ArticlePDF AvailableLiterature Review

Female Ejaculation Orgasm vs. Coital Incontinence: A Systematic Review



Women may expel various kinds of fluids during sexual arousal and at orgasm. Their origins, quantity, compositions, and expulsion mechanisms depend on anatomical and pathophysiological dispositions and the degree of sexual arousal. These are natural sexual responses but may also represent symptoms of urinary incontinence. The study aims to clarify the etiology of fluid leakage at orgasm, distinguish between associated physiological sexual responses, and differentiate these phenomena from symptoms of illness. A systematic literature review was performed. EMBASE (OvidSP) and Web of Science databases were searched for the articles on various phenomena of fluid expulsions in women during sexual arousal and at orgasm. Articles included focused on female ejaculation and its variations, coital incontinence (CI), and vaginal lubrication. Female ejaculation orgasm manifests as either a female ejaculation (FE) of a smaller quantity of whitish secretions from the female prostate or a squirting of a larger amount of diluted and changed urine. Both phenomena may occur simultaneously. The prevalence of FE is 10–54%. CI is divided into penetration and orgasmic forms. The prevalence of CI is 0.2–66%. Penetration incontinence occurs more frequently and is usually caused by stress urinary incontinence (SUI). Urodynamic diagnoses of detrusor overactivity (DOA) and SUI are observed in orgasmic incontinence. Fluid expulsions are not typically a part of female orgasm. FE and squirting are two different physiological components of female sexuality. FE was objectively evidenced only in tens of cases but its reported high prevalence is based mostly on subjective questionnaire research. Pathophysiology of squirting is rarely documented. CI is a pathological sign caused by urethral disorder, DOA, or a combination of both, and requires treatment. An in-depth appreciation of these similar but pathophysiologically distinct phenomena is essential for distinguishing normal, physiological sexual responses from signs of illness. Pastor Z. Female ejaculation orgasm vs. coital incontinence: A systematic review. J Sex Med 2013;10:1682–1691.
Differential diagnostics of female Bsexual^fluids: a narrative review
Zlatko Pastor
&Roman Chmel
Received: 9 October 2017 /Accepted: 24 November 2017
#The International Urogynecological Association 2017
Introduction and hypothesis Women expel various kinds of fluids during sexual activities. These are manifestations of sexual
arousal and orgasm or coital incontinence. This study is aimed at suggesting a diagnostic scheme to differentiate among these
Methods Web of Science and Ovid (MEDLINE) databases were systematically searched from 1950 to 2017 for articles on
various fluid expulsion phenomena in women during sexual activities, which contain relevant information on sources and
composition of the expelled fluids.
Results An ultra-filtrate of blood plasma of variable quantity, which is composed of transvaginal transudate at sexual stimulation,
enables vaginal lubrication. Female ejaculation (FE) is the secretion of a few milliliters of thick, milky fluid by the female prostate
(Skenes glands) during orgasm, which contains prostate-specific antigen. Squirting (SQ) is defined as the orgasmic transurethral
expulsion of tenths of milliliters of a form of urine containing various concentrations of urea, creatinine, and uric acid. FE and SQ
are two phenomena with different mechanisms. Coital incontinence (CI) could be classified into penetration and orgasm forms,
which could be associated with stress urinary incontinence or detrusor hyperactivity.
Conclusion Squirting, FE, and CI are different phenomena with various mechanisms and could be differentiated according to
source, quantity, expulsion mechanism, and subjective feelings during sexual activities.
Keywords Female ejaculation .Squirting .Coital incontinence .Female prostate .Vaginal lubrication
Women expel various kinds of fluids during sexual activi-
ties [1]. The prevalence is around 1054% [25], and the
quantity of the fluid ranges from 0.3 to 900 mL [510].
Expulsion may be manifested by the feelings of wetness,
secretion, discharge, or massive fluid emission.
Controversial opinions on the fluidsorigin, quantity, com-
position, and expulsion mechanism exist [11], and discrep-
ancy in terminology, inaccurate characteristics, and unclear
understanding. Most often, the fluids are described as fe-
male ejaculation because of its similarity to male ejacula-
tion. Previous research reported that Skenes paraurethral
glands (the female prostate) are the source of expulsion
[26,12,13]. Moreover, discrepancy in the amount of
expelled fluid [25,9] and the prevalence of various ex-
pulsions [59] were associated with the erroneous assump-
tion that the fluids expelled were identical and from the
same source. Currently, the expelled fluids could be related
to various phenomena [10,14,15]. A smaller volume of
fluids may be expelled by the female prostate [7,8,10,13,
1621], vagina [22], or Bartholinsglands[23]. A larger
volume could originate from the urinary bladder [6,7,10,
14,15]. Fluid emission could be a common and desirable
manifestation of sexual arousal (vaginal lubrication), a
physiological sexual response (squirting, SQ; female ejac-
ulation, FE), a result of coital incontinence (CI), or a com-
bination of various fluids.
The aim of our review was to identify the sources of
fluids expelled during sexual activities; compare their
volume, biochemical composition, and expulsion
*Zlatko Pastor
Obstetrics and Gynecology Department, 2nd Faculty of Medicine,
University Hospital Motol, Charles University, Prague, V Úvalu 84,
Prague 5, Czech Republic
National Institute of Mental Health, Klecany, Czech Republic
Institute of Sexology, 1st Faculty of Medicine, Charles University,
Prague, Czech Republic
International Urogynecology Journal
mechanism; create a scheme based on their characteris-
tics for differential diagnostics of similar but physiolog-
ically different phenomena; and distinguish pathological
conditions from physiological manifestations of sexual
Materials and methods
Literature search
We conducted a comprehensive and systematic search of
the international databases Web of Science and Ovid
(MEDLINE). These databases were searched for the peri-
od 1950 to 2017. The search was performed in June 2017
with the following terms: Bfemale ejaculation^AND
Borgasm,^Bfemale ejaculation^AND Bfemale prostate,^
Bsquirting^AND Borgasm,^Bvaginal lubrication^OR
Bsecretion^AND Borgasm,^and Bcoital incontinence^
AND Borgasm.^The search was then refined to Bhuman^
and Bwomen.^In addition, we performed a manual search
and scanned the reference list of selected articles. To ob-
tain appropriate articles related to a comparison between
male and female prostates and their secretion capacity, we
search for Bmale prostate^AND Bsperm^OR Bsemen^
Selection of studies and data analysis
EndNoteOnline(ClarivateAnalytics, Philadelphia, PA,
USA) was used for the preparation of the reference list.
We assessed the quality of the studies; confirmed the eli-
gibility of the titles, abstracts, and full texts; and indepen-
dently selected the titles and abstracts twice. To define the
differential diagnosis of FE and SQ, manuscripts without
exact information about the quantity, composition, and flu-
id expulsion mechanism were excluded. Studies that
assessed the previously mentioned phenomena based on
womens subjective feelings or on research questionnaire
were not included. Only reviews containing a comprehen-
sive analysis were included. In the case of CI, articles
showing no correlations with urine leakage during sexual
activities and in which the type of urinary incontinence
was not verified by urodynamic investigation were exclud-
ed. We read the full text of the articles and made the selec-
tion based on the aforementioned eligibility criteria.
Because of the small number of studies and patients and
the studiesheterogeneity, we could not use meta-
analytical methods. Hence, this review was based on a
descriptive analysis of selected articles; our study is pre-
sented as a narrative synthesis of selected studies. We used
semi-quantitative characteristics of the phenomena for
higher variability of the results and better compre
Fig. 1 The selection process
Int Urogynecol J
Characteristics of selected studies
Our search yielded 622 citations, of which 75 studies
were retrieved (in full text). Fifty-three studies published
from 1950 to 2017 were included in the list. Five book
chapters and two reports by the World Health
Organization (WHO) and International Urogynecological
Association (IUGA) were added. Figure 1shows the se-
lection process.
A total of 63 studies with relevantinformation (FE, 27; SQ,
4; female prostate, 15; vaginal lubrication, 15; CI, 13; male
prostate and semen parameters, 7; Table 1)wereincludedin
the review. Some of the studies reported on several topics
simultaneously, and the information overlapped.
Women may expel fluids during sexual activities from the
vagina, urinary bladder, and female prostate (Fig. 2).
Lubrication fluid (LF) originates from the vagina; urinary
bladder is the source of the fluids expelled at SQ or CI.
FE originates from the female prostate; female prostate
secretion may also contaminate other fluids, especially
during SQ.
The fluids differ from each other according to the source,
expulsion mechanism, volume, color, density, chemical com-
position (prostate-specific antigen [PSA], uric acid, urea, cre-
atinine, sodium, potassium, chloride), pH, manifestations, and
Vaginal lubrication fluid
Lubrication fluid is an ultra-filtrate of blood plasma. Blood flow
in the genital area is increased during sexual arousal, and LF
from the vaginal venous plexus enters the vaginal lumen
transvaginally [25,32,36]. The vaginal fluid may also contain
peritoneal and follicular fluid, uterine fluid, cervical fluid, and
secretions from BartholinsandSkenesglands[28]. The daily
production is approximately 6 g [32]. LF is characterized by
high potassium and low sodium concentrations compared with
plasma [29] and has an average pH of 4.7 (range, 3.46.4) [27].
The mean vaginal discharge quantity is 1.5 g/8 h (maximum at
mid-cycle, 2.0 g/8 h), although the amount varies significantly
between the different days of the cycle; low mean values may
be observed on days 7 and 26 (1.4 g/8 h) [30]. During sexual
stimulation, LF production is increased to 0.7 mL/15 min [26],
and both sodium and chloride ion concentrations also increase
[29]. Kinsey et al. assumed that vaginal fluid may be forced out
by the contractions of the perivaginal muscles; thus, it resem-
bles fluid expulsion [22].
Female ejaculation and female prostate
ABreal^FE is the secretion of an extremely scanty (few
milliliters), milky fluid by the female prostate [7,10,15],
which was described by de Graaf in 1762 and later de-
scribed as Skenes paraurethral glands [11,38]. The fe-
male prostate is an exocrine organ of variable size and
location and contains cellular equipment for neuroendo-
crine activity [33,39]. According to various authors, it
exists in only two-thirds of women [40], 1 in 2 women
[41], or in 6 out of 7 women [42]. It weighs 2.6 to 5.2 g,
consists of a maximum of one tenth to one quarter of the
male prostate (23.7 g), and consists of glands, ducts, and
musculofibrous tissues. Compared with the male prostate,
it has more musculofibrous tissues and ducts, but substan-
tially fewer glands (Table 3)[33].
The female prostates secretion contains a high concentra-
tion of PSA, prostatic-specific acid phosphatase, fructose, and
glucose (Table 2)[8,19]. It histomorphologically resembles
themaleprostatebeforepuberty[40]. According to Zaviačič
et al., the prostatic (paraurethral) ducts penetrate into the lu-
men of the urethra along its whole length [33]. Dwyer argues
that single or multiple orifices are on the sides of the urethral
meatus [40]. The role of the female prostate is unclear; some
Table 1 Articles according to
topic, character of the collected
information, and the type and
number of publications used for
the review
manual or
Female ejaculation 11 14 2 0 0 27
Squirting 2 1 1 0 0 4
Female prostate 11 3 0 1 0 15
Vaginal lubrication 11 1 0 3 0 15
Coital incontinence 10 2 0 0 1 13
Male prostate and semen
41 011 7
Int Urogynecol J
studies assume that prostate secretions have an antimicrobial
or protective effect against urinary tract infections [49].
Squirting (gushing)
Squirting is the involuntary expulsion of a substantial amount
of urine during sexual activity [14]. Until recently, most or-
gasmic emissions have been erroneously called the FE [10,
14,19,37]. Currently, such massive gushes at orgasm are
referred to as squirting (gushing) [10,14]. The biochemical
composition of this fluid could be identical to urine [14]orits
diluted form [10]. The volume of massive gushes (which
could be recurring) usually ranges from 15 to 110 mL (medi-
an, 60 mL), and the color is most frequently described as
Bclear as water^[7,9,14]. The fluid may be contaminated
by the female prostate secretion and may contain a small con-
centration of PSA [7,10]. Squirting occurs during sexual stim-
ulation of the clitoro-urethro-vaginal complex [10,14].
Women and their partners consider squirting to be a positive
phenomenon that improves their sexual life [9].
Fig. 2 Sources of fluids expelled during sexual activities
Table2 Summary of fluids compared according to source, expulsion mechanism, volume, density, chemical composition, color, manifestations, and
subjective feelings
Vaginal lubrication Female ejaculation Squirting (gushing) Coital incontinence
Source [6,7,10,14,15,2437] Vagina Female prostate Urinary bladder Urinary bladder
Expulsion mechanism [7,10,14,15,
Glands secretion Transurethral
Voided urine
Vol u m e [7,10,14,15,26,30] +/++ + ++/+++ ++/+++
Density [10,3032] +/++ ++/+++ + +
Prostate-specific antigen [7,10,14,15,33] /+ +++ +/++ /++
Uric acid [10,14]––+/+++ +++
Urea [10,14]––+/+++ +++
Creatinine [10,14]––+/+++ +++
Sodium [10,14,19,24,25,28,29]+ + ++/+++ +++
Potassium [10,14,19,24,25,28,29] +/++ + ++/+++ +++
Chloride [10,14,19,24,25,28,29] + + ++/+++ +++
Glucose [10,33]+++ /+
Fructose [10,33]+++ /+
pH (acidity) [7,27,33]+++ /+ +
Urodynamic examination [19] Normal finding Normal finding Normal finding Signs of stress incontinence
or DOA
Color [7,10,14,15,24,25,2832] Clear, transparent Whitish, milky Clear, yellowish Yellow
Manifestation [7,10,14,15,24,25,
Lubrication, transparent
Insignificant amount
of prostate
Massive expulsion
of transparent fluid
Involuntary leakage of urine
Subjective feelings [19] Sexual arousal,
Orgasm, satisfaction Orgasm, satisfaction Humiliation, shame,
+++ large quantity, ++ moderate quantity, + small quantity, no presence or no parameters available
Int Urogynecol J
Coital incontinence
Coital incontinence is manifested by an involuntary leakage of
urine during sexual intercourse and could be classified into
penetration and orgasm forms [50]. The prevalence of CI in
women with urinary incontinence (UI) ranges from 10 to 67%
[5155]. Compared with women with detrusor overactivity
(DOA), women with stress urinary incontinence (SUI) more
frequently report CI [53,55]. Women with CI always have
abnormal urodynamic parameters, unlike women with ejacu-
lation orgasm (FE or SQ) without CI [34]. Some studies cor-
relate penetration CI with the diagnosis of SUI and orgasmic
CI with DOA [51,55]; other studies in this regard are rather
ambiguous [5561].
Female ejaculation, SQ, and CI are three completely different
phenomena. Understanding their mechanisms may help to
differentiate them according to their manifestations, subjective
feelings, and biochemical composition of the expelled fluid.
Launching Bsquirting^as a term in the scientific literature in
2011 stopped the use of Bfemale ejaculation^as a Buniversal^
label for all kinds of fluids emitted by women during sexual
activity [10,14,15].
Main differential diagnosis criteria for clinical practice
In clinical practice, the diagnosis of emitted fluids is based
mainly on quantity, appearance, and subjective feelings.
Transurethral gushes of tens to hundreds of milliliters of trans-
parent fluid that is not considered by women without UI at
orgasm as urine is SQ [10,14]. These women, who have no
disorder related to urine leakage [34], usually experience in-
tensive sexual arousal and reach orgasm (even repeatedly)
without any problem. At fluid expulsion, they feel substantial
sexual catharsis and consider the fluid different from urine in
smell, taste, and appearance [6]. In women with SUI or DOA,
CI can be observed. During penile penetration or at orgasm,
they experience unwanted leakage of urine. Consequently,
they feel frustrated and the sexual activity is rather unpleasant
for them because of CI. During FE, a small amount of thick
and milky fluid mixed with lubrication fluid is expelled by the
female prostate, which in turn makes differentiation challeng-
ing. BReal^FE often occurs without noticing a leakage of a
larger fluid volume (unlike SQ). FE is perceived mainly as the
feeling of wetness due to increased lubrication during orgasm.
Moreover, a greater quantity of fluid from the vagina may be
forced out by a one-time pulse emission [22]. It may occur
primarily after penis withdrawal or after coitus, and it is most-
ly a discharge (not gush) of accumulated LF, which is possibly
mixed with sperm.
Table 3 Comparison of
morphological and functional
parameters of the mal e and female
Male prostate Female prostate
Morphological structures [21,33] Prostatic glands (+++)
Musculofibrous tissue (++)
Ducts (+)
Prostatic glands (+)
Musculofibrous tissue (+++)
Ducts (+++)
Average size of the prostate (cm)
Length (3.4)
Width (4.5)
Height (2.9)
Length (3.3)
Width (1.9)
Height (1.0)
Ave rag e weight (g) [21,33]23.7 2.65.2
Average volume prostatic
secretion (mL) [10,4148]
0.22.3 0.89 ± 0.52
Physiological function [4049] Increase in ejaculation semen volume,
facilitation of reproduction
Unclear, antimicrobial
Character of the emission [10,46] Expulsion, discharge during orgasm Secretion during orgasm
Localization [21,33,47] Surrounding the prostatic part of the
Urethral wall
Prostate-specific antigen
+++ ++
Glucose [21,33] + +++
Fructose [21,33] + +++
Potassium [19]+ +
Sodium [19]+ +
Chloride [19]+ +
+++ large quantity, ++ moderate quantity, + small quantity
Int Urogynecol J
Sources, volume, and mechanism of expelled fluids
The fluid expelled at SQ has a definite origin (the urinary
bladder) [7,10,14], which may accumulate hundreds of mil-
liliters of fluid; the contractions of musculus detrusor vesicae
facilitate the massive expulsions. When we assessed previous
research, we found that most of the orgasmic expulsions,
which are currently most likely referred to as SQ, are de-
scribed as FE [2,6,13,17,20,23]. The authors considered
all female orgasmic expulsions analogous to male ejaculation
[13] and noted that the female prostate is the main source of
the fluids [33]. The female prostate may produce fluid bio-
chemically comparable with the male prostate secretion; how-
ever, the quantity squirted at an orgasm differs [14].
Transurethral expulsion and their origin in the urinary bladder
were confirmed by catheterizing the urinary bladder [7]orby
ultrasound bladder examination before and after SQ [14].
With the bladders capacity (around 500 mL), expulsions
with an average volume of 60 mL during sexual stimulation
may be repeated [9,14]. Schubach assumed that during sexual
excitation (increased blood pressure, faster glomerular filtra-
tion, changes in hormonally conditioned reabsorption mecha-
nisms in the kidneys), the bladder is filled more rapidly with
less concentrated urine [7]. Such a premise could explain why
some authors (Schubach, 8 respondents; Rubio-Casillas and
Jannini, 1 respondent) reported that SQ is composed of diluted
urine, which contains muchless uric acid, urea, and creatinine
[7,10], whereas others claim that the fluid at SQ is identical in
biochemical composition to urine (Salama, 7 women; our un-
published study, 1 woman) [14]. Moreover, Wimpissinger
et al. proved that in two women, using their expelled fluid,
which they considered FE, a high PSA and glucose content
(without volume data), unlike voided urine [19]. Goldberg
et al. showed that the fluid emitted in six patients is chemically
similar to urine [6]. The chemical analysis (prostatic acid
phosphatase [PAP], urea, creatinine, glucose) in a previous
case report involving one patient indicated that the expulsion
fluid was not urine [13]. Neither Goldberg et al. [6]nor
Addiego et al. [13] provided the exact volumes of the emitted
fluid. Nevertheless, most likely, the volume of the bladder
content and urine concentration immediately before initiating
sexual activity and the possible dilution during sexual stimu-
lation play asubstantial rolein the composition of the expelled
fluid at SQ. The concentration of the emitted fluid may be
influenced by other factors, such as water intake, surrounding
temperature, physical activity, metabolic condition, hormonal
activity, overall health condition, and psychogenic aspects.
Previous studies with a small number of women with SQ
(16 respondents) had contradictory conclusions and thus
could not establish a clear mechanism of the creation of the
expelled fluid [7,10,14]. The function of the bladder sphinc-
ter, which should be closed during sexual arousal and orgasm,
remains to be clearly identified [11]. However, according to
Khan et al., involuntary bladder contraction and relaxation of
the sphincter during female orgasm are possible [57].
Earlier studies described most fluid expulsions as FE, and
the female prostate was considered to be the main source [62],
releasing 350 mL of fluid (Bullough et al., 312 mL;
Goldberg et al., 315 mL; Zaviačičet al., 15 mL; Heath,
3050 mL; Belzer, 10 mL) [5,6,8,17,20]. The main evi-
dence of the female prostate as the origin of the fluid was the
presence of PSA (or PAP) in the emission. Although PSA is
the main marker of female prostate secretion, PSA may also
be found in lower concentrations in the fluids expelled from
other sources, such as the vagina and urinary bladder, which
could be associated with contamination by the female prostate
secretion during simultaneous expulsions from the other
sources. According to Rubio-Casillas and Jannini, a decreas-
ing PSA concentration is observed in the following: female
ejaculate > urine > squirting > vaginal secretion [10].
However, a previous study demonstrated that the female pros-
tate could not be the source of massive expulsions considering
its size, structure, and secretion capacity. On average, it
weighs 2.6 to 5.2 g and it is four to five times smaller than
the male prostate. Moreover, the glandular and ductal compo-
nents are in reverse ratio tothose of the male prostate [33]. The
average volume of male ejaculate is 3.6 mL (1.27.6), of
which 1530% is from the male prostate; the secretion volume
[4346]. The secretion volume of the female prostate is
around 1 mL [10,19]. Hence, the female prostate could not
be the main source of the massive fluid expulsions.
Differential diagnostic criteria of expelled fluid
according to biochemical analysis and examination
using a device
The expelled fluids could be indicatively differentiated ac-
cording to their manifestations; however, the precise diagnosis
is based on a biochemical analysis or examination using a
device (ultrasound, urodynamic examination, magnetic reso-
nance imaging). Biochemical analysis of FE revealed high
concentrations of PSA, glucose, and fructose, whereas the
fluid at SQ, unlike FE, has higher concentrations of uric acid,
urea, creatinine, and sodium; has a substantially lower density;
and contain practically no fructose or glucose [7,9,10].
Biochemical differentiation of expelled fluids during orgasmic
incontinence at CI and orgasm at SQ is more difficult to per-
form. The quantity and appearance of the fluid may be similar.
The exact diagnosis is based on the fact that continent women
with ejaculation orgasm (SQ) show neither high detrusor ac-
tivity nor any other abnormal urodynamic parameters unlike
women with CI, who have urodynamic evidence of SUI or
DOA [34]. Differentiation based on biochemical markers
characteristic of urine (uric acid, urea, creatinine, chloride,
potassium) could be misleading; although some authors
Int Urogynecol J
provided evidence of lower quantity of these markers at SQ
(SQ is a diluted fluid from the urinary bladder) [10], others
found no differences (SQ is voided urine) [14]. Future studies
should investigate whether substantial urine dilution occurs at
SQ, resulting from sexual arousal and increased renal activity,
or whether the fluid at SQ is just urine. Differentiation of
lubrication fluid from other fluids is not usually difficult, as
the former is a desired and common sexual response. Massive
fluid emissions from the vagina are considered discharge of
accumulated LF rather than gushes of fluid. Women with lu-
brication problems are at a disadvantage in terms of sexual
satisfaction, and a prevalence of lubrication disorders of 5.8 to
19.7% among fertile women was reported [63].
Coital incontinence, its forms, and differential
Whether the fluid expelled at FE (or SQ) is from the
female prostate or the urinary bladder and whether it is
urine has been a major topic of dispute. The fluid at SQ
was (inaccurately) attributed to the female prostate based
on the concentrations of PSA and PAP, which were con-
sidered the main markers for differentiation. Moreover,
the detection of PAP in the urine may be complicated,
as the concentration is small and diagnostic kits primarily
serve to determine the level of phosphatase in the blood
and not in the urine [6]. Women with CI experience leak-
age of urine frequently and involuntarily during the day;
thus, there is no problem with the identification of CI.
They were able to recognize that urine is leaked during
sexual activities, unlike women who are capable of
squirting and do not consider the fluid to be urine [6].
CI is initiated by various situations, such as increased
abdominal pressure, penile insertion, deep penetration,
high arousal, orgasm, and clitoral stimulation [58], and
by psychogenic factors as well. Hence, most women
avoid sex or prevent involuntary urine leakage by voiding
before the sexual activity. Determining whether the incon-
tinence is penetration or orgasmic in form is not difficult,
as a woman could identify at which phase of sexual ac-
tivity urine leakage occurs. However, inconsistent opin-
ions are noted for whether penetration incontinence oc-
curs mainly at SUI [51,52,5458,60] owing to increased
mobility of the urethrovesical junction [56]andwhether
orgasmic incontinence is related to DOA [51]. El-Azab
stated that the reason for urine leakage at orgasm is not
definitely DOA, but an incompetent urethral sphincter or
vaginal prolapse [55]. In a differential diagnosis, we
should take into account the possibility that CI might de-
velop in the course of a womanslifeorinawomanwith
the ability to squirt, or that a woman with symptoms of UI
might gain the ability to squirt.
Limitations and deficiencies of the study
In our study, articles on the characteristics and the exact com-
position of expelled fluids during sexual activity among wom-
en were lacking, and the groups of respondents were small;
thus, having a statistically significant analysis was not possi-
ble. Only studies with approximately 10 respondents and a
few individual case reports were included in the assessment
[6,7,9,10,13,14,19]. Other previous studies use different
methodological procedures and inconsistent terminology, and
the characteristic of the examined fluids is mostly based on
only the subjective feelings of the respondents [3,4,12,23,
62]. The term Bsquirting^was only used for the first time in
the scientific literature in 2011 [10]. Currently, fluid expul-
sions during sexual activities would not be immediately re-
ferred to as FE only; the expulsions could also be SQ [49,11,
13,19,20,23]. Moreover, older studies are focused mainly on
the female prostate, its localization, anatomical composition,
and biochemical analysis of its secretion. Although they
looked into the relationship between orgasm and fluid gushes,
an exact biochemical analysis was not performed, and the
volume was not identified.
Having a larger group of respondents for the study appears
difficult as the topic is extremely sensitive, and full coopera-
tion of women and their partners with the research team is
Importance of further research and its benefit
for clinical practice
Further studies on expelled fluids during sexual activities in
women are warranted to obtain specific knowledge on their
characteristics and biochemical composition. The creation of a
practical algorithm for the differential diagnostics of the phe-
nomena (FE, SQ, CI) for the use of specialists is essential. The
information could be used to prevent erroneous consideration
of FE and SQ as disorder symptoms that require a therapy, as
is required in cases of CI.
We have differentiated among the four types of fluids expelled
during sexual activities in relation to sexual arousal and or-
gasm. Apart from the desired lubrication and involuntary
urine leakage disorder, two different physiological but unusual
phenomena exist: FE and SQ. At FE, a small amount of fluid
is secreted by the female prostate, and at SQ, the fluid similar
to or identical to urine is squirted transurethrally from the
urinary bladder. Further study is necessary considering the
limited number of studies, the small group of respondents,
and the unclear conclusions.
Int Urogynecol J
Compliance with ethical standards
Financial disclaimer/conflict of interest None.
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... Compared with the male prostate, there is a higher proportion of ducts and musculofibrous tissues than glands in the female prostate(Table1). It is not clear if the glands open into the distal urethra through single or multiple orifices, which is similar to the male prostate, or whether they lead to the sides of urethral meatus [21].Up to 20 ducts are found in the female prostate. The ducts are not visible on urethroscopy [19]. ...
... Insufficient lubrication is reported in 3-43% women and occurs most commonly after menopause [30]. Increased lubrication does not cause any problems and is considered a discharge rather than a gush, especially when a penis is inserted [21]. ...
... Mechanism of squirting has not been so far completely explained and is based on only a few methodologically inadequate studies or empirical observations, which are however insufficiently described. This is due to the technical difficulty of exact measuring in the course of this phenomenon and also problematic sample collection [21]. ...
... The female orgasm is a normal psychophysiological function in women [4], and some even can achieve ejaculation as a response at the height of sexual arousal [5]. However, there is a notable gap between heterosexual men and women's frequency of orgasm during sex. ...
... Female ejaculation consists of the orgasmic expulsion of a smaller quantity of whitish fluid produced by the female prostate (Skene glands). The quantity varies from 1 ml to 30 to 50 mL [5,43]; the function is unclear but could act as an antimicrobial function or a protective effect against urinary tract infection [5,38,43,44]. The female prostate's secretion is composed of a high concentration of PSA, prostatic-specific acid phosphatase, fructose, and glucose, which resembles its counterpart, the male's prostate secretion. ...
... Female ejaculation consists of the orgasmic expulsion of a smaller quantity of whitish fluid produced by the female prostate (Skene glands). The quantity varies from 1 ml to 30 to 50 mL [5,43]; the function is unclear but could act as an antimicrobial function or a protective effect against urinary tract infection [5,38,43,44]. The female prostate's secretion is composed of a high concentration of PSA, prostatic-specific acid phosphatase, fructose, and glucose, which resembles its counterpart, the male's prostate secretion. ...
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The anatomy and physiology of the female orgasm are often neglected. The female orgasm is a normal psychophysiological function to all women, and some even can achieve ejaculation as part of the normal physiological response at the height of sexual arousal. The complexity of female sexuality requires a deep understanding of genital anatomy. The clitoris is the principal organ for female pleasure. The vaginal stimulation of the anterior vaginal wall led women to orgasm due to the stimulation of the clitourethrovaginal complex and not due to stimulation of a particular organ called the G spot in the anterior distal vaginal wall. Female ejaculation follows orgasm. It consists of the orgasmic expulsion of a smaller quantity of whitish fluid produced by the female prostate. Squirting can be differentiated from female ejaculation because it is the orgasmic transurethral expulsion of a substantial amount of diluted urine during sexual activity, and it is not considered pathological. The female orgasm is influenced by many aspects such as communication, emotional intimacy, long-standing relationship, adequate body image and self–esteem, proper touching and knowledge of the female body, regular masturbation, male sexual performance, male and female fertility, chronic pain, and capacity to engage in new sexual acts. Stronger orgasms could be achieved when clitoral stimulation, anterior vaginal wall stimulation, and oral sex is involved in the same sexual act.
... Female sexual arousal is manifested in the genital area primarily through vaginal lubrication, which results from plasma ultrafiltration in the perivaginal vascular plexuses into the lumen of the vagina (Levin, 2003;Pastor, 2013). However, during the orgasm, some women can squirt or expel up to hundreds of milliliters of fluid. ...
... This ambiguity caused diagnostic confusion and controversial conclusions (Rubio-Casillas & Jannini, 2011). SQ and FE are considered physiological but uncommon sexual responses and CI is a symptom of a disorder, such as urinary incontinence (Pastor, 2013;Pastor & Chmel, 2018). The fluid outflow during sexual activities usually manifests as wetness, secretion, or gushes (Pastor & Chmel, 2018). ...
... The presence of prostate-specific antigen (PSA) has been considered as conclusive evidence that EO fluid originates from the paraurethral glands (often referred to as the female prostate in sexological literature), (Bullough et al., 1984;Dietrich et al., 2011;Wimpissinger et al., 2013;Zaviačič, 1999;Zaviačič et al., 2000;Zaviačič, Doležalová, et al., 1988;Zaviačič, Zaviačičová, et al., 1988). Although the secretion from female prostate can contaminate other fluids secreted during sexual activities (Pastor, 2013;Rubio-Casillas & Jannini, 2011;Salama et al., 2015). While the classification and differential diagnosis for EO have been proposed previously, (Levin et al., 2016;Pastor, 2013;Pastor & Chmel, 2018;Rogers et al., 2018;Rubio-Casillas & Jannini, 2011;Salama et al., 2015) it is rarely used both in practice and in studies. ...
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Introduction: Women expel fluids of various quantities and compositions from the urethra during sexual arousal and orgasm. These are classified as either female ejaculation (FE) or squirting (SQ). The aim of our analysis was to present evidence that FE and SQ are similar but etiologically different phenomena. Materials and methods: A review of studies was performed on fluids expelled from the urogenital tract during female sexual activities using the Web of Knowledge TM (Web of Science Core Collection) and MEDLINE (Ovid) databases from 1946 to 2021. Results: Until 2011, all female orgasmic expulsions of fluids were referred to as FE. The fluid was known to be either from the paraurethral glands or as a result of coital incontinence. At present, SQ is considered as a transurethral expulsion of approximately ten milliliters or more of transparent fluid, while FE is considered as a secretion of a few milliliters of thick fluid. The fluid in SQ is similar to urine and is expelled by the urinary bladder. The secretion in FE originates from the paraurethral glands and contains a high concentration of prostate-specific antigen. Both phenomena can occur simultaneously. Conclusions: The mechanisms underlying SQ and FE are entirely different. SQ is a massive transurethral orgasmic expulsion from the urinary bladder, while FE is the secretion of a very small amount of fluid from the paraurethral glands.
... 73 Furthermore, while female ejaculation is acknowledged to be an important aspect of the female sexual response, it does not occur in all women. 74 The origin of female ejaculate also remains unclear. Some have discriminated between the different fluids expelled during sexual activity which includes female ejaculate suspected to be produced by the female prostate due to its biochemical similarity to male ejaculate, 25 and squirting, referring to the expulsion of urine. ...
... Some have discriminated between the different fluids expelled during sexual activity which includes female ejaculate suspected to be produced by the female prostate due to its biochemical similarity to male ejaculate, 25 and squirting, referring to the expulsion of urine. 74 The precise differences between these phenomena, including the anatomical structures involved, should be clarified in ongoing investigations. Future studies should consider 3-dimensional reconstruction of this region to more comprehensively define the anatomy of this tissue, including the relationships of the glands to the surrounding innervation, blood supply, and other erotogenic tissues, to help address these remaining gaps in knowledge. ...
Background There is evidence of glandular tissue in the region of the anterior vaginal wall–female periurethral tissue (AVW-FPT) that has similar morphology and immunohistochemistry to the prostate in men. Surgical injury to this tissue has been suggested as a potential cause of sexual dysfunction following midurethral sling (MUS) procedures. However, the anatomy and embryology of these glands have not been fully resolved. This has led to difficulties in classifying this tissue as a prostate and defining its clinical significance related to MUS procedures. Aim To describe the histological and immunohistochemical characteristics of the female periurethral glands using markers of prostate tissue and innervation and to examine their anatomical relationships to an implanted MUS. Methods Using gross and fine dissection, the AVW-FPT was dissected from 9 cadavers. Prior to dissection, 2 cadavers underwent simulation of the MUS procedure by a urogynecologist. Samples were paraffin embedded and serially sectioned. Immunohistochemistry was performed using markers of prostate tissue and innervation. Outcomes Redundant immunohistochemical localization of markers for prostatic tissue and innervation of the glandular tissue of the AVW-FPT, including the region of MUS implantation. Results Female periurethral glands were immunoreactive for markers of male prostatic tissue, including prostate-specific antigen, androgen receptor, HOXB13, and NKX3.1. Markers of innervation (protein gene product 9.5, choline acetyl transferase, and vasoactive intestinal polypeptide) also localized to certain regions of the glandular tissue and associated blood supply. Surgical simulation of the MUS procedure demonstrated that some periurethral glands are located in close proximity to an implanted sling. Clinical Translation The AVW-FPT contains glandular tissue in the surgical field of MUS implantation. Iatrogenic damage to the female periurethral glands and the associated innervation during surgery could explain the negative impacts on sexual dysfunction reported following MUS procedures. Strengths and Limitations This is the first study to characterize the female periurethral glands using markers of prostatic tissue in concert with markers of general and autonomic innervation and characterize their anatomical relationships within the surgical field of MUS implantation. The small sample size is a limitation of this study. Conclusion We provide further evidence that the AVW-FPT contains innervated glands that are phenotypically similar to the male prostate and may share a common embryonic origin. The microscopic and immunohistochemical features of the periurethral glands may be indicative of their functional capacity in sexual responses. The location of these glands in the surgical field of MUS procedures underscores the clinical significance of this tissue.
... Classically, this symptom has been divided into that occurring with penetration and that occurring at orgasm. Coital UI occurring with penetration has been associated with urodynamic stress UI and coital UI occurring at orgasm has been associated with urodynamic detrusor overactivity [6,19]. Nevertheless, more recent studies have suggested the association between coital UI and urethral sphincter deficiency [18,20,21], as an association between orgasmic UI and urodynamic stress incontinence by intrinsic sphincter deficiency has been observed [18,21]. ...
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Objective: Globally, the prevalence of urinary incontinence (UI) in women is estimated to be in the range of 25% to 45%. Different types of UI exist, being the most frequent ones stress UI, urgency UI and mixed UI. Being affected by UI is associated with a higher risk of sexual inactivity, regardless of its type. Mechanism: It is estimated that 5–38% patients with UI are sexually inactive due to UI, whereas 25–38% sexually active women would restrict their sexual activity due to UI. The prevalence of sexual dysfunction within sexually active women with UI is 23–56%. Findings in Brief: In patients with UI, the most frequent sexual dysfunctions are dyspareunia (44%), female sexual interest/arousal disorder (34%) and orgasmic disorder (11%). Therefore, UI has a negative impact on the sexual function of sexually active women with UI. Coital incontinence is defined as the complaint of involuntary loss of urine during or after intercourse. UI with penetration represents any complaint of involuntary loss of urine with vaginal stimulation (either with a sexual toy, manually or with penetration). Orgasmic UI refers to any complaint of involuntary loss of urine occurring at orgasm, regardless of the sexual behaviour that has triggered it. Due to the high prevalence of coital UI (50–60%) in the female population and its strongly negative impact on women’s sexuality, patients should be specifically asked for coital UI in the gynecologic visits. Conclusions: UI affects between one in four and one in two women and had a negative impact on quality of life. Not only UI has an impact on female sexuality, but also different treatments which are offered to treat it can play a role. The reduction of sexual problems with pelvic floor muscle training in women with stress UI has been proved, being the rate of sexual activity doubled. A significant improvement of the overactive bladder associated to urgency UI and female sexual function has been described after the pharmacological treatment or botulinum toxin. Finally, significant improvement of the sexual function has also been found after midurethral slings for stress UI, as well as for coital UI.
... However, the liquid does not originate in the urinary bladder, but comes from female prostate glands (Gilliland 2009). The problem is that not every woman is physically capable of squirting: according to Pastor (2013), who reviewed existing studies of female ejaculation, the prevalence of female ejaculation lies between 10 and 54%. Squirting in pornography is a marginalized and fetishized practice. ...
Building on the feminist ‘sex wars’ debate, content studies of pornography interpret orgasms in pornography to argue for sexual objectification, sexual agency, and unequal power distribution among men and women in porn. While male orgasms are easily coded, female orgasms pose a particularly tricky obstacle due to their ‘invisibility’. I investigated peer-reviewed studies of the content of pornography published in the last 20 years to explore the different coding practices of female orgasms. I assessed the different approaches to measurement, authenticity, and theoretical assumptions connected to the number of orgasms. The analysis shows that methodologies are not always transparent and that researchers do not acknowledge the possible effects of methodologies on their results. This is especially alarming when taking into consideration that most of the studies argue with orgasms for inequality of men and women in pornography. Based on the analysis I offer a ‘best practice’ approach to coding orgasms.
Vaginal squirting is a phenomenon in which women expel fluid during the sexual response process, but it remains poorly understood in the extant literature. The study purpose was to use nationally representative data to investigate adult women's experiences with vaginal squirting. We assessed the prevalence of women who have ever squirted in their lifetime, the level of pleasure and concurrency of orgasm women reported during squirting, the ways in which women discovered squirting, and the challenges and/or concerns women experience with squirting. Forty percent of U.S. adult women (M = 47.6 years, SD = 16.8; Md = 24 years) had ever squirted in their lifetime (Md frequency = three to five times). Two thirds of women reported unintentional discovery of squirting, and most (75%) used specific techniques to promote build up and release of squirting versus squirting spontaneously. About 60% of participants reported squirting to be very or somewhat pleasurable, but only 20% "always" experienced squirting and orgasm together. Women reported different challenges with squirting, such as the time required to reach squirting or the experience being too emotionally intense. Our findings contribute to the growth of much needed, detailed literature on the ways in which women discover and enjoy squirting as part of their sexual lives. Knowledge of these techniques can enable women to better identify their own preferences, communicate about them with their partners, and advocate for their sexual pleasure.
Introduction: Squirting is the involuntary expulsion of fluid from the female urethra following stimulation of the anterior vaginal wall before or during orgasm. The mechanism underlying squirting has not been established. Purpose: To elucidate the mechanism of squirting. Methods: The subjects in the current study were women who were able to squirt. They were not sex workers. A urethral catheter was inserted before sexual stimulation and the bladder was emptied. Then, a mixture of indigo carmine (10 ml) and saline (40 ml) was injected into the bladder. Sexual stimulation was provided to facilitate squirting, which was videotaped and verified. The secretions were collected in sterile cups, and prostate specific antigen (PSA) and glucose levels were measured. Results: Five women (2 in the 30s, 2 in the 40s, and 1 in the 50s) participated in this study. All women were able to squirt; three squirted only with manual sexual stimulation and two with penetrative sexual stimulation. The discharged fluid was blue in all cases, confirming the bladder as the source. The fluid was PSA-positive in four patients. Conclusions: The main component of squirt fluid is urine, but may also contain fluid from Skene's glands (female prostate). This is the first report in which visualization of squirting was enhanced.
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ലൈംഗിക വിദ്യോഭ്യോസം ശോസ്ന്ദ്തീയ അെിവിൽ അധിഷ് ഠിതവും സൗജനയവും എല്ലോവർക്കും എളുപ്പ􀘋ിൽ ൈഭ്യമോകുന്ധതും സമന്ദ്ഗവുമോയിരിക്കണം എന്ധ് ഞോൻ വിശവസിക്കുന്ധു. ലൈംഗിക വിദ്യോഭ്യോസ􀘋ിന്ചെ (പുനരുൽപ്പോദ്ന ആഡരോഗയ വിദ്യോഭ്യോസം) ഡനട്ടങ്ങചള നമ്മൾ പൈഡപ്പോഴും കുെേുകോണുന്ധു. ചമോലബൽ, ഇന്െർചനറ്റ്, ടിവി എന്ധിവയുചട വരഡവോചട, മുതിർന്ധവരുമോയി ബ􀘖ചപ്പട്ട കോരയങ്ങൾ ഒരു കുട്ടിചയ തുെന്ധുകോട്ടുന്ധത് ചവല്ലുവിളിയോണ്. സുരക്ഷിതമോയ ബോൈയം ഓഡരോ കുട്ടിക്കും ഉണ്ോഡകണ്ത് അതയന്ത്ോഡപക്ഷിതമോണ്. ദ്ൗർഭ്ോഗയവശോൽ, നമ്മുചട സമൂഹ􀘋ിചൈ മുതിർന്ധവർക്കുഡപോൈും ലൈംഗികോഡരോഗയച􀘋ക്കുെിേ് അടിസ്ഥോന അെിവില്ല. "ചെെിയഡതോ ചതറ്റോയഡതോ ആയ അെിവ് എല്ലോയ്ഡപ്പോഴും അപകടകരമോണ്". വിശവസനീയവും ശോസ്ന്ദ്തീയവുമോയ ഉെവിട􀘋ിൽ നിന്ധുള്ള അെിവ് നൽകുന്ധതിചനക്കുെിേോണ് ഈ പുസ്കത ം .ഇനെ് ർചനറ്റിഡൈോ സമന്ദ്പോയക്കോർക്കിടയിഡൈോ ഉ􀘋രങ്ങൾ തിരയുന്ധ ജിജ്ഞോസയുള്ള മനസ്സുകൾക്ക് ഉ􀘋രം നൽകുന്ധതിനോണ് ഈ പുസ്കത ം നിർമ്മിേിരിക്കുന്ധത് .സ്ൂക ൾ, ഡകോഡളജ് വിദ്യോർത്തികൾ, അധയോപകർ, രക്ഷിതോക്കൾ, കൗൺസിൈർമോർ, എൻജിഒകൾ, ആഡരോഗയ വിദ്ഗ്ർധ എന്ധിവർക്ക് ഇത ് ഉപഡയോഗന്ദ്പദ്മോണ്. 📌 Link to download free ebook - Hindi ( and English ( 📌 Link for the android application -Hindi ( and English ( 📌 Link to buy a hard copy - . Use 25% off coupon code - SEXEDUCATION
A major area of continued controversy and debate among sex researchers, gynecologists and sex therapists has been and continues to be the question of the phenomenon known as "female ejaculation." The current study was an exploratory research experiment designed to provide information about this issue by catheterizing seven women, who reported that they regularly expelled fluid during sensual and/or sexual arousal. Evidence from various studies of live subjects, involving in total less than fifty women, has shown, at least in these subjects, that what was being considered was a urethral expulsion. However, with the total number of women studied being so small, it was impossible to rule out the possibility that some woman somewhere is expelling fluid other than through the urethra. While the current experiment, based upon a review of previous studies, focused on the nature, composition and source of female urethral expulsions during sensual arousal, this researcher was certainly open to observing, capturing and analyzing any expulsions other than from the urethra. With catheterization, the bladder could be isolated from the urethra so that it could be reliably determined which fluids came from which area. The fluids obtained could then be analyzed for their individual composition, having lessened the possibility that they had been mixed in the urethra. The entire experiment was videotaped with a medical doctor and/or a registered nurse present at all times. The overall environment was designed to be as comfortable and natural as possible for the women subjects in order to increase the probability that there would be fluid to be collected. The primary conclusion from the experiment was that almost all the fluid expelled from these seven women unquestionably came from their bladders. Even though their bladders had been drained, they still expelled from 50 ml to 900 ml of fluid through the tube and into the catheter bag. The only reasonable conclusion would be that the fluid came from a combination of residual moisture in the walls of the bladder and from post draining kidney output. There was also a consistency of results that showed a greatly reduced concentration of the two primary components of urine, urea and creatinine, in the expelled fluid. A review of previous literature leads to an inference that it is possible that the expelled fluid is an altered form of urine and that there may be a chemical process that goes on during sexual stimulation and excitement that changes the composition of urine. On four occasions the research team saw evidence of milky-white, mucous-like emissions from the urethra outside of the catheter tube. Although three of those emissions were recorded by the video cameras, the research team was only able to capture a small portion of the fluid for laboratory analysis. An objective reading of the previous literature indicated the possibility of such an emission from the urethral glands and ducts. In the past, the assumption has been that female urethral expulsions during sensual and/or sexual activity originated either in the bladder or from the urethral glands and ducts. The current study, which documented expulsions originating in the bladder, also indicated the possibility that, in some women, there may also be an emission from the urethral glands and ducts. That possibility seems promising enough to encourage future researchers to employ methodology similar to this study to resolve this age old controversy.