Beyond the G-spot: clitourethrovaginal complex anatomy in female orgasm

Jannini, Emmanuele A.; Buisson, Odile; Rubio‐Casillas, Alberto

doi:10.1038/nrurol.2014.193

Cited by 79 publications

(47 citation statements)

References 52 publications

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“…To date, several profound ultrasound studies have been conducted, focusing on the dynamic relationship of the clitoral complex, the urethra and the anterior vaginal wall, either during finger penetration or sexual intercourse in volunteer couples . These studies have contributed to the concept of the clitourethrovaginal complex, which goes beyond the search for a single G‐spot, stressing the role of these anatomic structures in a morphofunctional interplay which may induce female orgasm . We see the present study as another piece of the puzzle, promoting the usefulness of state‐of‐the‐art MRI imaging in shedding light on this complex matter.…”

Section: Discussionmentioning

confidence: 74%

The G‐spot: an observational MRI pilot study

Maratos

Gombergh

Cornier

et al. 2016

BJOG

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Objectives To identify a G-spot complex (GSC) in vivo in MRI examinations at 1.5 Tesla field strength.Design Observational study.Setting Single centre.Population Twenty-one consecutive patients (January-March 2014).Methods Imaging analysis of routine imaging protocols for usual medical indications with and without concomitant opacification of the vaginal cavity with inert ultrasound gel. The gel distends the otherwise collapsed vaginal walls, allowing for an improved discrimination of anatomic features. The macroscopic and histological results recently derived from the dissections of fresh cadavers by Ostrzenski et al. were translated into imaging characteristics to be expected in the respective MRI sequences (e.g. T1-and T2-weighted) in search of an in vivo correlate of the GSC. Age, menopause status, medical indication and diagnosis were co-variables.Main outcome measures To analyse primarily whether MRI imaging is able to depict a distinct morphological entity in vivo matching the GSC, based on anatomical descriptions published recently. The elaboration of an appropriate MRI-imaging protocol was a secondary aim.Results A total of 21 studies were obtained. A GSC was identified within the anterior vaginal wall in 13/21 patients (62%). In all, 10/ 21 (48%) had vaginal gel opacification. We identified a GSC in 10/ 10 patients (100%) with opacification in all three planes of the T2 images. This was only true for 3/11 cases (27%) without opacification.Conclusions There is evidence for an in vivo morphological correlate to the postmortem anatomical findings of a GSC described by Ostrzenski et al.; its visibility in MRI imaging can be significantly improved with vaginal opacification by ultrasound gel.

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Section: Discussionmentioning

confidence: 74%

The G‐spot: an observational MRI pilot study

Maratos

Gombergh

Cornier

et al. 2016

BJOG

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“…Several sexual medicine investigators also have pointed out that most studies analyzing the sexual function of women after sling placement for stress incontinence and anterior repairs for pelvic organ prolapse report overall better function after these surgeries 45, 46. This is presumably because of better functionality to the vaginal canal after prolapse repair and less leakage during activity to interfere with sexual intercourse.…”

Section: Discussionmentioning

confidence: 99%

A Meta-Analysis Detailing Overall Sexual Function and Orgasmic Function in Women Undergoing Midurethral Sling Surgery for Stress Incontinence

Szell

Komisaruk

Goldstein³

et al. 2017

Sexual Medicine

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IntroductionMore than 200,000 midurethral slings are placed yearly for stress urinary incontinence. Approximately 14% to 20% of women experience worsening sexual function overall after these procedures. We postulated that sling placement injures neural pathways regulating “female prostate” tissue within the anterior vaginal wall.AimTo perform a meta-analysis for overall sexual function and orgasm using validated questionnaires for transvaginal tape, transobturator tape, and their variants.MethodsEffect sizes of preoperative and postoperative questionnaire scores for overall sexual function and orgasm were calculated. Random-effects models were selected for meta-analyses. Statistical analysis involved determination of the ratio of total heterogeneity to total variability.Main Outcome MeasuresDifferences of overall sexual and orgasm functions were calculated by subtracting postoperative sling scores from preoperative sling scores. Forest plots of effect sizes were performed.ResultsSixty-seven percent of midurethral sling procedures analyzed showed no change or improvement in overall sexual function postoperatively, whereas 33% of studies analyzed for orgasm function showed improvement after the procedure. For transvaginal tape, mean total sexual function and orgasm postoperative scores were significantly higher than preoperative scores. For transobturator tape, mean total postoperative score was significantly higher than the preoperative score; however, the mean orgasm postoperative score was not significantly higher than the preoperative score, possibly because of variability in transobturator tape data.ConclusionThere is a discrepancy between postoperative sexual satisfaction and orgasmic function after midurethral sling surgery. Although overall sexual function remained the same or improved for most women, orgasmic function in only one third of cases improved overall, with most women experiencing no change or deterioration in orgasmic function. Dissection for, and placement of, the midurethral sling can compromise the neural integrity of the anterior vaginal wall, thereby detrimentally affecting the periurethral prostate tissue that is essential to the orgasmic response. We propose that this surgical procedure can compromise orgasmic function in some women.Szell N, Komisaruk B, Goldstein SW, et al. A Meta-Analysis Detailing Overall Sexual Function and Orgasmic Function in Women Undergoing Midurethral Sling Surgery for Stress Incontinence. Sex Med 2017;5:e84–e93.

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“…the clitoris, vestibular bulbs and pars intermedia, labia minora, and corpus spongiosum of the female urethra. Vaginal orgasm, G‐spot, G‐spot amplification, clitoral bulbs, clitoral or clitoris‐urethra‐vaginal complex, internal clitoris and female ejaculation (O'Connell et al, ; Rubio‐Casillas and Jannini, ; Jannini et al, ; Buisson and Jannini ; Jannini et al, ; Oakley et al, ; Vaccaro et al, ; Graziottin and Gambini, ; Herold et al, ; Levin, ; Pan et al, ; Pauls, ; Vaccaro, ) are terms without scientific basis and should not be used by urologists, gynecologists, sexologists, sexual medicine experts, women, or the mass media (Puppo, ; Puppo and Puppo, ).…”

Section: Is Pe Really a Male Sexual Dysfunction/disease?mentioning

confidence: 99%

Comprehensive review of the anatomy and physiology of male ejaculation: Premature ejaculation is not a disease

Puppo¹,

Puppo

2015

Clinical Anatomy

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Human semen contains spermatozoa secreted by the testes and a mixture of components produced by the bulbo-urethral and Littre (paraurethral) glands, prostate, seminal vesicles, ampulla, and epididymis. Ejaculation is used as a synonym for the external ejection of semen, but it comprises two phases: emission and expulsion. As semen collects in the prostatic urethra, the rapid preorgasmic distension of the urethral bulb is pathognomonic of impeding orgasm, and the man experiences a sensation that ejaculation is inevitable (in women, emission is the only phase of orgasm). The semen is propelled along the penile urethra mainly by the bulbocavernosus muscle. With Kegel exercises, it is possible to train the perineal muscles. Immediately after the expulsion phase the male enters a refractory period, a recovery time during which further orgasm or ejaculation is physiologically impossible. Age affects the recovery time: as a man grows older, the refractory period increases. Sexual medicine experts consider premature ejaculation only in the case of vaginal intercourse, but vaginal orgasm has no scientific basis, so the duration of intercourse is not important for a woman's orgasm. The key to female orgasm are the female erectile organs; vaginal orgasm, G-spot, G-spot amplification, clitoral bulbs, clitoris-urethra-vaginal complex, internal clitoris and female ejaculation are terms without scientific basis. Female sexual dysfunctions are popular because they are based on something that does not exist, i.e. the vaginal orgasm. The physiology of ejaculation and orgasm is not impaired in premature ejaculation: it is not a disease, and non-coital sexual acts after male ejaculation can be used to produce orgasm in women. Teenagers and men can understand their sexual responses by masturbation and learn ejaculatory control with the stop-start method and the squeeze technique. Premature ejaculation must not be classified as a male sexual dysfunction. It has become the center of a multimillion dollar business: is premature ejaculation-and female sexual dysfunction-an illness constructed by sexual medicine experts under the influence of drug companies?

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Beyond the G-spot: clitourethrovaginal complex anatomy in female orgasm

Cited by 79 publications

References 52 publications

The G‐spot: an observational MRI pilot study

The G‐spot: an observational MRI pilot study

A Meta-Analysis Detailing Overall Sexual Function and Orgasmic Function in Women Undergoing Midurethral Sling Surgery for Stress Incontinence

Comprehensive review of the anatomy and physiology of male ejaculation: Premature ejaculation is not a disease

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