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| Alice Kahn Ladas, Ed.D.,
a principal author of the 1982 book, The
G-Spot and Other Recent Discoveries About Human Sexuality,
writes on the subject of The Gräfenberg Spot (G Spot) in Clinical
Monograph, #3, of the American Academy of Clinical Sexologists. She
discusses what it is, where it is located, its function and importance
for clinicians. She then goes on to discuss the phenomenon known as
"female ejaculation."
My doctoral research project, "Urethral Expulsions during Sensual Arousal and Bladder Catheterization in Seven Human Females," as well as the popularized version, Female Ejaculation and The G-Spot, written as a magazine article, deal with much of the same subject matter and come to some similar conclusions about the G "Spot." However, on the question of female ejaculation, we do have some differences. Dr. Ladas's perspective regarding Gräfenberg is an important one and one with which I totally concur. She states that the G "Spot" was a term coined by Whipple and Perry and is not actually a "spot" on the anterior(upper) wall of the vagina but instead is the prostatic-like tissue which surrounds the urethra and which can be stimulated through the anterior wall of the vagina. Dr. Ladas renames it as the "G area" while I prefer the term "G-Crest." The word 'Crest' is more useful as a description than "spot" or "area" because the swollen female urethral glands feel like a protruding ridge or crest. Furthermore, the word 'Crest' also invokes an image of rising sensual/sexual pleasure.
While many people have read or heard about Gräfenberg, few have read his actual words. In reality, Gräfenberg only uses the word "spot" twice and he uses it to make the opposite point to the way it has been popularly used. He states that "....there is no spot in the female body, from which sexual desire could not be aroused." and "Innumerable erotogenic spots are distributed all over the body, from where sexual satisfaction can be elicited; these are so many that we can almost say that there is no part of the female body which does not give sexual response, the partner has only to find the erotogenic zones." (1) Dr. Ladas accurately points out that, in order for the G area (Crest ) to become engorged enough for detection, it is usually necessary that the woman be already sexually aroused. It is also crucial that the woman has learned to be responsive to stimulation in that area. A good analogy that she uses is that, while all women have breasts, not all are responsive to breast stimulation.
Additionally, Dr. Ladas makes the same point that I have made which is that orgasms induced through stimulation of the G area (Crest ) feel different and utilize a different pathway than orgasms stimulated solely from the clitoris. Dr. Ladas accurately points out that G area (Crest ) orgasms and ejaculation can create very intense feelings and emotions and even the recall of repressed memories. Her conclusion, similar to mine, is that exploration of G area (Crest ) orgasms and ejaculation need to be done with extreme sensitivity, caring and the intention to create an environment where a woman feels emotionally and physically safe. Dr. Ladas also makes the point that it is important that women not make ejaculation a goal to be sought after but instead to focus on the pleasure being received. She formulates the idea of women teaching themselves how to ejaculate as part of the overall furtherance of each woman's unique sensual/sexual potential. Dr. Ladas concludes that the emission of fluid during sensual/sexual arousal is similar to ejaculation in the male. She also claims that the chemical content of the fluid is similar to male prostatic fluid without semen but cites no specific references to support her conclusion. Furthermore, Dr. Ladas states that studies done after the publication of The G-Spot and Other Recent Discoveries About Human Sexuality found the chemical content of the female ejaculate to contain "many chemical substances similar to male ejaculate without the sperm." While this is certainly a logical interpretation of those studies as well as the previous literature, it is not the way that a scientific paradigm is changed. What will be required to support the conclusion that the chemical content of female "ejaculate" is similar to male ejaculate without the sperm will be the identification of a clearly unambiguous prostatic marker.
The methodology that has been employed in studies previous to mine has been to attempt to detect the presence of either fructose or Prostatic Acid Phosphatase as that unambiguous prostatic marker. These studies monitored the levels of one or the other in both urine specimens and ejaculate of the women subjects. The presence of a higher level of either fructose or Prostatic Acid Phosphatase in the ejaculate was used to conclude that the ejaculate had prostatic components. Their conclusions were further reinforced if the ejaculate was found to have lower levels of urea and creatinine, prime components of urine, than present in the urine sample.(2,3,4,5) The problem is that fructose appears naturally in urine and Prostatic Acid Phosphatase appears naturally in vaginal secretions. (6) The differences in their levels, particularly when the urethra was not segregated from the bladder make it impossible to determine with scientific certainty that the changes are being caused by a release from the urethral (Skene's) glands. There are simply other possible explanations for the differences. Also, the individual test results in the previous studies were sometimes inconsistent and not uniform. (8)
Dr. Ladas concludes her article with the proviso that "the source of female ejaculate is not definitely determined so it is premature to state that the female prostate is the sole source of female ejaculation." Overall, however, she appears to fall into the presumption made by many who have addressed this issue, that the ejaculate is either urine or prostatic fluid. In my study, having segregated the urethra from the bladder, we observed, at least for our seven subjects, that more than 95% of the fluid expelled during sexual arousal originated I n the bladder. However, that fluid contained an average of only 25% of the amounts of urea and creatinine found in the subjects' baseline urine samples. We theorized that it may lose the appearance and smell of urine due to the secretion of the hormone aldosterone during sensual/sexual arousal, causing the re-absorption of sodium and the excretion of potassium by the kidneys. (9) Furthermore, I found research material indicating that an involuntary opening of the bladder sphincter can be triggered with stimulation of either the G-Crest or the clitoris or both simultaneously. (10) Additionally, on five occasions we observed a small milky discharge from the urethra which may mix in the urethra with the fluid from the bladder. So it is possible that the ejaculatory fluid originates not from either the bladder or the urethral glands, but from both.
My project was an Ed.D. exploratory research experiment and not a dissertation. It was the viability of the catheterization procedure utilizing human subjects that was of primary importance. Sometimes the laboratory results overshadowed that because of the high interest in the previously unanswered questions regarding female ejaculation.. I simply conducted the experiment, reported the results, and gave my opinion as to possible conclusions. The key issue is whether the experiment can be replicated, verified and independently confirmed, with improved tests based upon what was learned from the first seven women. I think there is no question that can be done. For some time, I have been desirous of retesting two of my women subjects in the offices of a local female OB/GYN who is also Board Certified in Urology. We would again utilize the catheter to segregate the bladder from the urethra but this time we would monitor fluid intake for the 24 hours prior to the test. We would also test by blood draw and/or urinalysis for evidence of increased levels of aldosterone during arousal. In addition we would test for Osmolality (concentration of urine particles) as well as urea and creatinine levels in the baseline urine specimen, the fluid drained by the Foley catheter after insertion, any fluid subsequently expelled into the new storage bag during arousal, any fluid expelled from the urethra outside of the catheter tube and an additional urine sample taken one hour after conclusion of the experiment.
Dr. Milan Zaviaccic, who was very complimentary of both my experiment and my speculation regarding aldosterone, is close to isolation of the P-1 protein in Prostate Specific Antigens in the female urethral glands. This is the unambiguous prostatic marker that has been needed as a tool to resolve the biological questions. It will then be possible to test for the presence of P-1 in both the fluid coming through the catheter tube into the storage bag and from any expulsion of fluid from the urethra outside of the catheter tube such as we have observed in our experiment and which was recorded on videotape. I believe that we are incredibly close to a resolution of this long-term controversy regarding "female ejaculation" through a combination of Dr. Zaviaccic's isolation of the P-1 protein and the "Schubach" catheterization procedure. The resolution of these biological issues is important in terms of the evolution of our knowledge regarding human sexual response.
If it should turn out that medical science has underestimated the sexual capabilities of women's bodies by portraying pleasurable sexual activities like female ejaculation as abnormal and/or imagined, it could have a significant effect on women's views of their sexuality. If the new evidence about these expulsions demonstrates that they are natural sexual bodily functions, then many women could be free of guilt and shame about expelling fluid during sex. However, regardless of the composition of the fluid, the most important issue to me as a sex educator still is how women feel about their sexuality, their bodies and all fluids that come from them.
END NOTES (1) Gräfenberg, E. The role of urethra in female orgasm. International Journal of Sexology, 3: 145-148, 1950. (2) Addiego, F., Belzer; E. G., Jr.; Comolli, J., Moger, W., Perry, J. D. and Whipple, B. Female ejaculation: a case study. The Journal of Sex Research, 17: 13-21, 1981. (3) Belzer, E. G., Jr., Whipple, B. and Moger, W. On female ejaculation. The Journal of Sex Research, (20-4): 403-406, November, 1984. (4) Goldberg, D. C., Whipple, B., Fishkin, R. E., Waxman, H., Fink, P. J. and Weisberg, M. The GräfenberG-Spot and female ejaculation. The Journal of Sex and Marital Therapy, 9 (1): 27-37, Spring, 1983. (5) Zaviaccic, M., Dolezalova, S., Holoman, I. K., Zaviacicova, A., Mikulecky, M. and Brazdil. Concentrations of fructose in female ejaculate and urine: a comparative biochemical study. The Journal of Sex Research, 24: 319 - 325, 1988. (6) Gomez, R. R., Wunsch, C. D., Davis, J. H. and Hicks, D. J. Qualitative and quantitative determinations of acid phosphatase activity in vaginal washings. American Journal of Clinical Pathology, 64: 423-432, 1975. (7) Graves, M.D., M.P.H., H. C. B., Sensabaugh, D. Crim., G. G., and Blake, D. Crim., E. T. Postcoital detection of a male-specific semen protein. New England Journal of Medicine, 312 (6): 338-343, 1985. (8) Goldberg, et al. (9) Normal Renal Function, pg. 88, in Smith's General Urology. Norwalk, Connecticut: Appleton & Lange, 1995 (10) Tanagho, E. A., M.D. and McAninch, J. W., M.D. Smith's General Urology. Norwalk, Connecticut: Appleton & Lange, 1995, Table 30-5, pg. 539. |
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