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10.1002/ca.23654
Female Ejaculation: an update on anatomy, history, and controversies
Felix D. Rodriguez1, Amarilis Camacho1, Stephen J. Bordes2, Brady Gardner2, Roy J. Levin3, R.
Shane Tubbs2,4,5,6
1. University of Puerto Rico School of Medicine, San Juan, Puerto Rico
2. Department of Anatomical Sciences, St. George’s University School of Medicine, Grenada
3. Independent Research Worker, Sheffield, United Kingdom.
4. Department of Neurosurgery, Tulane University School of Medicine, New Orleans, LA, USA
5. Department of Structural & Cellular Biology, Tulane University School of Medicine, New
Orleans, LA, USA
6. Department of Neurology, Tulane University School of Medicine, New Orleans, LA, USA
ABSTRACT
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
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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.
Keywords: female ejaculation, female prostate, orgasm, paraurethral (Skene’s) glands,
reproduction
INTRODUCTION
Scholars have discussed female sexuality in detail (Levin, 2017; 2018; 2019; 2020).
However, one aspect of female sexuality that is not well understood is female ejaculation
(Davidson et al., 1989). Although its occurrence has been described for over two millennia
(Korda et al., 2010), there is still controversy regarding its function and even its existence (Azate
and Hoch, 1986). Female ejaculation is defined as the expulsion of fluid through the urethra
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during orgasm in response to sexual stimulation. It became a focus of anatomical study during
the 1900s and has recently sparked renewed interest in the scientific community. During the mid-
1600s, Dutch physician and anatomist Regnier De Graaf (1641-1673) described the female
erogenous zone and introduced the concept of the female prostate after studying a set of
intraurethral glands, which he considered fundamental for female ejaculation. Psychologist
Havelock Ellis (1859-1939) believed that female ejaculate was similar to male ejaculate and
originated from the Bartholin’s glands (Ellis, 1906). In 1940, Ernst Gräfenberg (1881-1957) re-
examined the erogenous zone originally described by De Graaf and found that it is anatomically
situated on the anterior vaginal wall and follows the course of the urethra. Stimulation of this
zone, later known as the Gräfenberg spot or G-spot, can result in female climax (orgasm)
(Grӓfenberg, 1950; Ladas et al., 1982). Recent studies affirm that female ejaculation is a real
phenomenon. The fluid expelled originates from the paraurethral (Skene’s) glands, which were
referred to by De Graaf as the female prostate. Extensive studies over the past 30 years have
revealed the function of Skene’s glands and their role in ejaculation. This review discusses the
history, physiology, and anatomical evidence surrounding the controversial topic of female
ejaculation.
Gross Anatomy and Embryology
General female reproductive anatomy is described in detail in the literature (Marino and
Lepidi, 2014; Standring, 2015; Abrahams et al., 2019), where external and internal structures are
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distinguished in terms of structure and function. The fundamental differences between male and
female embryology are important for our understanding. During the germinal and embryonic
stages (conception to the end of the 7th developmental week), sexual organs (gonads) are
indifferent and have no specific sexual characteristics (Graziottin and Gambini, 2015). However,
the external genitalia begin to develop from the urogenital sinus, genital tubercle, and
labioscrotal swellings after the fetal stage begins (8th developmental week) (Graziottin and
Gambini, 2015; Pauls, 2015).
The vestibule of the vagina, labia minora, vestibular bulbs, and corpus spongiosum
(erectile tissues surrounding the urethra) are formed from the urogenital sinus (Graziottin and
Gambini, 2015). The clitoris, homologous to the male penis in much of its anatomy, develops
from the genital tubercle (Graziottin and Gambini, 2015; Pauls, 2015). The labioscrotal swellings
do not fuse together as in males but instead form the labia majora. The urethra is significantly
shorter in females than males because the urogenital folds do not fuse.
The vulva, or external female genitalia, comprises the labia majora and minora and
vestibule along with erectile tissues such as the clitoris and vestibular bulbs (Graziottin and
Gambini, 2015; Yeung and Pauls, 2016). The vestibule is a triangular region found between the
glans clitoris and labia minora (Graziottin and Gambini, 2015). The male counterpart is the
dorsal wall of the urethra. The urethral orifice and vaginal opening lie within the vestibule. The
paraurethral (Skene’s) glands empty into the vestibule. While some authors refer to these glands
as the female prostate (Darling et al., 1990; D’Amati et al., 2003), others reject the notion and
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refer to it as the Gräfenberg spot (Goldberg et al. 1983). It is important to note that Skene’s
glands expel a fluid during orgasm that contains traces of prostate specific antigen (PSA). This
expulsion constitutes female ejaculation, so named because of its similarity to seminal
ejaculation in males. The Bartholin’s or greater vestibular glands are exocrine structures located
in the vaginal opening posterior to the labia in roughly the 4 o’clock and 8 o’clock positions.
These glands are homologous to the male bulbourethral or Cowper’s glandsand secrete a
colorless, mucoid fluid that increases with stimulation (Masters and Johnson, 1966). Their often-
proposed purpose is to lubricate the anterior vagina during intercourse, but Masters and Johnson
(1966) reported that their secretions were minimal for such function.
Historical overview
Female ejaculation was described in different cultures as long as two millennia ago.
However, some authors consider the topic to have been ignored and dismissed by other scholars
because scientific research and supporting evidence have been minimal (Hines, 2001; Kordaet
al., 2010). Female ejaculation was first described in a fourth century Chinese text called “Secret
Instructions Concerning the Jade Chamber,” which provides information with respect to
romance, sexual partners, and intercourse (Korda et al., 2010). In this text, the authors document
and detail the stages of female arousal as “five signs, five desires and ten movements.” These
five signs refer to the female response to sexual stimulation (Korda et al., 2010). The text refers
to the expression of two different female fluids: one for vaginal lubrication and another
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transmitted during orgasm, i.e. female ejaculate (Korda et al., 2010). This text is one of many
from the Eastern and Western worlds that mention or allude to female ejaculation through
observation or detailed study.
More recent scholars such as Ellis and Gräfenberg have attempted to identify the origin
of female ejaculate. Ellis proposed that the emission is jet-like and released mostly from the
Bartholin glands (Ellis, 1906). Gräfenberg offered a different opinion in his article “The role of
the urethra in female orgasm.” He described an erogenous zone in the anterior superior vaginal
wall that coincides with the course of the urethra and, upon stimulation, results in orgasm with a
secretion from the urethra. Gräfenberg further concluded that the fluid differed in composition
from urine and originated from intraurethral glands (Gräfenberg, 1950), which by location and
description correspond to Skene’s glands (Skene, 1889) and de Graaf’s female prostate (Jocelyn
and Setchell, 1972; Sevely and Bennet, 1978). Interestingly, immunohistochemical staining of
Skene’s glands reveals similar characteristics to the prepubescent prostate in males (Yeung and
Pauls, 2016 ). Controversies surround not only the existence of female ejaculate but also the
presence of a Gräfenberg spot (Davidson et al., 1989; Graziottin and Gambini, 2015; Kilchelvsky
et al., 2012; Mazloomdoost and Pauls, 2015; Pan et al, 2015; Pauls, 2015; Yeung and Pauls,
2016). Hoch dismissed the idea of a localized Gräfenberg spot, instead suggesting a broader
region of sensitivity including Halban’s fascia and deep urinary structures that could culminate
in urethral fluid expulsion upon stimulation (Alzate and Hoch, 1986). Burri et al. (2010) believed
that the Gräfenberg spot varies in prevalence and heritability because it has no physical identity,
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but Colton (2010) found ample evidence in support of a highly innervated periurethral area on
the anterior vaginal wall that forms a vaginal, clitoral, and urethral complex. Ostrzenski (2019)
found no histological relationship between the Gräfenberg spot and the prostate gland; however,
he described a nerve ganglion at this landmark. This study also dismissed the relationship
between the Gräfenberg spot and female ejaculation owing to the lack of glandular and erectile
tissue at the site.
Is Female Ejaculate Differentiable from Urine?
Female ejaculation has been validated by some and dismissed by others during the past
two centuries. Masters and Johnson (1966) published the “Human Sexual Response”, which
described physiological and anatomical changes during sexual arousal. The authors dismissed
female ejaculation as a “widespread myth” (Korda et al., 2010). Hines (2001) did not deny the
existence of female ejaculate but believed that it is urine. Alzate and Hoch (1986) also agreed
that fluids were released during orgasm but discussed the possibility of an episode of coital stress
incontinence. This idea was supported by Belzer (1984) because of the sheer volume of fluid
released. However, studies by Cartwright et al. (2007) revealed no evidence of urinary
incontinence or detrusor overactivity associated with female ejaculation. Huynh et al. (2013)
localized neuronal activity to the left side of the dorsolateral pontine tegmentum, an area they
termed the pelvic-organ stimulating center, during ejaculation and orgasm, while the right side of
the dorsolateral pontine tegmentum was only activated during micturition. Goldberg et al. (1983)
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analyzed the ejaculates of six women and reported that the samples did not differ in composition
from urine collected prior to orgasm. This contrasted sharply with the findings of Addiego et al.
(1981) two years earlier, which found significant chemical differences in the levels of prostatic
acid phosphatase, urea, and creatinine between urine and female ejaculate.
Further studies by Heath (1984) and Zaviacic et al. (1988a) supported the findings of
Addiego et al. (1981) and established that female ejaculate was not urine. Interestingly, Zaviacic
et al. (1988b) determined that the components of the ejaculate were similar to those of males.
Female ejaculate has a higher glucose concentration than urine, though the levels are10 to 15
times lower than in males (Zaviacicet al., 1988b). Wimpissinger et al. (2007) reported the
existence and position of structures responsible for female ejaculation using ultrasound, analyzed
the fluids expelled by those structures, and identified biochemical differences between the
ejaculate and previously-voided urine. The study concluded that “the fluid emitted during
orgasm was biochemically comparable to male prostatic plasma” (Wimpissinger et al., 2007),
supporting the earlier data reported by Zaviacic et al. (1988b) and Heath (1984). However,
electromyographical studies by Shafik et al. (2009) showed no correlation between orgasm and
the passage of ejaculate in females.
Some of the confusion in the literature could in part be attributable to analyses of two
different fluids arising from separate structures and processes. Pastor (2013) and Pastor and
Chmel (2018) identified and distinguished the female fluids expelled during coitus. It is clear
that most vaginal secretions function as lubricants, but misconceptions regarding female
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ejaculate are rampant. Pastor and Chmel (2018) drew attention to the fact that many individuals
refer to any fluid expressed from the vagina or urethra during coitus as female ejaculate, which
leads to significant confusion in the literature. For example, female ejaculate is biochemically
and physiologically different from squirting fluids or urine from coital incontinence (Pastor and
Chmel, 2018). The study found that squirting, or gushing, refers to a large, involuntary expulsion
of clear, watery fluid during coitus, while female ejaculation yields a milky substance. Both
fluids are expelled through the urethra but do not originate from the same structures.
Squirting culminates in gushes of fluid, ranging in volume from 15 to 110 mL, that are
biochemically identical to urine (Wimpissinger et al., 2013; Salama et al., 2015). This fluid can
be released by stimulation of the Gräfenberg spot (anterior vaginal wall clitoro-urethro-vaginal
complex) (Rubio-Casillas and Jannini, 2011; Salama et al., 2015; Pastor and Chmel, 2018) and is
reported as a positive response to a sexual encounter between partners (Wimpissinger et al.,
2013). In contrast, female ejaculate consists of a small volume of secretion from Skene’s glands
(Pastor and Chmel, 2018), which is also attributed to orgasm (Wimpissinger et al., 2007) but is
less evident than squirting fluids. The fluid is biochemically different from urine as it contains
high concentrations of prostate specific antigen (PSA), prostatic-specific acid phosphatase,
fructose, and glucose (Zaviacic et al., 1988b; Wimpissinger et al., 2007; Pastor and Chmel,
2018).
Biochemical and anatomical investigations suggest that female ejaculation is a real
phenomenon, as opposed to an illusion, as some researchers suggest. Some studies suggest that
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the fluid expelled during ejaculation is actually urine and not the product of urethral glands.
However, recent data regarding the chemical composition of the ejaculate distinguish it
biochemically from urine. Concentrations of compounds such as creatinine, urea, uric acid, PSA,
and prostate acid phosphatase differ completely between female ejaculate and urine (Pastor
2013; Wimpissinger et al., 2007; Gilliland, 2009; O’Connell et al., 2008). Most relevant is the
presence of PSA. Clinically, elevated levels of PSA are used as a marker of prostate pathology in
males (Wimpissinger et al., 2007; Korda et al., 2010). Wimpissinger et al. (2007) showed that
PSA was present in intraurethral gland secretions from two female subjects. The PSA levels in
the ejaculate were 213.49 ng/mL and 105.9 ng/mL in female subjects 1 and 2, while the levels in
their urine were 0.80 ng/mL and 0.16 ng/mL, respectively (Wimpissinger et al., 2007). A recent
study by Pastor et al. (2018) yielded similar results and further demonstrated the differences
between the two fluids.
Perhaps the dismissal of female ejaculation as a real phenomenon has resulted from the
scientific evaluation of squirting or lubricating fluids instead of true female ejaculate. Despite the
increased evidence supporting female ejaculation, the fluid’s function remains a subject of
debate; however, some speculate that it confers antimicrobial protection against postcoital
urinary tract infections (Moalem and Reidenberg, 2009).
CONCLUSION
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Ample evidence is found in the literature to support the existence of female paraurethral
gland ejaculate, the subject warrants further study to elucidate the fluid’s function and effect on
the female sexual experience. It is further evident that the literature is riddled with
misconceptions regarding the phenomenon, much of which could be clarified by standardization
of the terminology for the various female fluids expressed during coitus. Proper fluid
identification and use of terminology will ensure that future research in this area is not futile.
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