Emerging evidence for a discrete genital site for orgasm?

Abstract

Grafenberg and Dickinson first described a sensitive area felt through the anterior wall of the vagina and difficult to palpate when unstimulated. In 1950, Grafenberg noted that when this area was stimulated it caused the female urethra to enlarge and swell, and was sometimes associated with expulsion of fluid different from urine. Perry and Whipple in 1981 described this sensitive area on the anterior vagina wall as the G-spot. Despite this, Whipple acknowledges (Curr Sex Health Rep 2015;7:59-62) that some sexologists have heavily disputed the presence of a discrete anatomical entity, or ‘spot’. An anatomical G-spot was described in a prospective descriptive case series on 11 consecutive female cadavers (Ostrzenski A. Eur J Obstet Gynecol Reprod Biol 2014;180:186-191). Histological features of the G-spot were defined microscopically as a neurovascular structure with its own nerve ganglion. The absence of cavernous or spongiosum tissue excluded the concept that the anterior wall engorgement was in some way related to expansion of erectile tissue. Ostrzenski argued that electric vaginal waves originated from within the G-spot, effectively enabling it to produce vagina-activated (internal) orgasm independent of clitoral orgasm. Reviewing the biological and physiological background of the pharmacology of the human female orgasm, Levin (Levin RJ. Pharmacol Biochem Behav 2014;121:62-70) describes areas of activity of the brain during orgasm but notes that the genital sites ‘responsible’ for activating orgasm may be diverse and that there may be a ‘cusp or tipping point’ for induction of orgasm, citing the concept described by Michael Perelman. The great variability in the subjective experience of orgasm and the possibility of maturation and ‘learning’ alongside environmental factors results in a lack of clarity of the complex role of the neural pathway and expression in the brain. The interconnections between the anterior vagina, the pelvic floor and the brain remain under investigation but for many women these combine to produce a pleasurable and often ecstatic sensation at orgasm. The article by Maratos et al. (2016;123:1542–49) describes a retrospective study of MRI imaging for women with routine medical indications. The failure to obtain any basic sexual history or discover whether the women had ever described ‘G-spot’ orgasms is an obvious limitation of the study, and is more frustrating than the opportune sample of cadaveric dissections reported by Ostrzenski, where the sexual history was elusive. The authors describe a higher detection rate of the ‘G-spot’ in those women with distension of the vagina and in 62% of cases overall. Further studies in women with and without sexual dysfunction, including orgasmic disorder and orgasmic anhedonia, and where there is distension of the normally collapsed vaginal wall, may enable additional understanding of the structures of the anterior vaginal wall, urethra and clitoral complex, as well as an understanding of why some women report differences in their sexual experiences that could be at least partly explained by inherent anatomical differences. If these can be identified with limited invasive out-patient ultrasound investigations this will markedly enhance the diagnostic opportunities for clinicians. The sexual medicine clinician will always attempt to recognise the multitude of factors contributing to a particular sexual experience, but having a greater appreciation of inherent differences and how pharmacological agents may influence these will widen the opportunities for a successful clinical consultation. None declared. Completed disclosure of interests form available to view online as supporting information. Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.