Fluid Expulsion During Female Sexual Activiy - A Journal Article I Read

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J Sex Med.2013 Jul;10(7):1682-91. 2013 May 1.
Female ejaculation orgasm vs. coital incontinence: a systematic review. Pastor Z

So this is another installment of A Journal Article I Read. Let's get right down to it. This is a review article, which means it's not about a study the author did. The author simply looks at the articles that exist on a particular subject and discusses where there is agreement and where there is not, and then gives a conclusion, given the current scientific understanding, about the topic in question.

I very much like a review because it's kind of what science is all about. One study is one study - might be useful, might be a bit of an anomaly, might be bullshit. However, looking at many studies on a topic from all different directions, with different biases and methods and disciplines involved - now that is the way to get to the bottom of something.

This article does, in fact, try to get as close to the bottom of a thing as it can - which isn't really very far given the lack of high quality studies to go from, but in the right direction none the less. It's about liquid coming out of women during sexual activity - what the hell is it and why does it happen? It's a fair question. Not only are there women who report that something spurts out of them during certain sexual activity or orgasm, but there is also objective documentation of this in a lab situation. The problem is, it's hard to categorize it all as one thing because the timing of the expelling of liquid (during orgasm, arousal, penetration?) and the amount and make-up of the liquid seems to be quite variable. Currently there seems to be a few different ways that studies describe liquid expelling from women during the ol' sex and some are sexual releases or arousal related and some are due to Coital Incontinence (CI), otherwise known as some pee escaping during the sex. So, this article aims to see what the existing studies on liquid expulsion have shown so far.

The author used a variety of terms were used to search through literature databases, and anything that focused on "evaluating fluid expulsion occurring during female sexual activity or describing types of CI, including characteristics, quantity, and composition of the fluid and mechanism of leakage" were used. In the end 46 studies were evaluated including 4 reviews - and 4 books were also used.

So types of fluid expulsion:

First off, we're not really talking about vaginal lubrication here. Vag lube is a fluid that is emitted from the walls of the vagina during arousal. Although, a lack of this fluid can be problematic for some women, increased lube doesn't cause a problem and is considered a discharge more than a gush. Apparently Alfred Kinsey and his crew suggested that lubrication could be forced out through contractions of the perivaginal muscles thus resembling Female Ejaculation (FE). However, there is no actual evidence of an "expulsion" of this kind happening. The authors here talk about vaginal lube very quickly at the beginning of the article in much the same way I do above, but the focus of this article is liquid that comes out of the urethral opening - or as I like to call it the ol' pee hole. I want to mention this because this can be confusing. A lot of people think women actually pee out of the vagina or ejaculate out of the vagina, but we don't. We have a pee hole down there for that, and if you didn't know that, don't worry, you are very much not alone. I used to (into my 20's really) think I peed out of my clit, but that's another story.

So anyway, here's just that basics - because to really give you all the nuances- and there are a lot, you would just need to read the article in its entirety - which I suggest you do if you have any further questions or are interested in this kind of thing. Anyway, the body of evidence so far seems to suggest that the quantity and composition are kinda good indicators of where the fluid is coming from and what it's all about.

Here's the kinda flow chart that was made for the different categories of fluid.

 Female ejaculation orgasm vs. coital incontinence: a systematic review. Pastor Z J Sex Med.2013 Jul;10(7):1682-91. 2013 May 1.

1. Female Ejaculation (FE) - A little bit of milky white fluid that contains some prostate enzymes and sugars also seen in male ejaculate. This likely originates from the female prostate (kinda similar to the male prostate before puberty) in response to clitoral or vaginal stimulation in some women or during orgasm. 
2. Squirting - A larger amount of fluid released that may be a chemically altered urine from the bladder. Some very small studies were done that emptied the bladder before orgasm and then checked the make-up of the fluid released during squirting. It did have a little bit of uric acid and urea, but it also had some sugars and prostate enzymes. It was not urine, but probably came from the bladder. The mechanism for how this happens - even after the bladder is drained, is not fully understood. It seems to be a clear liquid that doesn't smell like pee.
3. The other possible fluid release is basically urine. It can happen during arousal, stimulation, penetration and orgasm. There is some speculation in different studies about what types of problems (stress urinary incontinence or detruser over activity for instance) are most likely to cause urine leakage during which sexual activities, but there is little agreement. This type of fluid looks chemically like urine, though.

Here's the table showing the chemical make-up of the different categories of fluid.

Female ejaculation orgasm vs. coital incontinence: a systematic review. Pastor ZJ Sex Med.2013 Jul;10(7):1682-91. 2013 May 1.

Other things this article said were suggested from the studies so far:

• Women who squirt or ejaculate as described above don't generally have issues with incontinence, but women who have urine leakage do tend to. 
• I noticed from the article that the estimates of the percentage of women who complain of urine leakage during sexual activity varies wildly, but it seemed to me it's not insignificant...my point being that it seems to be a fair amount of women, so if this is you - you're not alone by any means.
• There are clearly some women who naturally have fluid release in relation to certain stimulation or orgasms, but it doesn't seem to be a very high number of women.
• A lot of the studies don't involve solid clinical evidence: "Only eight studies objectively confirmed FE in a total of 52 respondents. Studies reporting a higher prevalence of FE in hundreds of cases were based on questionnaire studies or anecdotal evidence" 
• "A consensus regarding terminology and classification may contribute to more precise diagnosis and provision of correct information to both healthcare professionals and the public." - I mean, right?
• There are better studies about this stuff that can and should be done. They may not be super easy, but good science never is...usually...I think.

So that's the very basics. I know some people can tend to get a little defensive and worried when it comes to defining fluid during sexual activity - given that ejaculation/squirting has and still is misunderstood. However, I hope everyone can recognize that gaining knowledge through good research on this topic is important, and that we can all figure out how to be tolerant and accepting no matter what things are learned as more research is done.