Welcome back to An Article I Read. In this series I read a peer reviewed journal article that relates to female orgasm, and then I write a summary of it for you. I do my best to be thorough, but I also try to make it shorter and more comprehensible than reading the actual article. I do a lot of googling and re-reading in my attempt at achieving that, but still this is by far my favorite series in this blog. I wish I had more time for these. I will also give you my opinion about the article, but when I do, it will be clearly marked under a heading ('My opinion' for instance might be one such heading) or I will put them into these brackets [me: ] so that you know it's my opinion and not something in the article. Otherwise, everything I write will be as best a summary of something said in the article as I can do.
Anatomy of Sex: Revision of the New Anatomical Terms Used for the Clitoris and the Female Orgasm by Sexologists
Vincenzo Pupp and Giulia Puppo Clinical Anatomy 28:293-304 2015
So, this is one I've been wanting to do for quite a while. Vincenzo and Giulia Puppo are Italian scientists that, if you ask me, are dropping scientific truth bombs on the world of lady-gasm research. They will have none of this willy-nilly assuming about orgasms caused by stimulation inside the vagina because, well, anatomy. It doesn't make anatomical sense, and the Puppos tell us why.
Vincenzo actually contacted me after my critique of the BBC article on female orgasm got a little traction a couple years back and told me he was interviewed for that article, but he didn't end up in the final release. There may have been unrelated reasons for this, but I'm here to say in no uncertain terms that the Puppo perspective on lady-gasm research is not in line with the current trajectory of the most outspoken scientists in the field, and I would not be surprised if there is serious shit-talk about the Puppos from other researchers in the field that gets them excluded from this and that.
In fact, their article I'm summarizing today elicited some backlash from one of the most pop-media famous female orgasm researchers out there, Barry Komisaruk. Here's his response letter* to the Scientific Journal that published this Puppo paper (BTW, Komisaruk's research papers he refers to in the letter, in my opinion, don't support the conclusions he gives them. I have summaries of both of the papers HERE and HERE). Here is Puppo's letter back to the Komisaruk letter. It's scientific journal fist-a-cuffs, and it's awesome. Awesome because it's damn well time for a more anatomically, realistically, physically logical perspective on female orgasm in the research world, and I praise the Puppos for standing up and challenging the status quo..
So, this article is actually available on the internet for free - which is fabulous for the people of the world - respect to the Puppos. It's also fabulous for me because I feel like I can slack off a little. I don't have to spend so much time presenting the details because you can just go check them yourself. I like that. It frees me up (I was still pretty long-winded though. Sorry).
The Quick And Dirty Version With My Opinions Included
The wierd, the exclamations, and the female penis
Let me just first say that this article is, how to say it...a bit wild. Like, there are numerous exclamation points here. I don't know if I've ever seen even 1 before in a peer reviewed journal article on female orgasm. There is also this thing where they call a particular group of lady parts 'the female penis.' So, before you get bothered (because people picked up on that real quick, and there was definitely some offense taken on that phrase alone), let me just tell you that this should all be taken in anatomical terms. It's hard to take the emotion out of lady-sex-parts naming, and I get why even calling something so important to women a female version of a male thing is annoying, but the truth is, the Puppos name it this because it makes anatomical sense. It's all the erectile parts in the lady junk that are embryonic-ally related to the parts in the penis: the clitoris, vestibular bulbs and pars intermedia, labia minora, and corpus spongiosum of the female urethra.
They're making the point that those are the actual parts related to arousal like in the penis, and then contrasting that to the random mix-up of other claims orgasm researchers are making about how the female anatomy all relates down there. I don't see this as them being sexist assholes at all. They just like to be real clear about how things are anatomically related. For instance: HERE's a letter they wrote to International Journal of Urology about an article on the prostatic utricle where they say this should more accurately be called the male vagina...and HERE is the authors writing back to say they "totally agree with the authors' precise opinions." and that it will be important to decide whether to call it both prostatic utricle and male vagina or just male vagina in the future. So, to me, the Puppos are just real precises about anatomy, and I think - you know - as scientists writing for scholarly purposes, they sure the fuck should be real precise.
It's a review about anatomy terminology, female orgasm, the g-spot, and some conditions
Anyway, I wanted to get that all out of the way before talking about the meat of the article because I don't want the terminology to overpower the other really thoughtful and important points this article makes. So let me go on. This article is a review of terminology used in other articles about female orgasm. It assesses if they make any damn sense and then uses anatomy and embryological development to support why or why not. They also clearly have an opinion that incorrect terminology is overall harmful to female ability to learn about our orgasms. Here's their introduction in its entirety.
Orgasm is a normal psycho-physiological function of humans: women have the right to feel sexual pleasure, and for this reason sexual medicine experts and sexologists must spread certainties on the biological basis of the female orgasm to all women, not hypotheses or personal opinions, and they must use scientific sexual terminology. The embryology, anatomy and physiology of the female erectile organs, triggers of orgasm, are often neglected by sexological and sexual medicine textbooks, and some researchers have proposed and divulged new anatomical and physiological terminology for the sexual response in women. The aim of this review is to clarify whether these new terms used for the clitoris and female orgasm by sexual medicine experts and sexologists have a scientific basis.I mean what's not to agree with here. They're basically saying that scientists should - like, oh I don't know - use scientifically accurate language when trying to talk scientifically about a thing. And, lets get real, this is particularly important when it comes to female orgasm, because frankly, women all over the world are suffering in a variety of ways because the information we get related to how we can orgasm, what body parts are involved in our orgasms, and why we orgasm so much less than we would like (or so much less our male counterparts) is incredibly confusing, often downright incorrect, and absolutely full of contradictions. This is something that affects a very deep part of women's lives and relationships, and it is hard to imagine a woman unaffected by this tornado of contradictory info. This is too important to allow misinformation and scientifically incorrect terminology in places like journal article, where the most rigorous science should be existing.
So here's the basics of the article bullet pointed for your convenience:
- The clitoris is an external organ with some hidden parts.
- The vestibular bulbs are the vestibular bulbs. They are not a new part of the clit discovered in 1998. They are anatomically separate from the clit. The analogous structures for both the clit and the vestibular bulbs in males are also separate pieces of anatomy, but sit against each other in the penis with the urethra running between them.
- The vagina is not anatomically related to the clit or the vestibular bulbs
- There is no thing analogous to the vagina in the penis, so including it as part of a 'clitoral complex' of some sort and comparing that to the penis is inaccurate.
- The clitoris, vestibular bulbs and pars intermedia, labia minora, and corpus spongiosum of the female urethra together can be called the female penis
- There is a thing that has been termed Persistent Genital Arousal Disorder (PGAD), but it's the same thing we call Priapsim in men and can be treated the same way. It is not about sexual arousal and is unwanted, so why make up a new name with arousal in the title for women? It's BS.
- The G-spot is not a thing - especially not a thing that causes orgasms: Scientists, even within a single paper, cannot agree on a single definition of it; One author of 3 peer-reviewed papers saying he proves the existence of the G-spot is actually a plastic surgeon that gives G-spot injections, a medically shady procedure. So, he's got crazy conflict of interest. Plus, he makes some ridiculously dumb mistakes in the articles; The 1981 paper coining the term 'g-spot' did not prove anything about a g-spot causing orgasm, used a subject that was maybe less than perfect for the study, and based a lot of ideas about this 'g-spot' on a 1950's paper that the Puppos say did not claim what the 1981 paper says it claimed.
- There is a female prostate, but female ejaculation might better be termed female emission. Also, the fact that women don't normally ejaculate during orgasm like men do might be why women are more likely to have multiple orgasms.
- Vaginal Orgasm does not exist: The vagina has no anatomical structure that can cause orgasm; Having an artificial vagina is no different in terms of orgasm than a regular ol' vagina; Women can orgasm with something in their vagina as long as their erectile tissue like the clit/vuvla etc. are being stimulated as well.
- We should be calling any orgasms women have 'female orgasm' because speaking about different types of orgasms is simply not accurate (I agree but think they overstep when they say why women who claim to have vaginal orgasm do so)
- My personal opinion - The Puppos made a badass, bold, and scientifically sensible statement about the silliness of the female-orgasm-research-field's obsession with the g-spot and the vaginal orgasm. They are making important and long overdue points that, it seems, others are either unwilling to say or just plain ignorant about.
ARTICLE SUMMARY
The authors of this paper (AKA the Puppos) begin by quoting the many times researchers used the terms 'inner' and 'outer clitoris' and the times that 'the inner clitoris' was pointed to as related to the g-spot or pleasure during vaginal penetration. They take these quotes from high-profile lady-gasm and female genital anatomy related articles (for instance like THIS one, THIS one, THIS one and THIS one).
They say the following:
The entire clitoris is an external genital organ: the glans and body covered by the prepuce are visible/free while the roots are hidden, so the “internal” clitoris does not exist.The vestibular bulbs are often now said to be part of the clitoris. [me: This came about, I believe, after the O'Connell's 1998 article that did an MRI and said the vestibular bulbs should be included as part of the clit. This might ring a bell for you because it's become common to include as a fact about the clit that its full structure was not even discovered until 1998. If true, that would be sad and appalling, but it's not really. Everyone knew of the clitoral structure and the vestibular bulbs. The only thing that happened in 1998 was that one researcher said they should be discussed as one anatomical unit...a controversial statement that the Puppos completely disagree with on basic anatomical terms]
The vestibular bulbs correspond to the bulb of the penis. They are two erectile organs situated in the anterior region of the perineum (i.e., bulbo-clitoral region), and they are covered by the bulbocavernosus muscles ...“Bulbs of the clitoris” is an incorrect term from an embryological and anatomical viewpoint. The bulbs do not in fact develop from the phallus and they do not belong to the clitoris (as the male bulb does not belong to the male corpora cavernosa): the correct term for these female structures is vestibular bulbs.Basically, the clit is the 1. glans that we see, 2. the body that extend from the glans back up a bit towards the belly button (you can feel it just under the skin above the glans an inch or so, about the size of a pencil. It can also be quite sensitive), and 3. the 'legs' or 'roots' that turn sharply and v off to extend down into the body.
In males the analogous structure (corpus cavernosa) is part of the penis. Just like in females it makes a sharp turn down into the body where the roots are hidden. However, in females the vestibular bulbs are erectile organs positioned just below the skin at the labia majora. In males the homolgous structure, the bulb of penis, also an erectile structure, is positioned next to the phallus inside the penis skin. So in both males and females the phallus is an outer organ that has roots extending into the body and the bulb (vestibular or of penis) are also just under the skin and cause swelling in the outer genitals...it's just in males, the bulbs are next to the phallus inside the penis....and it has the urethra moving through it.
Female Penis...not clitoral complex
The authors now look at all the times researchers talked about 'the clitoral complex' or 'the clitoro-Urethro-Vaginal (CUV) complex' in research papers and how that complex is analogous to the male penis and asks the questions...does it make any anatomical sense? [me: I think it's important to see the nuance of the Puppos's answer. They are not outright rejecting the idea that different parts of the female genital region are related. They are pointing out that how they are grouped and named is not based in anatomical reality.]
Firstly, and most importantly, they note that the vagina is a completely different and separate organ than the clit or the vestibular bulbs or the urethra, and that including the vagina into the 'clitoral complex' and then saying the complex is analogous to the penis is ridiculous because there is no homologous organ to the vagina in the penis (see again their letter about the male vagina above).
The female external genitals/vulva, i.e. labia majora and female erectile organs, at rest, are juxtaposed though separated by the vaginal opening, and correspond to the scrotum and penis of the male. The correct and simple anatomical term to describe the cluster of erectile tissues (i.e. clitoris, vestibular bulbs and pars intermedia, labia minora, and corpus spongiosum of the female urethra) responsible for female orgasm is 'female penis,'They also take issue with the lack of anatomical knowledge and presice-ness researchers use to try and describe a so-called clitoral or CUV complex. [me: and rightly so. Defining something with messy or imprecise boundaries is problematic indeed] In response to some of the quotes from other papers about the clitoral complex, etc., they write;
The definition of “clitoral complex” is based on the studies by O’Connell et al. (2008), but in this article, published by the Journal of Sexual Medicine, O’Connell et al. fail to describe the “anatomy of the distal vagina,” because nothing is written about the size of the“distal vagina” or its gross and microscopic anatomical structure! In addition: the female urethra is only 3- to 4-cm long and the authors do not clarify the meaning of “distal urethra”; they do not define the differences between the lateral and posterior walls of the vagina; there are no exocrine glands in the walls of the vagina; the labia minora and the vagina are not formed from the phallus; the clitoris is not “covered by the vulva,” it is a part of the vulva, and it does not lie deep to the vaginal wall mucosa laterally; the distal vagina is not the site of the female sexual response; the vagina and clitoris are two separate structures: the vagina has no anatomical relationship with the clitoris.So, one may not like calling it a 'female penis,' but if one is going to group pieces of the female genitals together and put them forth as a serious anatomical grouping, this is an anatomically accurate way to do this and CUV or clitoral complex is not.
[Me: I will say, I have often been perplexed by this clitoral complex or CUV phrase, and have seen it used to describe basically everything in the female genital region. I've personally always found it annoying because it gives the impression that everything in the so-called 'clitoral complex' is something that can be stimulated to orgasm...just because it has the word clitoral in its description. It just intensifies the confusion around female anatomy and female orgasm].
Female Priapism not PGAD
PGAD is Persistent Genital Arousal Disorder and basically is the same problem that in men we call Priapism - a persistent erection that continues hours beyond or is unassociated with sexual arousal. It is a rare but serious problem that if left untreated could do damage. After discussing some of the accepted treatments for and sub-categories of Priapism, the authors conclude the following, reminding us all that we as a culture love to complicate, sexualize, and 'discover' things about women's bodies in ways we don't for men:
The definition of persistent genital arousal disorder (PGAD) is equal to that of female priapism. PGAD is not a newly recognized condition, and if the “genital arousal” is unwanted, why use “arousal”? This term could suggest that women should end up feeling“abnormal” in regard to sexuality. Restless genital syndrome (ReGS) includes restless legs and/or an overactive bladder, and it can include PGAD but it cannot be defined as PGAD. Female priapism is a more accurate term than PGAD or ReGS. It is not a sexual medicine disease but a gynecological/urological dis-ease. Treatments prescribed for male priapism should be also be therapeutic for female priapism (Puppo,2013a,c).The G-Spot Does Not Exist. Is It a Scientific Fraud? [Me: this is the actual title of this section in the paper]
The Puppos' main point here is that a lot of scientist write about the idea of the G-spot as a place in the vagina that can cause orgasm, but that is not something that is backed by anatomy and scientific investigation. They further point out a few things:
1 The paper that coined the term G-spot in 1981 (you can see the full thing HERE - thanks to whatever hero printed it out and uploaded it for the world to see) was a case study of a woman that claimed to have an orgasmic response that resulted in expulsion of liquid that she had assumed was urine even though it did not appear to be urine.
The researchers did a pelvic examination on her in 1979 and were able to identify a raised spot in the vagina along the urethra that when stimulated at first felt like she had to pee, then felt pleasurable. However, the researchers found that contractions could not be felt in the spot either voluntarily or involuntarily. [Me: These researchers were likely looking for contractions so that they could make a correlation between this woman's claim of 'orgasm', that spot they felt (that they termed the 'g-spot'), and the physical markers of orgasm (rhythmic contractions of the pelvic muscles) that are well established in the scientific literature. They didn't seem to find that connection in this study - or in any study since, but that has not stopped them and other researchers from assuming or desperately reaching for those connections to this day].
The researchers also recorded a movie of this woman's vulva as her husband used his finger to stimulate her 'g-spot' (the lower end of her vagina towards her bellybutton and corresponding to the area against which the urethra lies). She claimed to have several 'orgasms' during this time; one after another with a brief time in between. [me: Although the researchers continue to use the word 'orgasm' to describe the sensation this woman was having, there is not data in this paper that indicated the physical elements of orgasm were observed or recorded- i.e rhythmic contractions of the pelvic muscles. However, when I looked back into the full text of this paper, I saw that the researchers did note that before these claims of orgasm there was one physiological change. They said that the area directly around the urethra became "clearly prominent and everted a few seconds prior to orgasm."]. Only the 1st 3 of the woman's 'orgasms' included liquid coming from the urethra. The others did not, but the woman said they all felt the same.
Okay, so the other thing is that the researchers noted that this woman had a grade 1 (mild) cystocele, which means that there was a tear or weakening on her vaginal wall that allowed a bit of the bladder to bulge into the vagina. The "g-spot" is also felt as a protruding bulge in a similar area of the vagina (lower anterior wall near the urethra), and the Puppos found it problematic that this 1 woman with this particular type of condition is the sole subject of this G-spot-discovering-paper.
Pawlik’s triangle, a region that corresponds to Lieutaud’s triangle in the bladder, is located on the anterior vaginal wall. The mucosa of this region of the anterior vaginal wall is smooth and has little resistance; hence, it can easily bulge into the vagina of a woman with a cystocele (Testut and Latarjet, 1972; Chiarugi and Bucciante, 1975; Puppo, 2013a, 2014b). Of all potential candidates to investigate for establishing the existence of an erotically sensitive spot in the vagina, it is quite surprising that Addiego et al. chose to report their findings from a woman with a cystocele. Such a woman is surely not the ideal subject for identifying an “erotically sensitive spot” or for detecting the G-spot.2 Going backwards a bit, there was a paper written in 1950 by a man named Grafenberg called, "The role of the urethra in female orgasm." This man, because of this paper, is what the G-spot was named after when 'the g-spot' was named in the 1981 paper discussed above. The Puppos tell us that the 1981 paper overreached in using the 1950 article to support their idea of a 'G-spot' in the vagina.
Grafenberg did not describe a vaginal spot in his 1950 article. In fact, the title of his article was “The role of the urethra in female orgasm,” not the role of the vagina in female orgasm.The Puppos go on to quote from the Grafenberg article showing that he described both the swelling of the tissue around the urethra that could be felt through the vaginal wall and an emission of fluid from some women through the urethra which Grafenberg believed to be "secretions of the intraurethral glands correlated with the erotogenic zone along the urethra in the anterior vaginal wall.”
Although Grafenberg did describe some cases of female and male urethral masturbation and illustrated the corpus spongiosum of the female urethra, he did not describe an orgasm of the intraurethral glands (or female prostate).
But for the 1981 article, the Puppos tell us,
Addiego et al. in 1981 made a hotchpotch of the thoughts and ideas set forth and expounded on pages 146 and 147 of Grafenberg’s 1950 article: the intraurethral glands are not the corpus spongiosum of the female urethra![me: 1. Love the exclamation mark. 2. I am a little confused about what significance the mix-up of intraurethral glands (which I believe is otherwise known as Skeen's gland) and the corpus spongiosum have to do with Puppos' point. I mean, I'm just barely getting through all the anatomy here, and I'm just still a little confused about where and how specifically Addiego et al. are off base in this particular instance. Puppos - if you are reading this and want to give me a lesson, I'd love it.]
3 Three papers out there proving the G-spot were written by a man, Ostrenzki, and they were just plain shoddy. His claims about finding the g-spot in a cadaver of an 83 year old woman and identifying the 'g-spot complex' are not backed up. He also just strait up makes unacceptable errors like saying that the "G-Spot gene' has been identified, which is completely wrong because he was referring to a thing in genetics that is called 'the g-spot' due to having 4 Guanines in a row (the G in ATCG - the 4 nucleic acids that make up DNA) - and has absolutely nothing to do with female sexual anatomy. Also, and this is a good topper, he claimed no conflict of interest at the end of his papers, but actually has a huge conflict of interest.
He is a plastic surgeon who profits heavily from g-spot injections meant to give women better orgasms. These injections are not based in science and a "Committee Opinion" from The American College of Gynecology and Obstetrics say these procedures could be dangerous and have no proven merit. The Puppos are not having his g-spot BS.
4 The Puppos also use a very popular and often cited article called, "Measurement of the thickness of the urethrovaginal space in women with or without vaginal orgasm," by Gravina et al. 2008 (which I write about HERE) to point out that scientists are all over the board when they describe/define the G-spot. They quote 3 descriptions of the G-spot within this 1 article. Each defines the G-spot differently and, the Puppos tell us, incorrectly.The G-spot has become the center of a multimillion dollar business: G-spot amplification, also called G-spot augmentation, G-Spotplasty or the G-shot, is a cosmetic surgery procedure for temporarily increasing the size and sensitivity of what some believe to be the G-spot, which is located about half way between the pubic bone and the cervix about 3 in. into the pelvis, in which a dermal filler or a collagen-like material is injected into the bladder-vaginal septum. If the supposed G-spot is located on the anterior vaginal wall between the vagina and the urethra, why is the dermal filler injected into the bladder-vaginal septum for G-spot amplification?
“Grafenberg described an erogenous zone located in the anterior vaginal wall and subsequent studies have correlated the focus of female sensitivity with the external urethral sphincter"[me: So this quote from by Gravina et al. 2008 places the G-spot in the anterior vaginal wall and on the pee hole maybe?]
"between the thickness of urethro-vaginal space, or G-spot"[me: this quote by Gravina et al. 2008 quote places the g-spot somewhere in the tissue between the vagina and the urethra]
"clitoris-urethrovaginal complex, also known as the G-spot"[me: and this Gravina et al. 2008 quote seems to place it in a general area close to where the clitoris (although I believe they are actually talking about the vestibular bulbs not the clitoris) is closest to the vagina and also kinda close to the urethra]
The Puppos also say this paper claims to have ultra-sound images of the G-spot, but that no such images were included in the article. Furthermore, the Puppos say the G-spot debate hit an unprofessional level when one of the authors of the above article, Dr. Jannini, blasted a peer-reviewed article in a respected journal. It was a review article by Dr. Terence Hines, and Jannini claimed that it was poorly researched and said that Hines was almost unknown in academic medicine and had never published in the field before. The Puppos thought that was unjustified and could be seen as offensive to both Dr. Hines and the American Journal of Obstetrics and Gynecology.
5 The authors also point out that in the book "The Science of Orgasm" by Komisaruk et al, they only passingly speak about the G-spot and conclude:
As so little is mentioned about the G-spot in such a thick, detailed book focused specifically on orgasm, one can only infer that the G-spot, if it does indeed exist, is devoid of importance in the female orgasm.[Me: If I were to guess, I'd think that the Puppos targeted this specific book out of all the books written out there about orgasm to speak on because Komisaruk is incredibly outspoken in mainstream media touting things like g-spot, cervical, and mental orgasms, and because his paper claiming to show that women with spinal injuries can orgasm without clitoral stimulation and via the vagus nerve through vaginal/cervical stimulation is widely cited in defense of the G-spot and vaginal orgasm (btw Komisaruk's paper does not actually support the claims he make -imo. I write about that article HERE). So, it seems like this is just a good old fashioned poke at Komisaruk]
Their g-spot conclusion
All published scientific data indicate that the G-spot does not exist (and the female prostate has no anatomical structure that can cause an orgasm)...The claims by Frank Addiego, Beverly Whipple ,Emmanuele Jannini, Odile Buisson, Helen O’Connell,Adam Ostrzenski, Susan Oakley, Christine Vaccaro, Journal of Sexual Medicine/Irwin Goldstein, Barry Komisaruk, Stuart Brody, Chiara Simonelli, and others, have no scientific basis (Puppo, 2013a,2014b).They also say this.
Orgasms with a finger in the vagina are possible in all women, but the partner must also move the hand in a circle to stimulate all the female erectile organs (Fig. 10) (from Puppo, 2011a, 2014b).
[me: So this is a little perplexing to me. Like, I'm down with the idea that all women are capable of orgasm because there is every indication that's true. But, why digress into asserting the specific way in which a hand must move to bring a woman to orgasm? It seems sensible to me to generically say what organs should be stimulated in order for a woman to orgasm, but getting into the specific hows seems to overreach. Plus, I'm confused at what they actually mean by move in a circle. My best guess given their discussion of orgasm and female anatomy thus far is that the Puppos are saying that if you are trying to orgasm with a finger in the vagina (as one might try to do after hearing about the 'g-spot'), then your best bet is not this 'g-spot' at all (given that it is not something real) but instead your best bet is to use the hand by jostling/touching the female erectile organs (i.e. clit, vestibular bulbs/labia) so that enough stimulation is created to allow orgasm. I mean the caption on the figure says stimulation of the female penis - which absolutely includes the clit and the labia, so that all makes sense to me. However, why so specific about moving the hand in circles in the text, but on the picture it just generically says 'moves the hand'? Anyway, I feel like this is an overstep.]
After discussing the anatomy around the urethra and pointing out where the female prostate is and how it can get the same diseases as the male prostate, they end this section by telling us that female secretions from the prostate probably corresponds to the emission phase of male ejaculation [me: which is the 1st part of ejaculation where the liquid begins to move. The 2nd part is ejaculation proper, where the liquid actually gets propelled forward].
They say female emission might be a better term than female ejaculation (although they note some women have a more powerful emission).
They also say that the lack of ejaculation phase in women might be the reason women don't have as much of a refractory period and are able to have multiple orgasms [me: men are also actually able to have multiple orgasms. The man in THIS study did so by holding off ejaculation until he orgasmed a couple times].
Vaginal Orgasm Does not Exist [me: again, their title - not mine]
The Puppos note that researchers often use terms like Vaginally Activated Orgasms (VAO) or Vaginal Orgasm (VO) to describe an orgasm caused by stimulation from vaginal penetration with no additional direct stimulation of the external clitoris, and that researchers will attribute things to a woman's ability to have this type of orgasm. For instance they note Nicholas's study on the ability to have 'vaginal orgasms' affecting a woman's walk (that I oh so enjoyed writing about HERE) or Brody's paper about ability for vaginal orgasms being discernible by the way a woman's lips look.
But the Puppos tell us quite frankly, "Vaginal orgasm has no scientific basis and the term was invented by Freud."
They then quote from the book Making Sex: Body and Gender from the Greeks to Freud. by T. Laqueur to point out that at the time Freud decided women should be having vaginal, not clitoral, orgasms, the medical community was not on the same page. The medical community seemed to have a clear understanding that female orgasm came from the clit and not the vagina.
The Puppos then go on to say,
The vagina has no anatomical structure that can cause an orgasm (and the vaginal–cervical genitosensory component of the vagus nerve is a hypothesis without scientific basis) (Puppo, 2011a,b, 2013a,2014a). In fact, in women with vaginal agenesis (con-genital absence of the vagina), the sexual responses of the artificial vagina are identical to those of the normal vagina (Supporting Information Video 1 online).[me: btw I believe the Puppos bring up the vaginal-cervical genitosensory component of the vagus nerve because in THIS study Komisaruk et al. hypothesized that the vagus nerve was the reason for the cervix-stimulated orgasms (completely physically unverified orgasms, I might add) had by 3 women with complete spinal cord injury. This study is often referenced to back up the idea that vaginal stimulation can cause orgasms (even though this study never physically verified that any orgasms actually happened...and the stimulation was super wierd...maybe read my summary on it). Anyway, that's why I think the Puppos made that aside.]
They then go on to point out that arousal and orgasm are the same for a vagina and an artificially created vagina. For both, lubrication seeps through the walls of the vagina at the first part of arousal; the erection of the vestibular bulbs (that sit on either side of the lower vagina) causes later stage arousal changes in the vaginal shape; the vulva lips deepen in color with impending orgasm; and when orgasm happens, the bulbocavenous muscles squeeze the lower part of the vagina in rhythmic contractions along with involuntary muscle contractions of other pelvic muscles. A fabricated vagina makes no real difference in the physiology of an orgasm.
[me: So I don't know where to find the supporting video (will post if I find it), but let me just speak quickly about an artificial vagina. I've wanted to know exactly what this meant ever since I read Master and Johnson's studies about how artificial vaginas react during orgasm and arousal. If you google that phrase, I'm afraid you will mostly find info about things for penises to masturbate into, so I dug slightly deeper, and here is a full article online about the creation of vaginas for women who were not born with either vagina or uterus. It helped me a bit. Getting an artificial vagina is more commonly referred to as vaginoplasty now days. This article says, "The vagina is a pliable, viscous, hollow organ, whose shape is determined by the surrounding structures and by its attachment to the pelvic wall. The vaginal wall is made up of the same layers as all hollow viscera (i.e. mucosa, submucosa, muscularis, and adventitia)." So, my understanding is that the 'artificial vagina' is commonly created with skin grafting in a space made between the bowels and the bladder. The skin then adapts to become normal vagina tissue. This study showed this transition to functional vaginal tissue happening within about 12 months. There is normal lubrication through the vaginal walls, normal pH, and normal bacterial growth. Anyway, I guess I just want everyone to know that an artificial vagina is not some robotic vagina, it is just the creation of a tube of tissue that acts just like a vagina in many ways, because the vagina is largely a simple tube of tissue.]
The Puppos then show quotes related to how the penis, during intercourse, might interact with the inner parts of the clit, how the inner parts of the clit might interact with the vagina, how the penis might press on or crush the Kobelt plexis, and how all that interaction from the penis in the vagina might be the cause of 'vaginal orgasm.' They use a few different peer reviewed articles to pull the quotes from including a couple often cited ones I wrote about HERE and HERE and a couple other often cited ones like THIS one and THIS one.
[me: So, Kobelt Plexus is a hard one to Google, but I believe - judging from the line in this book, that it is a group of veins also known as the pars intermedia of Kobelt (I assume after the old scientist who drew them in the first picture below) or just pars intermedia. It sets just under the surface of the clitoral glan, I think]
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| Dessin de Clitoris disséqué par Georg Ludwig Kobelt en 1844 |
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| Figure 11 from this Puppo article |
Regardless of the positioning of the clitoral body, the penis rarely comes into direct contact with the clitoral glans during active coition. In fact, clitoral retraction, which always develops during the plateau phase and elevates the clitoral body from its normal pudendal-overhang positioning, further removes the glans from even the theoretical possibility of direct penile contact (Masters and Johnson, 1966). The male penis cannot come into contact with the venous plexus of Kobelt or with the clitoris during vaginal intercourse; the Kobelt plexus cannot “play a part in the trigger of the vaginal orgasm,” it drains not toward the vaginal veins but towards the venous plexus on Santorini, and it cannot be compressed by the penis; the root of the clitoris cannot be stretched by the penis and the entire clitoris has no anatomical relationship with the anterior vaginal wall (Figs. 6 and 11) (Testut and Latarjet, 1972; Chiarugi and Bucciante, 1975; Standring, 2008; Paulsen and Waschke,2011; Puppo, 2013a, 2014a,c; Netter, 2014).The article then goes on to quote some articles about the 'sexual dysfunction' of premature ejaculation (PE), and reminds us that PE is only considered in cases of vaginal intercourse. They then point out that since 'vaginal orgasm' does not exist (meaning orgasm caused by stimulation inside the vagina with no additional clitoral stimulation), then PE is also a made-up problem. A man, in reality, could not be expected [Me: because physical realities of female orgasm] to 'give' a woman an orgasm with his penis, so it really doesn't matter how long his penis stays hard and pumps into her. Plus, a sexual dysfunction is a case in which ordinary sexual function is impaired, and PE is not that. The male sexual response works fine even if he orgasms a few seconds after insertion. It's just that in relation to the made-up idea of vaginal orgasm, ejaculating quickly seems insufficient.
The authors further remind us that sex doesn't have to stop with male ejaculation and that there are plenty of ways to continue on and get the women an orgasm.
Female Orgasm: A Scientific Term For All Women
The Puppos quote from the Dickenson's 1949 Atlas of Human Anatomy textbook [me: this book is from after Freud made his BS clit vs. vag orgasm claims, but before Masters and Johnson released actual research to prove it was BS]
Exalting vaginal orgasm while decrying clitoris satisfaction is found to beget much frustration. Orgasm is orgasm, however achieved.They then quoted Masters and Johnson speaking about the physical nature of female orgasm in their groundbreaking research on the physiology of orgasm and arousal. M&J assert that all female orgasms are physiologically the same no matter how the stimulation occurs.
The Puppos tell us:
The majority of women worldwide do not have orgasms during intercourse: as a matter of fact, female sexual dysfunctions are popular because they are based on something that does not exist, i.e. the vaginal orgasm. Sexual medicine experts, sexologists and psychologists must use the (scientific) term“female orgasm” (Fig. 12) (Puppo, 2011a, 2014a), so women worldwide will not feel inferior or abnormal for not reaching a “vaginal” orgasm or “vaginally activated orgasm,” and for the few women who report “vaginal” orgasms (they use the term because in the mass-media, and in sexual education, the sexologists use it), the use of “female orgasm” makes no difference!A few paragraphs earlier the Puppos also say:
The “vaginal” orgasm that some women report is always caused by the surrounding erectile organs (triggers of female orgasm) (Puppo, 2011a,b, 2013a,2014a).[me: I 10,000% agree with the Puppos assessment about how very few women even claim to have 'vaginal orgasms' and how likely it is for a woman to be assessed as having a sexual dysfunction just because she doesn't experience a vaginal orgasm - something that doesn't really even exist. However, I feel like the Puppos overreach a bit when they attempt to describe what is causing so-called 'vaginal orgasms' in women who say they have them or what women mean when they say or why they say they have "vaginal orgasms." The truth is, we don't have much data on what women mean when they say 'vaginal orgasm' because most researchers refuse to parse out how women's descriptions of their sexual climaxes match up to the physical things happening to their bodies when they have these experiences. It is very likely true that, as the Puppos assume, some women who say they are having a 'vaginal orgasm' are actually having an orgasm caused by simulation of tissue on the vulva, clit, etc. while having intercourse. However, it also might be true that some women who claim to have 'vaginal orgasms' are not having any physical orgasm at all and merely calling whatever sensation they are having a 'vaginal orgasm.' Other women might actually be experiencing ejaculation/emission instead of orgasm but calling it a 'vaginal orgasm.' Anyway, while I largely agree with the Puppos on almost everything, I think their assumptions about what is actually happening for women who claim to experience 'vaginal orgasm' are just that - assumptions. ]
The Puppos then tell us that female sexual satisfaction is based on orgasm and resolution, again using a quote from the 1949 Atlas of Human Anatomy to describe the number of bodily unpleasantness that can happen from women getting sexually aroused without the release of orgasm.
Conclusion
Here is the conclusion section in its entirely
Female orgasm is possible in all women, always with effective stimulation of the female erectile organs, e.g. the female penis, during masturbation, cunnilingus, partner masturbation, and also during vaginal/anal intercourse simply by stimulating the clitoris with a finger (Puppo, 2011a, 2013a). Masters and Johnson reported in 1966 on the importance of development by partners of specific coital techniques to facilitate clitoral stimulation and that the female superior coital position allows direct stimulation of the clitoris to be achieved easily with the fingers (Puppo,2014c, Free Audioslides).
As with “male orgasm,” “female orgasm” is the correct term. G-spot/vaginal/clitoral orgasm, vaginally activated orgasm, clitorally activated orgasm, clitoral or clitoris-urethra-vaginal complex, clitoral vagina, clitoral urethra, clitoral bulbs, clitoral raphe, internal clitoris, are without scientific basis and they not accepted by experts in human anatomy. Findings from the disciplines of embryology, anatomy, and physiology about the congestive structures of the vulva, which are homologous to men’s erectile organs, must form the basis of the biological discourses about the female orgasm.
MY FINAL THOUGHTS
I cannot tell you how much I love that these two scientists are assessing female orgasm research from a critical anatomical point of view. Words matter. They matter a lot, and for years scientists have been bending the language, in my opinion, in order to make the idea of a 'vaginal orgasm' seem more legit. I don't think that this bending has always been nefarious. I think part of it is just a natural tenancy for people to want to make connections that they believe are there. So, given that it is undisputed knowledge that stimulation of the clit can be orgasm inducing, then trying to connect (through language) the vagina and the penis during intercourse more closely to the clit can help to make sense of how this never-actually-verified-but-much-discussed 'vaginal orgasm' might work. So, I see why the language of female anatomy has been creeping this way, but it doesn't make it right. Women continue to be confused about how our orgasms work and how we might come to have an orgasm, and playing fast and loose with the language only makes it worse.
I will say this article covers a lot, and it's a little wild, full of exclamations marks and hard to follow (or at least it was for me). It oversteps at times when discussing specifics on what women actually mean when they say they have 'vaginal orgasms.' It uses the term 'female penis' which is absolutely sure to bring controversy (although it's not inaccurate). However, this paper is absolutely not off-base. It's perspective is unusual for lady-gasm research, but that's what makes it important. Any good scientific subject needs a robust variety of perspective and bias among the researchers and reviewers in the field, and lady-gasm research is long overdue for people who don't blindly accept vaginal orgasms or orgasm-giving-g-spots as reality...because frankly there has been no actual physical data that either exist in the many decades we've been discussing them.
The Puppos deep critique of the anatomical language in popular lady-gasm research puts significant cracks in the facade that so many lady-gasm researchers hid behind for decades. The Puppos seem to stick tight to anatomical/embryological knowledge and to a healthy skepticism of other scientists' conclusions. They call bull-shit!, or should I say they call baseless!, when they see it. I also think the Puppos perspective, which is pretty unique among this research field's big players, is so incredibly necessary right now to counteract the status quo of female orgasm research; to point out the lack that others have so often ignored, to give possibilities others have not thought of, to strengthen this field and push it to be better, more precise, and more robust.
The Puppos should not be ignored.
*The link doesn't seem to want to go to the pdf, although you can google the name and get to it easily, but for you convenience I added a snip of it below.
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