Urethral Expulsions During Sensual Arousal and Bladder Catheterization in Seven Human Females
From a review of well over 100 books, articles and other reference sources, it is impossible to look at the question of vaginal expulsions and not also to some extent consider the material on the urethral ducts and glands and on the so called Gräfenberg Spot. No direct connection has been conclusively established between vaginal expulsions, the Gräfenberg spot, and urethral ducts and glands. However, while these are three distinct entities, most of the previous researchers saw the possibility of some interconnectedness, if for no other reasons than their physical proximity and the anecdotal reports of women.4 For these reasons, the significant history of all three areas will be reviewed.
The expulsion of fluid from the vagina during sexual arousal and/or orgasm has been reported throughout time. There were many references to such historic scientific figures such as Aristotle and Galen discussing and identifying vaginal expulsions. The first modern description both of female genitalia and the question of vaginal expulsions came from the 17th century Dutch physician, Regnier De Graaf. He stated:
“The urethra is lined internally by a thin membrane. In the lower part, near the outlet of the urinary passage, this membrane is pierced by large ducts, or lacunae, through which pituito-serous matter occasionally discharges in considerable quantities. Between this very thin membrane and the fleshy fibres we have just described there is, along the whole duct of the urethra, a whitish, membranous substance about one finger-breadth thick which completely surrounds the urethral canal....The substance could be called quite aptly the female prostatae or corpus glandulosum, ‘glandulous body.’ It seems to us too to be what Galen is talking about when, in Book 14 of this work on the use of the parts, he writes, on the authority of Herophilus, that women as well as men have glandulous ‘prostatae.’”5
There were also many references to vaginal expulsions in classical literature, although it is impossible to determine whether these passages are simple reporting of what the writer saw, or a romanticized fictional version of popular male sexual fantasies of the times. In the twentieth century, people such as Robert Latou Dickinson and Havelock Ellis believed that the fluid came from the cervix. Others felt that the secretions came from Bartholin’s glands or a combination of Bartholin’s glands and cervical secretions.6
In 1950, the German obstetrician, Ernst Gräfenberg, wrote of observing the expulsion of fluid from the urethra.
“If there is the opportunity to observe the orgasm of such women, one can see that large quantities of a clear, transparent fluid (that) are expelled not from the vulva, but out of the urethra in gushes. At first, I thought that the bladder sphincter has become defective by the intensity of the orgasm. Involuntary expulsion of urine is reported in sex literature. In the cases observed by us, the fluid was examined and it had no urinary character. I am inclined to believe that ‘urine’ reported to be expelled during female orgasm is not urine, but only secretions of the intraurethral glands correlated with the erotogenic zone along the urethra in the anterior vaginal wall. Moreover, the profuse secretions coming out with the orgasm have no lubricating significance, otherwise they would be produced at the beginning of intercourse and not at the peak of orgasm.”7
A few years later, Alfred Kinsey, in his landmark work, Sexual Behavior in the Human Female, states a different point of view when he writes:
“Since the prostate gland and seminal vesicles are only vestigial
structures in the female, she does not actually ejaculate. Muscular
contractions of the vagina following orgasm may squeeze out some of the
genital secretions, and in a few cases eject them with some force.
This is frequently referred to, particularly in the deliberately exotic
literature, as an ejaculation in the female; but the term cannot be strictly
used in that connection. Ejaculation is, in fact, the only phenomenon
in the physiology of sexual response which is not identically matched in
the male and the female, or represented by closely homologous functions.”8
In 1966, Masters and Johnson in their book, Human Sexual Response, dismiss “female ejaculation” as an “erroneous but widespread concept.”9 In their 1982 book, Masters and Johnson on Sex and Human Loving, they further state that “despite a popular misconception, most women do not ejaculate during orgasm. The erroneous belief that women ejaculate probably stems from descriptions in erotic novels of fluid gushing from the vagina as a woman writhes and moans at the peak moment of sexual passion. Such descriptions are not particularly accurate.”10 They do later admit that “although it is clear that at least some women experience this ejaculation-like response, it should be realized that a number of these cases represent a condition called urinary stress incontinence in which urine is expelled from the urethra due to physical straining such as occurs with coughing, sneezing or sexual arousal. Since this condition is usually correctable, either by the use of Kegel exercises or minor surgery, medical evaluation is warranted if a women is bothered by such a response.”11
Prior to the early nineteen eighties, when live subjects began to be tested, most of the literature on the subject of vaginal expulsions came from one of three general categories. First, from reviews of historical writings that anecdotally described vaginal discharges that did not appear to have the smell or color of urine or that left stains on bedding. Secondly, from analyses of anatomy books that described the homologous organs and processes of the male and female reproductive systems, and then semantically, with an attempt at logic, drew a conclusion that vaginal expulsions at orgasm were at least theoretically possible.
Later, there were two excellent statistical studies of the anecdotal experiences and knowledge of selected women regarding “female ejaculation,” the Gräfenberg spot, and sexual responsiveness.12 In these two studies, an anonymous questionnaire was distributed to 2,350 professional women in the United States and Canada and 55% were completed and returned. The researchers chose professional women on the theory that they would have a superior understanding of physiology and the terminology involved. Among the principal findings of these studies was that 58.8% of the respondents had read about “female ejaculation” and 39.5% reported having experienced an expulsion of fluid at orgasm at some time.13 Moreover, it was found that 65.9% of the respondents perceived a sensitive area in their vaginas. Of those, 72.6% reported experiencing orgasm from stimulating that area during sexual arousal and 82.3% of them indicated that they had at some time also experienced ejaculation.14 An additional interesting finding was that 59.3% of those experiencing orgasm did not require simultaneous clitoral stimulation to achieve orgasm.15
Finally, beginning in the early nineteen eighties, a series of studies attempted to scientifically study the phenomenon as it occurred, by creating experiments designed to observe the expulsions and obtain samples of the liquid for analysis. The first of those case studies (Addiego, et al, 1981) involved only one subject. Specimens were “obtained by having the woman hold a clean glass firmly against the perineum while she lay in a supine position, knees flexed, with her feet resting on a bed.” 16 Analyses of the specimens showed that concentrations of prostatic acid phosphatase (PAP) were significantly higher while concentrations of urea and creatinine, primary components of urine, were significantly lower in the four expulsion specimens than in three urine specimens from the same subject. The authors concluded that, “the dissimilarity of chemical composition of the orgasmic expulsion and urine specimens indicates that the expulsion in this subject was not a manifestation of urinary incontinence.”17 They also hypothesized that “the expulsion is largely a glandular secretion” and that, “the PAP suggests that at least part of the glandular secretion came from prostatic tissue.”18
This study was later criticized for its collection procedures and for the tests used to determine levels of PAP in both the expulsion and urine specimens.19 PAP was later discovered to occur naturally in vaginal secretions.20 Also, the authors did not consider the possibility that part of the fluid might be coming from the bladder and mixing with any urethral gland expulsion in the urethra. To them it was a question of either the fluid was urine coming from the bladder or ejaculate coming from the urethral glands.
The next scientific effort to collect and analyze vaginal expulsions came in a study by Goldberg, et al (1983), of eleven women, six of who claimed to be ejaculators. Analysis of the expulsions of the six ejaculators “failed to detect elevated levels of prostatic acid phosphatase and the substance appeared similar in biochemical properties to urine.”21 However, this study, for the first time, suggested that “one alternative explanation for the existence of a ‘unique’ ejaculate is that the chemical composition of urine changes during sexual stimulation and excitement. Perhaps the ejaculate is merely an altered form of the woman’s urine.”22
Subsequent to the Goldberg study, Edwin G. Belzer, Jr., Beverly Whipple and William Moger, co-researchers with Addiego, et al (1981), released a study in 1984 involving seven women mentioned in Addiego but whose results were not reported because the specimens were “collected in the absence of the research team.”23 Because of concerns that the findings of Goldberg might discourage scientists from making the commitment of resources necessary to do further research, they decided to release the analyses of the specimens of the seven women. Some of the tests were incomplete as there were insufficient quantities of ejaculate to compare with the urine specimen. However, in three of the cases, acid phosphatase and glucose were reported to be present in greater quantities and urea and creatinine in lesser quantities in the ejaculate than in the urine sample. In the other four cases, acid phosphatase was detected in the ejaculate but not in the urine. These results were certainly more encouraging than those of Goldberg for those supporting the concept of “female ejaculation”.
The next major study of female vaginal expulsions with live subjects did not come until 1988. Milan Zaviacic, M. D., Ph.D., head of the Institute of Pathology, Comenius University Bratislava published a study of five women who were patients at a fertility department of a hospital of gynecology and obstetrics. Total samples from one of the participants and one of four samples from a second participant were collected in the laboratory. The rest were collected at the homes of the women and transported to the laboratory in ice. In four of the five cases, the samples were analyzed within three hours of collection, with the fifth subject’s specimens analyzed three months after collection. The results in all five cases showed a higher concentration of fructose in the ejaculate sample than in the urine sample. Zaviacic concluded that, “The determination of a higher fructose level in the ejaculate than in the urine suggests that the female ejaculate cannot be simply regarded as urine although urine is a regular component of the fluid of urethral expulsions at ejaculation.”24 Further, he states, “The release of fructose into the fluid of expulsions emphasizes the need to broaden our notion on the mechanism of the urethral ejaculation phenomenon in the female.”25
In a 1993 paper in the Journal of Sexual Research , Zaviacic states that, “The phenomenon of female ejaculation exists. Based on the previously mentioned research, one could conclude that some women expel a fluid from the urethra during sexual response that is similar to urine and may be related to urinary stress incontinence, and others expel a fluid that is different from urine.”26
PARAURETHRAL AND PERIURETHRAL GLANDS AND DUCTS
First, it is necessary to define terms. Para means “near, alongside of, a departure from the normal.” Peri means “around and about.”27 When used to describe the ducts and glands of the urethra, both are not as precise as simply referring to the ducts and glands that surround the urethra. However, to avoid confusion and not to hang up on semantics, for purposes of the literature review, they will be used interchangeably in whatever form was used by the individual authors.
Again, there were references by both Galen and Aristotle to the “female” prostate. As discussed earlier, De Graaf, in his 1672 work, New Treatise, Concerning the Generative Organs of Women, describes with detailed drawings, a “female” prostatae or corpus glandulosum.28 This clearly was the existing paradigm for more than two hundred years.
Modern science first began to address the question of the nature of the urethral ducts and glands in 1880. In that year Alexander Skene, M. D., professor of gynecology in the Long Island College Hospital in Brooklyn, New York, wrote a paper describing various glands and ducts surrounding the female urethra. He made diagrams of these glands and, subsequently, they were named for him.29 Later, in 1922, Franklin P. Johnson, M. D., made a case for the urethral glands and the urogenital sinus glands (Skene’s glands) being homologous to the prostate gland in the male. He goes on to detail the nature of these structures and speculates that they were capable of a secretion into the urethra but that they appeared to have no current anatomical function.30
Almost twenty years later, in 1941, George Caldwell, M. D., wrote that Skene’s glands could vary in degree of development from woman to woman. Further, he stated, “they possess a structure and elaborate a secretion comparable only to the prostatic glands of the male.... They are embryonic remnants which may have no essential function in the female, but which are apparently capable of some response to functional stimuli in the normal female, as indicated by the frequent occurrence of retained secretion within the glands.”31
In 1943, John Huffman, M. D., an obstetrician and gynecologist, conducted research on Skene’s glands and came to the conclusion that the extent of the glands and ducts surrounding the urethra had been greatly underestimated by Skene.32 In 1948, Huffman wrote that he saw general acceptance of the paraurethral ducts and their glands being homologues of the prostate, but the extent and detailed anatomy of those structures remained controversial.33
In 1953, Samuel Berkow, M. D., a urologist, came to the conclusion that the tissue of Skene’s glands was erectile and could be viewed as a “corpus spongeosum.” However, Berkow’s primary interest was in urination and he believed that the function of the “erectile tissue” was to pinch off the urethra in order to control urination. He never explored the question of under what conditions it would become erect.34
It should be noted that Skene, Johnson, Caldwell, Huffman and Berkow all represented mainstream medical thought and were published in such prestigious journals as The American Journal of Obstetrics and Gynecology, The Archives of Surgery and The Journal of Urology. Conspicuously absent from the literature review for this period of time were any articles criticizing their conclusions. These are all articles that medical students were, and still are, required to read.
In the early 1980’s, there were several papers written regarding immunohistochemical identification of prostatic acid phosphatase (PAP) and prostate specific antigen (PSA) in the female paraurethral and/or periurethral glands and ducts. In 1984, Pollen and Dreilinger found the presence of periurethral glands in seven out of ten women whose urethras were examined at autopsy. In all of the seven cases where the glands were found, immunoperoxidase staining showed a positive reaction for the presence of PAP in the glandular acini. A positive reaction for PSA was observed in four out of seven of the cases. The authors concluded that their findings supported the existence of a female homologue of the male prostate.35
Tepper, et al, (1984) found the presence of paraurethral glands in 18 out of 19 women, age 0-86 at autopsy, and a positive tissue reaction to PSA in 83% of the cases and to PAP in 67%. They concluded that their “study demonstrates the homologous nature of the female paraurethral glands and the prostate and supports speculations about functional similarity.”36
In 1984 and 1985, Zaviacic released the results of studies utilizing autopsies of fourteen women of childbearing age, chosen randomly, who had died of accidental causes and upon whom autopsies were carried out within eight hours following death. In these studies, Zaviacic found the presence of the same fifteen enzymes in the female urethral tissue that are also present in the male prostate. Furthermore, Zaviacic states, “In some of the analyzed cases, however, the glands or ducts were observed only in some histological sections, while in others no components of the female prostate could be found. In these cases the volume and secretory capacity of the female prostate must be minimal. On the other hand, in some women such rich conglomerates of prostatic glands filled with secretion were found that on histologic examination these pictures might easily be mistaken for male prostatic tissue.”37 To summarize his findings as to the paraurethral glands and ducts, Zaviacic concluded that what had been called Skene’s glands and/or paraurethral ducts and glands are, in fact, not a vestigial homologue of the male prostate but, instead, a “small, functional organ that produces female prostatic secretion and possesses cells with neuroendocrine function, comparable to the male prostate.”38
THE G SPOT
Perhaps the most misunderstood area in the three seemingly interconnected subjects of vaginal expulsions, the urethral glands and ducts, and the G spot, is the G spot. The term was first introduced to the public at large in the book, The G Spot and Other Recent Discoveries About Human Sexuality. It referred to a 1950 article in the International Journal of Sexology in which Ernst Gräfenberg, M. D., an ob/gyn, wrote about, among other things, erotic sensitivity in the anterior vaginal wall. He clearly states that it is his opinion that what he is feeling through the anterior vaginal wall is erectile tissue like the “corpora cavernosa.” He states that during sexual arousal “the female urethra begins to enlarge and can be felt easily. It swells out greatly at the end of orgasm. The most stimulating part is located at the posterior urethra where it arises from the neck of the bladder.”39 At no time in his article does Gräfenberg use the word “spot.”
In the book, The G Spot and Other Recent Discoveries About Human Sexuality, there is a reference on page 45 on how to find the G spot. It reads “To the finger, the G spot feels like a small bean, and, when stimulated, it may swell to the size of a dime or sometimes becomes as large as a half dollar.” While the authors make clear, if you read their entire book, that they also feel that the G spot is the place on the anterior wall of the vagina where the tissue surrounding the urethra can be felt, the popular press has promulgated the notion of a “spot.” As has been noted in the earlier literature review section on the female urethral glands and ducts, the size and development of these tissues will vary greatly from woman to woman and will change during arousal. The search for a “spot” on the anterior wall of the vagina as opposed to through the anterior wall as in the preceding definition, may be contributing to the difficulty of finding the “G spot.”
One particularly concise and accurate definition of the G spot appears in Our Sexuality (Crooks & Baur), a widely used college text on human sexuality:
“The Gräfenberg spot is an area located within the anterior (or front) wall of the vagina, about one centimetre from the surface and one-third to one-half way in from the vaginal opening. It is reported to consist of a system of glands (Skene’s glands) and ducts that surround the urethra. This area is believed to be the female counterpart of the male prostate gland and to develop from the same embryonic tissue.”40
There have been studies that have indicated that the stimulation of the G spot by itself may induce an orgasm that feels different to women than a clitoral orgasm and, as Gräfenberg previously observed, may induce an expulsion of fluid through the urethra at orgasm. In 1988, Zaviacic examined and stimulated the G spot of 27 women patients who volunteered for the study believing that their participation would assist in finding the cause of their sterility. Ten of the 27 women (37%) were induced to have urethral expulsions. However, there was a wide variation in the amount of stimulation required before the expulsion.41 There were also other studies which indicated “stimulation of the anterior vaginal wall is clearly not a prerequisite to ejaculation, although the data suggest it may be facilitated by this type of stimulation.”42
5. De Graaf, pgs. 103-104
6. Sevely and Bennnett, pg. 5
7. Gräfenberg, pg. 147
8. Kinsey, Alfred, Sexual Behavior in the Human Female, pgs. 634-635
9. Masters and Johnson, Human Sexual Response, pg. 135
10. Masters and Johnson, Masters and Johnson on Sexuality and Human Loving, pgs. 69-70
11. Ibid., pg. 70
12. Davidson, et al and Darling, et al
13. Darling, et al, pgs. 37-38
14. Ibid., pg. 40
15. Davidson, et al, pg. 110
16. Addiego, et al, pg. 17
17. Addiego, et al, pg. 19
18. Ibid., pg. 19
19. Alzate and Hock, pg. 217
20. Gomez, et al, pg. 430
21. Goldberg, et al (1983), pg. 27
22. Goldberg, et al, pg. 31
23. Belzer, Whipple and Moger, pg. 403
24. Zaviacic, et al, 1988, pg. 323
25. Ibid., pg. 324
26. Zaviacic & Whipple, pg. 150
27. Huffman, 1948, pg. 97
28. De Graaf, pg. 104
29. Skene, pgs. 265-270
30. Johnson, pgs. 18-33
31. Caldwell, pg. 631-632
32. Huffman, 1943, pgs. 783-784
33. Huffman, 1948, PG. 97-98
34. Berkow, 1953, pg. 350
35. Pollen and Dreilinger, pg. 303
36. Tepper, et al, pg. 423
37. Zaviacic, 1985, pg. 28
38. Zaviacic and Whipple, pg. 149
39. Gräfenberg, pg. 146
40. Crooks and Baur, pgs. 206-208
41. Zaviacic, Journal of Sex Research, 1988, pg. 311.
42. Bullough, et al, 1984, pg. 59
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