p = 0.006). There were abundant microvessels in the lamina propria and muscle layer, but no small vessels in the lamina propria and few in the muscle layer. Significant differences were noted in the number of microvessels when comparing the distal- with proximal-third parts in the lamina propria (p = 0.046) and muscle layer (p = 0.002). Conclusions Significantly increased density of nerves and microvessels in the distal-third of the anterior vaginal wall could be the histomorphological basis of the G-spot. Distal anterior vaginal repair could disrupt the normal anatomy, neurovascular supply and function of the G-spot, and cause sexual dysfunction.
... Na tému klitorisu a ženského orgazmu boli popísané už stohy papiera, pre atraktívnosť témy hlavne mimo odborných publikácií [61]. Veľké množstvo takto kolujúcich "faktov" sú mýty, z ktorých sa opakovaním stávajú sväté pravdy. ...
... Aj v roku 2013 sa stretneme s relevantnými odbornými názormi, ktoré absolútne nepochybujú o striktnom rozlíšení vaginálneho a klitoridálneho orgazmu [8,9,14,17], ďalšími, ktoré vymenúvajú pre a proti pre každú z hypotéz a definitívne sa neprikláňajú ani k jednej [64]. A napokon existujú autori, ktorí celý koncept vaginálneho orgazmu, bodu G [54, 60] a ženskej ejakulácie odmietajú ako umelý konštrukt vymyslený Freudom v roku 1905, pre ktorý sa dodnes nenašli valídne, vedecké dôkazy [24,30,61,62]. Posledná skupina autorov tvrdí, že za každý typ orgazmu sú u ženy zodpovedné dráždenie klitorisu a kontrakcie priečne pruhovaného perineálneho svalstva. ...
Article
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The clitoris is the female external sexual organ and is composed of erectile bodies. The distal portion of the vagina, clitoris and urethra form an integrated entity sui generis. All these components share a common vasculature and nerve supply and during sexual stimulation they respond as one functional unit. The clitoris is closely linked to the mechanism of sexual arousal in women. Glans has a dense network of receptors, innervated often with a several nerves at the same time - taking care of tactile sensitivity, thus, standing on the begining of the journey, which culminates in orgasm. Nervus dorsalis clitoridis, which is a branch of n. pudendus, takes care of sensitive innervation. For blood suply is responsible a. clitoridis, which is a branch of a. pudenda interna. The most common congenital developmental anomalies of the clitoris include: clitoromegaly, penis-like clitoris and bifid clitoris. All, however, are among the relatively rare birth defects. Mechanism of orgasm gets attention between both laic and scientific community, although to this date there are speculations about its exact mechanism. There is relevant opinion, influenced by Freuds doctrine, which strictly recognizes two kinds of female orgasms - vaginal and clitoral, and, according to proponents of this theory, only the second mentioned is caused by stimulation of the clitoris. The second school unifies the term orgasm and claims that only clitoral stimulation (digital, penile, cunnilingus) and contraction of striated perineal muscle are responsible for orgasm, whether the glans (external part) or the body of the clitoris from the vaginal approach is stimulated. Therewithal, special term for mythical and still undocumented (despite many attempts and bold claims about its finding) G spot (named after Ernst Gräfenberg, a German doctor who predicted the existence of this place) is redundant. Important role in the regulation of female sexuality and responsiveness play a hormonal influences and varying concentrations of neurotransmitters. Keywords: clitoris, anatomy of clitoris, development of clitoris, orgasm, sexuality.
... The vaginal orgasm and G-spot do not exist, therefore, the duration of penile-vaginal intercourse is not important for a woman's orgasm. [3][4][5] Physicians and clinicians must acknowledge that PE is normal, and it is common for any healthy adolescent male. It is important for teenagers to understand that PE is absolutely normal at this age. ...
... Physicians, urologists, gynaecologists, sexologists and sexual medicine experts should define having sex/ making love as the situation in which orgasm happens in both partners with or without vaginal intercourse, a definition for all human beings. [3][4][5] PE does not exist if both partners agree that the quality of their sexual encounters is not influenced by efforts to delay ejaculation. PE has become the centre of a multimillion-dollar business, but PE during vaginal intercourse is not a male sexual dysfunction. ...
Article
Full-text available
Premature ejaculation has become the centre of a multimillion-dollar business, but PE during vaginal intercourse is not a male sexual dysfunction.
... The vital organ in males is the penis, whereas the uterus, vagina, clitoris, and the Grafenberg-spot (G-spot), whose existence is not definite, are among the factors that are effective in women (1) . The G-spot is a current and controversial issue, and it now attracts interest in female sexuality because it involves a market share in genital esthetics with interventions such as its augmentation (2) . Ernst Grafenberg was the first to describe the G-spot as an erogenous zone approximately half a centimeter in size, below the urethra on the anterior wall of the vagina, but the first reports of its presence date back much further. ...
... Studies are contradictory. In a study conducted by Puppo and Gruenwald (2) , Puppo and Puppo (25) in which they reviewed the terminology of female sexuality, they wrote that the G-spot did not exist under the subtitle of "The G-spot does not exist: Is it a scientific fraud?" They stated that there was no vaginal orgasm and added that there was no scientific support for research that said the G-spot and vaginal orgasm existed. ...
Article
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Objective Aim of study to determine the existence of the G-spot from the healthy women’s point of view and to assess the relationship with sexual function and genital perception. Materials and Methods Sexually-active healthy polyclinic patients aged between 18 and 54 years (n=309) were classified into three groups as group 1 (do not agree, n=90, 29.1%), group 2 (neutral/do not know, n=61, 19.7%) and group 3 (agree, n=158, 51.1%) with regard to participants’ responses to a question of “does the G-spot exist.” The Female Sexual Function index (FSFI) and Female Genital Self-Image scale (FGSIS) were administered to the participants. Results Half of the patients (51.1%, n=151) indicated that the G-spot exists. The groups were statistically homogeneous in terms of body mass index, parity, marital status, number of partners, and sexual orientation (p=0.41, p=0.06, p=0.12, p=0.19, p=0.25; respectively). Women with an education level of “less than high school” reported the absence of the G-spot significantly more often than others, whereas women with an education level of “university and higher” reported the presence of the G-spot more often (p≤0.001). Sexual dysfunction was found to be more frequent in group 1 when compared with group 3 (p=0.002, 67.8%, 45.6%). The orgasm subdomain scores of the FSFI and FGSIS total scores were significantly higher in group 3 than in group 1 (p<0.001, p=0.041). Conclusion Half of healthy women in the Turkish population believe that the G-spot exists. Those women showed better scores in sexual functioning and genital perception.
... A critical question that continues to generate controversy concerns the existence of a "G-Spot" that when stimulated properly leads to a "deep vaginal orgasm". 688 Still others argue that such an anatomical entity does not exist 689 citing clinical or case studies of women who have never found theirs despite trying. It may well be the case that not all vaginas are constructed the same way, and that internal sensory inputs come in various sizes and shapes. ...
Chapter
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This chapter reviews the current state of knowledge concerning the neurobiology of female sexual behavior, including sexual arousal, appetitive desire, pacing of sexual stimulation, the receptive postures that allow vaginal penetration to occur, and the inhibitory or refractory states induced by sexual stimulation, sexual nonreward, and/or the steroid hormone milieu. Data from a variety of species, including humans, is discussed at several levels of analysis that link neuroendocrinology, neuropharmacology, and molecular biology. The context in which sexual behavior occurs, especially during an animal's first sexual experiences, is considered in terms of culture and experimental conditioning, processes that alter neuronal responses, and ultimately behavior in the presence of external sexual incentive cues that predict sexual pleasure or nonreward. New vistas for further research are discussed.
... The current state of the debate over women's orgasm continues to posit the clitoris against the vagina and is punctuated on both sides by the writings of two men: Vincenzo Puppo arguing for the clitoris and Stuart Brody arguing for the vagina. Puppo (2011aPuppo ( , 2011b, Puppo and Gruenwald (2012), Puppo and Puppo (2014) argue that women's orgasm cannot be vaginal because there is nothing in the vagina Á no stimulation of an internal clitoral complex and no stimulation of the cervix Á that could possibly stimulate orgasm. Orgasms are generated by stimulation of the external clitoral glans alone, and women should not suffer the frustration of trying to obtain orgasm from vaginal stimulation and the indignities of self-doubt when those orgasms do not occur. ...
Article
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Background The nature of a woman’s orgasm has been a source of scientific, political, and cultural debate for over a century. Since the Victorian era, the pendulum has swung from the vagina to the clitoris, and to some extent back again, with the current debate stuck over whether internal sensory structures exist in the vagina that could account for orgasms based largely on their stimulation, or whether stimulation of the external glans clitoris is always necessary for orgasm. Method We review the history of the clitoral versus vaginal orgasm debate as it has evolved with conflicting ideas and data from psychiatry and psychoanalysis, epidemiology, evolutionary theory, feminist political theory, physiology, and finally neuroscience. Results A new synthesis is presented that acknowledges the enormous potential women have to experience orgasms from one or more sources of sensory input, including the external clitoral glans, internal region around the “G-spot” that corresponds to the internal clitoral bulbs, the cervix, as well as sensory stimulation of non-genital areas such as the nipples. Conclusions With experience, stimulation of one or all of these triggering zones are integrated into a “whole” set of sensory inputs, movements, body positions, autonomic arousal, and partner- and contextual-related cues, that reliably induces pleasure and orgasm during masturbation and copulation. The process of integration is iterative and can change across the lifespan with new experiences of orgasm.
... Published scientific data highlight the fact that the G-spot does not even exist. In a recent review, Puppo et al. (6) proposed that G-spot amplification is an unnecessary and inefficacious procedure. Nevertheless, introital injections of hyaluronic acid have been able to increase sexual satisfaction (4,7). ...
Article
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Lipofilling for G-spot augmentation is appealing because long-term persistence of the fat is expected to be very good. We report the case of a 29-year-old patient who requested G-spot augmentation to enhance sexual sensation. Autologous fat (8 cc) that was harvested from the trochanteric area was injected. Although there are few published data acknowledging the presence of the G-spot, the patient was satisfied with the procedure and no side effects occurred. Nevertheless, evaluation with standard questionnaires, such as Fragebogen zur Lebenszufriedenheit (FLZ) and Kurzfragebogen für sexuelle Probleme (KFSP-F), did not indicate the positive effects on subjective well-being and sexual parameters of a surgical G-spot augmentation. Studies comprising a larger series of patients are required before substantiated recommendations regarding the benefits and risks of this procedure will be possible.
... The identity of the multiple anatomical structure(s) creating this arousal is the problem (see Table 1 for their possible identities). Some authors simply argue that there is no convincing evidence that any structure exists in and around the anterior vaginal wall that could give rise to such responses (Hines, 2001;Burri et al., 2010;Puppo, 2012;Puppo and Gruenwald, 2012;Jannini et al., 2014). Others disagree and there have been proposals (Shafik et al., 2004a, b), descriptions (Lenck et al., 1992) and even published dissections (Thabet, 2009(Thabet, , 2013Ostrzenski, 2012) claiming to have identified its anatomy. ...
Article
This review deals critically with many aspects of the functional genital anatomy of the human female in relation to inducing sexual arousal and its relevance to procreation and recreation. Various controversial problems are discussed including: the roles of clitorally versus coitally induced arousal and orgasm in relation to the health of women, the various sites of induction of orgasm and the difficulty women find in specifically identifying them because of “'ambiguity problems” and “genital site pareidolia,” the cervix and sexual arousal, why there are so many sites for arousal, why multiple orgasms occur, genital reflexes and coitus, the sites of arousal and their representation in the brain, and identifying aspects and functions of the genitalia with appropriate new nomenclature. Clin. Anat., 2014. © 2014 Wiley Periodicals, Inc.
... Few other topics in the field of sex research and sexology have evoked such a firestorm of debate as the nature and expression of women's orgasms. Interestingly, and as noted by Pfaus, Quintana, Mac Cionnaith, and Parada (2016), the debate surrounding women's orgasms is polarized by Brody arguing in favour of the superiority of the vaginal orgasm at one end, and Puppo and Gruenwald (2012), arguing in favour of the clitoris at the other end. As Brody himself seems to recognize, this argument is as much political as it is scientific. ...
Article
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This brief article is a reply to Brody and Costa's (2017) commentary on the article "A critical examination of the relationship between vaginal orgasm consistency and measures of psychological and sexual functioning and sexual concordance in women with sexual dysfunction" (Therrien &Brotto, 2016). Although I could provide a counter-point to each of the criticisms of our article, I have chosen instead to use this space to remind readers that our understanding of the underlying anatomy of women's orgasms is nascent. In addition, a variety of types of stimulation contribute to whether, how, and how intensely a woman may reach orgasm. Findings on the nature of female orgasm don't "prove" or "disprove" other findings. Rather they need to be analyzed in the context of the range of contributory variables.
... Contudo, os estudos não mostram deterioração da função sexual -pelo contrário, após a realização deste tipo de cirurgias, mesmo com uso de redes 44,45 ! Apesar dos trabalhos de um grupo muito escasso de autores defendendo a existência do ponto G, a maior parte da evidência é contrária 46,47 e todas estas intervenções devem ser consideradas inúteis e ineficazes. ...
Article
Full-text available
Aesthetic vulvar and vaginal surgery have been increasing in the last few years. The same procedure can be found under several designations, as well as different designations might refer to the same procedure. Despite the increasing number of patients seeking these procedures, there is a lack of scientific basis for the performance of most of it, as well as of good follow-up studies in terms of complications. It is important to distinguish cases of plastic surgery needed for the treatment of vulvar lesions or correction of symptomatic hypertrophic labia minora, pelvic organs prolapse or urinary incontinence from pure aesthetic surgery, just to pursue a sometimes unrealistic model of perfection. Despite the easiness of performance of most of these procedures, the chance of complications must always be kept in mind. A psychological evaluation of the women candidate to genital aesthetic surgery should be considered in most cases.
... The existence of the "G-spot" itself is debatable, and all procedures aiming at its augmentation, despite being offered by some providers, are considered useless and unethicaljust like laser vaginal tightening. 5,11,12 Hymenoplasty was suggested by Reziciner as a way to prevent recurrent post-coital cystitis, 13 but without any scientific support to recommend it. Although there is never any medical indication to perform it, it has been life-saving for some Muslim girls, and this highlights how important relative ethical issues can be in different communities. ...
Article
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Objective To assess the medical doctors and medical students' opinion regarding the evidence and ethical background of the performance of vulvovaginal aesthetic procedures (VVAPs). Methods Cross-sectional online survey among 664 Portuguese medical doctors and students. Results Most participants considered that there is never or there rarely is a medical reason to perform: vulvar whitening (85.9% [502/584]); hymenoplasty (72.0% [437/607]); mons pubis liposuction (71.6% [426/595]); “G-spot” augmentation (71.0% [409/576]); labia majora augmentation (66.3% [390/588]); labia minora augmentation (58.3% [326/559]); or laser vaginal tightening (52.3% [313/599]). Gynecologists and specialists were more likely to consider that there are no medical reasons to perform VVAPs; the opposite was true for plastic surgeons and students/residents. Hymenoplasty raised ethical doubts in 51.1% (283/554) of the participants. Plastic surgeons and students/residents were less likely to raise ethical objections, while the opposite was true for gynecologists and specialists. Most considered that VVAPs could contribute to an improvement in self-esteem (92.3% [613/664]); sexual function (78.5% [521/664]); vaginal atrophy (69.9% [464/664]); quality of life (66.3% [440/664]); and sexual pain (61.4% [408/664]). Conclusions While medical doctors and students acknowledge the lack of evidence and scientific support for the performance of VVAPs, most do not raise ethical objections about them, especially if they are students or plastic surgeons, or if they have had or have considered having plastic surgery.
... For this reason, less invasive and low adverse-risk interventions may also be planned through good identification of the major motivators for patients whose only expectations are to increase sexual functions. From this point of view, laser, filler injections, and PRP are gaining popularity nowadays (3,(24)(25)(26) . It is also possible that in such minimally invasive methods, a positive effect is enhanced by providing the woman's sensitive focus to the vagina during sexual intercourse. ...
Article
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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.
... Contudo, os estudos não mostram deterioração da função sexual -pelo contrário, após a realização deste tipo de cirurgias, mesmo com uso de redes 44,45 ! Apesar dos trabalhos de um grupo muito escasso de autores defendendo a existência do ponto G, a maior parte da evidência é contrária 46,47 e todas estas intervenções devem ser consideradas inúteis e ineficazes. ...
Article
Full-text available
Aesthetic vulvar and vaginal surgery have been increasing in the last few years. The same procedure can be found under several designations, as well as different designations might refer to the same procedure. Despite the increasing number of patients seeking these procedures, there is a lack of scientific basis for the performance of most of it, as well as of good follow-up studies in terms of complications. It is important to distinguish cases of plastic surgery needed for the treatment of vulvar lesions or correction of symptomatic hypertrophic labia minora, pelvic organs prolapse or urinary incontinence from pure aesthetic surgery, just to pursue a sometimes unrealistic model of perfection. Despite the easiness of performance of most of these procedures, the chance of complications must always be kept in mind. A psychological evaluation of the women candidate to genital aesthetic surgery should be considered in most cases.
... They are paired erectile organs located directly below the labia majora, abutting the distal vaginal wall. Both bulbs are covered by bulbocavernosus muscle [24]. As the vestibular bulbs become engorged during sexual arousal, the clitoris is drawn closer to the vaginal opening enabling direct stimulation. ...
Article
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Purpose of Review There is a growing body of evidence-based research in the area of female sexual arousal that has led to improved understanding of the female sexual arousal response and the development of FDA-approved treatments for female sexual dysfunction. The purpose of this paper is to review the existing literature on female sexual arousal and response with a focus on local genital arousal and the mechanisms underlying vaginal lubrication. Recent Findings From May 2000 to May 2020, PubMed and Cochrane databases were reviewed and manuscripts selected, based on keywords, content, references, and relevance to the topic. Vaginal lubrication occurs due to vasodilation of the major branches of iliohypogastric and pudendal arterial beds. The increase in intravascular and vaginal wall pressure forces fluid to pass through the vaginal intraepithelial gap junctions, forming a transudate of plasma. The fluid coalesces to form water-like droplets that lubricate the entire vaginal canal, allowing for ease of penetration during sexual intercourse. Vaginal lubrication is a fundamental component of female sexual arousal and directly correlates with subjective levels of satisfaction and enjoyment. Summary The female sexual arousal response is a complex reflex involving multiple organs and bodily functions. There are numerous age-related, metabolic, environmental, hormonal, and other factors that can negatively impact female sexual arousal and vaginal lubrication. As women age, vaginal lubrication declines due to declining genital blood flow and serum hormone levels. Concomitant reduction in physical activity and other medical comorbidities can also negatively impact vaginal blood flow and lubrication. The new and evolving treatment modalities for female sexual arousal disorder are directed toward optimizing vaginal health, function, and lubrication.
... The so-called 'G-spot' has not been without its detractors as there is still controversy over whether it actually exists (Levin, 2003a;Jannini et al., 2010) or not (Hines, 2001;Puppo and Gruenwald, 2012;Kilchevsky et al., 2012). Claims to have located it anatomically have been made in a number of published studies but unfortunately the locations are at different sites and with different structures (Lenck et al., 1992;Thabet, 2009Thabet, , 2013Ostrzenski, 2012). ...
Article
The female orgasm has been examined over the years by numerous scientific disciplines yet it still has many secrets to be disclosed. Because its physiology, especially its neurophysiology, is sparingly understood its pharmacology is necessarily limited based mainly on the side effects of drugs. Few published studies have used a placebo group as controls. The paucity of focussed studies is well illustrated by the fact that there still is no approved medication to treat female orgasmic dysfunction. The present brief overview examines the mostimportant aspects of its biology and especially its physiology highlighting the many questions that need answering if we are to have a comprehensive pharmacology of the female orgasm.
... While a more detailed description of female prostate was elaborated thanks to the meritorious work of the Slovak pathologist Milan Zaviacic [34], many ultrasound and MRI studies as well as cadaveric dissections have given other insights into its complex structure, but surprisingly still much controversy exists around this topic, and the existence of the G-spot is today still a matter of debate [35,36]. ...
Article
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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).
... In 1950, Gräfenberg described an area known as the G-spot located on the anterior vaginal wall midway between the cervix and pubic bone, 1-2 cm from the urethra, which is responsible for stimulation of systematic orgasm that differs from clitoral orgasm [16,33,34]. However scientific community defies its existence [16,35]. ...
Article
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Female genital cosmetic surgery is a set of multiple procedures focused on improving genital appearance, structure, and function. Sexual dysfunction affects a large proportion of the female population and appears to be associated with distorted genital anatomy although what women perceive as normal varies vastly depending on cultural and social beliefs. Cosmetic gynaecology office procedures are simple, quick, and effective solutions to improve sexual function as well as body image with minimal interventions and minimal side-effects. In this narrative review, we present these widely used minimally invasive aesthetic gynaecology interventions, focusing on their efficacy, and reported complications. Recommendations regarding heath professionals' approach and ethical issues arising are also discussed.
... Originally described by the German gynecologist Ernst Gräfenberg in 1950, the G-spot refers to an erogenous zone located 1-2 cm from the urethra on the anterior vaginal wall [65]. Since this description was published, there have been many reviews and papers questioning the validity of the G-spot [66,67]. Ostrzenski claimed to have found the G-spot during a cadaver dissection; however, no histological analysis was performed to confirm neurovascular tissue [68]. ...
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The aesthetic and functional procedures that comprise female genital cosmetic surgery (FGCS) include traditional vaginal prolapse procedures as well as cosmetic vulvar and labial procedures. The line between cosmetic and medically indicated surgical procedures is blurred, and today many operations are performed for both purposes. The contributions of gynecologists and reconstructive pelvic surgeons are crucial in this debate. Aesthetic vaginal surgeons may unintentionally blur legitimate female pelvic floor disorders with other aesthetic conditions. In the absence of quality outcome data, the value of FGCS in improving sexual function remains uncertain. Women seeking FGCS need to be educated about the range and variation of labia widths and genital appearance, and should be evaluated for true pelvic support disorders such as pelvic organ prolapse and stress urinary incontinence. Women seeking FGCS should also be screened for psychological conditions and should act autonomously without coercion from partners or surgeons with proprietary conflicts of interest.
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In 2013 Thabet SMA. stated “localized the site of the G-spot by the presence of two small bodies” “the G-spot to be formed of characteristic epithelium, erectile tissue and urethral glands”. The pelvic and perineal urethral lumen is surrounded by mucosa (with transitional/squamous epithelium), by submucosa, by muscle fibers, by erectile spongy tissue (i.e., corpus spongiosum of the female urethra), by Skene’s peri-urethral glands, and by the Skene’s para-urethral ducts (their length is 0.5-3 cm). The Skene’s glands open through a single or multiple orifices either into the distal urethra (similar to the male prostate) or open through Skene’s ducts orifice onto the left and right sides of the external urethral orifice. As a matter of fact female sexual dysfunctions are popular because they are based on something that doesn’t exist, i.e. the vaginal/G-spot orgasm.
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The G-spot amplification is a process of “functional” intimate surgery consisting of a temporary physical increase of the size and sensitivity of the G-spot with a filler injected into the septum between the bladder and the vagina's anterior wall, in order to increase the frequency and importance of female orgasm during vaginal penetration. This surgical technique is based on the existence of an eponymous anatomical area described by Dr Gräfenberg in 1950, responsible upon stimulation of systematic orgasm different from the clitoral orgasm, referring to the vaginal orgasm as described by Freud in 1905. The purpose of this article is to review the scientific basis of the G-spot, whose very existence is currently a debated topic, and to discuss the role of G-spot amplification surgery.
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Despite its central role in sexual function, we lack a description of the nerve distribution and histology for the central components of the clitoris. This study aims to characterize microscopic anatomy of the clitoral-urethral complex (CUC) and aid our understanding of sexual sensation METHODS: The CUC was excised from three female fresh-frozen cadavers en bloc and prepared in 5-μm longitudinal sections with hematoxylin and eosin and S100 immunohistochemistry for neural elements. Approximately 20 sections were obtained from each specimen. On low power microscopy, the 30 most innervated fields on each section were identified. On high power, the total number of nerves per field was quantified, then was averaged. The histologic characteristics of each clitoral component were described. Two investigators evaluated all specimens. Descriptives of large (≥3 fibers) and small nerves based on location in the CUC. Nerve quantification revealed the glans to be the most populated by small nerves (52.1, standard deviation [SD] 26.2). As slices through each specimen moved caudad toward the urethra, the number of small nerves dramatically decreased from 40.4 (SD 10.8) in the body and 29.8 (SD 8.8) (superior CUC) near the bulb to 23.7 (SD 9.8) in the middle CUC and 20.5 (SD 10.4) (inferior CUC) near the urethra. Although the variation in small nerves was striking, large nerves were somewhat uniform and comprised a minority of the overall quantity. Neuroanatomy was consistent for all cadaver specimens. Our study provided a description of the nerve distribution throughout the central CUC. Increased density of small nerves in the glans suggests this is the location of heightened sensation. Decreasing quantity of nerves in segments closer to the urethra may indicate these zones are less important for sexual sensation. Knowledge of human clitoral innervation is important for understanding the complexities of the female sexual response cycle. Oakley SH, Mutema GK, Crisp CC, Estanol MV, Kleeman SD, Fellner AN, and Pauls RN. Innervation and histology of the clitoral-urethal complex: A cross-sectional cadaver study. J Sex Med **;**:**-**.
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Premature ejaculation (PE) during vaginal intercourse is not a male sexual dysfunction. PE has become the centre of a multimillion dollar business. Questionnaires for male ejaculation and female orgasm must to assess masturbation.
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IntroductionThe clitoris is often considered the female version of the penis and less studied compared to its male counterpart. Nonetheless, it carries the same importance in sexual functioning. While it has more recently been allocated the appreciation it deserves, the clitoris should be examined as a separate and unique entity.AimTo review clitoral anatomy, its role in sexual functioning, the controversies of vaginal eroticism and the female prostate, as well as address potential impacts of pelvic surgery on its function.Methods We examined available evidence (from 1950 until 2015) relating to clitoral anatomy, the clitoral role in sexual functioning, vaginal eroticism, female prostate, female genital mutilation/cutting, and surgical implications for the clitoris.Main Outcome MeasuresMain outcomes included an historical review of the clitoral anatomy and its role in sexual functioning, the controversies regarding vaginal sources of sexual function, and the impact of both reconstructive and nonmedical procedures on the clitoris.ResultsThe intricate neurovasculature and multiplanar design of the clitoris contribute to its role in female sexual pleasure. Debate still remains over the exclusive role of the clitoris in orgasmic functioning. Normal sexual function may remain intact, however, after surgical procedures involving the clitoris and surrounding structures.Conclusions The clitoris is possibly the most critical organ for female sexual health. Its importance is highlighted by the fact that the practice of female genital cutting is often used to attenuate the female sexual response. While its significance may have been overshadowed in reports supporting vaginal eroticism, it remains pivotal to orgasmic functioning of most women. Donna Mazloomdoost and Rachel N. Pauls. A comprehensive review of the clitoris and its role in female sexual function. Sex Med Rev **;**:**–**.
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Female emission is more accurate than female ejaculation. The lack of the ejaculation phase in the female could explain why women do not have a refractory period and are able to have multiple orgasms.
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Vaginal rejuvenation, designer vaginoplasty, revirgination are not medically indicated. G-spot does not exist: G-spot amplification is an unnecessary and inefficacious medical procedure. Female Genital Mutilation (FGM) type IV includes all other harmful procedures to the female genitalia for non-medical purposes. Female Genital Cosmetic Surgery (FGCS) should be considered or classified as FGM type IV.
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Introduction and hypothesis: The current terminology used to describe cosmetic gynecologic procedures includes many nondescriptive, trademarked, or informal names, which contributes to substantial ambiguity about their aims and specific techniques. The development of clear, uniform descriptive terminology for cosmetic gynecology is needed for patients, researchers, and practitioners across multiple specialties. Methods: This document was developed from a collaboration of selected members from the International Urogynecological Association (IUGA) and the American Urogynecologic Society (AUGS). Wide-ranging literature reviews were performed to identify the breadth of currently used terms and tools for measuring efficacy and safety. After extensive internal review the adoption of each definition was ratified by group consensus. Results: A terminology report for elective cosmetic gynecology procedures, anatomical classification, outcome metrics, and reporting of complications has been developed. This document seeks to provide clear descriptive guidance for patients, researchers, and practitioners across multiple specialties. This document will be subject to internal review by IUGA and AUGS to incorporate and adopt evidence-based changes in the field. Conclusions: A consensus-based document establishing clear terminology for cosmetic gynecology procedures has been created. Use of these terms should be encouraged to provide clarity to patients seeking these procedures and to facilitate future research to establish the safety and efficacy of these procedures.
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Mehr als 300 Millionen Treffer erhält, wer den Begriff „G-Spot“ in Google eintippt. Die Beiträge reichen von Anleitungen, wie der G-Punkt zu finden und zu stimulieren wäre, bis zu Angeboten, ihn kollagengestützt vergrößern zu lassen. Aber existiert er überhaupt?
Article
Background: Aging, childbearing, and hormonal changes can lead to vulvovaginal laxity and mucosal atrophy that negatively affect a woman's quality of life. As more minimally and noninvasive options for genital rejuvenation become available in the outpatient setting, it becomes increasingly important for the dermatologic surgeon to be familiar with these popular procedures. Objective: To familiarize dermatologists with the nonsurgical options available for female genital rejuvenation, patient motivations for pursuing these procedures, relevant anatomy, and potential adverse events. Materials and methods: A MEDLINE search was performed on nonsurgical female genital rejuvenation from 1989 to 2015, and results are summarized. Results: Reports of nonsurgical female genital rejuvenation procedures using fractional carbon dioxide lasers, nonablative lasers, monopolar radiofrequency devices, hyaluronic acid fillers, and fat transfer are concisely summarized for the practicing dermatologist. Conclusion: Review of the literature revealed expanding options for nonsurgical female genital rejuvenation.
Article
Introduction: There is evidence of glandular tissue within the region of the anterior vaginal wall-female periurethral tissue (AVW-FPT) having similar morphology and immunohistochemistry to the prostate in men and having physiological roles in the female sexual response (FSR). Whether this tissue should be called a prostate in women has been debated. Iatrogenic injury to structures of the AVW-FPT, including these glands and the associated neurovasculature, could be a cause of female sexual dysfunction (FSD). Objectives: To consolidate the current knowledge concerning the glandular tissue surrounding the urethra in women, evidence was reviewed to address whether: (i) these glands comprise the prostate in women, (ii) they have specific functions in the FSR, and (iii) injury to the AVW-FPT and prostate has sexual dysfunction as a likely outcome. Methods: A literature review was conducted using keywords including female prostate, Skene’s/paraurethral glands, periurethral tissue, Gr€afenberg (G)-spot, female ejaculation, mid-urethral sling (MUS), and sexual dysfunction. Results: Histological and immunohistochemical studies of the glandular tissue surrounding the urethra support the existence of prostate in women. Evidence suggests this tissue may have physiologically and clinically relevant autonomic and sensory innervation, and during sexual arousal may contribute to secretions involved in ejaculation and orgasm. Gaps in knowledge relating to the functional anatomy, physiological roles, and embryological origins of this tissue have impeded the acceptance of a prostate in women. Injury to the innervation, vasculature, and/or glandular tissue within the surgical field of MUS implantation suggests iatrogenic sexual dysfunction is plausible. Conclusions: Continuing to advance our understanding of the morphology, histochemistry, and physiologic capacity of this glandular tissue will clarify the characterization of this tissue as the “prostate” involved in the FSR, and its role in FSD following surgical injury.
Article
Knowledge of the actual anatomy and function of the clitoris has been underrepresented for a long time. Anatomical descriptions and illustrations existed but were scientifically disregarded for centuries. Even now anatomy books and textbooks are still dominated by incorrect depictions and inadequate functional descriptions of the clitoris, even though the knowledge about this complex organ is essential for the clinical practice in gynecology, obstetrics, urology and other specialist disciplines. From a special gynecological perspective, the sociocultural and medical history are presented, including misunderstandings and misconceptions. The correct anatomy and physiology are closely related to the rediscovery of the clitoris in research and practice as well as in the social perception. The relevance of the clitoris for contemporary medicine regarding sexuality, self-awareness, self-determination and therefore gender equity can be seen as a fundamental and also political issue.
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Aesthetic gynecologic surgery is gaining popularity among women and physicians. Aesthetic genital surgery for women encompasses both minimally invasive and open surgical procedures. Cosmetic genital procedures for women described in this article include perineoplasty, vaginoplasty, vaginal rejuvenation, labiaplasty, G-spot enlargement, Bartholin gland surgery, clitoral hoodoplasty, clitroplasty, hymenoplasty, and mons pubis plastic surgery. Based on a review of the literature for each procedure, the article discusses procedural methods and techniques, indications for implementation, potential consequences and side effects of the procedure, nursing implications, patients' motives for undergoing the procedure, and positions of scientific institutions relative to the procedure.
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Introduction The G-spot, a putative erogenous area in the anterior vaginal wall, is a widely accepted concept in the mainstream media, but controversial in medical literature. Aim Review of the scientific data concerning the existence, location, and size of the G-spot. Methods Search on Pubmed, Pubmed Central, Cochrane, clinicaltrials.gov and Google Scholar from inception to November 2020 of studies on G-spot's existence, location and nature. Surveys, clinical, physiological, imaging, histological and anatomic studies were included. Main Outcome Measure Existence, location, and nature of the G-spot. Results In total, 31 eligible studies were identified: 6 surveys, 5 clinical, 1 neurophysiological, 9 imaging, 8 histological/anatomical, and 2 combined clinical and histological. Most women (62.9%) reported having a G-spot and it was identified in most clinical studies (55.4% of women); in 2 studies it was not identified in any women. Imaging studies had contradictory results in terms of its existence and nature. Some showed a descending of the anterior vaginal wall, that led to the concept of clitourethrovaginal complex. In anatomic studies, one author could systematically identify the G-spot, while another group did not find it. Studies on innervation of the vaginal walls did not systematically identify an area with richer innervation. Conclusion The different studies did systematically agree on the existence of the G-spot. Among the studies in which it was considered to exist, there was no agreement on its location, size, or nature. The existence of this structure remains unproved. Vieira-Baptista P, Lima-Silva J, Preti M, et al. G-spot: Fact or Fiction?: A Systematic Review. Sex Med 2021;XX:XXXXXX.
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With advances in the standards of living and public perceptions, female genital cosmetic surgery is becoming a new hot topic in the field of plastic surgery, gaining considerable interest recently among beauty seekers and professionals alike. However, the needs of beauty pursuers seem to be exuberant but vague; on the other hand, practitioners who have received strict professional training are still desperately needed. Additionally, interest-driven marketing and promotion render the field prone to chaos, resulting in widespread attention and concerns regarding the scientificity, safety, effectiveness, and necessity of the performance of multiple treatment procedures. Extensive survey of the relevant literature was performed, and several beauty seekers as well as surgeons with working experience of pertinent techniques were consulted, in order to examine the current status and future developments of this field.
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For sexologists, physicians, psychologists, gynecologists etc., it is a duty to update their knowledge. Female and male orgasm-sexuality, free pdf with 36 Pubmed-full text Dr Vincenzo Puppo-New Sexology Project: Eur J Obstet Gynecol, Eur Urol, Clin Anat, BJOG, J Urol, Int Urogynecol J, J Sex Med, BJU Int, J Pediatr Adolesc Gynecol, ISRN Obstet Gynecol, Gynecol Obstet Fertil, Maturitas, Int J Urol, etc. Sexual pleasure/orgasm, (clitoris, labia minora and vestibular bulbs, exist in all women) is a source of physical and psychological wellbeing that contributes to human happiness. Female sexual anatomy is not has been a neglected area of study and the existing terminology is accurate from centuries... The key to female orgasm are the female erectile organs of the vulva (external organs)... Female orgasm is possible in all women, always, with effective stimulation of the female erectile organs... female sexual dysfunctions are popular because they are based on something that does not exist, i.e. the vaginal orgasm... Female sexual satisfaction is based on orgasm: sexologists must define having sex/love making when orgasm occurs for both partners, always, with or without vaginal intercourse (definition for all human beings)... the duration of penile-vaginal intercourse is not important for a woman’s orgasm: premature ejaculation is not a male sexual dysfunction... Website http://www.vincenzopuppo.altervista.org/articoli.html Free video: clitoris/labia minora erection in woman https://www.researchgate.net/publication/273966598_Flaccid_Erect_Clitoris_Labia_minora_in_woman_Clin_Anat_2013 Free video: orgasms in all women https://www.researchgate.net/publication/343851657_Video_Female_orgasms_in_all_women_always_with_stimulation_clitoris-labia_minora_with_fingers https://www.youtube.com/watch?v=Pm_Qg2b4kKI
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Vaginal atrophy caused by the aging process and perineal trauma has a negative impact on women. A new vaginal atrophy treatment is injection of materials into the vaginal wall, including platelet-rich plasma (PRP), autogenous fat graft (AFG), hyaluronic acid (HA), botulinum toxin (BTX), and collagen, but to date their efficacy has not been reviewed. Vaginal wall injection is available only for mild cases of vaginal atrophy or as an adjunct to vaginal surgery. PRP is used mainly to restore vaginal function, and multiple injections are needed to achieve good results in vaginal atrophy. HA, AFG, and collagen are used mainly to augment the vaginal wall. BTX injection can inhibit vaginal muscle spasm and reduce pain during sexual intercourse in patients with vaginismus. Injection of most of these materials into vaginal wall is effective and relatively safe. Vascular embolisms are the most serious complication of vaginal injection and should be prevented. In addition, there has been no randomized double-blind placebo-controlled trial or discussion of methods to avoid serious complications resulting from vaginal injection. Therefore, further studies of the injection of materials into the vaginal wall to treat vaginal atrophy are required, and the procedures should be standardized to benefit more patients. Level of Evidence IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.
Article
Female genital cosmetic surgeries (FGCSs) and procedures are increasingly being advertised as common, simple, and complication-free, capable of not only improving aesthetic appearance but also increasing self-esteem and sexual pleasure.Guidelines for physicians and clear, scientifically correct information for patients must be made available, to minimize the number of ineffective or deleterious procedures.The International Society for the Study of Vulvovaginal Disease positions/recommendations regarding FGCS are as follows:1. There is a wide variation regarding genital normalcy; providers must be able to explain this to women.2. There are no data supporting FGCS including, G-spot augmentation, hymenoplasty, vulvar and perianal bleaching/whitening, vaginal tightening procedures, and other procedures aimed at increasing sexual function.3. Women should not be offered FGCS before the age of 18 years.4. Women undergoing FGCS should be evaluated by a provider with expertise in vulvovaginal diseases, including attention to their psychological, social, and sexual context. Evaluation by an experienced mental health provider should be considered when the motivation for seeking surgery and/or expectations are not clear or realistic.5. Female genital cosmetic surgery is not exempt from complications.6. Informed consent must always be obtained.7. Surgeons performing FGCS should refrain from solicitous advertising or promoting procedures without scientific basis, including on Web sites.8. Surgeons should not perform surgery that they do not agree with and explain their rationale/position when pressured by patients.9. The genital surgeon must be adequately trained in performing FGCS including knowledge of the anatomy, physiology and pathophysiology of the vulva, vagina and adjacent organs.
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Background: Controversy exists in the literature regarding the presence or absence of an anatomic "G-spot." However, few studies have examined the detailed topographic or histologic anatomy of the putative G-spot location. Aim: To determine the anatomy of the anterior vaginal wall and present detailed, systematic, accessible findings from female cadaveric dissections to provide anatomic clarity with respect to this location. Methods: Systematic anatomic dissections were performed on 13 female cadavers (32-97 years old, 8 fixed and 5 fresh) to characterize the gross anatomy of the anterior vaginal wall. Digital photography was used to document dissections. Dissection preserved the anterior vaginal wall, urethra, and clitoris. In 9 cadavers, the vaginal epithelial layer was reflected to expose the underlying urethral wall and associated tissues. In 4 cadavers, the vaginal wall was left intact before preservation. Once photographed, 8 specimens were transversely sectioned for macroscopic inspection and histologic examination. Outcomes: The presence or absence of a macroscopic anatomic structure at detailed cadaveric pelvis dissection that corresponds to the previously described G-spot and gross anatomic description of the anterior vaginal wall. Results: Deep to the lining epithelium of the anterior vaginal wall is the urethra. There is no macroscopic structure other than the urethra and vaginal wall lining in the location of the putative G-spot. Specifically, there is no apparent erectile or "spongy" tissue in the anterior vaginal wall, except where the urethra abuts the clitoris distally. Clinical implications: The absence of an anatomic structure corresponding to the putative G-spot helps clarify the controversy on this subject. Strengths and limitations: Limitations to this study include limited access to specimens immediately after death and potential for observational bias. In addition, age, medical history, and cause of death are not publishable for privacy reasons. However, it is one of the most thorough and complete anatomic evaluations documenting the anatomic detail of the anterior vaginal wall. Conclusion: The G-spot, in its current description, is not identified as a discrete anatomic entity at macroscopic dissection of the urethra or vaginal wall. Further insights could be provided by histologic study. Hoag N, Keast JR, O'Connell HE. The "G-Spot" Is Not a Structure Evident on Macroscopic Anatomic Dissection of the Vaginal Wall. J Sex Med 2017;14:1524-1532.
Chapter
Sexual health can be defined as a state of physical, emotional, mental and social well-being that is related to sexuality and not merely the absence of disease, dysfunction or infirmity. Achieving sexual health requires the sexual rights of individuals to be recognized and guaranteed. Among these rights are “the right to comprehensive sexual education” and “the right to information based on scientific knowledge”, suggesting that sexual information should be generated through free and ethical scientific research and appropriately disseminated at all social levels. However, sexology remains a neglected educational discipline in the general population, in particular among physicians, and it is therefore possible that misinformation leads to the proliferation of myths and misconceptions about sexuality. In this chapter, we describe how ingrained these myths or misconceptions are in our population. In addition, we provide answers and recommendations about sexual health that are based on the best evidence.
Chapter
The term G-spot was first coined by Addiego and colleagues, referring to an erotically sensitive spot located in the pelvic urethra and palpable through the anterior vaginal wall. The genetic and environmental influences on the presence of the G-spot have recently been evaluated in a large study of 1,804 twins aged 22-83 years. Overall 56% of women reported having a G-spot and the prevalence decreased with age. The authors conclude that while objective measures have failed to provide consistent evidence, reliable anecdotal reports of a highly sensitive area in the distal anterior vaginal wall continue to support the existence of the G-spot. If the G-spot does exist, then, theoretically, augmenting the size of the G-spot may lead to more friction during intercourse and this may possibly lead to increased sexual satisfaction. This has lead to the development of G-spot amplification procedures, of which perhaps the best known is the G-Shot.
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This review, with 21 figures and 1 video, aims to clarify some important aspects of the anatomy and physiology of the female erectile organs (triggers of orgasm), which are important for the prevention of female sexual dysfunction. The clitoris is the homologue of the male's glans and corpora cavernosa, and erection is reached in three phases: latent, turgid, and rigid. The vestibular bulbs cause "vaginal" orgasmic contractions, through the rhythmic contraction of the bulbocavernosus muscles. Because of the engorgement with blood during sexual arousal, the labia minora become turgid, doubling or tripling in thickness. The corpus spongiosum of the female urethra becomes congested during sexual arousal; therefore, male erection equals erection of the female erectile organs. The correct anatomical term to describe the erectile tissues responsible for female orgasm is the female penis. Vaginal orgasm and the G-spot do not exist. These claims are found in numerous articles that have been written by Addiego F, Whipple B, Jannini E, Buisson O, O'Connell H, Brody S, Ostrzenski A, and others, have no scientific basis. Orgasm is an intense sensation of pleasure achieved by stimulation of erogenous zones. Women do not have a refractory period after each orgasm and can, therefore, experience multiple orgasms. Clitoral sexual response and the female orgasm are not affected by aging. Sexologists should define having sex/love making when orgasm occurs for both partners with or without vaginal intercourse. Clin. Anat., 2012. © 2012 Wiley Periodicals, Inc.
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Kegel's theory (1952a) concerning the sexual importance of the pubococ‐cygeus muscle was combined with Singer's theory (1973) of “uterine” orgasms to produce the hypothesis that women who ejaculate at orgasm have stronger pelvic muscle contractions under voluntary control than women who do not ejaculate. The vaginal myograph and a new “uterine myograph” developed for this project were utilized to measure EMG levels in 47 women. Ejaculators were found to have significantly stronger pubococcygeal muscle contractions and significantly stronger uterine contractions than non‐ejaculators. The Grafenberg spot, an area of exceptional sexual sensitivity located in the anterior wall of the vagina, was identified in every subject. Hartman and Fithian's version (1974) of Kegel's theory of vaginal sexual sensitivity at “4 and 8 o'clock” was not supported; sexual sensitivity was focused at 12 o'clock in 90 % of the subjects. Kaplan's description (1974) of two “phases” of orgasm (in males) is expanded to account for ejaculation in both males and females. Female ejaculation is hypothesized to be a component of some women's “uterine” orgasms. The limitations and problems of research on orgasmic response are discussed.
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The anatomy of the clitoris is described in human anatomy textbooks. Some researchers have proposal and divulged a new anatomical terminology for the clitoris. This paper is a revision of the anatomical terms proposed by Helen O'Connell, Emmanuele Jannini, and Odile Buisson. Gynecologists, sexual medicine experts, and sexologists should spread certainties for all women, not hypotheses or personal opinions, they should use scientific terminology: clitoral/vaginal/uterine orgasm, G/A/C/U spot orgasm, and female ejaculation, are terms that should not be used by sexologists, women, and mass media. Clitoral bulbs, clitoral or clitoris-urethrovaginal complex, urethrovaginal space, periurethral glans, Halban's fascia erogenous zone, vaginal anterior fornix erogenous zone, genitosensory component of the vagus nerve, and G-spot, are terms used by some sexologists, but they are not accepted or shared by experts in human anatomy. Sexologists should define have sex, make love, the situation in which the orgasm happens in both partners with or without a vaginal intercourse.
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No controversy can be more controversial than that regarding the existence of the G-spot, an anatomical and physiological entity for women and many scientists, yet a gynecological UFO for others. The pros and cons data have been carefully reviewed by six scientists with different opinions on the G-spot. This controversy roughly follows the Journal of Sexual Medicine Debate held during the International Society for the Study of Women's Sexual Health Congress in Florence in the February of 2009. To give to The Journal of Sexual Medicine's reader enough data to form her/his own opinion on an important topic of female sexuality. Expert #1, who is JSM's Controversy section editor, reviewed histological data from the literature demonstrating the existence of discrete anatomical structures within the vaginal wall composing the G-spot. He also found that this region is not a constant, but can be highly variable from woman to woman. These data are supported by the findings discussed by Expert #2, dealing with the history of the G-spot and by the fascinating experimental evidences presented by Experts #4 and #5, showing the dynamic changes in the G-spot during digital and penile stimulation. Experts #3 and #6 argue critically against the G-spot discussing the contrasting findings so far produced on the topic. Although a huge amount of data (not always of good quality) have been accumulated in the last 60 years, we still need more research on one of the most challenging aspects of female sexuality.
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High Density Oligonucleotide arrays (HDONAs), such as the Affymetrix HG-U133A GeneChip, use sets of probes chosen to match specified genes, with the expectation that if a particular gene is highly expressed then all the probes in that gene's probe set will provide a consistent message signifying the gene's presence. However, probes that contain a G-spot (a sequence of four or more guanines) behave abnormally and it has been suggested that these probes are responding to some biochemical effect such as the formation of G-quadruplexes. We have tested this expectation by examining the correlation coefficients between pairs of probes using the data on thousands of arrays that are available in the NCBI Gene Expression Omnibus (GEO) repository. We confirm the finding that G-spot probes are poorly correlated with others in their probesets and reveal that, by contrast, they are highly correlated with one another. We demonstrate that the correlation is most marked when the G-spot is at the 5' end of the probe. Since these G-spot probes generally show little correlation with the other members of their probesets they are not fit for purpose and their values should be excluded when calculating gene expression values. This has serious implications, since more than 40% of the probesets in the HG-U133A GeneChip contain at least one such probe. Future array designs should avoid these untrustworthy probes.
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The G-spot is an allegedly highly erogenous area on the anterior wall of the human vagina. Since the concept first appeared in a popular book on human sexuality in 1982, the existence of the spot has become widely accepted, especially by the general public. This article reviews the behavioral, biochemical, and anatomic evidence for the reality of the G-spot, which includes claims about the nature of female ejaculation. The evidence is far too weak to support the reality of the G-spot. Specifically, anecdotal observations and case studies made on the basis of a tiny number of subjects are not supported by subsequent anatomic and biochemical studies.
Article
Background: High Density Oligonucleotide arrays (HDONAs), such as the Affymetrix HG-U133A GeneChip, use sets of probes chosen to match specified genes, with the expectation that if a particular gene is highly expressed then all the probes in that gene’s probe set will provide a consistent message signifying the gene’s presence. We have tested this expectation by examining the correlations between probes using the data on thousands of arrays that are available in the NCBI Gene Expression Omnibus (GEO) repository. Results: We have identified probes that are not well-correlated with the other probes in their probeset but nevertheless are highly correlated with probes in other probesets. The common element of these highly correlated probes is that they contain a G-spot (a sequence of four or more guanines). Conclusions: Since these G-spot probes generally show little correlation with the other members of their probesets they are not fit for purpose and their values should be excluded when calculating gene expression values. This has serious implications, since more than 40% of the probesets in the HG-U133A GeneChip contain at least one such probe. Future array designs should avoid these untrustworthy probes.
Article
So-called "vaginal rejuvenation", "designer vaginoplasty", "revirgination", and "G-spot amplification" are vaginal surgical procedures being offered by some practitioners. These procedures are not medically indicated, and the safety and effectiveness of these procedures have not been documented. Clinicians who receive requests from patients for such procedures should discuss with the patient the reason for her request and perform an evaluation for any physical signs or symptoms that may indicate the need for surgical intervention. Women should be informed about the lack of data supporting the efficacy of these procedures and their potential complications, including infection, altered sensation, dyspareunia, adhesions, and scarring.
Article
This case study provides objective evidence supporting the hypothesis that female ejaculation, a partial, infertile homologue of male ejaculation, exists. A karyotypically normal, multiparous woman suffered for a decade with urinary stress incontinence. During that time she had learned to inhibit an orgastic response which led to bedwetting. Although the liquid produced did not appear to be urine, she falsely concluded that her orgasmic expulsion was a manifestation of urinary incontinence. Using feedback from a Vaginal Myograph, she learned to do Kegel exercises properly, and the urinary stress incontinence soon disappeared. Around this time she became aware of the concept of female ejaculation and its possible association with an erotically sensitive area that could be stimulated through her anterior vaginal wall. Stimulation of this area, the “Grafenberg spot,” produced what she described as orgasm which felt “deeper” than orgasms in response to vulvar stimulation. Such an orgasm was often accompanied by expulsion of liquid from the urethra. Chemical analysis indicated that the expulsion was not urine. It contained prostatic acid phosphatase, an enzyme characteristically found in prostatic secretion.
Article
The anatomic existence of the G-spot has not been documented yet. To identify the anatomic structure of the G-spot.   A stratum-by-stratum vaginal wall dissection on a fresh cadaver. Primary outcome is the identification of the G-spot and the secondary outcome is its measurements and anatomic description of the G-spot. The G-spot has a distinguishable anatomic structure that is located on the dorsal perineal membrane, 16.5 mm from the upper part of the urethral meatus, and creates a 35° angle with the lateral border of the urethra. The lower pole (tail) and the upper pole (head) were located 3 and 15 mm next to the lateral border of the urethra, respectively. Grossly, the G-spot appeared as a well-delineated sac with walls that resembled fibroconnective tissues and resembled erectile tissues. The superior surface of the sac had bluish irregularities visible through the coat. Upon opening the sac's upper coat, blue grape-like anatomic compositions of the G-spot emerged with dimensions of length (L) of 8.1 mm × width (W) of 3.6-1.5 mm × height (H) of 0.4 mm. The G-spot structure had three distinct areas: the proximal part (the head) L 3.4 mm × W 3.6 mm, the middle part L 3.1 mm × W 3.3 mm, and the distal part (tail) L 3.3 mm × W 3.0 mm. From the distal tail, a rope-like structure emerged, which was seen for approximately 1.6 mm and then disappeared into the surrounding tissue. The anatomic existence of the G-spot was documented with potential impact on the practice and clinical research in the field of female sexual function.
Article
Introduction: There is an ongoing debate around the existence of the G-spot--an allegedly highly sensitive area on the anterior wall of the human vagina. The existence of the G-spot seems to be widely accepted among women, despite the failure of numerous behavioral, anatomical, and biochemical studies to prove its existence. Heritability has been demonstrated in all other genuine anatomical traits studied so far. Aim: To investigate whether the self-reported G-spot has an underlying genetic basis. Methods: 1804 unselected female twins aged 22-83 completed a questionnaire that included questions about female sexuality and asked about the presence or absence of a G-spot. The relative contribution of genetic and environmental factors to variation in the reported existence of a G-spot was assessed using a variance components model fitting approach. Main outcome measures: Genetic variance component analysis of self-reported G-spot. Results: We found 56% of women reported having a G-spot. The prevalence decreased with age. Variance component analyses revealed that variation in G-spot reported frequency is almost entirely a result of individual experiences and random measurement error (>89%) with no detectable genetic influence. Correlations with associated general sexual behavior, relationship satisfaction, and attitudes toward sexuality suggest that the self-reported G-spot is to be a secondary pseudo-phenomenon. Conclusions: To our knowledge, this is the largest study investigating the prevalence of the G-spot and the first one to explore an underlying genetic basis. A possible explanation for the lack of heritability may be that women differ in their ability to detect their own (true) G-spots. However, we postulate that the reason for the lack of genetic variation-in contrast to other anatomical and physiological traits studied-is that there is no physiological or physical basis for the G-spot.
Article
The existence of an anatomically distinct female G-spot is controversial. Reports in the public media would lead one to believe the G-spot is a well-characterized entity capable of providing extreme sexual stimulation, yet this is far from the truth. The aim of this article was to provide an overview of the evidence both supporting and refuting the existence of an anatomically distinct female G-spot. PubMed search for articles published between 1950 and 2011 using key words "G-spot," "Grafenberg spot," "vaginal innervation," "female orgasm," "female erogenous zone," and "female ejaculation." Clinical trials, meeting abstracts, case reports, and review articles that were written in English and published in a peer-reviewed journal were selected for analysis. The main outcome measure of this article was to assess any valid objective data in the literature that scientifically evaluates the existence of an anatomically distinct G-spot. The literature cites dozens of trials that have attempted to confirm the existence of a G-spot using surveys, pathologic specimens, various imaging modalities, and biochemical markers. The surveys found that a majority of women believe a G-spot actually exists, although not all of the women who believed in it were able to locate it. Attempts to characterize vaginal innervation have shown some differences in nerve distribution across the vagina, although the findings have not proven to be universally reproducible. Furthermore, radiographic studies have been unable to demonstrate a unique entity, other than the clitoris, whose direct stimulation leads to vaginal orgasm. Objective measures have failed to provide strong and consistent evidence for the existence of an anatomical site that could be related to the famed G-spot. However, reliable reports and anecdotal testimonials of the existence of a highly sensitive area in the distal anterior vaginal wall raise the question of whether enough investigative modalities have been implemented in the search of the G-spot.
Article
Dr. Dwyer wrote: “The distal urethra, vagina, and clitoris have a shared vasculature and nerve supply (the dorsal nerve to the clitoris) and form a tissue cluster described by O’Connell et al. [4] as the “locus of female sexual function and orgasm”” [1]. The vasculature and the dorsal nerve of the clitoris are not shared with the distal urethra and vagina; the definition for the “tissue cluster” by O’Connell et al. has no embryological, anatomical, or physiological support. The locus of female sexual function and orgasm is not the distal urethra and vagina, but rather the clitoris and the other female erectile organs.
Article
L’article d’O. Buisson présente des hypothèses pour en expliquer d’autres qui sont des conclusions et qui n’ont pas de base scientifique. Le vagin n’a pas de relation anatomique avec le clitoris ; l’urètre est complètement entouré par le corps spongiosum de l’urètre féminin et il n’y a pas de partie clitoridienne ni de bulbe vestibulaire dans le septum urétrovaginal ; le « clitoris interne » n’existe pas. Le point G n’existe pas : « orgasme clitoridien, vaginal, utérin, point G, A, C, U sont des termes qui ne devraient pas être utilisés par les sexologues, les femmes et les médias ». Le clitoris existe chez toutes les femmes (i.e. 100 % !), pourquoi donc ne pas le stimuler simplement le clitoris avec le doigt pendant le rapport sexuel avec pénétration pénienne ?
Article
To evaluate what the appropriate indications are for vulvovaginal (VV) plastic surgeries in our environment. This is a retrospective study of 73 consecutive patients who were seen on consultation at the gynecologic aesthetic unit between January 2008 and January 2009 asking for a VV aesthetic surgery.All patients completed the Female Sexual Function Index questionnaire and received information on sexuality. Of the 73 patients seen on consultation, 32 (43.8%) underwent surgery, and the main reason for this was reduction labioplasty in 19 patients, widening vaginoplasty in 6, reduction vaginoplasty in 1, and resection of asymmetries in 6 patients. None of the patients seen on consultation for vulvar bleaching, G-spot amplification, or augmentation labioplasty underwent surgery. Postoperative complications included wound dehiscence in 3 patients (9.3%) and a vulvar hematoma in 1 patient (3.1%).Postoperative sexual satisfaction was optimal for 30 patients; only 2 complained of dyspareunia. Most patients seen on consultation for VV plastic surgery had no need for it and only received information regarding female anatomy and sexuality. Reduction labioplasty owing to hypertrophy of the labia minora represented the most frequent reason for consultation and surgery. Indications for VV plastic surgeries should be based not only on surgical results but also on the reported satisfaction achieved by those patients who did not undergo surgery and only received appropriate information during consultation.
Article
Sexual health is vital to overall well-being. Orgasm is a normal psycho-physiological function of human beings and every woman has the right to feel sexual pleasure. The anatomy of the vulva and of the female erectile organs (trigger of orgasm) is described in human anatomy textbooks. Female sexual physiology was first described in Dickinson's textbook in 1949 and subsequently by Masters and Johnson in 1966. During women's sexual response, changes occur in the congestive structures that are essential to the understanding of women's sexual response and specifically of their orgasm. Female and male external genital organs arise from the same embryologic structures, i.e. phallus, urogenital folds, urogenital sinus and labioscrotal swellings. The vulva is formed by the labia majora and vestibule, with its erectile apparatus: clitoris (glans, body, crura), labia minora, vestibular bulbs and corpus spongiosum. Grafenberg, in 1950, discovered no "G-spot" and did not report an orgasm of the intraurethral glands. The hypothetical area named "G-spot" should not be defined with Grafenberg's name. The female orgasm should be a normal phase of the sexual response cycle, which is possible to achieve by all healthy women with effective sexual stimulation. Knowledge of the embryology, anatomy and physiology of the female erectile organs are important in the field of women's sexual health.
Article
Opinions vary over whether female ejaculation exists or not. We investigated the hypothesis that female orgasm is not associated with ejaculation. Thirty-eight healthy women were studied. The study comprised of glans clitoris electrovibration with simultaneous recording of vaginal and uterine pressures as well as electromyography of corpus cavernous and ischio- and bulbo-cavernosus muscles. Glans clitoris electrovibration was continued until and throughout orgasm. Upon glans clitoris electrovibration, vaginal and uterine pressures as well as corpus cavernous electromyography diminished until a full erection occurred when the silent cavernosus muscles were activated. At orgasm, the electromyography of ischio-and bulbo-cavernosus muscles increased intermittently. The female orgasm was not associated with the appearance of fluid coming out of the vagina or urethra.
Article
The physiology and anatomy of female sexual function are poorly understood. The differences in sexual function among women may be partly attributed to anatomical factors. The purpose of this study was to use ultrasonography to evaluate the anatomical variability of the urethrovaginal space in women with and without vaginal orgasm. Twenty healthy, neurologically intact volunteers were recruited from a population of women who were a part of a previous published study. All women underwent a complete urodynamic evaluation and those with clinical and urodynamic urinary incontinence, idiopathic detrusor overactivity, or micturition disorders, as well as postmenopausal women and those with sexual dysfunction were excluded. The reported experience of vaginal orgasm was investigated. The urethrovaginal space thickness as measured by ultrasound was chosen as the indicator of urogenital anatomical variability. Designated evaluators carried out the measurements in a blinded fashion. The urethrovaginal space and distal, middle, and proximal urethrovaginal segments were thinner in women without vaginal orgasm. A direct correlation between the presence of vaginal orgasm and the thickness of urethrovaginal space was found. Women with a thicker urethrovaginal space were more likely to experience vaginal orgasm (r = 0.884; P = 0.015). A direct and significant correlation between the thickness of each urethrovaginal segment and the presence of vaginal orgasm was found, with the best correlation observed for the distal segment (r = 0.863; P < 0.0001). Interobserver agreement between the designated evaluators was excellent (r = 0.87; P < 0.001). The measurement of the space within the anterior vaginal wall by ultrasonography is a simple tool to explore anatomical variability of the human clitoris-urethrovaginal complex, also known as the G-spot, which can be correlated to the ability to experience the vaginally activated orgasm.
Page 1 Available at: http://www.browardpalmbeach.com/2007-07-12/news/doctor-g-spot
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Clarifications about some theories in sexology and about a correct sexual terminology. Oral Presentation-9th Congress of the European Federation of Sexology (EFS). Rome
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Puppo V, Mannucci A, Abdulcadir J, Puppo G (2008) Clarifica-tions about some theories in sexology and about a correct sexual terminology. Oral Presentation-9th Congress of the European Fed-eration of Sexology (EFS). Rome, 13–17 April 2008. Sexologies 17(Suppl. 1):T10-O-25: S147. Full text available at: http:// www.youtube.com/user/NewSexology?gl0IT&hl0it#p/u/0/ E52HiDw5bhM. Accessed 21 Nov 2011
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Doctor G-spot (2007) Page 2. Available at: http://www.broward palmbeach.com/2007-07-12/news/doctor-g-spot/2/. Accessed 21 Nov 2011
The G-spot and other recent discoveries about human sexuality. Holt, Reinehart & Wiston, New York 14. Wikipedia. G-spot amplification
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Ladas AK, Whipple B, Perry J (1982) The G-spot and other recent discoveries about human sexuality. Holt, Reinehart & Wiston, New York 14. Wikipedia. G-spot amplification. Available at: http://en.wikipedia.org/ wiki/G-Spot_amplification. Accessed 21 Nov 2011
G-spot amplification
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The science of orgasm
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Komisaruk BR, Beyer-Flores C, Whipple B (2006) The science of orgasm. Johns Hopkins University, Baltimore
ACOG Committee Opinion No. 378: Vaginal “rejuvenation” and cosmetic vaginal procedures
  • American College
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  • American College of Obstetricians and Gynecologists
American College of Obstetricians and Gynecologists (2007) ACOG Committee Opinion No. 378: Vaginal "rejuvenation" and cosmetic vaginal procedures. Obstet Gynecol 110:737-738
The G-spot and other recent discoveries about human sexuality
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