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Female Ejaculation: an update on anatomy, history, and controversies

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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 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.
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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
This article is protected by copyright. All rights reserved.
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 (Skenes) 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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... While the classification and differential diagnosis for EO have been proposed previously, (Levin et al., 2016;Pastor, 2013;Pastor & Chmel, 2018;Rogers et al., 2018;Rubio-Casillas & Jannini, 2011;Salama et al., 2015) it is rarely used both in practice and in studies. The differences among sexual fluids are known at present (Pastor, 2013;Pastor & Chmel, 2018;Rodriguez et al., 2021;Rubio-Casillas & Jannini, 2011;Salama et al., 2015;Schubach, 2001) However, orgasmic fluid excretion is often universally considered FE, and the fluid itself is considered an ejaculate from female prostate because it contains PSA (Rodriguez et al., 2021). This review aimed to clarify the inaccuracies regarding "sexual" fluids and highlight the differences between FE and SQ. ...
... While the classification and differential diagnosis for EO have been proposed previously, (Levin et al., 2016;Pastor, 2013;Pastor & Chmel, 2018;Rogers et al., 2018;Rubio-Casillas & Jannini, 2011;Salama et al., 2015) it is rarely used both in practice and in studies. The differences among sexual fluids are known at present (Pastor, 2013;Pastor & Chmel, 2018;Rodriguez et al., 2021;Rubio-Casillas & Jannini, 2011;Salama et al., 2015;Schubach, 2001) However, orgasmic fluid excretion is often universally considered FE, and the fluid itself is considered an ejaculate from female prostate because it contains PSA (Rodriguez et al., 2021). This review aimed to clarify the inaccuracies regarding "sexual" fluids and highlight the differences between FE and SQ. ...
... More accurately, this fluid is mainly from FE or SQ. The difference between these two terms, in terms of their similarity to urine, has been discussed (Rodriguez et al., 2021). In our opinion, the ambiguity between these two terms may unnecessarily complicate previous and future clinical and anatomical research. ...
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Introduction: Women expel fluids of various quantities and compositions from the urethra during sexual arousal and orgasm. These are classified as either female ejaculation (FE) or squirting (SQ). The aim of our analysis was to present evidence that FE and SQ are similar but etiologically different phenomena. Materials and methods: A review of studies was performed on fluids expelled from the urogenital tract during female sexual activities using the Web of Knowledge TM (Web of Science Core Collection) and MEDLINE (Ovid) databases from 1946 to 2021. Results: Until 2011, all female orgasmic expulsions of fluids were referred to as FE. The fluid was known to be either from the paraurethral glands or as a result of coital incontinence. At present, SQ is considered as a transurethral expulsion of approximately ten milliliters or more of transparent fluid, while FE is considered as a secretion of a few milliliters of thick fluid. The fluid in SQ is similar to urine and is expelled by the urinary bladder. The secretion in FE originates from the paraurethral glands and contains a high concentration of prostate-specific antigen. Both phenomena can occur simultaneously. Conclusions: The mechanisms underlying SQ and FE are entirely different. SQ is a massive transurethral orgasmic expulsion from the urinary bladder, while FE is the secretion of a very small amount of fluid from the paraurethral glands.
... Skene's glands are tubuloaveolar structures that resemble pre-pubescent male prostate glands and which produce a fluid that contains prostate specific antigen and prostate acid phosphatase. This fluidcommonly referred to as female ejaculateis often expelled during female orgasm (Dwyer, 2012;Rodriguez et al., 2021). Vaginal fluid is a complex mixture of vaginal transudate, secretions from the Bartholin and Skene glands, exfoliated epithelial cells, residual urine, and fluids from the upper reproductive tract, such as cervical mucus or tubal fluids. ...
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Electrospinning is an innovative technique that allows production of nanofibers and microfibers by applying a high voltage to polymer solutions of melts. The properties of these fibers – which include high surface area, high drug loading capacity, and ability to be manufactured from mucoadhesive polymers – may be particularly useful in a myriad of drug delivery and tissue engineering applications. The last decade has witnessed a surge of interest in the application of electrospinning technology for the fabrication of vaginal drug delivery systems for the treatment and prevention of diseases associated with women's sexual and reproductive health, including sexually transmitted infections (e.g. infection with human immunodeficiency virus and herpes simplex virus) vaginitis, preterm birth, contraception, multipurpose prevention technology strategies, cervicovaginal cancer, and general maintenance of vaginal health. Due to their excellent mechanical properties, electrospun scaffolds are also being investigated as next-generation materials in the surgical treatment of pelvic organ prolapse. In this article, we review the latest advances in the field.
... G-spot and CUV complex are in fact frequently associated with other sexual phenomena, such as squirting (SQ) [61,75] and female ejaculation (FE) [62,[76][77][78][79]. FE is the secretion of a few milliliters of a thick, milky fluid by the female prostate (Skene's glands) during orgasm, which contains prostatespecific antigen. ...
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In the field of female sexuality, the existence of the so-called “G-spot” represents a topic still anchored to anecdotes and opinions and explained using non-scientific points, as well as being overused for commercial and mediatic purposes. Purpose of Review The scope of this review is to give an update on the current state of information regarding the G-spot and suggesting potential future directions in the research field of this interesting, albeit controversial, aspect of human sexual physiology. Recent Findings From evolutionary, anatomical, and functional points of view, new evidence has rebutted the original conceptualization of the G-spot, abandoning the idea of a specific anatomical point able to produce exceptional orgasmic experiences through the stimulation of the anterior vaginal wall, the site where the G-spot is assumed to be. From a psychological perspective, only few findings to date are able to describe the psychological, behavioral, and social correlates of the pleasure experience by G-spot-induced or, better, vaginally induced orgasm (VAO). Summary Recent literature suggests the existence of a G-spot but specifies that, since it is not a spot, neither anatomically nor functionally, it cannot be called G, nor spot, anymore. It is indeed a functional, dynamic, and hormone-dependent area (called clitorourethrovaginal, CUV, complex), extremely individual in its development and action due to the combined influence of biological and psychological aspects, which may trigger VAO and in some particular cases also female ejaculation (FE).
Chapter
The leading motives of the book prepared to celebrate the jubilee of Professor Zbigniew Izdebski are the sexuality of man and the humanization of medicine, i.e. the fields on which Professor has had profound influence with his publications, research and statements. The volume includes scientific essays and analytical studies, presenting research results, theoretical texts which are within the area of Professor’s interests, memories, reflections and accounts of Professor Izdebski’s less- or well-known activities.
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Introduction and hypothesisWomen expel various kinds of fluids during sexual activities. These are manifestations of sexual arousal and orgasm or coital incontinence. This study is aimed at suggesting a diagnostic scheme to differentiate among these phenomena. Methods Web of Science and Ovid (MEDLINE) databases were systematically searched from 1950 to 2017 for articles on various fluid expulsion phenomena in women during sexual activities, which contain relevant information on sources and composition of the expelled fluids. ResultsAn ultra-filtrate of blood plasma of variable quantity, which is composed of transvaginal transudate at sexual stimulation, enables vaginal lubrication. Female ejaculation (FE) is the secretion of a few milliliters of thick, milky fluid by the female prostate (Skene’s glands) during orgasm, which contains prostate-specific antigen. Squirting (SQ) is defined as the orgasmic transurethral expulsion of tenths of milliliters of a form of urine containing various concentrations of urea, creatinine, and uric acid. FE and SQ are two phenomena with different mechanisms. Coital incontinence (CI) could be classified into penetration and orgasm forms, which could be associated with stress urinary incontinence or detrusor hyperactivity. Conclusion Squirting, FE, and CI are different phenomena with various mechanisms and could be differentiated according to source, quantity, expulsion mechanism, and subjective feelings during sexual activities.
Article
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.
Article
The discovery of the G‐spot and verification of its anatomy and histology paved the way to better understanding. Until 2012, the G‐spot was defined as a physiological sexual response phenomenon with no identifiable anatomical correlate. The weakness of this definition is that a physiological response cannot exist without an anatomical basis, so the question motivating the present study was formulated: are current scientific‐clinical data sufficient to resolve the controversy about the anatomical existence of a G‐spot? It is important to stipulate that no systematic review of the G‐spot has hitherto been published. Manual and electronic searches revealed postmortem and in‐vivo studies describing the G‐spot and findings reported within PRISMA‐IPD guidelines. The objective of the present review was to provide evidence‐based information related to the G‐spot. Articles were quality‐assessed using validated instruments. Publications on the G‐spot from 1950 to May 2019 were reviewed. Of the 279 full‐text articles examined, thirty met the eligibility criteria. The findings indicate that there are reliable scientific‐clinical data to support the existence of an anatomical G‐spot structure. Transient anterior‐distal vaginal wall engorgement is caused by blood entrapment within the G‐spot structure. Histological examination effectively ruled out the G‐spot as the organ responsible for female ejaculation, since no glandular tissue was identifiable. Finally, the results of this study could assist in developing new therapeutic, surgical interventions to treat secondary G‐spot dysfunction. Additionally, this review indictes ample opportunities for further scientific‐clinical investigations and has thereby moved the field forward. This article is protected by copyright. All rights reserved.
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
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.
Article
The female vulva is an intricate structure comprising several components. Each structure has been described separately, but the interplay among them and physiologic significance remain controversial. The structures extend inferiorly from the pubic arch and include the mons pubis, labia majora, labia minora, vestibule, and clitoris. The clitoris is widely accepted as the most critical anatomic structure to female sexual arousal and orgasm. The female sexual response cycle is also very complex, requiring emotional and mental stimulation in addition to end organ stimulation.
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
"Anatomy is destiny": Sigmund Freud viewed human anatomy as a necessary, although not a sufficient, condition for understanding the complexity of human sexual function with a solid biologic basis. The aim of the chapter is to describe women's genital anatomy and physiology, focusing on women's sexual function with a clinically oriented vision. Key points include: embryology, stressing that the "female" is the anatomic "default" program, differentiated into "male" only in the presence of androgens at physiologic levels for the gestational age; sex determination and sex differentiation, describing the interplay between anatomic and endocrine factors; the "clitoral-urethral-vaginal" complex, the most recent anatomy reading of the corpora cavernosa pattern in women; the controversial G spot; the role of the pelvic floor muscles in modulating vaginal receptivity and intercourse feelings, with hyperactivity leading to introital dyspareunia and contributing to provoked vestibulodynia and recurrent postcoital cystitis, whilst lesions during delivery reduce vaginal sensations, genital arousability, and orgasm; innervation, vessels, bones, ligaments; and the physiology of women's sexual response. Attention to physiologic aging focuses on "low-grade inflammation," genital and systemic, with its impact on women sexual function, especially after the menopause, if the woman does not or cannot use hormone replacement therapy. © 2015 Elsevier B.V. All rights reserved.