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

The search for the legendary, highly erogenous vaginal region, the Gräfenberg spot (G-spot), has produced important data, substantially improving understanding of the complex anatomy and physiology of sexual responses in women. Modern imaging techniques have enabled visualization of dynamic interactions of female genitals during self-sexual stimulation or coitus. Although no single structure consistent with a distinct G-spot has been identified, the vagina is not a passive organ but a highly dynamic structure with an active role in sexual arousal and intercourse. The anatomical relationships and dynamic interactions between the clitoris, urethra, and anterior vaginal wall have led to the concept of a clitourethrovaginal (CUV) complex, defining a variable, multifaceted morphofunctional area that, when properly stimulated during penetration, could induce orgasmic responses. Knowledge of the anatomy and physiology of the CUV complex might help to avoid damage to its neural, muscular, and vascular components during urological and gynaecological surgical procedures.

Pilot echographic study of the differences in clitoral involvement following clitoral or vaginal sexual stimulation.

INTRODUCTION: Women describe at least two types of orgasms: clitoral and vaginal. However, the differences, if any, are a matter of controversy. In order to clarify the functional anatomy of this sexual pleasure, most frequently achieved through clitoral stimulation, we used sonography with the aim of visualizing the movements of the clitorourethrovaginal (CUV) complex both during external, direct stimulation of the clitoris and during vaginal stimulation. METHOD: The ultrasounds were performed in three healthy volunteers with the General Electric® Voluson® sonography system (General Electric Healthcare, Vélizy, France), using a 12-MHz flat probe and a vaginal probe. We used functional sonography of the stimulated clitoris either during manual self-stimulation of the external clitoris or during vaginal penetration with a wet tampon. MAIN OUTCOME MEASURES: Functional and anatomic description, based on bidimensional ultrasounds, of the clitoris and CUV complex, as well as color Doppler signal indicating speed of venous blood flow, during arousal obtained by external or internal stimulation. RESULTS: The sagittal scans obtained during external stimulation and vaginal penetration demonstrated that the root of the clitoris is not involved with external clitoral stimulation. In contrast, during vaginal stimulation, because of the movements and displacements, the whole CUV complex and the clitoral roots in particular are involved, showing functional differences depending on the type of stimulation. The color signal indicating flow speed in the veins mirrored the anatomical changes. CONCLUSIONS: Despite a common assumption that there is only one type of female orgasm, we may infer, on the basis of our findings, that the different reported perceptions from these two types of stimulation can be explained by the different parts of the clitoris (external and internal) and CUV complex that are involved.

Female orgasm(s): one, two, several.

INTRODUCTION: There is general agreement that it is possible to have an orgasm thru the direct simulation of the external clitoris. In contrast, the possibility of achieving climax during penetration has been controversial. METHODS: Six scientists with different experimental evidence debate the existence of the vaginally activated orgasm (VAO). MAIN OUTCOME MEASURE: To give reader of The Journal of Sexual Medicine sufficient data to form her/his own opinion on an important topic of female sexuality. RESULTS: Expert #1, the Controversy's section Editor, together with Expert #2, reviewed data from the literature demonstrating the anatomical possibility for the VAO. Expert #3 presents validating women's reports of pleasurable sexual responses and adaptive significance of the VAO. Echographic dynamic evidence induced Expert # 4 to describe one single orgasm, obtained from stimulation of either the external or internal clitoris, during penetration. Expert #5 reviewed his elegant experiments showing the uniquely different sensory responses to clitoral, vaginal, and cervical stimulation. Finally, the last Expert presented findings on the psychological scenario behind VAO. CONCLUSION: The assumption that women may experience only the clitoral, external orgasm is not based on the best available scientific evidence.

Coitus as revealed by ultrasound in one volunteer couple.

INTRODUCTION: The anatomy and function of the G-spot remain highly controversial. Ultrasound studies of the clitoral complex during intercourse have been conducted to gain insight into the role of the clitoris and its relation to vagina and urethra during arousal and penetration. AIM: Our task was to visualize the anterior vaginal wall and its relationship to the clitoris during intercourse. METHODS: The ultrasound was performed during coitus of a volunteer couple with the Voluson® General Electric® Sonography system (Zipf, Austria) and a 12-MHz flat probe. The woman was in a gynecologic position, and her companion penetrated her with his erected penis from a standing position. We performed a coronal section on the top of the vulva during the penetration. MAIN OUTCOME MEASURE: We focused on the size of the clitoral bodies before and after coitus. RESULTS: The coronal section demonstrated that the penis inflated the vagina and stretched the root of the clitoris that has consequently a very close relationship with the anterior vaginal wall. This could explain the pleasurable sensitivity of this anterior vaginal area called the G-spot. CONCLUSIONS: The clitoris and vagina must be seen as an anatomical and functional unit being activated by vaginal penetration during intercourse.

Who's afraid of the G-spot?

INTRODUCTION: No controversy can be more controversial than that regarding the existence of the G-spot, an anatomical and physiological entity for women and many scientists, yet a gynecological UFO for others. METHODS: The pros and cons data have been carefully reviewed by six scientists with different opinions on the G-spot. This controversy roughly follows the Journal of Sexual Medicine Debate held during the International Society for the Study of Women's Sexual Health Congress in Florence in the February of 2009. MAIN OUTCOME MEASURE: To give to The Journal of Sexual Medicine's reader enough data to form her/his own opinion on an important topic of female sexuality. RESULTS: Expert #1, who is JSM's Controversy section editor, reviewed histological data from the literature demonstrating the existence of discrete anatomical structures within the vaginal wall composing the G-spot. He also found that this region is not a constant, but can be highly variable from woman to woman. These data are supported by the findings discussed by Expert #2, dealing with the history of the G-spot and by the fascinating experimental evidences presented by Experts #4 and #5, showing the dynamic changes in the G-spot during digital and penile stimulation. Experts #3 and #6 argue critically against the G-spot discussing the contrasting findings so far produced on the topic. CONCLUSION: Although a huge amount of data (not always of good quality) have been accumulated in the last 60 years, we still need more research on one of the most challenging aspects of female sexuality.

The clitoral complex: a dynamic sonographic study.

INTRODUCTION: The existence of the G-spot remains controversial partly because no appropriate structure and innervation have been clearly demonstrated in this pleasurable vaginal area. Using sonography, we wanted to visualize the movements of the clitoris and its anatomical relationship with the anterior wall of the vagina during voluntary perineal contraction and vaginal penetration without sexual stimulation. AIM: The aim of this presentation is to provide a dynamic sonographic study of the clitoris and to describe the movements of the quiescent clitoral complex during a voluntary perineal contraction. We aim to visualize the mechanical consequences of the pressure of the anterior vaginal wall with women who claim to have a special sensitivity of the G-spot area and vaginal orgasm. Histology and immunohistochemistry of the G-spot and other female genital tissues are beyond the scope of this study and have not been discussed. METHOD: The ultrasounds were performed in five healthy volunteers with the Voluson General Electric Sonography system (GE Healthcare, Zipf, Austria), with a 12-MHz flat probe, and with a vaginal probe. We used functional sonography of the quiescent clitoris with voluntary perineal contractions and with finger penetration without sexual stimulation. MAIN OUTCOME MEASURES: We focused on the size of the clitoris (raphe, glans, and clitoral bodies) and of the length of the movements of the clitoris during voluntary perineal contractions. RESULTS: The coronal planes during perineal contraction and finger penetration demonstrated a close relationship between the root of the clitoris and the anterior vaginal wall. CONCLUSIONS: We suggest that the special sensitivity of the lower anterior vaginal wall could be explained by pressure and movement of clitoris' root during a vaginal penetration and subsequent perineal contraction. The G-spot could be explained by the richly innervated clitoris.

Sonography of the clitoris.

INTRODUCTION: The prevalence of invasive procedures in diagnosing female sexual dysfunctions and pathologies is high. There is a need for a less invasive evaluation tool and medical imaging of the clitoris may be a solution. The clitoris has already been studied with nuclear magnetic resonance but there are very few sonographic 2D and 3D studies despite the fact that it is a simple, noninvasive, and inexpensive method. AIM: This study aims at determining the feasibility of using ultrasound (US) techniques to image the clitoris in sufficient detail to permit evaluation of anatomy for possible use in study. METHODS: The ultrasounds were performed in five healthy volunteers with the Voluson GE Sonography system (GE Healthcare Ultrasound, Zipf, Austria), using one 12-MHz flat probe. MAIN OUTCOME MEASURES: The clitoral body's diameter, the length of the raphe. RESULTS: The three planes-the cross-section, sagittal section, and coronal section-were revealed making it possible to study the entire organ. CONCLUSION: The sonography is a simple, inexpensive, noninvasive mean which might help for the evaluation of this organ.