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© 2010 International Society for Sexual Medicine

Controversies in Sexual Medicine


Who’s Afraid of the G-spot? jsm_1613 25..34

Emmanuele A. Jannini, MD,* Beverly Whipple, PhD, RN, FAAN,† Sheryl A. Kingsberg, PhD,‡
Odile Buisson, MD,§ Pierre Foldès, MD,¶ and Yoram Vardi, MD**
*Course of Endocrinology and Medical Sexology, Department of Experimental Medicine, University of L’Aquila, Italy;

Professor Emerita, Rutgers University, NJ, USA; ‡Division of Behavioral Medicine, University Hospitals Case Medical
Center, MacDonald Women’s Hospital, Department of Reproductive Biology, Case Western Reserve University School of
Medicine Cleveland, OH, USA; §Centre d’échographie, Saint Germain en Laye, France; ¶Hôpital de Saint Germain en
Laye, Clinique Louis XIV, Saint Germain en Laye, France; **Neuro-Urology Unit, Rambam Health Care Center and
Technion Faculty of Medicine, Haifa, Israel

DOI: 10.1111/j.1743-6109.2009.01613.x

ABSTRACT

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 demon-
strating 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. Jannini EA, Whipple B,
Kingsberg SA, Buisson O, Foldès P, and Vardi Y. Who’s afraid of the G-spot?. J Sex Med 2010;7:25–34.
Key Words. G Spot; Vaginal Orgasm; Vagina; Clitoris; Skene Glands; Female Ejaculation

V ery few issues in sexology, and now also in


sexual medicine, instigate so much reactivity
as those related to the female orgasm in general
tion after the celebration of the clitoris during the
sexual revolution. Their claims are mostly based
on a poorly researched review article, written by an
and to G-spot in particular. It is an old story: the author who is almost unknown in academic medi-
goddess Hera blinded the poor Tiresias just cine and who never published on the field, where
because the soothsayer revealed scientific truths on the G-spot has been defined as a “a modern gyne-
the female orgasm [1]. But some sexologists and cologic myth” [2].
feminists are still afraid of the G-spot, considered, Some women are able to reach orgasm without a
with a dramatically prescientific mentality, a male direct stimulation of the external clitoris but just
attempt to recoup importance for vaginal penetra- with the mechanical stimulation of the vagina.

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Controversies in Sexual Medicine

Others do not reach the vaginally activated orgasm, paper. However, some papers refute the evi-
despite different partners and different instruments dence on the G-spot. For instance, Schultz
used. These statements can be hardly denied. The et al. was unable to find by magnetic resonance
term “G-spot” was used by two researchers, Beverly imaging (MRI) the “widening of the vaginal
Whipple (who kindly accepted to write the para- canal, structures suggesting a Gräfenberg spot,
graph on the history of the G-spot) and John D. or a separate reservoir of fluid indicating female
Perry, to name the sensitive area felt through the ejaculation” [16]. However, this statement was
anterior vaginal wall, halfway between the back of based on a single scan obtained from a single
the pubic bone and the cervix, along the course of woman!
the urethra [3]. 3. Sexual stimulation of the G-spot seems to
The data in the available literature have differ- produce a variety of feelings: discomfort, sen-
ent levels of evidence. sation of urination, or pleasure. With additional
stimulation, the area may begin to swell, and
1. Histological studies are very consistent. The then produce an intense orgasm, possibly
G-spot (or area) is composed of individually together with a semen-like (although less
different amount of cavernosal tissue from the viscous) fluid emission, the so-called “female
inner clitoris [4], exocrine glands (Skene’s ejaculation,” thought to be the product of
glands, the female counterpart of the prostate Skene’s glands. This part of the story needs
[5]), muscles, and nerves within the anterior more studies and more clear evidence: for
vaginal wall [6,7]. The urethra seems also to play instance, the papers which have yielded positive
a major role in the G-spot. The whole bio- evidence for female ejaculation involve small
chemical machinery of excitation is especially participant samples [17] and have some meth-
expressed in these structures (all nitric oxide odological biases [18].
synthases, phosphodiesterase type 5) [8], as well 4. The absence (or the low expression of one or
as specific markers of prostatic tissue (prostate more of the G-spot components) is not a
specific antigen (PSA), human protein 1, chro- disease or a dysfunction: orgasm is achievable
mogranin) [7]. In fact, application of alprostadil by any woman properly stimulated and with
to the G-spot area is effective in women with a good relationship with her own body and
female sexual arousal disorder [9]. Studies are in environment.
progress to determine how many of these struc- 5. Nomenclature is the final problem: words such
tures and how much are under hormonal (i.e., as “female ejaculation,” “urethral sponge,”
under testosterone) control changing on the “urethral–vaginal space,” “anterior vaginal
basis of the cycle phase or the menopausal state. wall,” “inner clitoris,” “female prostate,”
The histological “picture” of the G-spot is “Kobelt plexus,” vaginal vs. clitoral orgasm, and
very well defined, but this “picture” changes G-spot/area itself need to be revised in light of
when comparing anterior vaginal walls from new evidence. A consensus conference of the
different women. This explains contrasting data International Society for Sexual Medicine
on this anatomical region as well the different (ISSM) would be an excellent instrument to
ways to define it. Moreover, examinations of accomplish this task.
vaginal wall innervations have shown that there
is no single area with a greater density of nerve Finally, I have to say few words as rebuttals to
endings [10]. A study of 110 biopsy specimens the opinions of the two excellent colleagues who
drawn from 21 women concluded that there is are . . . afraid of the G-spot. Dr. Kingsberg is using
no single specific vaginal locus with greater the elegant argument that “the location of the
nerve density and thus argued against the G-spot is more likely found in a woman’s brain
G-spot [11]. However, the urethral sponge does than in her vagina.” Who disagrees? I am sure that
contain sensitive nerve endings as well as erectile humans have sex not only with something between
tissue. Furthermore, it is evident that sensitivity their legs, but definitively with something which is
is not determined by neuron density alone. between their ears. Yes, orgasm is a perception,
2. Echo scan imaging [12–14] or urodynamics [15] under strict brain control (Is this the reason why
may be helpful in localizing the G-spot, as orgasm from penetration is frequently referred as
reviewed by Buisson and Foldès later in this deeper than that obtained from the external stimu-

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lation of the clitoris?) but arising from muscular The G-spot was found in each of these women.
contractions triggered by stimulation of discrete However, they cautioned that they could not state
areas . . . between the legs. with certainty that every woman has a G-spot [3].
Dr. Vardi’s main reason to reject existence of They named this area after the first modern
the G-spot is the presumed absence of sexual con- researcher to describe its location. A literature
sequences after surgery of this region. I am afraid search found that Dr. Ernst Gräfenberg described
that, being far from evidence against the G-spot, a zone of erogenous feeling that was located along
this argument seems not in favor of some surgeons the suburethral surface of the anterior vaginal wall
and of their attention to female sexuality. In any [20]. He later went on to write, “An erotic zone
case, I decided to give the last word to Yoram could always be demonstrated on the anterior wall
Vardi, as a tribute to an outstanding scientist and of the vagina along the course of the urethra . . .
gentleman, who was the editor of this section of (which) seems to be surrounded by erectile tissue
The Journal of Sexual Medicine, for doing an excel- like the corpora cavernosa (of the penis) . . . In the
lent job, just before me. course of sexual stimulation, the female urethra
Emmanuele A. Jannini, MD begins to enlarge and can be easily felt” [20].
Gräfenberg was not the first person to describe
The Gräfenberg spot or the G-spot was named by this sensitive area; Regnier deGraff, described it in
Drs. John Perry and Beverly Whipple [19] for the the 17th century, and called it the female prostate
German obstetrician and gynecologist, Dr. Ernst or corpus glandulosum. Others have described this
Gräfenberg, who wrote about this sensitive area area before and since deGraff [3].
in 1950 [20]. The G-spot is a sensitive area felt Women have reported that they have difficulty
through the anterior wall of the vagina about locating and stimulating their G-spot by them-
halfway between the back of the pubic bone and selves, except with a dildo, a G-spot vibrator, or
the cervix, along the course of the urethra. It is similar device (there are over 50 such devices now
easiest to feel the G-spot with the woman lying on available), but they have no difficulty identifying
her back. If one or two fingers are inserted into the the erotic sensation when the area is stimulated by
vagina, with the palm up, using a “come here” a partner. To stimulate the G-spot during vaginal
motion, the tissue that surrounds the urethra will intercourse, the best positions are the woman on
begin to swell. When the area is first touched, the top or rear entry, so the average penis will hit the
woman may feel as if she needs to urinate, but if anterior wall of the vagina [21].
the touch continues for a few seconds longer, it Some women describe experiencing orgasm
may turn into a pleasurable feeling. from stimulation solely of the G-spot. The orgasm
In 1982, Perry and Whipple wrote that “The resulting from stimulation of the G-spot is felt
G-spot is probably composed of a complex deep inside the body, and a bearing-down sensa-
network of blood vessels, the paraurethral glands tion, similar to a Valsalva maneuver, during the
and ducts (female prostate), nerve endings, and the orgasm is commonly reported [3,22]. Physiologi-
tissue surrounding the bladder neck” [3]. They cally, the orgasm from G-spot stimulation is dif-
rediscovered this sensitive area while teaching ferent from an orgasm that is produced by clitoral
women Kegel exercises using biofeedback to help stimulation. During orgasm from clitoral stimula-
treat stress urinary incontinence (SUI). Some of tion, the end of the vagina balloons out. During
the women reported that they emitted a small orgasm from G-spot stimulation, the cervix pushes
amount of fluid from the urethra that was different down into the vagina [3]. Many women experience
from urine during sexual activity and these women a “blended orgasm” when the G-spot and the cli-
had very strong pelvic floor muscles, whereas toris are stimulated at the same time [3]. However,
women with SUI have weak pelvic floor muscles it is important to note that not all women like the
[19]. The women with the strong muscles also feeling of stimulation of the G-spot area.
reported that stimulation of a sensitive area felt Some women experience an expulsion of a small
through the anterior vaginal wall seemed to trigger amount of fluid (about 3–5 cc) from the urethra
this fluid expulsion. with G-spot orgasms (as well as with orgasms
Perry and Whipple reported that they then had resulting from stimulation of other areas). The
a physician or nurse practitioner examine 400 fluid produced by this “female ejaculation” has the
women who volunteered to be research subjects. appearance of watered-down, fat-free milk. It is

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chemically similar to seminal fluid but is different in women with and without complete spinal cord
from urine [17,23–25]. Researcher Milan Zaviacic injury (SCI) as are activated during orgasm from
conducted hundreds of studies on autopsy speci- self-stimulation of the cervix of the uterus. The
mens and concluded that the fluid is from the same brain regions are also activated in women
paraurethral glands, which recently have been without SCI during orgasm from G-spot self-
named the “female prostate gland” [26]. Whipple stimulation, from clitoral self-stimulation, and
and Komisaruk stated that, based on research, from imagery alone, with no touching of the body
in some cases, these three distinct entities, the (see [29] for review).
G-spot, orgasm, and female ejaculation, may be There is much more to be studied in terms of
related, while in other cases, they are not related female sexual responses and it behooves research-
[27]. Many men enjoy stimulation of their pros- ers to listen to women and then to validate their
tate, which can produce an orgasm that is accom- pleasurable sensual and sexual experiences in labo-
panied by a bearing-down sensation similar to that ratory studies.
described by women when they experience an As has been written in the final chapter of the
orgasm from G-spot stimulation [3]. first book on The G-spot, if G-spot stimulation feels
Not all researchers have been able to locate the good, then women should enjoy it, but they should
G-spot; thus, there is some controversy about it. not feel compelled to find the G-spot. This is not a
Other researchers consider the G-spot obvious. It goal that women and their partners should strive to
may be that researchers use different methods of achieve [3]. Women need to be encouraged to enjoy
stimulation (and thus obtain different results) in what they find pleasurable and not set up finding
studying the G-spot area or that not all women have the G-spot or experiencing orgasm or female ejacu-
a sensitive G-spot area. One group of researchers lation as a goal. People need to be encouraged to
recently studied 20 women and observed a correla- regard the G-spot as one area of sensual and sexual
tion between vaginal orgasms and the thickness of pleasure that some women enjoy.
the “clitoris urethra–vaginal complex also known as Beverly Whipple, PhD, RN, FAAN
the G-spot” [13]. Therefore, pressure exerted
against the anterior vaginal wall may be more effec- Rarely has a debate over the existence or not of an
tive if the G-spot area is thicker, according to this anatomical structure garnered such vast attention
new research. However, the careful terminology from the general (dare I say lay) public as the
(clitoris urethra–vaginal complex) used by the controversy over the G-spot. In fact, thanks to
researchers refers to the fact that there are several Ladas, Whipple, and Perry’s 1982 hit book, The
different organs in this highly complex body G-spot and Other Recent Discoveries about Human
region. Komisaruk, Whipple, Nasserzadeh, and Sexuality [3], the G-spot has become a cultural
Beyer-Flores state that this area may include: (i) the truism. Had it not been for the wide acceptance of
anterior vaginal wall; (ii) the urethra; (iii) the the G-spot’s existence, where would it be today in
Skene’s glands (including the paraurethral glands sexual medicine (i.e., would we be able to find it)?
or female prostate gland); (iv) perhaps the other Would it have fallen into obscurity along with
glands in this region (vestibular glands, Bartholin’s other theories based on little scientific evidence? It
glands); (v) the surrounding muscle and connective is ironic that Gräfenberg’s hypothesis [20] has
tissue; and (vi) perhaps the crura of the clitoris [28]. been used to provide anatomical support for one
The effect of G-spot stimulation might primarily such theory with little methodologically rigorous
be the result of stimulation of just one structure evidence—Freud’s theory of the vaginal orgasm.
(such as the female prostate gland) or it might be This “vaginal transfer theory” holds that clitoral
the result of stimulation of several sensitive struc- responsivity must be superseded by vaginal orgasm
tures that are close together. in mature women. Is this an example of the blind
More recent research from our laboratories has leading the blind or the blind leading to going blind
documented that self-stimulation of the area of the if a woman touches her own G-spot?
G-spot produces a very strong analgesic effect, While my colleagues have been charged with
which is also activated naturally during labor. We the task of debating the existence of the G-spot as
have documented, using functional MRI of the an anatomical area located on the anterior wall of
brain, that orgasm from self-stimulation of the the vagina one-third of the way up from the
area of the G-spot activates the same brain regions vaginal opening, my task is to address the question

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of whether the G-spot should more accurately be the expectation that it will. Placebos have measur-
considered a placebo response. From a pragmatic able physiologic effects. For example, if subjects
perspective, as an anatomical structure, it has not will speed up their pulse rate, increase their blood
been easily been made evident, albeit allowing for pressure, and improve reaction time after being
a pronoun shift from an “it” to a “there,” reflecting told they have taken a stimulant, imagine the effect
the concept of a sensitive “area.” The neurophysi- of telling a subject what stimulating the G-spot is
ology of the vagina itself is poorly understood and supposed to do! Beliefs about what effect the
there is scant evidence to support the hypothesis placebo will have are related to changes in the
that vaginal innervation is correlated with sexual body’s neurological regulatory systems found in
sensation and function [11]. the higher cerebral cortex. Furthermore, although
One of the major sources of data in support of stimulation of the G-spot is considered to result in
the existence of a G-spot has been from associated intense orgasms (so strong, in fact, as to relegate
research investigating the existence of female the clitoral orgasm to second-class status),
ejaculation and the supposition that the parauer- researchers still have no definitive explanations for
thral (Skene’s) glands are the female equivalent of what triggers orgasm [32]. Therefore, if female
a prostate [4]. Other researchers have suggested orgasm is so nebulous, how confident can we be
that stimulation of the G-spot results in sexual about a G-spot?
pleasure due to its proximal location to the bulbs Sheryl A. Kingsberg, PhD
of the clitoris [30].
A second source of support has been from The existence of the G-spot remains controversial
research using behavioral methodology, again a partly because no appropriate structure and inner-
downstream source of evidence. These are reports vation have been clearly demonstrated in this
of intense pleasurable sensation and intense pleasurable vaginal area. Recently, Gravina et al.
orgasms as the result of stimulation of the G-spot demonstrated that the thickness of the ure-
area. For example, Addiego et al. [17] presented the throvaginal space is larger with women who have a
first report case report of a woman for whom stimu- vaginal orgasm than with women who have a cli-
lation of the anterior vaginal wall made the area toral orgasm [13]. It is now scientifically proven
expand by 50%, and that self-reported levels of that there is an objective anatomical difference.
arousal/orgasm were “deeper” when the G-spot However, the cause of the difference in the thick-
was stimulated. Goldberg et al. [31] examined 11 ness of this space remains unclear. Dynamic
women by palpating the entire vagina in a clockwise sonography can provide us with more facts about
fashion. They reported a specific response to stimu- the G-spot area.
lation of the anterior vaginal wall in four of the We placed a 12-MHz sonographic probe on the
women. However, even under the most rigorous of top of the vulva of a healthy 40-year-old woman,
experimental methods, it is difficult to reach the capable of achieving vaginal orgasms (i.e., without
G-spot without “accidentally” stimulating other direct stimulation of the external clitoris) with no
areas along the way. This would be absolutely the sexual dysfunction. We made a triplanar 3-D
case in a nonexperimental, sexual encounter using a reconstruction of her clitoris. The coronal planes
finger, penis, or other objects de pleasir. of what O’Connell names the “clitoral complex”
The excitement generated by the potential [4] contain the most information. It demonstrates
existence of a G-spot is due to the theory that a series of triangles: cavernous bodies, venous
stimulation supposedly results in high levels of Kobelt plexus, bulbs (because bulbs are located
pleasurable sexual sensations and powerful discreetly posteriorly in the root of the clitoris and
orgasms [3]. Therefore, I propose that the location then descend anteriorly) and, lastly, symphysis [12]
of the G-spot is more likely found in a woman’s (Figure 1). In fact, venous Kobelt plexuses are
brain than in her vagina. In other words, I submit entrapped between the double vault formed by
that the G-spot is inaccurately named and should cavernous bodies and bulbs. Sonography demon-
instead be more correctly labeled the P-spot where strates that a finger vaginal penetration evokes a
P stands for placebo. A placebo effect is a medical reflex perineal contraction and tightly narrows the
phenomenon in which an inactive substance like distance between the root of the clitoris (cavernous
sugar or distilled water or even a designated “spot” bodies and bulbs) and the distal anterior vaginal
improves a condition simply because a person has wall. When the patient locates her own G-spot

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Figure 1 Echo scan of human vagina.


The triplanar 3-D reconstruction dem-
onstrates a series of triangles: cavern-
ous bodies, venous Kobelt plexus,
bulbs (because bulbs are located dis-
creetly posteriorly in the root of the
clitoris and then descend anteriorly)
and, lastly, symphysis. CB = clitoral
body; BU = bulb; K = Kobelt plexus;
VA = vagina.

with her finger, the echoes of the finger are found vated and congestive clitoris. To date, it is not
at close proximity to the clitoris root and the pres- possible to visualize the clitoris during an MRI
sure movement of the finger displaces cavernous coitus [35], but a sonography of an erected penis
bodies and bulbs [14] (Figure 2). penetration allows visualization of the clitoral-
If the root of the clitoris containing cavernous complex modification. We performed the ultra-
bodies, venous Kobelt plexuses, and bulbs are sounds during the coitus of a volunteer couple
related to the anterior vaginal wall, why would it with the Voluson General Electric Sonography
not play a part in the vaginal pleasure? Under system (Solingen, Germany), a 12-MHz flat
erotic stimulation, neuromuscular reflex [33] and probe. The woman was in gynecologic position
vasomotor events [34] have been demonstrated. and her companion penetrated her from a standing
We suggest that these events could increase the position. We performed a coronal section on the
contact between the vagina and the richly inner- top of the vulva during the penetration. It becomes
obvious that the coitus creates a completely differ-
ent anatomical entity due to modification of the
way in which the organs are related to each other.
The sonography of the coitus provides us with the
following findings: the root of the clitoris is
ascending and completely widened by the penis.
During the thrusting, the anterior vaginal wall is
crushed against the root of the clitoris (Figure 3).
The Kobelt plexus is a venous plexus entrapped
between the clitoral bodies and the bulbs. It is well
visualized during the coitus and seems to be
repeatedly crushed by the pressure of the penis. It
is likely that a venous pumping effect exists at this
specific location: on the top of the double vault
Figure 2 Echo scan of the human vagina during digital made of the two cavernous bodies and the two
stimulation. Coronal plane of the root of the clitoris: when bulbs. It is very easy to measure the cavernous
the patient locates her own G-spot with her finger, the echos bodies and to see the enhanced clitoris’s size as
of the finger are found at close proximity to the clitoris root
and the pressure movement of the finger displaces cavern- shown with MRI [36].
ous bodies and bulbs. GL = glans; CB = clitoral body; The special location of the Kobelt plexus seems
BU = bulb. also interesting: first, it is located on the top of the

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repeated releases of the blood. With Color


Doppler, on a coronal view, a discontinuous but
regular color signal in the Kobelt plexus is visual-
ized. Measurements demonstrate that the releas-
ing flow is very slow: about 5 cm per second.
There is no flow between the releases as if the
Kobelt plexus played the role of a reservoir for a
short time (Figure 4). The Kobelt plexus is repeat-
edly crushed during the thrusting of the penis in
an area which is full of neurotransmitters [6].
These evidences lead us to ask four questions:
(i) During the coitus, does the root of the clitoris
compressing the Kobelt plexus create a venous
pumping effect and an accumulation of neu-
rotransmitters?; (ii) Does the Kobelt plexus play
Figure 3 Echo scan of the human vagina during coitus.
the role of a kind of reservoir from which the
Coronal plane of the coitus. The probe is placed transver-
sally on the top of the vulva in a coronal inclination. The accumulated neurotransmitters are released at a
cavernous bodies are enlarged and pushed up. The bulbs certain moment?; (iii) Does this release of accu-
are partially hidden by the erected penis. Venous Kobelt mulated neurotransmitters cause the sensation
plexuses are in a special location on the top of the vault. The perceived as vaginal orgasm?; (iv) Does the root of
clitoral complex is crushed by the erected penis against the
the clitoris participate to the vaginal orgasm, with
anterior vaginal wall. The plane of the three parts of the
erected penis is well visualized. BU = bulb; CB = clitoral different neurologic pathways than those for the
body; K = Kobelt plexus; CC = corpus cavernosum. clitoral orgasm?
Medical images open the gate toward a recon-
ceptualization of the G-spot. The G-spot is prob-
double vault which is situated on the G-spot area, ably not a unique anatomical structure but rather a
then it drains toward vaginal veins and, second, it functional one which involves the clitoral complex
seems to have a particular venous organization. and the vagina during a vaginal penetration. Part
Enlarging a sonographic image of the Kobelt of the solution to a better understanding of the
plexus of a quiescent clitoris, we can see distinctly female sexuality lays undoubtedly in functional
the blood whirl; it seems as if there is a kind of imagery [37].
stagnation followed by slow, periodical, and Odile Buisson, MD and Pierre Foldès, MD

Figure 4 Color Doppler of the human


vagina. The signal of the venous
Kobelt plexuses on a quiescent clitoris:
there is no flow between the repetitive
releasing of blood, as if the Kobelt
plexuses played the role of a reservoir
for a short time. BU = bulb; CB =
clitoral body; K = Kobelt plexus.

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It was in the early 1950s that the importance of the described differences in the thickness of the
anterior vaginal wall became evident in regard to “urethrovaginal space” which was detected by
sexual pleasure and orgasm. This can be attributed ultrasonic measurement, in 20 healthy female vol-
to the German gynecologist Ernst Gräfenberg unteers. The urethrovaginal space was found to be
[20] who described the existence of an area of high thinner in females without vaginal orgasm com-
sensitivity in the anterior vagina, later named the pared with those who did experience vaginal
G-spot. Sixty years later, there is still a wide dis- orgasm (nine and 11, respectively). He speculated
crepancy between the questionable existence of that a functional correlation between the thickness
the G-spot on one hand and the mass popularity of the “urethrovaginal space” (G-spot) and the
and its empowerment on the other. ability to experience vaginal orgasm may exist.
The first attempt to investigate the existence of Nevertheless, he was unable to directly demon-
the G-spot was performed by Goldberg et al. [31] strate that the thickness of this anatomical “space”
using a standardized manual technique. This study generates any mechanism related to the initiation
was conducted by two trained gynecologists in 11 or involvement of orgasm. Apart from Jannini’s
women. Using their methodology, they found the report, I did not find studies that were able to show
G-spot in four of them. Other sexology literature or describe the G-spot anatomically. Moreover,
provides only testimonials and anecdotal reports studies which evaluated biopsies from this area did
on the G-spot that describes it as different, pro- not demonstrate nerve ending condensation com-
viding sexual arousal and pleasure. On the other pared with other regions in the vagina [41]. From
hand, others have demonstrated that also the pos- an anatomical and histological point of view and
terior vaginal wall can similarly elicit an orgasmic from the data available, it seems that only very
response [38]. poor evidence for the existence of a distinct ana-
tomical structure that can be defined as a G-spot
exist.
Anatomical Concern
Scientific anatomical and imaging evidence for the
Sexual Function Postvaginal Surgery
existence of the G-spot are quite poor. The only
anatomical structures identified in this area are the One would assume that gynecological or urologi-
Skene’s glands that may play a role in the stimu- cal interventions in the anterior vaginal wall would
latory phase of the sexual response and orgasm in adversely affect sexual function, especially when
this region. However, no receptors for touch considering the possible existence of the G-spot in
stimulation and no direct evidence for their this location. Extensive dissection of the anterior
involvement in sensory input have been docu- vaginal wall is commonly performed during pro-
mented [39]. Data available today do not provide cedures such as mid-urethral slings, or repair of
any supporting evidence that these glandular anterior vaginal wall prolapse. These and similar
structures are part of the area named the G-spot. surgical interventions have the potential to
For many women, the anterior wall of the damage the nerve supply to this area.
vagina is an erogenous zone and one of the expla- There is no current study showing changes in
nations for its higher sensitivity may be the prox- genital sensation following mid-urethral sling or
imity to the clitoral cavernosal tissue. Mechanical prolapse repair. Moreover, when evaluating sexual
pressure on the anterior vaginal wall could indi- functioning in women who underwent these types
rectly stimulate clitoral structures enhancing of surgeries, a significant improvement in sexual
sensation of pleasure. This theory has been inves- function was claimed following the repair of ante-
tigated by Foldès et al. using ultrasonography [14]. rior vaginal wall prolapse [42]. This fact is a strong
Other imaging modalities, such as magnetic reso- argument against the existence of a distinct ana-
nance, was used during sexual arousal but did not tomical region in the anterior vagina responsible
show any significant change in the signal intensity, for sexual pleasure and orgasm.
nor did find any distinct anatomical structure in
this area [16,40].
Conclusions
Recently, some direct anatomical evidence for
the existence of the G-spot as a separate anatomi- From a scientific standpoint, there is poor evi-
cal entity was suggested by Jannini et al. [13] who dence to confirm the existence of the G-spot.

32 J Sex Med 2010;7:25–34


Controversies in Sexual Medicine

Objective measures such as MRI and ultrasound 8 D’Amati G, di Gioia CR, Bologna M, Giordano D,
did not provide solid evidence to the existence of Giorgi M, Dolci S, Jannini EA. Type 5 phosphodi-
the legendary G-spot. On the other hand, self- esterase expression in the human vagina. Urology
reported levels of arousal during stimulation, 2002;60:191–5.
9 Liao Q, Zhang M, Geng L, Wang X, Song X, Xia P,
numerous reliable reports and anecdotal testimo-
Lu T, Lu M, Liu V. Efficacy and safety of alprostadil
nials of its existence are available. Another prob- cream for the treatment of female sexual arousal
lematic aspect of the “search for the G spot,” disorder: A double-blind, placebo-controlled study
especially with regard to social pressure and media in Chinese population. J Sex Med 2008;5:1923–31.
coverage, is the fact that many women unable to 10 Hoyle CH, Stones RW, Robson T, Whitley K,
reach a vaginal orgasm may become frustrated and Burnstock G. Innervation of vasculature and
sexually handicapped in their obsessive search for microvasculature of the human vagina by NOS and
it. Even more problematic is the fact that some neuropeptide-containing nerves. J Anat 1996;188:
professionals take advantage of the cultural glori- 633–44.
fication of the G-spot, and offer interventions such 11 Pauls R, Mutema G, Segal J, Silva WA, Kleeman S,
as “G-spot augmentation.” Only time will tell if Dryfhout Ma V, Karram M. A prospective study
examining the anatomic distribution of nerve den-
science or human nature and future sexual experi-
sity in the human vagina. J Sex Med 2006;3:979–87.
ences will provide more information regarding the 12 Buisson O, Foldes P, Paniel BJ. Sonography of the
existence of this mysterious structure but will clitoris. J Sex Med 2008;5:413–7.
undoubtedly continue to occupy the public’s 13 Gravina GL, Brandetti F, Martini P, Carosa E, Di
imagination. Stasi SM, Morano S, Lenzi A, Jannini EA. Measure-
Yoram Vardi, MD ment of the thickness of the urethrovaginal space in
women with or without vaginal orgasm. J Sex Med
Corresponding Author: Emmanuele A. Jannini, 2008;5:610–8.
MD,Course of Endocrinology and Medical Sexology, 14 Foldes P, Buisson O. The clitoral complex: A
Department of Experimental Medicine, University of dynamic sonographic study. J Sex Med 2009;6:
L’Aquila, L’Aquila, 67100, Italy. Tel: +39 0862433530; 1223–31.
Fax: +39 0862433523; E-mail: emmanuele.jannini@ 15 Cartwright R, Elvy S, Cardozo L. Do women with
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16 Schultz WW, van Andel P, Sabelis I. Mooyaart E.
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