Nature and origin of "squirting" in female sexuality.

INTRODUCTION: During sexual stimulation, some women report the discharge of a noticeable amount of fluid from the urethra, a phenomenon also called "squirting." To date, both the nature and the origin of squirting remain controversial. In this investigation, we not only analyzed the biochemical nature of the emitted fluid, but also explored the presence of any pelvic liquid collection that could result from sexual arousal and explain a massive fluid emission. METHODS: Seven women, without gynecologic abnormalities and who reported recurrent and massive fluid emission during sexual stimulation, underwent provoked sexual arousal. Pelvic ultrasound scans were performed after voluntary urination (US1), and during sexual stimulation just before (US2) and after (US3) squirting. Urea, creatinine, uric acid, and prostatic-specific antigen (PSA) concentrations were assessed in urinary samples before sexual stimulation (BSU) and after squirting (ASU), and squirting sample itself (S). RESULTS: In all participants, US1 confirmed thorough bladder emptiness. After a variable time of sexual excitation, US2 (just before squirting) showed noticeable bladder filling, and US3 (just after squirting) demonstrated that the bladder had been emptied again. Biochemical analysis of BSU, S, and ASU showed comparable urea, creatinine, and uric acid concentrations in all participants. Yet, whereas PSA was not detected in BSU in six out of seven participants, this antigen was present in S and ASU in five out of seven participants. CONCLUSIONS: The present data based on ultrasonographic bladder monitoring and biochemical analyses indicate that squirting is essentially the involuntary emission of urine during sexual activity, although a marginal contribution of prostatic secretions to the emitted fluid often exists.

Reliability of automated volumetric measurement of multiple growing follicles in controlled ovarian hyperstimulation.

OBJECTIVE: To evaluate the reliability of a computer-assisted approach for automatically measuring ovarian follicles during controlled ovarian hyperstimulation (COH). DESIGN: Prospective, comparative study. SETTING: Hospital Béclère, Clamart, France. PATIENT(S): Twenty-seven infertile IVF-ET candidates undergoing COH. INTERVENTION(S): Just before the oocyte retrieval, growing follicles (n=72) had their mean diameters measured and their volumes determined semimanually by virtual organ computer-aided analysis (VOCAL) and automatically by SonoAVC. Follicles were sorted in small (12-16 mm; n=35) and large (>16 mm; n=37) growing follicles. Measures were compared with the follicular fluid volume. MAIN OUTCOME MEASURE(S): Concordance of results using intraclass correlation coefficient and limits of agreement methods, respectively. RESULT(S): Overall, VOCAL (median: 3.42 mL; range: 0.98-9.68 mL) and SonoAVC (3.25 mL; 0.98-8.63 mL) measurements were equivalent to the corresponding actual follicle volume (3.20 mL; 0.80-10.20 mL). The intraclass correlation coefficient values between follicular fluid volume and mean diameter, VOCAL, and SonoAVC were 0.51, 0.95, and 0.98, respectively, for small follicles, and 0.80, 0.93, and 0.92, respectively, for large follicles. 95% limits of agreement between actual volume and VOCAL (-1.09 to +1.07 mL) and SonoAVC (-1.08 to +0.84 mL) measurements were comparable in both groups. CONCLUSION(S): Automated measurement of multiple follicular volumes using SonoAVC is a simple technique, which reliability is superior to usual diameter measurements and comparable to VOCAL. This technologic refinement invites us to switch toward volumetric monitoring of follicle growth during COH.

Reproducibility and reliability of automated volumetric measurement of single preovulatory follicles using SonoAVC.

OBJECTIVE: To evaluate the reproducibility and the reliability of an innovative, computer-assisted approach for automatically measuring ovarian follicles. DESIGN: Prospective, comparative study. SETTING: Hospital Béclère, Clamart, France. PATIENT(S): Fifteen infertile women undergoing IVF-ET in monodominant follicle cycles. INTERVENTION(S): Just before oocyte retrieval, follicles were three-dimensionally reconstructed from transvaginal ultrasonographic images. Volumes were determined both manually by visual outlining of inner follicle borders (VOCAL) and automatically using SonoAVC. Each procedure was repeated three times. Follicular fluid volume indicated the actual follicle volume. MAIN OUTCOME MEASURE(S): Reproducibility and concordance of results were assessed by the intraclass correlation coefficient (ICC) and the limits of agreement method, respectively. RESULT(S): At any time, VOCAL (3.68, 2.41-8.29 mL; 3.73, 2.70-7.16 mL; 3.89, 2.96-7.83 mL; median, ranges, respectively) and SonoAVC (3.57, 2.41-8.19 mL; 3.71, 2.49-8.90 mL; 4.07, 3.12-8.16 mL, respectively) volume measurements failed to be statistically different from the corresponding actual follicle volume (3.60, 2.90-8.00 mL). Reproducibility (ICC, 95% confidence intervals) of repeated VOCAL (0.95, 0.87-0.98) and SonoAVC (0.97, 0.94-0.99) measurements as well as 95% limits of agreement between actual volumes and VOCAL (-0.48 to +0.80 mL) and SonoAVC (-0.61 to +0.99 mL) measurements were comparable. CONCLUSION(S): Automatic measurement of ovarian follicle volumes from three-dimensionally reconstructed ultrasound images (SonoAVC) is a rapid and simple technique, which reproducibility and reliability are comparable to the semimanual technique (VOCAL). It opens new perspectives for the accurate and objective assessment of ovarian function by ultrasound.