![Anatomy of the CUV complex. Schematic representation of the external and internal clitoris and the vaginal opening. The insert, an anterior vaginal wall obtained from a cadaver [15, 21], represent the intimate relationships between all the different anatomical structures involved in the female sexual pleasure. (See plate section for color representation of the figure)](https://www.researchgate.net/profile/Barry-Komisaruk/publication/324578379/figure/fig1/AS:631991238160384@1527689861367/Anatomy-of-the-CUV-complex-Schematic-representation-of-the-external-and-internal_Q320.jpg)
![.1 Histological findings in clitoris and vagina [8].](https://www.researchgate.net/profile/Barry-Komisaruk/publication/324578379/figure/tbl1/AS:668540227026957@1536403819857/1-Histological-findings-in-clitoris-and-vagina-8_Q320.jpg)
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Peripheral and Central Neural Bases of Orgasm
Abstract and Figures
The clitoris and the clito‐urethro‐vaginal complex are responsive to ovarian hormones and are the main peripheral structures that, with significant individual differences, provide the genital peripheral afferent component of female sexual pleasure. In the central nervous system during orgasm, essentially all of the major brain systems are activated, including the brainstem, limbic system, cerebellum, and cortex. In a symphony of integration, these peripheral and central systems mediate the sensory, cognitive, autonomic, and motor events of orgasm.
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... Vaginal orgasm is a controversial subject with many women reporting that have difficulties attaining orgasm by penile-vaginal intercourse alone (Jannini et al., 2012). More recent research has been suggesting that there are physiological differences between orgasm by vaginal penetration and orgasm by stimulating the clitoral gland (Brody, 2017;Jannini et al., 2012;Jannini et al., 2019). Future research is need to clarify if vaginal orgasm is more likely to happen during exceptional states of consciousness, and this makes it more infrequent. ...
... Future research is need to clarify if vaginal orgasm is more likely to happen during exceptional states of consciousness, and this makes it more infrequent. According to a study almost all women (95%) reports that clitoral stimulation contributes to their orgasms, while only 65% report that vaginal stimulation contributes to orgasm, and even less (35%) report that cervical stimulation contributes to orgasm (Jannini et al., 2019). Interestingly, orgasms elicited by cervical stimulation were described in more abstract manners that are reminiscent of ASC, such as provoking "showers of stars" or "images of universal spaciousness" (Jannini et al., 2019) In the study by Costa and colleagues (2016a), occurrence of vaginal orgasm was related to greater changes in the perception of time than noncoital orgasms or coital orgasms with clitoral masturbation. ...
... According to a study almost all women (95%) reports that clitoral stimulation contributes to their orgasms, while only 65% report that vaginal stimulation contributes to orgasm, and even less (35%) report that cervical stimulation contributes to orgasm (Jannini et al., 2019). Interestingly, orgasms elicited by cervical stimulation were described in more abstract manners that are reminiscent of ASC, such as provoking "showers of stars" or "images of universal spaciousness" (Jannini et al., 2019) In the study by Costa and colleagues (2016a), occurrence of vaginal orgasm was related to greater changes in the perception of time than noncoital orgasms or coital orgasms with clitoral masturbation. ...
Sexual intercourse alters normal waking consciousness. Altered states of consciousness (ASC) refer to marked deviations from usual waking consciousness, and include alterations in the sense of self, attention, thought processes, time awareness and sensory perception. Sex can induce ASC, as indicated by states of attentional absorption in bodily sensations concomitant with loss of time awareness. The present study aimed at testing if, during sexual relations, higher sexual responsiveness relates to higher intensity of dimensions of ASC that can occur in other contexts, such as meditation or use of psychoactive substances. The personality trait of absorption appears to reflect individual differences in the proclivity to experience ASC; thus, a second aim was to examine if trait absorption relates to intensity of ASC during sex. The international sample consisted of 448 participants (303 women, 145 men). Sex-induced ASC were measured with four sub-scales of The Altered States of Consciousness Rating Scale (OAV): Experience of Unity, Spiritual Experience, Blissful State and Insightfulness. Trait absorption was measured by the Modified Tellegen Absorption Scale (MODTAS). Sexual responsiveness during the last intercourse was assessed by the sum of measures of arousal, desire, and satisfaction, as well as by questions on the occurrence of orgasm from different sexual activities. Trait absorption and sexual responsiveness predicted independently all dimensions of ASC among women and men. In women, vaginal orgasm (during vaginal intercourse without concomitant clitoral masturbation) was an additional independent predictor of ASC. Male orgasm related to ASC, but not independently from other aspects of sexual responsiveness.
... Love, sexual pleasure and orgasm in H. sapiens are far more complicated phenomena compared to the "mating" of the laboratory animals, although the same neurochemicals participate in the induction of sexual pleasure, such as dopamine (DA) and oxytocin (OXT), similar to animals [26,28]. Komisaruk., et al. reported, from some fMRI studies, that during the orgasms induced by vaginal-cervical stimulation or clitoral stimulation, hypothalamic paraventricular nucleus (where oxytocin is initially released), amygdala, hippocampus, nucleus accumbens (NA), nucleus Caudatus (NC), insula, preoptic area (where oxytocin is released), some basal ganglions, cerebellum, anterior cingulate gyrus, insularparietal and prefrontal cortices were activated [29][30][31][32][33]. By means of sophisticated technology and imaging techniques, now, we are able to see how human data, fits with the findings emerging from animal experiments. ...
... In regional cerebral blood low studies (rCBF), Georgiadis., et al. have found that during clitoral stimulation, blood flow was increased at the right somatosensorial cortex; during clitoral orgasm, rCBF was decreased at the left orbitofrontal cortex, inferior temporal gyrus and anterior temporal lobe; an increase of rCBF, was detected at the caudate nucleus (NC) and cerebellar nuclei [34,35] (Figure 1). The results coming from animal studies (mostly rats), have been tested in live human subjects by using very sophisticated imaging techniques, such as fMRI, show that, when there is pleasure the following areas of the brain may become activated [24][25][26][27]29,[30][31][32][33][34][35][36][37][38][39][40][41][42][43][44][45] (Table 1 ...
... Neuroimaging studies during sexual stimulation and orgasm Komisaruk., et al. have done extensive research on the activation of brain regions, during stimulation of nipple, clitoris, vagina and cervix, arousal and orgasm by using fMRI technique [30][31][32][33]46]. By self-stimulation of clitoris, vagina and cervix, the corresponding of sensory cortex and cortex region overlapping with the innervation of pudental, pelvic and hypogastric nerves, were activated [30][31][32][33]. ...
Pleasure principal" is one of the most important driving forces of the human psyche. Kinds of pleasure in human beings include various satisfactions, such as food intake for the survival, satisfaction of the ego and higher cortical cognitive functions, sexual satisfaction and orgasm, satisfaction of basic physiological needs and peak experiences, such as love, satori-like experiences, and some mystical-like experiences. Pleasure phenomenon has some neural correlates, circuitries and neurotransmitter systems involved. Some pleasure centers have been defined in both animals and humans, such as ventral tegmental area (VTA), nucleus accumbens (NA), prefrontal cortex, hypothalamus, cingulate cortex, insula, while amygdala, hippocampus and some structures of the temporal lobe may have an auxiliary role. Mainly neurotransmitters dopamine (DA) and oxytocin (OXT) are the mediators of pleasure experiences in humans. During love, sexual pleasure and orgasm, those hedonic hot spots are activated, as also shown by fMRI techniques. Recently it was proposed that sexual pleasure can be expanded and there were reports on expanded orgasms (EO or ESR). Also, some researchers have reported that there are erogenous zones other than clitoris, while some non-genital orgasms have also been reported. Pudental, pelvic, hypogastric nerves and vagus control the orgasmic reflex in females. OXT, which is also a pleasure molecule, just like DA, also has some separate pleasure pathways. The limits and extents of female pleasure and orgasms have not been investigated thoroughly until recently. One of the extremes of female pleasures, ESR, has some specific neurological mechanisms which can be explained by using current data on female sexuality. There are different types of female orgasms: clitoral, vaginal, blended orgasms, EO and status orgasmus, which are still debated in the academic circles. This review discusses the possible neurological and neuropharmacological mechanisms of EO and ESR, using the informatics theory, as well.
... Today it is even possible to detect the centers that are activated or inactivated during sexual pleasure and orgasm (Komisaruk, 2006;Wise, 2017;Jannini, 2018). New horizons have been discovered in the area of sexual physiology by fMRI. ...
... • orbitofrontal cortex These brain areas are often called "hedonic hotspots". The experiments and observations claim that either the electrical (using micro electrodes) or chemical stimulation (amphetamines or cocaine) of these brain structures can induce pleasure or positive emotions (Kringelbach, 2009;Berridge, 2007Berridge, , 2008Berridge, , 2015Koob, 1997Koob, , 2009Koob, , 2010Volkow, 2007;Komisaruk, 2006;Wise, 2017;Jannini, 2018;Funahashi, 2011;Kim, 2015). ...
Hedonism and pleasure are one of the main goals of human life. Pleasure can be accepted as a reward for the brain, while the major reward neurotransmitters are dopamine, norepinephrine, oxytocin and gluta-mate. Boost of dopamine in the "hedonic hot spots" creates euphoria, delight, pleasure, contentment and is associated with happiness. The reward circuitry and pleasure centers in the brain involve the ventral teg-mental area (VTA), nucleus accumbens (NA), substantia nigra (SN), ventral pallidum, insula, lateral thala-mus, cingulate cortex, hippocampus, amygdala, medial prefrontal cortex and orbitofrontal cortex. Pleasure is a learned enjoyable phenomenon and pursuing the pleasure principle is one of the crucial goals of human life. However, to some extent of pleasure, due to the release of dopamine and glutamate and the activation of D1-like excitatory dopamine receptors and NMDA receptors, may induce different forms of psychological addiction. Sexual motivation, sexual drive and orgasm also use the same reward circuitry and similar neuro-chemicals in the brain. The experience of "getting high on dopamine" has been one of the primary longstanding goals for human beings, as well as for other higher primates and animals during the normal course of evolution. Today, it is known that pleasure and sexual hedonism may even alter synaptic plasticity , and may influence a variety of psychological responses and the personality of individuals, as Sigmund Freud had pointed out a century ago.
... Coital orgasm without the direct stimulation of the clitoris (often named vaginal orgasm) and is a matter of controversy. Unlike previously thought, recent studies show physiological differences between vaginal and clitoral orgasm (Brody, 2017;Jannini et al., 2019;Jannini et al., 2012). Many women report to not attain vaginal orgasm at all or on a regular basis, which makes it an intriguing subject. ...
Associations between Big Five personality traits and sexual function
have been reported by many studies. Additionally, temporary alterations of consciousness influence sexual functioning. The present study examined how sexual responsiveness is independently associated with Big Five Personality traits and intensity
of awareness of body, time, and surrounding space. One hundred thirty six heterosexual Portuguese women answered an online survey. Big Five personality traits were measured by the NEO-FFI-20. To assess responsiveness during the last sexual intercourse, participants completed measures on sexual satisfaction, desire, arousal, and
orgasm occurrence, as well as awareness of body, space and time. Satisfaction and orgasm were associated to higher extraversion, higher conscientiousness, and lower neuroticism. Desire and arousal correlated with higher extraversion and lower neuroticism. Greater body awareness and lesser time awareness correlated with satisfaction, desire, and arousal. Body awareness was inversely related to time awareness. Satisfaction was independently predicted by body awareness, being in a relationship, extraversion, openness to experience, and conscientiousness. Desire was independently predicted by body awareness and lower neuroticism. Arousal was
independently predicted by body awareness, openness to experience, and lower neuroticism. The findings provide knowledge on how sexual responsiveness might be independently influenced by stable personality factors and transient changes of consciousness.
... Concerning the urethra and its surrounding exocrine glands, it is purported to be responsible for the secretions released during the peak of female arousal states. Specifically, the microscopic distal urethral glands, also known as Skene's or paraurethral glands, are the claimed source for this milky fluid, which is then released by the small and short ducts that drain via the urethra; the finding of specific markers of prostatic tissue such as prostate-specific antigen (PSA), type 5 phosphodiesterase (PDE5) [53] and other markers such as chromogranin and nitric oxide (NO) synthases (NOS) [54,55] in this "milky fluid" seem to have confirmed this theory, although the recognition of the "prostate foeminina" [2] is still not unanimously accepted. Nevertheless, a sort of vestigial "prostatic" tissue was found in around 90% of women [56], localized in the urethra, approximately 10% of it around the area of the bladder sphincter but the main part of the tissue being in the more distal urethra in 66% of women [57]. ...
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).
... Tantric practices involving orgasmic movements of subtle energy can foster experiences of transformative transcendence and spiritual bliss (Barratt, 2019). Western research into the neurological and subjective impact of orgasms has charted the neural bases of orgasm (Jannini et al., 2018), developed a scale to measure intensity (Elfers, 2019), has revealed that orgasms in some circumstances are unpleasant rather than blissful (Chadwick et al., 2019) and suggests spiritual experiences are common outcomes of extended sexual orgasms (Costa et al., 2017(Costa et al., , 2016a(Costa et al., , 2016bSayin, 2019aSayin, , 2019bSayin, , 2019cSayin, , 2017aSayin, , 2017bSayin, , 2011Sayin and This research, together with western typologies of altered states (Berkovich-Ohana and Wittmann, 2017), suggests that neuroscience could provide a map for orgasm state, the fourth state of consciousness on the Tibetan Buddhist Tantric tradition. Increased knowledge of the orgasm state of alternative consciousness could have undoubted spiritual, emotional, and therapeutic benefits in Buddhist and non-Buddhist contexts. ...
... There is a possibility that pain, and orgasm may be using similar or the same spinothalamic pathways, a neurophysiological mechanism which can explain why some women and men enjoy mild pain and pleasure/orgasm together in BDSM sessions. Also, it is shown that female orgasm is analgesic [63][64][65][66], probably due to the release of oxytocin, which has also analgesic effects, and endogenous opioids. This can also explain how mild pain and orgasmic pleasure can be interchangeable with each other. ...
CORRECTED PROOF:
In sexuality research and sex therapy, it is generally very difficult to define “the normal” and to
differentiate variations, mild and harmless fantasies, sexual games and fantasy role play from paraphilia.
In DSM classifications, there are still dilemmas, misinterpretations, contradictions and controversies to
define paraphilias and what pathology is and what is not. There are new definitions and terminology
in sexuality research, such as “Expanded Sexual Response” (ESR), “status orgasmus” “Never Ending
Orgasms (Super Orgasms)”, “Deep Vaginal Erogenous Zones” (DVZ),”Sexual Pleasure Objects” (SEPOs),
“Hypersexuality” “Non-genital orgasms” and “soft-non-pathological BDSM” etc. In this review novel
definitions of some new notions are given and it is discussed why those sexual behaviors cannot be
regarded as a pathology or paraphilia, such as “Hypersexuality” and soft-BDSM; a unified definition of
paraphilias is proposed. Sometimes, ESR women are often confused with pathological hypersexuality.
ESR is defined as: “being able to attain long lasting and/or prolonged and/or multiple and/or sustained
orgasms and/or status orgasmus that lasted longer and more intense than the classical orgasm patterns
defined in the literature”. Lately a research performed in United Kingdom revealed that the research team
had discovered more than 500 women who were having more than 30 to 50 orgasms in one or two hours
(see: You Tube, “Never Ending Orgasm” documentary). We have concluded in many publications that
during an ESR orgasm and status orgasmus, some women can have trains of tens of orgasms in a given
love making session. Women can be trained to achieve ESR orgasms and it is a learned phenomenon.
Although defined recently in medical literature, the notion of ESR is as old as history, starting from the
Dionysus Cult Era and Far Eastern sexual traditions descending from Early Ages and Tantra and Taoist
cultures. At the turn of 21st Century, Female Orgasm is still a mystery and we only know the tip of the
Orgasmic Iceberg of Females.
Keywords: Sexual pleasure objects; Fantasy; Variations; Soft-BDSM; ESR; Hypersexuality; Nymphomania;
Paraphilia; DSM-5; Normal; EQ; Sexual intelligence; SEPO
During pregnancy, maternal brain neuroplasticity indicates vast neurofunctional and neuroanatomical changes. Recent findings documented a similarly massive readjustment after pregnancy. Currently, these brain changes are interpreted as preparation for and adjustment of the maternal brain to motherhood. Yet, this perspective leaves many questions unsolved. Neuroscientific studies have not yet been conducted to determine the brain areas that function during natural childbirth even though physiological birth is the natural process of women who have reproduced successfully throughout two million years of evolution of the genus Homo. It is rational to believe that the female brain is an active and crucial actor during birth and that birth, itself, is a process that requires brain neuroplasticity. Lack of studies of the birthing brain and brain preparation for birth is a significant lacuna in neuroscience research. I demonstrate theoretically that a new hypothesis for complementary interpretation of maternal brain neuroplasticity is reasonable: Certain maternal brain changes during pregnancy can be interpreted as brain preparation for birth and certain maternal brain changes after birth can be interpreted as brain recovery after the tremendous event of birth. This essay can be a starting point for new directions in neuroscience studies.
Stimulating the clitoris activates the brain to instigate changes in the female genital tract, namely, the enhancement of vaginal blood flow that increases vaginal luminal pO2, vaginal transudate (lubrication) facilitating painless penile penetration and partial neutralization of the basal luminal acidic pH, vaginal tenting, and ballooning delaying sperm transport and allowing semen de‐coagulation and capacitation (sperm activation) factors to act until arousal ends (often by orgasm induction). All these genital changes taken together are of major importance in facilitating the possibility of reproductive success (and thus gene propagation) no matter how or when the clitoris is stimulated—they reveal its overlooked reproductive function. Of course, also commensurate with these changes, is its activation of sexual pleasure. The clitoris thus has both procreative (reproductive) and recreative (pleasure) functions of equal importance. Clitoridectomy creates not only sexual disability but also a reproductive disability. Clin. Anat., 2019.
Pleasure is a mental and emotional state that humans and other animals experience as positive, enjoyable, satisfying, giving joy and happiness or worth seeking. It may include other mind states such as happiness, entertainment, enjoyment, ecstasy, and euphoria, with peak experiences. According to the "incentive salience model" pleasure has three components: "wanting and motivation", "learning" and "liking-pleasure". Different brain regions cooperatively work together for each of these constituents. Since most of the data to establish this model came from animal studies, for human beings a more profound and complex model needs to be established. During the onset of pleasure or sensuality, dopaminergic neurons in ventral tegmental area (VTA) fire and their projections to the nucleus accumbens (NA) release dopamine which participates in the complex psychological processes of learning and liking. Similar episodes occur during the onset of sexual pleasure and human orgasm. Some complex human phenomena, such as passionate love or expanded orgasms, can be regarded as peak experiences, which the animal kingdom does not seem to experience. During passionate love, for instance, the release of some neurotransmitters, such as dopamine, oxytocin, and norepinephrine, is enhanced, while serotonin levels drop; in some fMRI studies, it is shown that some brain regions and "hedonic hot spots" are activated. During the female orgasm, VTA, NA, anterior cingulate, insula, amygdala, hippocampus, and hypothalamus are activated. In this article neuroanatomical, neurophysiological, neurochemical components of pleasure, love, motivation and orgasm, which lead to impressive behavioral changes, are discussed. Also, the phenomenon of experiencing sexual pleasure during the sleep found with the parasomnia "Sexsomnia" and also "Epileptic Sexsomnia", both for the affected person and the bed partner will be discussed, with further research encouraged on this intriguing new clinical and clinical research area.
Objective
To update the “Evaluation and Treatment of Hirsutism in Premenopausal Women: An Endocrine Society Clinical Practice Guideline,” published by the Endocrine Society in 2008.
Participants
The participants include an Endocrine Society–appointed task force of seven medical experts and a methodologist.
Evidence
This evidence-based guideline was developed using the Grading of Recommendations, Assessment, Development, and Evaluation system to describe the strength of recommendations and the quality of evidence. The task force commissioned two systematic reviews and used the best available evidence from other published systematic reviews and individual studies.
Consensus Process
Group meetings, conference calls, and e-mail communications facilitated consensus development. Endocrine Society committees, members, and cosponsoring organizations reviewed and commented on preliminary drafts of the guidelines.
Conclusion
We suggest testing for elevated androgen levels in all women with an abnormal hirsutism score. We suggest against testing for elevated androgen levels in eumenorrheic women with unwanted local hair growth (i.e., in the absence of an abnormal hirsutism score). For most women with patient-important hirsutism despite cosmetic measures (shaving, plucking, waxing), we suggest starting with pharmacological therapy and adding direct hair removal methods (electrolysis, photoepilation) for those who desire additional cosmetic benefit. For women with mild hirsutism and no evidence of an endocrine disorder, we suggest either pharmacological therapy or direct hair removal methods. For pharmacological therapy, we suggest oral combined estrogen–progestin contraceptives for the majority of women, adding an antiandrogen after 6 months if the response is suboptimal. We recommend against antiandrogen monotherapy unless adequate contraception is used. We suggest against using insulin-lowering drugs. For most women who choose hair removal therapy, we suggest laser/photoepilation.
Background:
During the course of a previous study, our laboratory made a serendipitous finding that just thinking about genital stimulation resulted in brain activations that overlapped with, and differed from, those generated by physical genital stimulation.
Objective:
This study extends our previous findings by further characterizing how the brain differentially processes physical 'touch' stimulation and 'imagined' stimulation.
Design:
Eleven healthy women (age range 29-74) participated in an fMRI study of the brain response to imagined or actual tactile stimulation of the nipple and clitoris. Two additional conditions - imagined dildo self-stimulation and imagined speculum stimulation - were included to characterize the effects of erotic versus non-erotic imagery.
Results:
Imagined and tactile self-stimulation of the nipple and clitoris each activated the paracentral lobule (the genital region of the primary sensory cortex) and the secondary somatosensory cortex. Imagined self-stimulation of the clitoris and nipple resulted in greater activation of the frontal pole and orbital frontal cortex compared to tactile self-stimulation of these two bodily regions. Tactile self-stimulation of the clitoris and nipple activated the cerebellum, primary somatosensory cortex (hand region), and premotor cortex more than the imagined stimulation of these body regions. Imagining dildo stimulation generated extensive brain activation in the genital sensory cortex, secondary somatosensory cortex, hippocampus, amygdala, insula, nucleus accumbens, and medial prefrontal cortex, whereas imagining speculum stimulation generated only minimal activation.
Conclusion:
The present findings provide evidence of the potency of imagined stimulation of the genitals and that the following brain regions may participate in erogenous experience: primary and secondary sensory cortices, sensory-motor integration areas, limbic structures, and components of the 'reward system'. In addition, these results suggest a mechanism by which some individuals may be able to generate orgasm by imagery in the absence of physical stimulation.
DefinitionA large family of acidic adaptor proteins of ∼30 kDa that mainly (but not solely) interact with phosphoserine or -threonine sites on target proteins to facilitate their activity. 14-3-3 proteins have 9–10 alpha helices, generally form homo- or heterodimers, and contain a number of common modification sites (e.g. phosphorylation, divalent cation binding, and so forth) to regulate their activities, interactions, and localizations.Synaptic Proteins and Regulated Exocytosis
Anterior cingulate cortex (ACC) is a part of the brain's limbic system. Classically, this region has been related to affect, on the basis of lesion studies in humans and in animals. In the late 1980s, neuroimaging research indicated that ACC was active in many studies of cognition. The findings from EEG studies of a focal area of negativity in scalp electrodes following an error response led to the idea that ACC might be the brain's error detection and correction device. In this article, these various findings are reviewed in relation to the idea that ACC is a part of a circuit involved in a form of attention that serves to regulate both cognitive and emotional processing. Neuroimaging studies showing that separate areas of ACC are involved in cognition and emotion are discussed and related to results showing that the error negativity is influenced by affect and motivation. In addition, the development of the emotional and cognitive roles of ACC are discussed, and how the success of this regulation in controlling responses might be correlated with cingulate size. Finally, some theories are considered about how the different subdivisions of ACC might interact with other cortical structures as a part of the circuits involved in the regulation of mental and emotional activity.
Study question:
Is the presence of polycystic ovary syndrome (PCOS) associated with anogenital distance (AGD), a biomarker for the prenatal hormonal environment?
Summary answer:
The presence of PCOS is associated with longer AGD.
What is known already:
Although the aetiology of PCOS is unclear, emerging data suggest that the natural history of PCOS may originate from intrauterine life. Prenatal exposure to androgen hormones is considered an important factor of PCOS. AGD is the distance measured from the anus to the genital tubercle and there is considerable evidence in humans and animals to support AGD as a sensitive biomarker of prenatal androgen activity.
Study design, size, duration:
This case-control study of 156 PCOS patients and 180 reproductively healthy women (control subjects) was performed from October 2015 to July 2016.
Participants/materials, setting, methods:
The patients and controls were recruited from the out-patient Department of Gynecology of Sun Yat-sen Memorial Hospital. Participants completed health questionnaires and provided a blood sample for evaluation of serum reproductive hormone profiles. Anthropometric indices of AGDAF (anus-fourchette) and AGDAC (anus-clitoris) were measured in all subjects. We used logistic regression to estimate the association between the presence of PCOS and AGD measurements while accounting for important confounders, including age and BMI. Multiple linear regression was used to analyse the relationships between PCOS characteristics (e.g. polycystic ovaries and total testosterone (T)) and two measurements of AGD in the PCOS group and controls.
Main results and the role of chance:
Overall, logistic regression showed that women with AGDAF in the highest tertile were 18.8 times (95% CI 9.6-36.6; P < 0.001) more likely to have PCOS compared with those in the lowest tertile. Women with AGDAC in the highest tertile were 6.7 times (95% CI 3.7-12.1; P < 0.001) more likely to have PCOS than those in the lowest tertile. In the PCOS group, multiple linear regression analyses revealed that both AGD measurements were positively associated with T levels (β = 0.246 for AGDAC, β = 0.368 for AGDAF; P = 0.003 and P < 0.001, respectively), and AGDAF was positively associated with the presence of polycystic ovaries (β = 0.279; P < 0.001). In the controls, a positive association was found only between T levels with AGDAF (β = 0.177, P = 0.020), whereas no associations were found between the remaining covariates and AGD measurements.
Limitations, reasons for caution:
As this was an observational study, causal inference cannot be obtained.
Wider implications of the findings:
This study suggests that PCOS may originate in intrauterine life, and be affected by prenatal exposure to androgens.
Study funding/competing interest(s):
This study was supported by funds obtained from the Science Technology Research Project of Guangdong Province (2010B031600058 and 2015A030310083) and the Major Science Technology Research Project of Guangdong Province (ZKM05602S). The authors have no competing interests to declare.
Trial registration number:
Not applicable.
Introduction:
The brain has two goals: survival of the individual and survival of the species. It ensures that the body resides in safe circumstances and can obtain sufficient drink and food. It also has to produce and protect offspring. Its most important tool is its motor system, which consists of the voluntary and emotional motor systems.
Aim:
To explain how the brain uses its emotional motor system to control the pelvic organs.
Methods:
Anatomic and physiologic data in cats and humans are used to find out how this motor system works and what parts of the brain and brainstem are involved.
Main outcome measures:
Main outcome is that the brain control of the pelvic organs is a specific descending system.
Results:
The pelvic organs are innervated by the sacral parasympathetic motoneurons, which are controlled by a specific group of neurons in the pontine brainstem, the pelvic organ stimulating center (POSC). Through long descending pathways, this POSC generates micturition, defecation, and sexual activities by stimulating different groups of sacral parasympathetic motoneurons. In turn the POSC is driven by the periaqueductal gray (PAG), which receives, through the sacral cord, precise information regarding the situation in all pelvic organs. In addition, the PAG receives instructions from higher brain levels such as the amygdala, bed nucleus of the stria terminalis, and various regions of the hypothalamus. Notably, in humans, the most important brain region having access to the PAG is the medial orbitofrontal cortex, which is deactivated in women with hypoactive sexual desire disorder.
Conclusion:
In women with hypoactive sexual desire disorder, deactivation of their medial orbitofrontal cortex produces a decrease in PAG-POSC activation, causing absence of vaginal vasocongestion and lubrication and decreased sexual behavior in general. It often leads to major problems in their personal circumstances. The question is whether new drugs can cure this.
Objectives
To generate normative data on clitoris length, anogenital distance and anogenital ratio in Indian newborns. DesignCross-sectional study. SettingNeonatal unit of a tertiary care teaching hospital in Kolkata. Participants378 female neonates, who were hemo-dynamically stable without critical illness or chromosomal anomaly, and without any vulval hematoma or genital abnormalities. InterventionsMeasurements were recorded using a digital vernier caliper between 24–72 hours. Infant was held in position by an assistant, while the investigator measured clitoral length by gently retracting the labia majora. Anogenital distance (centre of the anus to posterior convergence of the fourchette) and anogenital ratio (anogenital distance divided by the distance from centre of the anus to base of the clitoris) was also measured. Main outcome measuresGestational age- and birthweight-wise normative values of clitoral length, anogenital distance and anogenital ratios. ResultsMean clitoral length was 3.1 (1.54) mm for the whole cohort while anogenital distance and anogenital ratio were 10.2 (2.78) mm and 0.34 (0.07) mm, respectively. The gestation age-wise percentile charts of clitoral length, anogenital distance and anogenital ratio have been generated. There was no correlation between clitoral length and gestational age, body length, head circumference and birth weight. Correlations were also weak for anogenital distance. Conclusions
The normative values generated can serve as reference standard in the assessment of clitoromegaly, ambiguous genitalia, virilizing effects and suspected in utero androgen exposure.
Recent anatomical findings in the monkey indicate that the frontal cortex receives associative afferents from the visual, auditory, and somatosemsory areas of the cortex. The inferior parietal lobule and the inferior temporal cortex are important way-stations in these cortico-cortical afferent pathways. The olfactory system represents a fourth sensorium having access to the frontal cortex, namely, by way of substantial projections from the pirifom cortex and olfactory tubercle to the medial subdivision of the thalamic mediodorsal nucleus. Additional afferents to this nucleus originate from various fore- and midbrain structures implicated in the circuitry of the limbic system; such afferents could well be ediators of information related to the organism's internal milieu. On the efferent side, the frontal cortex is associated with the inferior parietal, temporal, cinguloparahippocampal cortex, and entorhinal area; it is the only cortical region known to project directly to the hypothalamus and hypothalamus-related structures in the paramedian midbrain tegmentum. The mosaic of origin and termination of the various connections indicates that the convexity of the frontal lobe (especially its caudal half) is reciprocally associated with the parietal and temporal cortex, while the major associations with the hippocampal mechanism originate from two separate areas, viz. the caudal orbitofrontal cortex and a region dorsal to the sulcus principalis, frontal fields from which also the major fronto-hypothalamic connections arise.
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 **;**:**–**.