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The Clitoris—An Appraisal of its Reproductive Function During the Fertile Years: Why Was It, and Still Is, Overlooked in Accounts of Female Sexual Arousal

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The Clitoris—An Appraisal of its Reproductive Function During the Fertile Years: Why Was It, and Still Is, Overlooked in Accounts of Female Sexual Arousal

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Abstract

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.

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... However, it has other reproductive functions. In fact, stimulation of the clitoris activates the brain to instigate changes in the female genital tract which are of major importance in facilitating reproductive success (Levin, 2020). ...
... Since the glans clitoris is covered by thin glabrous skin, it may be assumed that the sensory nerve endings share the structure and immunohistochemical properties of digital ones. The periaxonic cells that form sensory corpuscles are continuous with the cells of nerve trunks, except for the perineurium which can be either present (Pacinian corpuscles) or absent (Meissner's corpuscles; Vega et al., 2009;Feito et al., 2016;García-Piqueras et al., 2017, 2020. Thus, the first goal of this study was to analyse whether the sensory corpuscles present in the glans clitoris share basic immunohistochemical characteristics with the digital ones, including a capsule of endoneurial and/or perineurial filiation. ...
... To our knowledge, the presence of mechanoproteins, and in particular PIEZO2, in the sensory corpuscles of genital organs is reported here for the first time. These findings are of interest since mechanical stimulation of the clitoris is essential for sexual arousal and orgasmic response (Jannini et al., 2012;Pauls, 2015;Levin, 2020), and PIEZO2 ...
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The clitoris is a leading player in female sexual arousal, if not the main protagonist. Despite this role, studies performed on this structure with specific neuroanatomical techniques are few. This study focuses on glans clitoris innervation, with special emphasis on sensory corpuscles and the presence of the mechanotransducer protein PIEZO2 in these structures. Six glans clitoris samples were obtained at autopsy covering an age spectrum between 52 and 83 years old. Several types of nerve terminations including free nerve endings, genital endbulbs as well as Meissner‐like corpuscles and Pacinian corpuscles, but not Ruffini corpuscles, were found. Although corpuscular morphology in the glans clitoris was subtly different from the cutaneous digital counterparts, their basic composition was comparable for both Pacinian and Meissner‐like corpuscles. Genital endbulbs showed heterogeneous morphology, and the axons usually exhibited a typical “wool ball” or “yarn ball” aspect. Some of them were lobulated and variably encapsulated by endoneurial elements (65%); from the capsule originate septa that divides the genital endbulbs, suggesting that they are found in clusters rather than as single corpuscles. In addition, most corpuscles in the glans clitoris showed axonal PIEZO2 immunoreactivity, thus, suggesting a mechanical role and molecular mechanisms of mechanosensibility similar to those of digital Meissner's corpuscles. Our results demonstrate that sensory corpuscles of the glans clitoris are similar to those of other glabrous skin zones, as most genital organs are characterized by clusters of corpuscles and the occurrence of the mechanoprotein PIEZO2 in the axons. These findings strongly suggest that PIEZO2 participates in erotic and sexual mechanical sensing.
... The women highlighted the physical aspects of clitorectomy as causing problems with sexual desire and sensation. This may not be surprising, as there is a growing body of literature supporting the importance of the clitoris for women's sexual function and orgasm (Levin, 2020;Mahar et al., 2020). Even in contexts where FGC is common, such as Somalia, the clitoris is commonly perceived as the physical site for women's sexual desire and pleasure, which is why it is seen as being in need of removal (Talle, 2007). ...
... Yet, an inability to enjoy sex was perceived to limit their partner's pleasure, which created shame and guilt. As the coital imperative is dominant within the heterosexual sexual script, with its implicit focus on child production (Levin, 2020;Mahar et al., 2020), penetrative sex is also often the focus in studies on the effects of FGC on sexual function (Obermeyer, 2005;Nour, 2006;Catania et al., 2007;Krause et al., 2011;Rouzi et al., 2017;Villani, 2022). However, due to criticism of the coital imperative, which has been shown to create an orgasm gap in heterosexual couples (Mahar et al., 2020;Andrejek et al., 2022), a new sexual script with increased focus on pleasure for both parties is likely to be on the rise. ...
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Female genital cutting (FGC) is a traditional practice, commonly underpinned by cultural values regarding female sexuality, that involves the cutting of women's external genitalia, often entailing the removal of clitoral tissue and/or closing the vaginal orifice. As control of female sexual libido is a common rationale for FGC, international concern has been raised regarding its potential negative effect on female sexuality. Most studies attempting to measure the impact of FGC on women's sexual function are quantitative and employ predefined questionnaires such as the Female Sexual Function Index (FSFI). However, these have not been validated for cut women, or for all FGC-practicing countries or communities; nor do they capture cut women's perceptions and experiences of their sexuality. We propose that the subjective nature of sexuality calls for a qualitative approach in which cut women's own voices and reflections are investigated. In this paper, we seek to unravel how FGC-affected women themselves reflect upon and perceive the possible connection between FGC and their sexual function and intimate relationships. The study has a qualitative design and is based on 44 individual interviews with 25 women seeking clitoral reconstruction in Sweden. Its findings demonstrate that the women largely perceived the physical aspects of FGC, including the removal of clitoral tissue, to affect women's (including their own) sexual function negatively. They also recognized the psychological aspects of FGC as further challenging their sex lives and intimate relationships. The women desired acknowledgment of the physical consequences of FGC and of their sexual difficulties as “real” and not merely “psychological blocks”.
... If a person is unable to experience a vaginal orgasm, they are dubbed "frigid." The term "frigidity" is still used today to describe a woman's inability to have an orgasm during sexual activity (Levin, 2020). ...
... Moreover, for an extended period, menstruation in women was seen negatively or as filthy. (Levin, 2020). ...
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Infertility is a significant public health concern that affects a considerable proportion of men and women of reproductive age globally (Gnoth et al., 2005). The term "fertility research gaps" refers to the limits of early infertility research, such as empirical studies, while attempting to articulate a theory or concept. High-quality reviews have evolved into critical tools for facilitating evidence-based healthcare decisions and identifying infertility research gaps. This might be accomplished by limiting research inefficiency and filling critical gaps in fertility research that could significantly impact society (Duffy et al., 2017). Identifying a research gap in infertility and gaining the resources necessary to conduct an exhaustive and persistent study on it can be enormously rewarding for patients and researchers, let alone the tremendous influence its new results can have on society. Research gaps are especially beneficial for the advancement of science-based fertility remedies as a whole. Thus, to develop and comprehend fertility research gaps and improve the knowledge, understanding, and well-being of persons experiencing infertility and other family-building difficulties. It is critical to identify gaps for future research. This essay will identify research gaps for future infertility research by utilizing suggested readings, virtual learning lecture notes, and other relevant academic sources, including original articles. Keywords: Research gaps. Infertility, and Research
... Sexual arousal is found to influence the occurrence of lubrication and orgasm with reliability scores of 0.82 and 0.60, respectively. A similar relation was found in the studies conducted by Levin [35], which explains that sexual arousal will lead to lubrication and orgasm [3]. The lubrication variable is found to affect pain, while the level of pain affected sexual desire, and that matches the studies of Falk & Dizon's research [36]; Prastiwi, Niman, & Susilowati [37] explained that pain during intercourse occurs when there is no lubrication and will result in an unwillingness to have sexual intercourse. ...
... Apart from causal relationships, we also found strong associations between sexual desire and sexual arousal, sexual desire and orgasm, and sexual arousal and pain. All of the estimated causal relationships corroborated with those of finding of the previous studies [3], [34][35][36][37][38][39][40][41]. For future work, we suggest to add more demographic variables in the model and see how the causal model would extend. ...
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Women with cancer are at risk for sexual dysfunction characterized by problems with sexual desire, sexual arousal, lubrication, orgasm, sexual satisfaction, and pain during sexual intercourse. The literature review shows that most studies have focused on correlation analysis between factors, and no studies have attempted to identify a causal relationship between factors of sexual dysfunction. This study aims to determine the causal mechanism between factors of sexual dysfunction in cancer patients using a causal algorithm called the Stablespec Specification Search for Cross-Sectional Data With Latent Variables (S3C-Latent). The causal algorithm has been implemented into the R software package called Stablespec. The computation of the model is done in parallel using the CPU server. The result of this study is that there are a causal relationship and association with a high-reliability score of sexual dysfunction factors. We hope that the causal model obtained can be a scientific reference for doctors and health workers in making decisions so that the quality of life of female cancer patients who experience sexual dysfunction can be improved.
... Its position next to, or inside, the vaginal opening ensures its stimulation during thrusting, and potentiates orgasm. While orgasm is not directly correlated with female fertility or reproductive success (Zietsch & Santtila, 2013), clitoridean stimulation has been shown to increase vaginal blood flow, lubrication, and temperature (see Levin, 2020 for a review), all mechanisms linked to the potentiation of male orgasm and thus of sperm capture. In addition, in mammals with induced ovulation, tactile stimulation of the clitoris could play a determining role in triggering female receptivity (Brennan & Orbach, 2020;Pavličev & Wagner, 2016). ...
Chapter
The role of the female in copulation as long been studied exclusively as a response to male behavior, if not completely disregarded. Nevertheless, from the establishment of physical contact until penis withdrawal, mammalian females implement a number of hormonal, physiological, and behavioral adaptations to maximize and optimize sperm capture. The initiation of copulation is mostly dependent on female receptivity and the display of behavioral estrus, including the lordotic posture. During this period, the series of copulatory acts emitted by the female is based on a sequence of inhibitory-excitatory events at the initiative of both members of the copulating pair. The significance of female interference with copulatory thrusting has been highlighted in naturalistic conditions that give the female the possibility to pace sexual interaction. In such settings, male intromission, thrusting, and eventually ejaculation are rendered physically possible by female posture, as well as optimized by somatosensory feedback from the female vulva to the penis. Genital interaction during intromission, including female pelvic, perineal, and vaginal contractions, stimulate ejaculation and may increase insemination probability by improving sperm transfer through the cervix. In addition, females can provide direct copulatory stimulation during thrusting through visual and olfactory cues, or vocalizations. The neuroendocrinological mechanisms responsible for mammal sexual adaptations are similar across species, and some basic behaviors such a lordosis present a certain interspecific rigidity. However, many qualitative aspects vary between species, notably the structure of the pattern sequence in a copulatory series, or the characteristic of sensory stimuli and their relative importance for enhancing sperm capture. In particular, human adaptations to copulatory thrusting show a wide diversity that evolutionary tools do not entirely comprehend.
... The "pleasure deficit" in sexual and reproductive health literature and practice may favour the idea that sex is a physiological act and should be regarded as emotionally neutral. Several treatments of male and female sexual dysfunction in sexual medicine have often put aside pleasure and satisfaction, favouring the primacy of function (Fahs, 2014;Grunt-Mejer, 2021;Levin, 2020). Moreover, clinicians may have prejudices against people with alternative erotic preferences and might feel uncomfortable and inadequate talking about clitoral stimulation, masturbation, female ejaculation, BDSM bondage-discipline/domination-submission/sadismmasochism), kinky practices and sex toys (Botta et al., 2019;Eichenberg et al., 2019;Hoff & Sprott, 2009;Jannini et al., 2012;Kolmes et al., 2006;Miranda et al., 2019). ...
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Introduction The Biopsychosocial model (BPS) represents a comprehensive paradigm of consolidated practices. Although it has been outlined as the gold standard in sexology, its implementation is often challenging. The sex-positive approach is a ground-breaking movement that is gaining popularity all over and is focused on the recognition of different sexual expressions as valid, consensual, healthy, and meaningful. However, a pragmatic implementation of this approach is still missing. Methods A critical review was conducted based on bibliographic research on Medline, PubMed, EBSCO, Cochrane Library, Scopus and Web of Science on relevant articles published from January 2011 to July 2021. Results A total of 116 papers were included in the following review, indicating an increasing body of research about BPS and sex-positive frameworks during the last 10 years. One of the main limitations in the BPS is the scarce attention paid to socio-cultural factors involved in sexual expressions, such as the role of negative attitudes towards sexuality that may affect health care professionals’ work. An application of the sex-positive approach to the BPS model may bring greater attention to the needs, values and desires of the individual, as well as allow a new knowledge and understanding of sexuality within a broader spectrum, including diversities and pleasures. Conclusions The sex-positive approach represents a viable path that entails the willingness of health care professionals to get involved actively; criticize their personal attitudes, beliefs, and knowledge about sex and work hard to improve their practice in sexology. Policy Implications A discussion of the possible fruitful integration between the BPS and the sex-positive approach is presented, highlighting practical applications in research, clinical practice, training and sex education and giving possible directions for future studies and policies.
Article
Synopsis A review of the literature on the anatomy of the lower female genital tract in therian mammals reveals, contrary to the general perception, a large amount of inter-specific variation. Variation in females is anatomically more radical than that in the male genitalia. It includes the absence of whole anatomical units, like the cervix in many Xenarthra, or the absence of the urogenital sinus (UGS), as well as the complete spatial separation of the external clitoral parts from the genital canal (either vagina or UGS). A preliminary phylogenetic analysis shows two patterns. Some morphs are unique to early branching clades, like the absence of the cervix, while others arose multiple times independently, like the flattening out or loss of the UGS, or the extreme elongation of the clitoris. Based on available information, the ancestral eutherian configuration of the external female genitalia included a cervix, a single vaginal segment, a tubular UGS, and an unperforated clitoris close to the entrance of the genital canal. The evidence for either bilobed or unitary glandes clitorides is ambivalent. Despite the wealth of information available, many gaps in knowledge remain and will require a community-wide effort to come to a more robust model of female genital evolutionary patterns.
Article
Knowledge of the actual anatomy and function of the clitoris has been underrepresented for a long time. Anatomical descriptions and illustrations existed but were scientifically disregarded for centuries. Even now anatomy books and textbooks are still dominated by incorrect depictions and inadequate functional descriptions of the clitoris, even though the knowledge about this complex organ is essential for the clinical practice in gynecology, obstetrics, urology and other specialist disciplines. From a special gynecological perspective, the sociocultural and medical history are presented, including misunderstandings and misconceptions. The correct anatomy and physiology are closely related to the rediscovery of the clitoris in research and practice as well as in the social perception. The relevance of the clitoris for contemporary medicine regarding sexuality, self-awareness, self-determination and therefore gender equity can be seen as a fundamental and also political issue.
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A brief survey of how the news media reported and misreported on the publication of the review that revealed the overlooked empirical evidence for the reproductive function of the human clitoris. This article is protected by copyright. All rights reserved.
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Female ejaculation is a contentious topic. From a review of the literature, history indicates that it is not a modern concept; some females were aware of it in times past without understanding the role of the fluid or composition of the ejaculate. Over time, scholars experimented, mainly with anatomical studies, in an attempt to identify the source of the ejaculate and explore its physiological and anatomical benefits for the female sexual experience. Despite these studies, views about female ejaculation remain controversial and inconsistent, with no clear conclusion as to its function. This review discusses the history of studies of female ejaculation and presents various hypotheses from an anatomical and physiological perspective. After reviewing forty‐four publications from 1889 to 2019 it became apparent that clinical and anatomical studies conducted during recent decades provide substantial evidence in support of the female ejaculatory phenomenon. Anatomical studies have shown that the ejaculate originates in the paraurethral (Skene's) glands, but its composition has been debated. Female ejaculate differs from urine in its creatinine and urea concentrations. The fluid also contains prostate specific antigen (PSA) and could have antibacterial properties that serve to protect the urethra. While the specific function of female ejaculation remains a topic of debate, there is sufficient evidence to support the existence of the phenomenon. This article is protected by copyright. All rights reserved.
Article
Importance and objective: Little is known about the role of androgens in the female genital tract, specifically in the vulvovaginal area. The abundance of androgen receptors in this area could help us to explain their role. The main objective of the present article is to review current data on androgen receptors in the different structures of vulvovaginal tissues. Methods: A review of the literature using data from PubMed was carried out on androgen receptors in the vulva, labia majora and minora, vestibule, clitoris, and vagina. The effects of androgens and regulation of androgen receptors both in the embryo and in premenopausal and postmenopausal women were also reviewed. Given the characteristics of this review, we also analyzed animal studies and animal models of human disease. There were no filters or restrictions with respect to the date of publication. Discussion: Androgen receptors have been detected throughout the genitourinary tract by means of Western blot, immunohistochemistry, ligand binding, and gene expression. They are present in the labia majora and minora, the clitoris, the vestibule, and in the three layers of the vaginal mucosa (epithelium, lamina propria, and muscularis). More specifically, studies on the labia majora have shown that androgen receptors seem to be particularly abundant in epidermal keratinocytes and in dermal fibroblasts. Androgen receptors are also abundant in the epidermis, especially in the keratinocytes, and in the dermis of the labia minora and vestibule, where they are more numerous than in the vagina. Androgen receptors have also been found in the Bartholin glands. Conclusions: Estrogens play a major role in the maintenance of vaginal physiology. Although little is known about the role of androgens in the genital apparatus of women, specifically in the vulvovaginal area, the abundance of androgen receptors could enable us to explain their role. Androgens and estrogens play a major role in the maintenance of vaginal physiology. Better knowledge of the role of androgens and their receptors in vulvovaginal tissue would make it possible to discern their effects on female genitalia and help us to understand new therapeutic strategies.
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In the original study to determine the possibility of using subliminal visual stimulation in polygraph testing for the diagnosis of paraphilic disorders, 70 men were examined. Clinical, psychopathological, psychological, sexological and psychophysiological methods were used. According to the results of the study, in which the possibility of using subthreshold visual stimulation during polygraph testing was evaluated for the first time, it can be concluded that the change in vegetative processes does not allow to judge the importance of the stimuli presented, and it is recommended to conduct such studies related to the registration of brain potentials.
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Introduction: The Female Sexual Function Index (FSFI) is a patient-reported outcome measure measuring female sexual dysfunction. The FSFI-19 was developed with 6 theoretical subscales in 2000. In 2010, a shortened version became available (FSFI-6). Aim: To investigate the measurement properties of the FSFI-19 and FSFI-6. Methods: A systematic search was performed of Embase, Medline, and Web of Science for studies that investigated measurement properties of the FSFI-19 or FSFI-6 up to April 2018. Data were extracted and analyzed according to COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) guidelines. Evidence was categorized into sufficient, insufficient, inconsistent, or indeterminate, and quality of evidence as very high, high, moderate, or low. Main outcome measures: The Main Outcome Measure is the evidence of a measurement property, and the quality of evidence based on the COSMIN guidelines. Results: 83 studies were included. Concerning the FSFI-19, the evidence for internal consistency was sufficient and of moderate quality. The evidence for reliability was sufficient but of low quality. The evidence for criterion validity was sufficient and of high quality. The evidence for structural validity was inconsistent of low quality. The evidence for construct validity was inconsistent of moderate quality. Concerning the FSFI-6, the evidence for criterion validity was sufficient of moderate quality. The evidence for internal consistency was rated as indeterminate. The evidence for reliability was inconsistent of low quality. The evidence for construct validity was inconsistent of very low quality. No information was available on structural validity of the FSFI-6, and measurement error, responsiveness, and cross-cultural validity of both FSFI-6 and FSFI-19. Clinical implications: Conflicting and lack of evidence for some of the measurement properties of the FSFI-19 and FSFI-6 indicates the importance of further research on the validity of these patient-reported outcome measures. We advise researchers who use the FSFI-19 to perform confirmatory factor analyses and report the factor structure found in their sample. Regardless of these concerns, the FSFI-19 and FSFI-6 have strong criterion validity. Pragmatically, they are good screening tools for the current definition of female sexual dysfunction. Strength & limitation: A strong point of the review is the use of predefined guidelines. A limitation is the use of a precise rather than a sensitive search filter. Conclusions: The FSFI requires more research on structural validity (FSFI-19 and FSFI-6), reliability (FSFI-6), construct validity (FSFI-19), measurement error (FSFI-19 and FSFI-6), and responsiveness (FSFI-19 and FSFI-6). Further corroboration of measurement invariance (both across cultures and across subpopulations) in the factor structure of the FSFI-19 is necessary, as well as tests for the unidimensionality of the FSFI-6. Neijenhuijs KI, Hooghiemstra N, Holtmaat K, et al. The Female Sexual Function Index (FSFI)-A Systematic Review of Measurement Properties. J Sex Med 2019;16:640-660.
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Cambridge Core - Obstetrics and Gynecology, Reproductive Medicine - Female Genital Cosmetic Surgery - edited by Sarah M. Creighton Link: https://www.cambridge.org/se/academic/subjects/medicine/obstetrics-and-gynecology-reproductive-medicine/female-genital-cosmetic-surgery-solution-what-problem?format=PB
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Female Genital Cosmetic Surgery - edited by Sarah M. Creighton February 2019
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Background A clitoral frenuloreduction surgical intervention has not been described in the medical literature and through clinical-scientific research, a new surgical clitoral frenuloreduction intervention was developed. This procedure is based on the new anatomical discovery of the clitoral infrafrenulum fascial bundle, which is the deep stratum of the clitoral frenulum. Methods A descriptive case series clinical research was designed with objectives to: develop a new clitoral frenuloreduction surgical intervention; evaluate surgical outcomes; assess the impact of this operation on genital self-perceived body image; female sexual activities; and to record complications. The primary outcome measured the ability to implement a new clitoral frenuloreduction surgical intervention. The secondary outcome measured: surgical outcome; the impact of this operation on external genital self-perceived body image; female sexual activities; quality of life; and recording potential complications. The validated instruments were used in the study. Results A clitoral frenuloreduction surgical intervention was executed in the procedure room on an outpatient basis under local anesthesia with light conscious sedation (oral Valium and Phenergan rectal suppositories). No complications were recorded. Three-consecutive women were subjected to a new clitoral frenuloreduction surgical procedure. The average time of surgery was 27 minutes. Improvement of sexual activities, quality of life, self-perceived body image, social life, and no feelings of regret of undergoing surgery was recorded. Conclusions In the current study, clitoral frenuloreduction was easy to implement without complications and with very pleasing aesthetic surgical outcomes. Self-perceived body image, quality of life, and sexual activities improved.
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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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Purpose of Review The purpose of this study is to provide a comprehensive summary of the latest developments in the experimental brain study of human sexuality, focusing on brain connectivity during the sexual response. Recent Findings Stable patterns of brain activation have been established for different phases of the sexual response, especially with regard to the wanting phase, and changes in these patterns can be linked to sexual response variations, including sexual dysfunctions. From this solid basis, connectivity studies of the human sexual response have begun to add a deeper understanding of the brain network function and structure involved. Summary The study of “sexual” brain connectivity is still very young. Yet, by approaching the brain as a connected organ, the essence of brain function is captured much more accurately, increasing the likelihood of finding useful biomarkers and targets for intervention in sexual dysfunction.
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Background: Although the literature on imaging of regional brain activity during sexual arousal in women and men is extensive and largely consistent, that on orgasm is relatively limited and variable, owing in part to the methodologic challenges posed by variability in latency to orgasm in participants and head movement. Aim: To compare brain activity at orgasm (self- and partner-induced) with that at the onset of genital stimulation, immediately before the onset of orgasm, and immediately after the cessation of orgasm and to upgrade the methodology for obtaining and analyzing functional magnetic resonance imaging (fMRI) findings. Methods: Using fMRI, we sampled equivalent time points across female participants' variable durations of stimulation and orgasm in response to self- and partner-induced clitoral stimulation. The first 20-second epoch of orgasm was contrasted with the 20-second epochs at the beginning of stimulation and immediately before and after orgasm. Separate analyses were conducted for whole-brain and brainstem regions of interest. For a finer-grained analysis of the peri-orgasm phase, we conducted a time-course analysis on regions of interest. Head movement was minimized to a mean less than 1.3 mm using a custom-fitted thermoplastic whole-head and neck brace stabilizer. Outcomes: Ten women experienced orgasm elicited by self- and partner-induced genital stimulation in a Siemens 3-T Trio fMRI scanner. Results: Brain activity gradually increased leading up to orgasm, peaked at orgasm, and then decreased. We found no evidence of deactivation of brain regions leading up to or during orgasm. The activated brain regions included sensory, motor, reward, frontal cortical, and brainstem regions (eg, nucleus accumbens, insula, anterior cingulate cortex, orbitofrontal cortex, operculum, right angular gyrus, paracentral lobule, cerebellum, hippocampus, amygdala, hypothalamus, ventral tegmental area, and dorsal raphe). Clinical translation: Insight gained from the present findings could provide guidance toward a rational basis for treatment of orgasmic disorders, including anorgasmia. Strengths and limitations: This is evidently the first fMRI study of orgasm elicited by self- and partner-induced genital stimulation in women. Methodologic solutions to the technical issues posed by excessive head movement and variable latencies to orgasm were successfully applied in the present study, enabling identification of brain regions involved in orgasm. Limitations include the small sample (N = 10), which combined self- and partner-induced stimulation datasets for analysis and which qualify the generalization of our conclusions. Conclusion: Extensive cortical, subcortical, and brainstem regions reach peak levels of activity at orgasm. Wise NJ, Frangos E, Komisaruk BR. Brain Activity Unique to Orgasm in Women: An fMRI Analysis. J Sex Med 2017;XX:XXX-XXX.
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The capacity to experience an orgasm evolved to promote high-frequency sex in species with low reproductive rates. Growing evidence shows that orgasms also have a variety of other reproductive consequences. Based on a distinction between orgasm frequency and orgasm intensity, there is emerging evidence in humans that orgasms function to promote and fine tune what are often very different, sex-specific reproductive outcomes. We provide an overview of the effect of hormonal contraceptives on orgasm, mate choice, and sexual satisfaction. The effects of sex during pregnancy, along with orgasm induced vocalizations, facial expressions during orgasm, and the putative effects of semen exposure on orgasm and sexual functioning in females are also discussed. Recent research suggests that female orgasms evolved to promote good mate choices, and we propose that instances of orgasmic dysfunction in many women may be a byproduct of an inability to find and/or retain high-quality male partners. (PsycINFO Database Record
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The anatomy of the clitoris is much larger than commonly believed. Besides the small tip of the clitoris known as the glans, which protrudes in the external genitalia, the crura (or legs) of the clitoris extend 9 cm inside the body, with erectile tissue adjacent to the vagina and urethra. This finding has significance for theories of female sexual responsiveness, including the differentiation of clitoral and vaginal orgasms. It also offers guidelines for preserving erotic response during pelvic surgery in women. The facts of clitoral anatomy, clarified with modern scanning procedures by surgeon Helen O’Connell and colleagues (2005), have been repeatedly discovered, forgotten, and rediscovered, at least since 1844, when the German anatomist Kobelt made accurate drawings. Psychological reasons for why the true anatomy of the clitoris has so often been repressed or misrepresented by anatomists, psychologists, and other scientists are proposed. That most anatomists have historically been men may have led to disregard for precise charting of the clitoris that might lead to greater preservation of female sexual response. Envy by male anatomists of female sexual response may also play a role. Correct anatomical knowledge may significantly alter psychoanalytic theory and practice.
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Background The nature of a woman’s orgasm has been a source of scientific, political, and cultural debate for over a century. Since the Victorian era, the pendulum has swung from the vagina to the clitoris, and to some extent back again, with the current debate stuck over whether internal sensory structures exist in the vagina that could account for orgasms based largely on their stimulation, or whether stimulation of the external glans clitoris is always necessary for orgasm. Method We review the history of the clitoral versus vaginal orgasm debate as it has evolved with conflicting ideas and data from psychiatry and psychoanalysis, epidemiology, evolutionary theory, feminist political theory, physiology, and finally neuroscience. Results A new synthesis is presented that acknowledges the enormous potential women have to experience orgasms from one or more sources of sensory input, including the external clitoral glans, internal region around the “G-spot” that corresponds to the internal clitoral bulbs, the cervix, as well as sensory stimulation of non-genital areas such as the nipples. Conclusions With experience, stimulation of one or all of these triggering zones are integrated into a “whole” set of sensory inputs, movements, body positions, autonomic arousal, and partner- and contextual-related cues, that reliably induces pleasure and orgasm during masturbation and copulation. The process of integration is iterative and can change across the lifespan with new experiences of orgasm.
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Background Human female orgasm is a vexed question in the field while there is credible evidence of cryptic female choice that has many hallmarks of orgasm in other species. Our initial goal was to produce a proof of concept for allowing females to study an aspect of infertility in a home setting, specifically by aligning the study of human infertility and increased fertility with the study of other mammalian fertility. In the latter case - the realm of oxytocin-mediated sperm retention mechanisms seems to be at work in terms of ultimate function (differential sperm retention) while the proximate function (rapid transport or cervical tenting) remains unresolved. Method A repeated measures design using an easily taught technique in a natural setting was used. Participants were a small (n=6), non-representative sample of females. The introduction of a sperm-simulant combined with an orgasm-producing technique using a vibrator/home massager and other easily supplied materials. Results The sperm flowback (simulated) was measured using a technique that can be used in a home setting. There was a significant difference in simulant retention between the orgasm (M=4.08, SD=0.17) and non-orgasm (M=3.30, SD=0.22) conditions; t (5)=7.02, p=0.001. Cohen's d=3.97, effect size r=0.89. This indicates a medium to small effect size. Conclusions This method could allow females to test an aspect of sexual response that has been linked to lowered fertility in a home setting with minimal training. It needs to be replicated with a larger sample size.
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Introduction: Most women report that clitoral stimulation is an integral aspect of their orgasm experience. Thus, recent claims that vaginal stimulation and vaginally generated orgasms are superior to clitoral stimulation and clitorally generated orgasms pathologize most women and maintain a clitoral vs vaginal dichotomy that might not accurately reflect the complexity of women's sexual experience. Aim: To have women report on their experienced source of orgasm, including combinations of vaginal and clitoral stimulation, the solo or partnered context of the stimulation, and the intensity of the orgasms from different sources and to predict indicators of mental health and sexual health using the orgasm source. Methods: Eighty-eight women 18 to 53 years old answered detailed questions about their usual and recent orgasm experiences, sexual history, depression, and anxiety. Then, they viewed a series of neutral and sexual films. They were instructed to increase or decrease their sexual arousal or respond "as usual" to the sexual films. They reported their sexual arousal after each film. Main outcome measures: Outcomes assessed included mental health (depression and anxiety) and sexual health (orgasm quality, ability to regulate sexual response to sex films). Reported sexual arousal was analyzed for the regulation task. Results: Most women (64%) reported that clitoral and vaginal stimulation contributed to their usual method of reaching orgasm. Women who reported that clitoral stimulation was primarily responsible for their orgasm reported a higher desire to self-stimulate and demonstrated greater control over their self-reported sexual arousal. The primary stimulation site for orgasm was unrelated to measurements of depression or anxiety despite sufficient statistical power. Conclusion: Most women reported that clitoral and vaginal stimulation is important in orgasm. Women experience orgasms in many varied patterns, a complexity that is often ignored by current methods of assessing orgasm source. The reported source of orgasm was unrelated to orgasm intensity, overall sex-life satisfaction, sexual distress, depression, or anxiety. Women who reported primarily stimulating their clitoris to reach orgasm reported higher trait sexual drive and higher sexual arousal to visual sexual stimulation and were better able to increase their sexual arousal to visual sexual stimulation when instructed than women who reported orgasms primarily from vaginal sources.
Article
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Background: Clitoral reconstruction is a new surgical technique for women who have undergone female genital mutilation/cutting (FGM/C). Objectives: To review evidence on the safety and efficacy of clitoral reconstruction. Search strategy: PubMed and Cochrane databases were searched for articles published in any language from database inception until May 2014. Search terms related to FGM/C and clitoral reconstruction were used in various combinations. Selection criteria: Studies of any design that reported on safety or clinical outcomes (e.g. appearance, pain, sexual response, or patient satisfaction) associated with clitoral reconstruction after FGM/C were included. Data collection and analysis: Evidence was summarized and systematically assessed via a standard data abstraction form. Main results: Four of 269 identified articles were included. They were fair to poor in quality. Summary measures could not be computed owing to heterogeneity. The studies reported on immediate surgical complications, clitoral appearance, dyspareunia or chronic pain, and clitoral function postoperatively via non-standardized scales. Conclusions: Women who request clitoral reconstruction should be informed about the scarcity of evidence available. Additional research is needed on the safety and efficacy of the procedure to identify both long-term outcomes and which women might benefit.
Article
Objective To characterize in depth and investigate the role of exosomes present in seminal plasma in affecting parameters underlying sperm activity. Design In vitro experimental study. Setting Research hospital. Patient(s) Normozoospermic, severe asthenozoospermic, and post-vasectomy azoospermic men 18–55 years of age were considered for the study. Seminal plasma was collected and processed to separate spermatozoa and exosomes. Intervention(s) None. Main Outcomes Measure(s) Exosomes from seminal plasma were isolated and characterized by means of nanoparticle tracking analysis, transmission electron microscopy and Western blot. Exosome uptake by spermatozoa was monitored by means of immunofluorescence and flow cytometry. The effect of exosomes on spermatozoa was determined by evaluating progressive motility and capacitation, the latter assessed by means of tyrosine phosphorylation and acrosome reaction. Result(s) We isolated and characterized exosomes from seminal plasma of normo-, astheno-, and azoospermic patients. They display similar features in terms of shape, size, expression of canonic exosome markers and proteins involved in spermatozoa maturation, and fertilization capacity. After ejaculation, sperm cells are still receptive and are able to take up exosomes in a time- and pH-dependent manner. Exosomes derived from normozoospermic but not from asthenozoospermic individuals improve spermatozoa motility and trigger capacitation. Transfer of cysteine-rich secretory protein 1 from exosomes to spermatozoa may have a role in these phenomena. Conclusion(s) These findings provide evidence that: 1) sperm can still receive vesicle-derived cargo after ejaculation; 2) sperm motility and ability to undergo capacitation can benefit from exosomal transfer; and 3) semen quality is affected by male tract exosomes.
Article
This article reviews clitoral structures, their functions and how they are activated during the stages of female life. The paradox that occurs is that different procedures of activation are claimed by some to favour ‘noxious outcomes' to the physical and psychic health of women who use it to achieve sexual arousal/orgasm with or without penile vaginal intercourse. A number of the difficulties and inconsistencies in relation to these claims are explored. The proposed justification for the ‘noxious outcomes' is that ‘evolution' punishes sexual arousals other than by coitus because it is the only one that leads to gene propagation. In this context, however, the new, evolutionary interpretation of clitoral function in the fertile years as a fundamental proximate mechanism for facilitating female reproductive fitness makes such a justification improbable. The role of coital alignment technique (CAT) in the treatment of female orgasmic disorder is discussed in relation to its features of introital, clitoral and periurethral glans stimulation. Attempts to control female sexuality through various ‘clitoridectomies' are examined and unanswered questions about clitoral stimulation are listed. This article is protected by copyright. All rights reserved.
Article
In human females, direct or indirect stimulation of the clitoris plays a central role in reaching orgasm. A majority of women report that penetrative coitus alone is insufficient for triggering orgasm, puzzling researchers who expect orgasm to be an outcome of procreative intercourse. In the present paper, we turn our attention to the evolutionary role that such unreliability of orgasm at coitus might have played in human evolution. We emphasize that we do not thereby attempt an explanation of its origin, but its potential evolutionary effect. The present proposal suggests that the variable female orgasm, the position of the clitoris remote from the vagina, and the mismatch of the male refractory period with the female capacity for multiple orgasms, may have contributed to the evolution of human prosocial qualities.
Article
Abstract The present review examines the continued claims in a number of published articles that the oxytocin released by the human female orgasm is a component to enhance reproductive fitness by facilitating the rate or the amount, or both, of sperm transported to the ovum. The errors in these accounts, both of omission and commission, which undermine the claimed support for this proposed function of oxytocin are highlighted and discussed. Other functions of oxytocin present better candidates for its possible orgasmic actions.
Book
You have in your hands the most rigorous, complete and readable book ever written about the fascinating science of human sexuality. This book goes beyond the well-worn sexual education advice and the usual evolutionist psychology. After The Brain Snatcher, Pere Estupinyà comes back with the first popular science book on sex aimed at a wide audience. While there are some tips for the more adventurous, there is also a wealth of new information to be discovered. Distancing himself from the many books on advice or techniques, Estupinyà brings sex to another dimension by combining popular beliefs and science. Do you want proof that our decision-making in the "heat of the moment" is less rational than we think? Did you know that mind and vagina each go their own way? Are you interested in learning about the effects of yoga on sexual pleasure? Did you know about the attempts in the 60s to "cure" homosexuals with electric shock therapy, the chemical analysis of female ejaculation, or the fundamental relationship between the sympathetic and parasympathetic nervous system? The author has spoken directly with asexual and intersexual individuals, fetishists, multi-orgasmic women, women who never have orgasms through penetration, and men who have no refractory period. He has also participated in sadomasochistic events; learned tantric techniques with a couple of coaches, spoken with porn performers at Barcelona's Bagdad, and attended workshops in which a woman teaches how to have orgasms with your mind and breathing. The result is an incredible miscellany of information that appeals to both the scientific community and the curious.
Article
Background: Female genital mutilation/cutting (FGM/C) changes normal genital functionality and can cause complications. There is an increasing demand for treatment of FGM/C-related complications. Objectives: We conducted a systematic review of empirical quantitative research on the outcomes of interventions for women with FGM/C-related complications. Search strategy: A search specialist searched 16 electronic databases. Selection criteria: Selection was independent by two researchers. We accepted quantitative studies that examined the outcome of an intervention for a FGM/C-related concern. Data collection and analysis: We extracted data onto a pre-designed form, calculated effect estimates, and performed meta-analyses. Main results: We included 62 studies (5829 women), which investigated the effect of defibulation, excision of cysts, and clitoral reconstruction. Meta-analyses of defibulation versus no defibulation showed a significantly lower risk of cesarean section (RR=0.33, 95% CI 0.25, 0.45) and perineal tears with defibulation: 2nd degree tear (RR=0.44, 95% CI 0.24, 0.79), 3rd degree tear (RR=0.21, 95% CI 0.05, 0.94), 4th degree tear (RR=0.06, 95% CI 0.01, 0.41). The meta-analyses detected no significant differences in obstetric outcomes of antenatal versus intrapartum defibulation. Except for one, none of the studies on excision of cysts indicated complications, rather, resolution of problems were favorable. Reconstructive surgery resulted in a visible clitoris in about 77% of women. Most women self-reported improvements in their sexual life, but up to 22% experienced a worsening in sexuality-related outcomes after reconstruction. Conclusions: Women with FGM/C who seek therapeutic surgery should be informed about the scarcity of evidence on benefits and harms of available procedures. This article is protected by copyright. All rights reserved.
Article
Speculation that the release of oxytocin by orgasm in the human female during coitus facilitates fertility by enhancing uterine sperm transport has been criticised as having no unequivocal empirical human evidence. However, a counter claim that this supports human 'exceptionalism' as some form of uterine sperm transport occurs in other species. This is a misconception as it ignores that human uterine peristalsis, powered by contractions of the smooth muscle of the archimyometrium, facilitates sperm transport even without any systemic oxytocin involvement. Moreover, examination of various unique reproductive mechanisms in numerous animals also indicates that the claim is misjudged and rests on a biased interpretation of what 'exceptionalism' means in this biological context. Ten chosen aspects of our sexuality are presented as being exceptional to humans. This article is protected by copyright. All rights reserved.
Chapter
This chapter reviews the development of the human sexual response cycle. Initial attempts to characterise the cycle focussed on the phases of the arousal process now referred to as “modelling”. The usefulness of such models is assessed by asking “what kind of models can be used to describe sexual responses” and “what properties should a good model possess?” While a number have been developed from earlier forms, others have been conceptualised de novo. Some have become more popular than others; the notable is the four-phase “excitation, plateau, orgasm, resolution” model now modified to include desire phases. Little or no controversy exists over models for males, but the empirical testing of those for females has been disputatious. A number of models are promoted by their authors as being useful contributors to clinical practice. All are simplifications of reality; no one model is perfect.
Book
Prepared by one of the world's leading authorities, Human Sexuality and its Problems remains the foremost comprehensive reference in the field. Now available in a larger format, this classic volume continues to address the neurophysiological, psychological and socio-cultural aspects of human sexuality and how they interact. Fully updated throughout, the new edition places a greater emphasis on theory and its role in sex research and draws on the latest global research to review the clinical management of problematic sexuality providing clear, practical guidelines for clinical intervention. Clearly written, this highly accessible volume now includes a new chapter on the role of theory, and separate chapters on sexual differentiation and gender identity development, transgender and gender non-conformity, and HIV, AIDS and other sexually transmitted diseases. Human Sexuality and its Problems fills a gap in the literature for academics interested in human sexuality from an interdisciplinary perspective, as well as health professionals involved in the management of sexual problems.
Article
The evolutionary explanation of female orgasm has been difficult to come by. The orgasm in women does not obviously contribute to the reproductive success, and surprisingly unreliably accompanies heterosexual intercourse. Two types of explanations have been proposed: one insisting on extant adaptive roles in reproduction, another explaining female orgasm as a byproduct of selection on male orgasm, which is crucial for sperm transfer. We emphasize that these explanations tend to focus on evidence from human biology and thus address the modification of a trait rather than its evolutionary origin. To trace the trait through evolution requires identifying its homologue in other species, which may have limited similarity with the human trait. Human female orgasm is associated with an endocrine surge similar to the copulatory surges in species with induced ovulation. We suggest that the homolog of human orgasm is the reflex that, ancestrally, induced ovulation. This reflex became superfluous with the evolution of spontaneous ovulation, potentially freeing female orgasm for other roles. This is supported by phylogenetic evidence showing that induced ovulation is ancestral, while spontaneous ovulation is derived within eutherians. In addition, the comparative anatomy of female reproductive tract shows that evolution of spontaneous ovulation is correlated with increasing distance of clitoris from the copulatory canal. In summary, we suggest that the female orgasm-like trait may have been adaptive, however for a different role, namely for inducing ovulation. With the evolution of spontaneous ovulation, orgasm was freed to gain secondary roles, which may explain its maintenance, but not its origin.
Article
A substantial body of research supports the hypothesis that vaginal orgasm is associated with overall better health outcomes for women. The primary aim of this study was to examine correlates of orgasm consistency with intercourse (OCI) in a sample of women with sexual dysfunction to see whether these findings held in a clinical sample. Study 1 (n = 255) focused on demographic and psychological correlates of OCI and Study 2 (n = 81) focused on the association between sexual arousal concordance and OCI. A longer relationship length and higher orgasm scores predicted OCI whereas mood, sexual abuse history, and relationship satisfaction did not. In Study 2, sexual arousal concordance, as measured with vaginal photoplethysmography and a continuous self-report measure of sexual arousal, was not associated with OCI. These findings challenge the conclusions of Brody et al. that vaginal orgasm is a sign of psychological, sexual, and relational health.
Article
The surface pH of the vagina was measured before and after sexual arousal by self-stimulation in ten healthy women. The mean value of six spots measured and pH measured in collected vaginal fluid was highly correlated. Two-way analysis of variance showed a mean increase of pH after orgasm (significant at the 0.5% level). The Wilcoxon matched-pairs test and a paired t -test showed a significant increase in three and four of the subjects, respectively, and a decrease in pH in one other subject. It is concluded that in the present laboratory setting, clitoral self-stimulation to orgasm only results in small changes of the vaginal surface pH.
Book
Engaging both with science and popular culture, this book examines the meanings given to orgasmic bodies in contemporary heterosex. Starting from the assumption that orgasm is not a 'natural' or pre-social experience, Orgasmic Bodies argues that the meaning of 'orgasmic experience' must be learned - sometimes through explicit pedagogical instruction which is wrapped up in gendered ideologies. Despite detailed attention to 'knowing' the orgasmic body, especially the female body, embodied experience remains ambiguous and ineffable even as scientific and lay discourses seek to make it concrete and unmistakable. The dominance of an 'orgasmic imperative' where orgasm is essential to 'good sex', combined with evidence that women experience fewer orgasms than men, generates differing obligations to produce, work on, and enact, orgasm. Orgasmic Bodies explores how bodily experiences of orgasm are worked up as present/absent, complicated/straightforward, too slow/too fast, fake or real, in the doing of masculinities and femininities.
Book
This eagerly awaited book offers a unique, comprehensive scientific study of the anatomy of the organ of female sexual pleasure. The authors use macroscopic and microscopic research to guide the reader from the glans, the visible part of the clitoris, where they explore the impressive sensory corpuscles, to the hidden roots of the bulbo-clitoral organ. They show its complexity, its exact location within the external genitalia and its intimate relationship with the urethro-vaginal pyramid. They also remind us that throughout history there has been a failure to understand this organ and explain that this misunderstanding remains the cause of persistent excisions, criminal mutilating practices that have not yet been eradicated. Using extensive iconography, they demonstrate throughout this book that the bulbo-clitoral organ is an exceptional natural treasure that every woman possesses and that every man should know well.
Article
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 **;**:**–**.
Article
When placed in a suitable environment, mammalian spermatozoa begin to capacitate and continue until fully capacitated; in vitro, some will ‘over-capacitate’ and undergo spontaneous acrosome loss, undesirable since acrosome-reacted cells are nonfertilizing. Seminal plasma contains several molecules able to bind to specific receptors on spermatozoa, thereby activating/regulating important intracellular signalling pathways. Three such ‘first messengers’ are fertilization promoting peptide (FPP), adenosine and calcitonin, all of which stimulate capacitation and then inhibit spontaneous acrosome reactions by regulating adenylyl cyclase (AC)/cAMP. A recent study has reported the presence in spermatozoa of several membrane-associated AC isoforms, mainly smaller in size than the corresponding ACs in somatic cells, and evidence suggests that more than one of these isoforms may be involved in responses to these first messengers. To regulate AC, FPP receptors appear to interact initially with stimulatory A2A adenosine receptors, which function only in uncapacitated cells, and then with inhibitory A1 receptors, which function only in capacitated cells. In contrast, there appears to be a single population of calcitonin receptors. Responses to cholera and pertussis toxins suggest involvement of G proteins and Gs plus several Gi subunits have been identified in both mouse and human spermatozoa. In particular, Gas and Gai2 are found in the same regions as FPP, adenosine and calcitonin receptors, supporting biochemical evidence for G protein involvement in these responses. In vivo, these first messengers could have a significant effect, helping to maximize the number of capacitated, acrosome-intact (i.e. potentially fertilizing) spermatozoa by regulating what is clearly an important signalling pathway.
Article
Pleasure is mediated by well-developed mesocorticolimbic circuitry and serves adaptive functions. In affective disorders, anhedonia (lack of pleasure) or dysphoria (negative affect) can result from breakdowns of that hedonic system. Human neuroimaging studies indicate that surprisingly similar circuitry is activated by quite diverse pleasures, suggesting a common neural currency shared by all. Wanting for reward is generated by a large and distributed brain system. Liking, or pleasure itself, is generated by a smaller set of hedonic hot spots within limbic circuitry. Those hot spots also can be embedded in broader anatomical patterns of valence organization, such as in a keyboard pattern of nucleus accumbens generators for desire versus dread. In contrast, some of the best known textbook candidates for pleasure generators, including classic pleasure electrodes and the mesolimbic dopamine system, may not generate pleasure after all. These emerging insights into brain pleasure mechanisms may eventually facilitate better treatments for affective disorders. Copyright © 2015 Elsevier Inc. All rights reserved.
Article
The effect of sperm concentration on the fertilization of preovulatory and immature human eggs was studied in the context of an ongoing in vitro fertilization-embryo transfer (IVF-ET) program. Fertilization success was independent of the follicular recruitment protocol used, and with preovulatory eggs, was inversely related to sperm concentration over the range of 2.5 - 50 X 10(4) motile sperm/ml. Maximum fertilization (80.8%) occurred at a concentration of 2.5 X 10(4) motile sperm/ml. The incidence of polyspermic fertilization was directly related to the sperm concentration, decreasing from 5.5% at 10 X 10(4) to 0% at 1-2.5 X 10(4) motile sperm/ml. Immature eggs cultured in vitro, then inseminated, also demonstrated an inverse relationship between fertilization and sperm concentration with a maximum fertilization rate of 66.6% at 5 X 10(4) motile sperm/ml. The percentage of motile sperm in the inseminating population had no influence on fertilization rates unless the value dropped below 40%. Fertilization success using sperm from oligospermic and polyzoospermic males was also examined. In contrast to males with normal semen parameters, oligospermic males demonstrated highest fertilization success at 50 X 10(4) motile sperm/ml. The IVF of preovulatory eggs using sperm from polyzoospermic males was comparable to that for males with normal semen parameters at equivalent sperm concentrations. The implications of these findings to the application of IVF-ET technology to the infertile couple is discussed.
Article
The clitoris may be the most pivotal structure for female sexual pleasure. While its significance has been reported for hundreds of years, no complete anatomical description was available until recently. Most of the components of the clitoris are buried under the skin and connective tissues of the vulva. It comprises an external glans and hood, and an internal body, root, crura, and bulbs; its overall size is 9-11 cm. Clitoral somatic innervation is via the dorsal nerve of the clitoris, a branch of the pudendal nerve, while other neuronal networks within the structure are complex. The clitoris is the center for orgasmic response and is embryologically homologous to the male penis. While the source of vaginal eroticism might or might not be exclusively clitoral stimulation, it is necessary to understand the intricate anatomy of the organ to assess the data in this regard. Ultimately, sexual enjoyment entails a balance of physical and emotional factors and should be encouraged. Clin. Anat., 2015. © 2015 Wiley Periodicals, Inc. © 2015 Wiley Periodicals, Inc.
Article
This review deals critically with many aspects of the functional genital anatomy of the human female in relation to inducing sexual arousal and its relevance to procreation and recreation. Various controversial problems are discussed including: the roles of clitorally versus coitally induced arousal and orgasm in relation to the health of women, the various sites of induction of orgasm and the difficulty women find in specifically identifying them because of “'ambiguity problems” and “genital site pareidolia,” the cervix and sexual arousal, why there are so many sites for arousal, why multiple orgasms occur, genital reflexes and coitus, the sites of arousal and their representation in the brain, and identifying aspects and functions of the genitalia with appropriate new nomenclature. Clin. Anat., 2014. © 2014 Wiley Periodicals, Inc.
Article
IntroductionClitoral reconstruction following female genital mutilation/cutting (FGM/C) is a new surgical technique reported to be a feasible and effective strategy to reduce clitoral pain, improve sexual pleasure, and restore a vulvar appearance similar to uncircumcised women. However, data on safety, care offered, and evaluation of sexual and pain outcomes are still limited. AimsThis study aims to present the care offered and clinical outcomes of two women who received multidisciplinary care, including psychosexual treatment, with clitoral reconstruction. We report their long-term outcomes, and the histology of the removed periclitoral fibrosis. Methods We report the cases of two women with FGM/C types II and III who requested clitoral reconstruction for different reasons. One woman hoped to improve her chronic vulvar pain, as well as improve her sexual response. The other woman requested surgery due to a desire to reverse a procedure that was performed without her consent, and a wish to have a genital appearance similar to non infibulated women. They both underwent psychosexual evaluation and therapy and surgery. The histology of the periclitoral fibrosis removed during surgery was analyzed. ResultsAt 1-year postoperatively, the first woman reported complete disappearance of vulvar pain and improved sexual pleasure, including orgasm. Our second patient also described improved sexuality at 1-year follow-up (increased sexual desire, lubrication, vulvar pleasure, and sensitiveness), which she attributed to a better self body image and confidence. Both women reported feeling satisfied, happy, and more beautiful. Conclusion We show a positive outcome in pain reduction and improved sexual function, self body image, and gender after psychosexual therapy and clitoral reconstruction. More evidence is needed about clitoral reconstruction to develop guidelines on best practices. Until research is conducted that rigorously evaluates clitoral reconstruction for its impact on pain and sexuality, we advise always offering a multidisciplinary care, including sexual therapy before and after the surgery. Abdulcadir J, Rodriguez MI, Petignat P, and Say L. Clitoral reconstruction after female genital mutilation/cutting: Case studies. J Sex Med 2015;12:274-281.
An extensive series of papers by Brody and co-workers using questionnaires have correlated penile vaginal intercourse (PVI) and clitoral stimulation with various female functions and malfunctions. A major claim is that only PVI 'competently performed and sensitively experienced' leading to orgasm is 'associated with. and in some cases, causes processes associated with better psychological and physical functioning'. Clitoral stimulation to orgasm per se or to facilitate orgasm even during PVI, however, is not beneficial to women's psychological, interpersonal or behavioural health and can lead to 'noxious consequences'. Recently , as correlations are no guarantee of causation, independent studies have not confirmed some of their claims. The present review examines critically and rejects :- the demonising of the clitoris as an organ inducing 'deadly pleasures' or that it should become vestigeal by self-creating a 'psychological clitoridectomy', that evolution 'rewards' PVI but punishes clitoral stimulation, that cervical buffeting is normally involved in PVI-orgasms or that a longer penis facilitates these, that orgasm is involved in sperm transport and thus reproductive fitness, that prolactin released at orgasm is an instigator of sexual satiation, that the coital alignment technique does not involve clitoral and periurethral glans stimulation by the penis and that women who cannot have orgasms induced by PVI alone are sexually dysfunctional and that their male partners are sexually inadequate.
Article
Objective: Given that adiposity is related to poorer female sexual function, among many other health problems, the present study aimed at testing the hypothesis that larger waist circumference, an index of subcutaneous and abdominal fat mass, is associated with lack of specifically vaginal orgasm. Study design One hundred and twenty Portuguese women of reproductive age had their waist measured and reported their past month frequency of penile-vaginal intercourse (PVI), vaginal orgasm, orgasm from clitoral masturbation during PVI, non-coital partnered sex (in the absence of same-day PVI), non-coital partnered sex orgasm (regardless of same-day PVI), masturbation, and masturbation orgasm. Results: In both simple and partial correlations (controlling for age, social desirability responding, relationship status, and cohabitation status), larger waist circumference was associated with lack of any vaginal orgasm and with having masturbated in the past month. In a multiple regression, larger waist circumference was independently predicted by lesser frequency of vaginal orgasm, greater frequency of masturbation, and older age. Conclusion: Abdominal fat mass appears to be adversely associated with lesser capacity for vaginal orgasm, but not for orgasms from other sexual activities. Results are discussed in the context of vaginal orgasm being relatively more contingent on situations of increased fitness in both partners.
Article
Brody, Costa and Hess (2012) have produced a critique containing errors both of commission and omission of my editorial (Levin 2012a) and review (Levin 2012b). This reply identifies a number of these and makes the appropriate rebuttals and vindications to correct both.