Showing posts with label Pauls. Show all posts
Showing posts with label Pauls. Show all posts

8.05.2015

Hey BBC - The Female Orgasm Is Actually Not A Mystery!



Those of you that have been reading this blog or have seen our movie, Science, Sex and the Ladies, could probably guess where my gripes with the BBC article, "The Mystery of the Female Orgasm." begin - THE FEMALE ORGASM IS NOT A MYSTERY.

Reading that article would lead one to believe that the lady-gasm is incredibly complicated to figure out in the ol' bedroom, that it revolves around the vagina, that science doesn't have a clue what it even is, and that only quite recently have scientists really begun to find any answers. All of that is utterly incorrect. The female orgasm is no more complicated than the male orgasm. It revolves around the external clitoral glans. Science has had this shit pretty solidly figured out since about 1966 - about as long as it's had the male orgasm figured out, and all of the exciting new studies in this article that are supposedly cracking this female-orgasm thing wide open: Well, actually they're better categorized as studies that focus on fringe ideas about female orgasm - speculating about ways of coming that have never been verified in scientific literature.

The 'orgasms' this article focuses on are G-spot orgasms, vaginal orgasm, and orgasm from inner clitoral leg or cervical stimulation. These are just things people talk about. There is no scientific proof that they exist. Seriously, an orgasm caused this way has never been observed or recorded in science, not even in the scientific research this BBC article references. In the same way, for men, spiritual orgasms, orgasms from anal sex, prostate stimulated orgasms, and mental orgasms are just things that people talk about. They are not actual orgasms well documented in scientific literature. The big difference here is that an article about male orgasm would treat these things as the  fringe hearsay that they are, and an article about the female orgasm treats these as what female orgasm is.

I honestly don't want to blame the author of this article or the BBC for this. It's bigger than them. This article flies because it is the status quo. It is what people understand about female orgasm. I will put a touch of blame on the scientists interviewed for this article. I know they have to at least be aware that vaginally induced orgasms have never been physically verified in science, and I know they know that their research does not prove this orgasm exists, but only speculates about how this orgasm might happen if it exists. And if they are not aware of this, may I be so bold as to say that they should probably become a bit more thoughtful about what exactly they are researching?

So, let me re-write this article for you:

Hi Everyone! BBC Future presents: The Female Orgasm - It Ain't Such a Mystery (my re-write)

Lady-gasms?!? What Are Them Things?
Orgasm is the rhythmic release of the pelvic muscle tension created during arousal, and it is caused by sufficient stimulation of the penis or the clitoral glans/vulva area. It's the same for all sexes, all genders, trans people, gay people, straight people, intersex people - you name em' if they got something that is like a penis or a clitoral glans, then it can be stimulated to orgasm. Males generally trigger ejaculation at orgasm, but orgasms and ejaculation are 2 different things and can be experienced separately. It is possible for men to have multiple orgasms if they are able to hold off ejaculation until they orgasm a couple times, although it doesn't seem to be common. They are also able to ejaculate w/o orgasm, sometimes due to prostate (G-spot) stimulation through the anus. It seems some women can ejaculate through direct stimulation of their G-spot, which is the sorta female version of the male prostate that surrounds the urethra that can be felt through the vaginal wall. Although this doesn't seem to be super common either - and it has never been shown to cause an orgasm. Add in some clitoral stimulation, though, with the G-spot stimulation and a woman might be able to orgasm and ejaculate at the same time. Although it is possible for both men and women to ejaculate, it is the orgasm that is that release of muscle tension pent up through arousal.

Now, let's go back a bit. A person first needs to be aroused before he or she can orgasm. Any ol' stimulus can arouse; smell, touch, sound, sight. It's incredibly individual and has everything to do with a person's culture, past experiences, and state of mind (I'd argue our culture creates a lot more barriers to female arousal than to male), but once the arousal happens, our bodies all react quite similarly. An increase of blood flow begins to makes the penis hard and lubrication seep through the walls of the vagina and for the inner clitoral legs swell. Ladies and gentlemen both have a similar amount of blood pooling in the groin. We just see men's more easily. Then if arousal is continued and if there is appropriate stimulation to either the penis or the clitoral glans, an orgasm will occur. The pelvic muscle of men and women alike will rhythmically release that tension. It is recordable, predictable, and no knowledgeable researcher out there would deny that this can be described as an orgasm.

What About Vaginal Orgasms?!?
There is a minority of women who claim to orgasm from vaginal stimulation alone. Although women's claims should never be disregarded, it is important to realize that this type of orgasm has never actually been observed and recorded in scientific literature, and it's possible that at least some of these claims involve the use of the word 'orgasm' to mean something other than the physical orgasm that can be identified through rhythmic pelvic muscular activity. It's actually possible that an orgasm caused only by stimulation inside the vagina is merely a myth made up by Freud. As some Italian researchers pointed out just this year as part of their criticism of the re-naming of female genitals and female sexual response happening in a lot of recent research on female sexual response, "(Komisaruk) ignores the fact that 'vaginal orgasm' has no scientific basis; the term was invented by Freud in 1905, and medical authorities writing in French, German, and English during Freud's time were unanimous in holding that female pleasure originated in the structures of the vulva generally and in the clitoris specifically. No alternative sites were proposed."  (Puppo 291)

In fact, in 1966 researchers Masters and Johnson released Human Sexual Response, a large, groundbreaking study that described arousal and orgasm in both men and women. Their findings are still important and relevant, and they unequivocally said that all female orgasms resulted from stimulation of the clitoral glans, laying to rest Freud's vaginal orgasm. Since the time Masters and Johnson released their work, there have been over 40 year of studies investigating what might cause a vaginal orgasm, but not a one of those studies has actually documented a vaginal orgasm. That's a lot of years that have gone by with absolutely no proof, and it's not particularly hard to get the proof. Recording the rhythmic pelvic muscle activity during orgasm is completely possible to do. It's probably even easier to do now than it was in M&J's time. Studies have done it plenty of times, further corroborating Master and Johnson's findings. Strange that this has not happened for vaginally stimulated orgasm. If these orgasms do exist, they are yet undocumented, and likely even less common than we now believe them to be - certainly a fringe situation.

My Critique From The Beginning of the BBC Article to End

The article begins with anecdotes and metaphors creating a sentiment that can basically be summed up by the picture below.


Then, the article tells us "It's a stark contrast to a man's experience; so long as they can get an erection, a few minutes of vigorous stimulation generally results in ejaculation."

Okay,
1. An erection means a man is aroused, and similarly, as long a woman can get aroused, she too needs only a few minutes of vigorous stimulation in order to come. (Seriously, women can masturbate to orgasm about as fast as men do.)
 2. Ejaculation and orgasm are different things, remember. Since this is an article about orgasm, I think the author probably should have used the word orgasm instead of ejaculation.

So, clearly the article is coming from the premise that lady-gasms are confusing, but it tells us, "recent years have seen a flurry of studies by these real-life Masters of Sex, and they are finally getting some answers."

This is particularly funny to me because these 'real-life Masters of Sex' the article refers to are the scientists interviewed for this article, and they are all working on fringe ideas of female orgasm. The article completely ignores the work of the actual real-life Masters of Sex, Masters and Johnson. These are the people who did the work to actually understand female (and male) orgasm. These are the researchers who lifted the mystery from lady-gasms, but clearly, even with a Showtime series about them, their contribution has gotten overshadowed, skewed, and ignored over the years. It absolutely boggles my mind that an article about the female orgasm from a revered news site like the BBC doesn't even mention Masters and Johnson or their discoveries. It is an appalling oversight, but it is also completely unsurprising and indicative of how far from reality the cultural discussion of female orgasm is, and how few people seem to notice.

After informing us that scientists are just now doing studies that begin to answer these long held secrets of the female orgasm and that fMRI studies basically show that male and female brains are similar during orgasm. (Here's a good 2011 overview of the fMRI research on arousal and orgasm to date btw. It's the full text article - not just the abstract!)
Then things get a little dicey again. We are told that pinning down the anatomy of an orgasm is hard because, "the penis has just one route for carrying sensations to the brain, the female genital tract has three or four."

A point about female orgasmic pathways being more complicated than male orgasmic pathways is being made here, but it's comparing apples to oranges. The penis is the male organ of sexual pleasure and the 'female genital tract' is the clitoris (the female organ of sexual pleasure), plus the vagina, the cervix and uterus, hell they're probably throwing the urethra in too. So, yeah, obviously the female genital tract will have more routes for carrying sensation to the brain than just the penis. However, if we compare the two organs that are able to be stimulated to orgasm, the clitoris/vuvla area and the penis, they both have one route, the pudendal nerve. The pelvic nerve, for instance, does involve itself with inside the vagina and cervix, but for men it is involved with erection and the rectum, so the male genital tracts has more than one route too, but that doesn't mean there are more ways for males to orgasm.

Here's the 1 external clitoral glans portion of the article. Although it is introduced as the "seat of female pleasure," it is only really discussed as one of many instead of the organ of sexual pleasure (the way an article might discuss the penis and male orgasm). There is no discussion about the scientific research that cemented its place, alongside the penis, as where orgasms arise. There is just a brief discussion of when the clit was acknowledged through history, ending with Freud's assessment that orgasm from clitoral stimulation is inferior to vaginal orgasm. The article then tells us, "Between thirty and forty percent of women claim never to have experienced an orgasm through vaginal penetration alone - though many more can have orgasms through clitoral stimulation. The suggestion that the vaginal orgasm is somehow superior has irked feminists. It sounds as if women who don't experience vaginal orgasm just aren't trying hard enough. So should vaginal orgasms be a rite of passage for all women, or just a privileged few? Is it even possible to have an orgasm in the absence of the clitoris?"After that, the article moves directly into discussing orgasm in relation to vaginal penetration. 

There's a few things about this section that bother me. I understand that there was an attempt here to give a nod to the clit and to question the idea that vaginal orgasms are more mature, but I think as a whole, it fails to do that, and possibly gives even more credibility to Freud's backward ideas about vaginal orgasm.

1. The stat here put the amount of women who have vaginally orgasmed at around 60-70%. I don't know where in particular that stat's from, but it's high. I understand how stats can range on this topic because depending on how specific the survey question is about whether additional clitoral stimulation is used during intercourse, the numbers vary (The Case of the Female Orgasm: Bias in the Science of Evolution has a fantastic overview of lots of surveys on this), but the numbers I normally see are only about 30% of women claim to orgasm with only vaginal stimulation.

2. This might be just me being obsessive, but contrasting the stats for vaginal orgasm versus the "many more" that can have orgasms through clitoral stimulation makes it seem like an either/or situation, as if there are some women who are 'wired differently' and have the ability to orgasm through vaginal stimulation but not clitoral and vice versa (and some who can do both). The truth is that there is every indication that all healthy women can orgasm from clitoral glans stimulation, and there is no indication that there are other women who are 'wired' to orgasm vaginally.

3. Why are we still even approaching Freud and his ideas on lady-gasms as worthwhile? He literally just made up that shit. Asking if vaginal orgasms should be a rite of passage or for only a privileged few validates not only that vaginal orgasms are a thing, but that they are something special that should be envied.

4. Saying feminists were 'irked' by the idea of vaginal orgasms being superior sounds trivial, minimizing the egregious nature of Freud's assertions and how ridiculous and harmful they were. The inability to have vaginal orgasms classified women as psychologically damaged by the established medical community up into the 1970's. Feminists in the 70's and 80's were outspoken about this, not just because it 'irked' their feminist sensibilities, but because they were on the side of science. The first actual large scale studies about female orgasm had come out and shown quite clearly that vaginal orgasm was not even a thing, much less some kind of superior thing. They were looking at female orgasm from the perspective of scientific knowledge and what they saw was women being punished for the inability to do something that their bodies actually couldn't do.

The article goes right into research by Barry Komisaruk. He and Beverly Whipple did a study in which women with spinal cord injuries that severed the ability for clit stimulation to get to the brain, were still able to orgasm through vaginal stimulation - likely due to the Vagus nerves that carry sensation from the cervix to the brain without using the spinal cord. Komisaruk thinks maybe this is why women describe clitoral orgasms as more localized and external and vaginal orgasms as more whole-body and internal. He also says of this study, "Women with spinal cord injury who could not feel their clitoris, nevertheless had orgasms from vaginal stimulation. That's probably the best evidence that vaginal orgasms exist."

If this is the best evidence for vaginal orgasm, then things don't look good for the vaginal orgasm. First off, as with all vag-gasm studies, the women merely said they had an orgasm. It was not physically verified. It's just that 3 of the 5 women in this study claimed to orgasm and were taken at their word. Maybe they did, maybe they didn't, but since this is a scientific investigations, and as of yet no orgasm like the one they are claiming to have has ever been observed, it really does need to be verified.
Secondly, nonchalantly calling the stimulation these 5 women were receiving 'vaginal stimulation' is rather misleading. That makes it sound like it was just some in-out of the vagina with a dildo or something, but in fact it was a very specific type of cervical stimulation that involves a pessary, which is kinda like a hard cervical ring that had to be professionally fitted to each woman individually. The pessary has Velcro on it, and a device that ends with a modified tampon with Velcro on the end is inserted in and attached to the Velcro on the pessary. It is controlled by the patient and sort of puts suction-y pressure on the cervix (without really touching the cervix - cause that can hurt like a bitch, right?). It’s not your average vaginal stimulation, so even if this contraption did cause a verifiable physical orgasm in these 3 women with spinal cord injuries, it's not exactly the kind of stimulation that's easily replicated at home.
I go into more detail about this study HERE.

Never the less, that study, which certainly does not prove women can orgasm from vaginal stimulation is deemed sufficient enough for the article to state the following. "So if different nerves can carry sensation from different regions of the female genitalia - and both can trigger orgasm - are some regions of the vagina more sensitive than others? Where should couples go hunting for the elusive vaginal orgasm?"

And the article is still stuck on the false premise that vaginal orgasms are a proven reality.

I described above that stimulation of the G-spot, or more clearly stated - the female prostate, has been shown to cause ejaculation, but not orgasm, in women. However, that distinction is often lost, and the 'G-spot' becomes a way to describe something that doesn't exist - a button in the vagina that causes orgasm. That is where this article ends up in the section on the G-spot. It first describes that studies have shown the G-spot is a bundles of nerves, blood vessels, and remnants of the prostate gland, and then it goes on to say that a minority of women could stimulate it to trigger, "powerful orgasms and the release of a small amount of fluid from the urethra that was not urine," but admits that actual evidence to support or refute the G-spot is patchy.

Of course the evidence for the G-spot is spotty because the word 'G-spot' is sometimes used to mean the female prostate area and sometimes used to mean a mystical orgasm button in your vag. Although there is plenty more research that should go into ejaculation and the female prostate, it's largely evident that there is a prostate-like area around the urethra in women that can be felt through the vaginal wall and that some women can ejaculate when it's stimulated. There is no evidence, however, that stimulation to anything in the vagina, much less the prostate-like area, can cause orgasm. One way of speaking about the G-spot is backed by evidence and the other is not, but in both research and common language it's confused, and so yeah, it makes the research look spotty.

The article next moves to a study with 20 women by a researcher named Jannini that showed there does,"seem to be physical differences between women who claim to experience vaginal orgasm and those who don't." A thicker area of tissue between the vagina and the urethra correlates with women who orgasm vaginally.

It's true. That is what the study finds, but it must be noted that per usual there is no proof that the women who say they can orgasm vaginally can actually do that. I know I harp on this, but the word orgasm, when it comes to women, is used so loosely, and the cultural assumptions about it are so confusing that it is not unreasonable to think that there may be a woman or two out there who says, and maybe even believes, that she orgasms from vaginal stimulation only, but she actually does not. Maybe she just has a psychological or spiritual 'climax.' Maybe she ejaculated. These things might feel pleasurable or satisfying but if she does not exhibit the release of pelvic muscle tension known to indicate orgasm, then scientifically, it should not be categorized as an orgasm. If even 1 of the women in this study were using the word orgasm incorrectly, then that would make a huge difference to the results of a 20 person study like this. Also, even if it were verified that the claims of vaginal orgasm were true, there is no proof that the thickness differences have anything to do with the ability to orgasm this way. It's merely a correlation. In the end this study says nothing about if or how women orgasm vaginally. It is at best merely a starting point for further investigation. I go into more detail about this study HERE.

Jannini conducted another study on 3 women where ultrasound was used to find that moving a lubricated tampon in and out of the vagina shifted both the internal parts of the clit and the tissue around the urethra. When the women just rubbed their external clit, just the external parts of the clit shifted. The article uses this to back up the idea that the inner clitoral legs, stimulated through the vaginal wall, might be the way vaginally stimulated orgasms happen.

Maybe. Or maybe not. No orgasms were observed in this study. This, like the last study, can only really be viewed as a starting point. If vaginal orgasms happen, then this article might be a starting point for investigating the mechanism for how they happen. That's about as much as can be taken from it. I go into more detail about this study HERE.

Pauls, another researcher, did a case study about a woman with incredibly unique genital structure that included a clit positioned closer to the vaginal opening than normal. She claimed to vaginally orgasm every time she had sex (although it was never physically verified that she was able to do this). (I go into detail about that study HERE). The article wondered if this indicated that vaginal penetration may be "stimulating both the external and internal parts of the clitoris." Pauls and her colleagues wondered about this too, and created a study to see if the size and location of the clit made a difference in ability to orgasm. With MRI measurements, the researchers found that for the 30 subjects, "the smaller the pea-shaped glans, and the further from the vagina, the harder they found it to achieve orgasm."

That was the conclusion that came from the study, but I don't think that conclusion is reasonably supported by this study. Out of the ~ 23 measurements of the clit size and distance, only 5 actually show significant differences between the groups. In fact, the clitoral glans area that the authors put forth as a significant difference between the two groups of women is only significant when they measured it from the coronal, but not the sagittal view. Unfortunately, this study also failed at asking the participants the proper questions so that they could be grouped in a way that would create meaning when compared to the clitoral measurements. Statistics are only as good as the understanding that exists of the population it is describing, and I don't think the understanding was good at all. I go into more detail on this study HERE.

"Taken together, these studies imply that there are multiple routes by which women can experience an orgasm, be it through vaginal stimulation, clitoral stimulation, or both at once. "

Or not. These studies taken together show that the vaginally stimulated orgasm has still not been observed, and although there are lots of theories, just as there has been for the past 40 years, as to how this type of orgasm might occur, none are conclusive...particularly because it's awful hard to prove the mechanism that causes vaginally stimulated orgasms, when a vaginally stimulated orgasm has never been observed. Maybe, just maybe, these types of 'orgasms' are so mysterious because they don't really exist, and so investigating them would naturally be tricky.

Komisaruk chimes in a final time in reference to a study he did revealing that, "projections from different regions of the female genitals - and indeed the nipples - all converge on the same general region of the brain, albeit in slightly different areas." (I go into more detail about that study HERE). He says, "There's a good neuroanatomical basis for different types of orgasms and different types of sensations." He goes on to say, "This could account for why combining clitoral, vaginal, and cervical stimulation seems to produce these more intense, complex and pleasurable orgasms that women describe." 

I'll just leave it at this. No, there is actually not good evidence for different types of orgasms. Different types of sensations? Sure. Moving a penis in and out of the vagina feels different than lightly touching the vulva, feels different that sucking on the nipple, and feels different than kissing the back of the neck. I personally like them all, but that doesn't mean they all can cause orgasm. Also, I'd like to know more about these more intense, complex and pleasurable orgasms that women describe. When do they describe them? How are they more complex, intense and pleasurable? And how exactly did he find that these amazing orgasms were specifically related to a combination of cervical, vaginal, and clitoral stimulation?

The article ends with some advice from Pauls and Jannini. I particularly appreciate that Pauls tells us if we don't have orgasms through straight out vaginal penetration, then that's normal. She's absolutely right, but her one statement within an article that focuses almost entirely on vaginally stimulated orgasms is a beautifully perfect microcosm of our sexual culture. Sure we hear now and then that lots of women need clitoral stimulation to orgasm, but as a whole our culture obsesses on the completely un-verified vaginally stimulated orgasm to a point, I would argue, of absurdity.

I honestly don't want to hate on the author of this article. It was certainly not that she was ignorant or terrible at her job. The sources she used and the people she spoke to are top studies and top researchers in female orgasm. What she said in her article is not off-base from things other reporters and sexperts say. I critique this article, but it is more a critique of the sexual culture that stimulates this type of discussion around female orgasm and that allows this type of article to be published by the BBC and that makes audiences accept the misinformation so easily.

What I do want is to open eyes and start tough conversations, and I hope this critique helps to do that.

Extra Info
If you are unsure about my assertions that orgasm can be defined with the rhythmic pelvic muscle activity, or that the clitoris needs to be stimulated to cause orgasm, or that Masters and Johnson really did create important, fundamental and still relevant work in regards to human sexual response, then please check out a debate I had with Edward Clint at Skeptic Ink HERE. I address all those things in detail.

If you want to understand more clearly what I mean when I say vaginal stimulation has never been shown to cause orgasms. I detail that out HERE.

If you want to see more about the affects and reasons for this cultural misunderstanding of female orgasm - Watch Science, Sex and the Ladies HERE.

If you want to see an artist doing bold, important work on the ignorance about and cultural erasing of the clitoris (which goes hand in hand with the ignorance about and cultural erasing of a realistic female orgasm), check out 101 Laws of Cliteracy by Sophia Wallace.

Cited
"Relationships Among Cardiovascular, Muscular, and Oxytocin Responses During Human Sexual Activity" Carmichael, et al. Archives of Sexual Behavior Vol. 23, No. 1 1994

Response to the letter to the editor by Barry K. Komisaruk "re: Puppo V, Puppo G. 2014. Anatomy of sex: Revision of the new anatomical terms used for the clitoris and the female orgasm by sexologists". Puppo V1, Puppo G. Clin Anat. 2015 Apr;28(3):291-2. doi: 10.1002/ca.22500. Epub 2014 Dec 22.

"Relationships Among Cardiovascular, Muscular, and Oxytocin Responses During Human Sexual Activity" Carmichael, et al. Archives of Sexual Behavior Vol. 23, No. 1 1994

The Case of the Female Orgasm: Bias in the Science of Evolution. LLoyd, Elisabeth A.  Cambridge: Harvard University Press. 2005.

Women's clitoris, vagina, and cervix mapped on the sensory cortex: fMRI evidence. Komisaruk BR1, Wise N, Frangos E, Liu WC, Allen K, Brody S. J Sex Med. 2011 Oct;8(10):2822-30. doi: 10.1111/j.1743-6109.2011.02388.x. Epub 2011 Jul 28.

Clitoral size and location in relation to sexual function using pelvic MRI. Oakley SH1, Vaccaro CM, Crisp CC, Estanol MV, Fellner AN, Kleeman SD, Pauls RN. J Sex Med. 2014 Apr;11(4):1013-22. doi: 10.1111/jsm.12450. Epub 2014 Feb 13.

Sexual function in a woman with congenital bladder exstrophy and multiple pelvic reconstructive surgeries: a case report. Vaccaro CM1, Herfel C, Karram MM, Pauls RN. J Sex Med. 2011 Feb;8(2):617-21.

Pilot echographic study of the differences in clitoral involvement following clitoral or vaginal sexual stimulation. Buisson O1, Jannini EA. J Sex Med. 2013 Nov;10(11):2734-40.

"Measurement of the thickness of the urethrovaginal space in women with or without vaginal orgasm." Gravina GL, Brandetti F, Martini P, Carosa E, Di Stasi SM, Morano S, Lenzi A, Jannini EA. J Sex Med. 2008 Mar;5(3):610-8.

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

Brain activation during vaginocervical self-stimulation and orgasm in women with complete spinal cord injury: fMRI evidence of mediation by the vagus nerves. Komisaruk BR1, Whipple B, Crawford A, Liu WC, Kalnin A, Mosier K. Brain Res. 2004 Oct 22;1024(1-2):77-88.

Human Sexual Response. Masters, W. and V. Johnson. Little, Brown & Co. 1966.

7.29.2015

Vaginal Orgasm in Woman With Unique Pelvic Anatomy? - A Journal Article I Read



Sexual function in a woman with congenital bladder exstrophy and multiple pelvic reconstructive surgeries: a case report. Vaccaro CM1, Herfel C, Karram MM, Pauls RN. J Sex Med. 2011 Feb;8(2):617-21.

Today, on A Journal Article I Read, we'll be talking about a case study of a woman who was born with a condition that affected her outer genitals and bladder. She has had her bladder and urethra removed, had necessary plastic surgery on her vulva and vagina, and endured many other pelvic surgeries including the removal of her cervix. She claims to have vaginal orgasms 100% of the time she has sex. The authors wonder whether she orgasms this way so easily because of the particularly unique organ configuration down there. So, to investigate this, they had her note the sexually sensitive areas on her genitals and then used MRI to see if clitoral tissue is related to those areas. The authors felt that her inner clitoral tissue corresponded to her sexually erotic areas.

So, that's basically the whole paper,  All in all, I thought the investigation into this women's experience was pretty cool. I have one big problem with it though. The researchers did not investigate into what exactly the subject meant when she said she orgasmed, and frankly when it comes to claims of orgasming through vaginal stimulation alone, researchers should not simply be taking a subject's word on the matter. This type of orgasm has a lot of baggage, and it has never been documented before. It requires special treatment. This is the same gripe I have with so many female orgasm studies, but it really is an important one. There is a physically verifiable rhythmic release of arousal-induced muscle tension that is an orgasm, and scientific investigation should verify and not simply assume, this is what is happening when a woman claims to orgasm vaginally. If a study does not take time for this verification, as is the case for this study, it deeply weakens any conclusions that are made from it.

So on to the study description. (All quoted material is from this study btw.)

A Disclaimer
I am no medical expert, and honestly, this article was pretty confusing for me the first couple times I read it. However, I do these article overviews so that I can get a deeper understanding of them and also so that I can offer other people a more accessible yet still extensive version of what these studies have to say.  So, I looked up a lot of shit on WebMD and Wikipedia, and things did start making more sense, so I tried to write about the procedures and stuff without so many big incomprehensible words. I hope that I didn't completely misunderstand anything and that what I did write is somewhat more comprehensible.

Some Background
  • She was born with bladder exstrophy which occurs in only 1 in 50,000 births (males and female equally). It is a failure of development of the lower abdominal wall, genital tubercules (the embryonic beginnings of what will become either the penis or clitoral glans), and pubic rami (a piece of the pubic bone).
  • Pelvic Organ Prolapse (a situation in which pelvic organs begin to kinda drop and end up pressing against things they shouldn't like the vagina) is a fairly common female disorder (about 1 in 11 women develop this), but it's way more common among women with bladder exstrophy. This condition could require surgery or multiple surgeries for some women.
  • In a previous study of 12 women with bladder exstrophy: 8 reported regular sexual activity, 6 reported regular orgasm, and 4 reported vaginal pain (other that the pain involved with having a shorter vagina as seems to often end up being the case for these women).

The Details On This Lady
  • She's 42, physically fit, well-groomed (I'm not sure why that was added to this report), 1 pregnancy delivered cesarean
  • At 2, she had her bladder removed. She also had an operation (that looks like it is no longer used for people with her condition) where the ureters that carry urine from the kidney were diverted to the lower colon (uretero-sigmoidostomy).
  • At 15 she had pain and found that her upper vagina was filling with menstrual blood. She then had a distal vaginoplasty  to "open and reconstruct the lower 1/3 of the vagina."
  • During her pregnancy, she began experiencing pelvic organ prolapse in the form of cervical prolapse and 2 years later her cervix was removed as part of the treatment (Manchester procedure), which helped for a while.
  • In 2000 she had a hysterectomy with an anterior repair, and "an anterior repair involves a midline dissection of the anterior vaginal mucosa and removal of redundant mucosa." (Vaginal mucosa is basically the lubrication making layer of the vaginal tissue)
  • In 2003 she was back with a Stage 4 vaginal prolapse, in which it seems her upper vagina was sagging down into her lower vagina, basically turning it sorta inside-out, and a ligament vaginal vault suspension was performed to correct it.
  • 2 years later the vaginal vault suspension failed and she had Stage 2 anterior vaginal wall prolapse. Sacrocolpoexy, another procedure to repair organ prolapse, was used.
  • Over the following 2 years she had 3 more surgeries for these types of problems.
  • She completed several questionnaires: the PISQ-12 and got 10/48 indicating a small impact of her pelvic orgasm prolapse on her sexual function, the FSFI with a 29.4/36 indicating good sexual function, the SF-12 with scores of 36.6 and 57.9, indicating she was above average in mental health and below average in physical health (which makes sense given her condition).
  • At the time of this study, a pelvic exam confirmed Stage 2 anterior vaginal wall prolapse and a shortened vagina length of 6 cm (okay - so that's about 2.3 inches and I've read stuff that says average is 3 to 4. I know the vagina expands during arousal, so that's not as tiny as it seems, but I just wanted to know how short 6cm really was in the grand scheme of things)

Her Sexual History
  • "Via recorded face-to-face interview with the subject and her husband, a full sexual history was outlined. She reported that typical sexual encounters result in one vaginal orgasm with manual stimulation, followed by one orgasm with vaginal penetration, thus being multi-orgasmic with each coital episode. Although she prefers the female dominant position, she reported the ability to orgasm from any position without additional manual stimulation of the clitoris." (I really don't know what exactly is meant by vaginal orgasm by manual stimulation)
  • "She described her pelvis as 'naturally tilted forward'...and she feels this leads to better stimulation of her clitoral tissue while in the female dominant position." 
  • She has some lack of lubrication and uses lubricants about 50% of the time. Due to her shortened vagina she has pain during deep thrusting, but it doesn't prevent orgasm. She desires sex about once a week now, but it was daily at her sexual peak.
  • She reports daily use of fluoxetine for depression, and alprazolam and acetaminaphen/hydrocodone as needed for anxiety and musculoskeletal pain.

The Investigation
  • "Together with her husband, her erotic tissues were marked and photographed. The markings include her sites of sexual stimulation and engorgement. This mapping identified the 12 and 1 o'clock positions of the vagina just inside the introitus to be sites of sexual sensation leading to orgasm. Additionally, her mons pubis was marked as another area of sensitivity." (introitus is the hole btw)
  • The pelvic MRI images were taken, and the researchers "identified the marked erotic locations as being consistent with clitoral tissue. therefore, in this subject the clitoris lies superficially on the distal anterior vaginal wall just beneath the mons pubis, with the most superficial sites being on her left." Superficially here means just beneath the surface and distal anterior is the part of the vagina that is close to the hole and towards the front of your body.
  • I was seriously confused about the picture below from this study. It doesn't give a lot of detail in the writing, and let's be honest, sometimes looking at the vulva area close up with nothing to orient yourself is hard to figure out. But, I'm pretty sure that is the vaginal hole with no urethra or visible clitoral glans above it.   



Conclusion
So, this woman does not have a bladder or a urethra, and the authors tell us it's unlikely a G-spot could exist on this women. (The G-spot being the female prostate that surrounds the urethra and can be felt through the distal anterior vaginal wall. Some say it could be the cause of vaginal orgasms but although it has been shown to stimulate ejaculation, it has never been shown to cause orgasm - this is true for both men and women). The researchers point this out to eliminate the g-spot as a possible cause for the "vaginal" orgasms this woman claims to have. Instead, they point to the inner clitoris.

"...we believe that this patient's vaginal eroticism is the clitoral complex that 'drapes' the anterior distal vagina. Given the findings reported here it is clear that further research is needed to investigate how position and location of the clitoris relates to female orgasm and sexual function."

My Thoughts
Connecting Clitoral Placement to Her Vaginal Orgasm Ability
Relating the inner clitoris to vaginal eroticism is nothing new. In fact I'd say, within research, it's currently the most hip way of reasoning how vaginally stimulated orgasms might happen.  The hypothesis goes vaguely like this; the penis jostles the vaginal wall, which jostles the tissue outside the vaginal wall, which jostles the clitoral legs, and that's how the orgasm is caused. So, I imagine for these researchers it seems sensible to connect clitoral legs to this woman's capacity to vaginally orgasm, but it's much more of a stretch than one might think. There is indication that a penis moving in a vagina does jostle and press down on stuff in there, including the clitoral legs, but like all other hypotheses for how a vaginal orgasm happens, there is absolutely no proof an orgasm can or has ever been caused this way.

Still, the woman in this study has a unique anatomy which could provide insight into how women might orgasm vaginally if vaginal orgasms are, in fact, a thing that can happen. I'm honestly a little confused about how exactly the clitoris exists in this woman and how it is different from what is normally expected. My best assumption from the reading is that the glans is hidden beneath the skin and the clitoral legs are closer to the surface of the skin than is normally expected. The paper does not specifically describe these things in detail, so I could be wrong.

How The Glans Fits In
Without a visible, external glans, the researchers tell us that this woman's genital anatomy "has been altered in such a way not unlike those who have had female circumcision." However, they rightly point out that many women who have gone through female circumcision do still report the ability to orgasm due to undamaged clitoral tissue beneath the skin - which she seems to have. So stimulation of the glans through her skin seems to be a possibility for how she reaches orgasm - but she specifically claims to reach orgasm during any intercourse position without additional stimulation of the glans.

The glans is an important factor here because stimulation of the glans area is an observed, recorded and verified way that seemingly all intact, healthy women can orgasm. Stimulation to that external clitoral glans area is, actually, the only way that scientist have observed woman orgasming.

How The Clitoral Legs Fit In
The clitoral legs are the inner clitoral structures. They are 2 spongy erectile legs that straddle the vagina. The researchers kept using the term "superficial placement" of the clitoris when discussing it's uniqueness, which I kinda just took to mean not the 'real' place it's supposed to be, but I slowly realized that they are probably meaning that it is very close to the surface of the skin (see I can learn vocabulary!). So, I imagine her clitoral legs are a little closer to the surface of the skin and maybe closer to the vagina...but I'm not positive about that. I do know that there's no bladder in there, so they are probably placed at least somewhat differently than most women's clitoral legs. I am also not completely sure whether the researchers felt the "superficial nature" of the vagina was important because it could be stimulated more easily through her pelvic skin around her vulva, or whether they felt it was closer to her vaginal opening and could be stimulated to orgasm through the movement of things going in and out of the vagina. Either way, the researchers seem to be focusing on orgasm through stimulation of the clitoral legs, and that is is not something that has ever been observed.

The Researchers Are Looking For The Cause Of Something That Hasn't Been Proven to Exist
So the idea that women can orgasm by stimulating the clitoral legs during intercourse is merely an untested hypothesis for how vaginally stimulated orgasms might work. Furthermore, vaginally stimulated orgasms themselves are also merely an untested hypothesis. Yes, this woman and a minority of other women clearly say they do have them, but this is a scientific investigation after all, and investigators really should be quite hesitant to take women at their word about experiencing something that the researchers have never seen proof for. Here's a few reasons why:
  • Even quite educated people may not know what an orgasm is physically (the rhythmic release of muscle tension that has built up during arousal), or that an ejaculation is different from an orgasm in both men and woman. We don't usually learn those things in school, and people may use the word incorrectly.
  • Even though a 'vaginal' orgasm has never been documented ever in science, and even though it is undisputedly not something the majority of women say they experience, it is the #1 way we see women orgasming in books, TV, movies, and porn. It's not unreasonable to assume women may be influenced in the way they describe and experience their sexual functioning by this discrepancy between their actual experiences vs. media depictions of female orgasm. It's not crazy to wonder whether women's words might not match the physical things happening in their bodies.
  • The inability to orgasm 'vaginally' was professionally deemed a mental illness in our country up into the 1970's. My mother and her generation, the people who raised me and the other 20-40 somethings walking around today, were already functioning, sexually active people by that time. Do researchers think that this kind of deeply personal stigma around the ability to orgasm vaginally just fell off the earth? Do they not think that this stigma might influence answers to questions about whether she can or cannot? Do they not think they should take special care when investigating this?

This all to point out that, well, the subject in this study says she orgasms twice every single time she has sex, but...maybe she doesn't. It might be that she's not really lying about it. It might be that she's authentically describing her experience, but maybe that experience is more of a climactic feeling rather than the rhythmic muscle release that is physically an orgasm. Maybe she is physically orgasming 100% of the time she has intercourse. But, the truth is, we just don't know, and the researchers simply didn't think it was important enough to verify or even discuss the lack of verification as a possible limitation to this study.

Can I just say too, that ESPECIALLY because she was giving her sexual history face-to-face with her husband sitting right next to her, the researchers should have considered the possibility that the situation may have put undue pressure on the subject and could have skewed her answers. I mean, researchers know some women lie to their partners about their ability to orgasm, so they must know that there is pressure out there in the world that encourages women to misrepresent their sexual functions to their partners. It seems to me that having a woman describe her sexual function while her husband sits next to her puts a possible barrier to honest answers. The researchers should have at least commented and acknowledged that the husband situation complicated the study a bit.

My Conclusion
This truly was an interesting paper. With the subject's unique physiology, this paper could be a starting point for further investigation into orgasm ability in women with more common pelvic anatomy (and these researchers clearly understood that - in fact they actually followed up with THIS study that I wrote about here last week. It looked at clitoral size and distance in relation to a woman's ability to orgasm).

However, even as just a starting point, there are problems. The lack of verification for the subject's ability to orgasm during intercourse without additional clitoral stimulation is an important limitation for this study. Looking at this rationally, the subject has claimed to orgasm in a way that has never been observed. As far as scientific knowledge goes, it may not even be possible. I mean, if she is actually physically orgasming this way, she, with her unique genital anatomy, might be the only person who can orgasm like that. Verifying her ability to orgasm this way would actually be pretty huge. Yet, the researchers didn't even seem to consider verification. They simply go forward assuming that this type of orgasm is possible. Furthermore, they take the subject at her word that this type of yet-undocumented orgasm happens to her. There is a lot of assuming going on here. Granted, researchers almost never verify claims of vaginal orgasm, so this study is not out of the norm. However, just because this lack of verification is common doesn't mean it's quality science. Maybe, just maybe, some researcher somewhere should verify that there are women who can attain an orgasm from stimulation inside the vagina (checking for the rhythmic muscular activity is quite possible). If researchers are able to do that, then it would make sense for researchers to start concerning themselves with the mechanisms for how these types of orgasms happens and what kinds of things make it easier or harder for women. Until that happens though, any study that assumes without verification that its subject(s) can orgasm vaginally will contain conclusions that simply cannot be taken too seriously.


7.24.2015

A New Study about Clit Size and Orgasms!!!



This time on An Article I Read, I'll be looking at an article that aims to "evaluate clitoral size and location with regard to female sexual function." The conclusion, from the authors was, "Women with anorgasmia possessed a smaller clitoral glans and clitoral components farther from the vaginal lumen than women with normal orgasmic function." (The vaginal lumen is basically the vaginal hole BTW)

Clitoral size and location in relation to sexual function using pelvic MRI. Oakley SH1, Vaccaro CM, Crisp CC, Estanol MV, Fellner AN, Kleeman SD, Pauls RN.J Sex Med. 2014 Apr;11(4):1013-22. doi: 10.1111/jsm.12450. Epub 2014 Feb 13.

The Quick and Dirty
Here's the basics. This study is comparing measurement of clitoral size and also distance from different areas of the clitoris to the vagina among 10 women grouped as "anorgasmic" and 20 grouped as "normally orgasmic." The measurements for each woman are gained through pictures from pelvic MRI. The women were grouped based on their answers to 4 specific questions on commonly used sexual functioning assessments. Those same assessments were used in their entirely to assess the women's overall sexual function, and assessments were also used to evaluate their overall health and level of body self-consciousness during sex. Personal data was taken, and also their blood was also taken at the same time in each of their menstrual cycles in order to test for 5 different hormone levels measurements. All the information received from the women were assessed to see if there was a statistically significant difference between the 2 groups and to see if any of the assessments showed significant correlations to another assessment.

This is a pretty new article - 2014, and I think it's the newest one on this topic. I reviewed an article from a few years back that re-evaluated very old data on this topic HERE. This new study is important because, well, it's a modern study with modern techniques, and this is a topic that people wonder about. Although the paper concludes that there is a connection between women with anorgasmia and having a smaller clit, farther from the vagina, I don't think that statement is reasonably supported in this study. There were a lot of measurements of the clit size and distance that didn't show any statistically significant differences between the two groups of women. They took around 23 different measurements of size and distance, and only 5 actually show significance. In fact, the clitoral glans area that the authors put forth as a significant difference between the two groups of women is only significant when they measured it from the coronal, but not the sagittal view.  Unfortunately, this study also failed at asking the participants the proper questions so that they could be grouped in a way that would creating meaning when compared to the clitoral measurements. Statistics are only as good as the understanding that exists of the population it is describing, and I don't think the understanding was good at all. So, this might be harsh,  but I think there is some picking and choosing and bad assumptions going on with this study that make it basically meaningless....but oh do let me go into more detail...

The Study's Introduction
The authors point out that orgasm difficulty is found to be common among women, and that it's possible that the size and position of the clitoral complex has something to do with that. (Clitoral complex is a phrase that is used with some variety of meaning. Here I believe they are including it to mean all the inner parts of the clitoris, the vestibular bulbs, and the area around the urethra and anterior part of the vagina - or what is now being called the CUC or clitoral urethral complex). It points to other related studies: one that compares ability to vaginally orgasm with the thickness of the urethro-vaginal space (I wrote about that one HERE), one that I previously wrote about HERE that reassesses historical data, one on reconstructive surgery after female genital mutilation ([16] below) and another MRI study that concluded smaller clits were actually related to better sexual function ([15] below - I'll get to reviewing this one soon). The authors end the intro with the following.
"However, very little has focused on the clitoral-vaginal distance or size of the organ relative to female response. The available data were biased by small sample size [15], retrospective evaluation [15], or nongeneralizable populations undergoing surgery [16] and bear conflicting results. As such, a clear understanding of these facets of clitoral anatomy impact orgasm is lacking."
The Studies Aims
"Thus, the purpose of this cross-sectional study was to determine if the size of the clitoris and its location relative to the vagina impact sexual stimulation and subsequent orgasmic function. We hypothesized that women with normal orgasmic function may possess a larger clitoral area or a CUC which is closer to the vaginal wall compared to women with anorgasmia."

The Population, Experimental Design, and My Rant

Dividing the women into groups
The researchers divided the women into either the "anorgasmic" or "normally orgasmic" groups based on their answers to 4 questions from 2 different questionnaires. Both these questionnaires are used to rate a woman's sexual function, and one is specifically related to pelvic organ prolapse or incontinence.

A response of "rarely able" or "never able" to achieve orgasm on question #2 of the the Prolapse/Incontinence Sexual Questionnaire-12 (PISQ-12)  and/or a total unadjusted score of < 6 on the orgasm domain of the Female Sexual Function Index (FSFI) put women in the "Anorgasmic" group. Likewise, in the PISQ-12 a response of "most" or "all" on question #2  and/or a total unadjusted score of  > 12 on the orgasm domain of the FSFI put women in the "normally orgasmic" group. The authors say the following about these questionnaires: "Both of these validated questionnaires inquire about sexual function during sexual activity, which could include caressing, foreplay, masturbation, and vaginal intercourse."

The actual questions used 
However, I looked those questionnaires up (The FSFI is used all the time in these types of studies so I thought I should become familiar) and strangely that's just not true.

PSQI-12 Question #2 (to be answered considering sex life over the last 6 months):
Do you climax (have an orgasm) when having sexual intercourse with your partner? -Always -Usually -Sometime -Rarely -Never 

The underline is their emphasis not mine, and since this question is from the validation study for the PISQ-12 that was cited (I triple checked), I find it incredibly odd the authors would say what they said above...cause it is clearly about intercourse. Also, the authors quoted the terms "most" "all" "rarely able" and "never able" when speaking about the question, but those terms aren't used in the actual question, so I find all that curious. Now, the FSFI questions were more open.

Orgasm Domain Questions (11-13) from FSFI - with the scoring included. (Here's the Scoring Key for the FSFI too):

11. Over the past 4 weeks, when you had sexual stimulation or intercourse, how often did you reach orgasm (climax)?
0 = No sexual activity
5 = Almost always or always
4 = Most times (more than half the time)
3 = Sometimes (about half the time)
2 = A few times (less than half the time)
1 = Almost never or never 
12. Over the past 4 weeks, when you had sexual stimulation or intercourse, how difficult was it for you to reach orgasm (climax)?
0 = No sexual activity
1 = Extremely difficult or impossible
2 = Very difficult
3 = Difficult
4 = Slightly difficult
5 = Not difficult 
13. Over the past 4 weeks, how satisfied were you with your ability to reach orgasm (climax) during sexual activity or intercourse?
0 = No sexual activity
5 = Very satisfied
4 = Moderately satisfied
3 = About equally satisfied and dissatisfied
2 = Moderately dissatisfied
1 = Very dissatisfied
Why I think they are terrible questions for this study
So this is my absolute biggest gripe with this study: The questions that the researchers used to categorize these women are not useful to an investigation about clitoral size/location and orgasm ability.  First off, it's not necessarily women who have never/rarely orgasmsed vs. women who orgasm all the time. Both groups could include women who orgasm sometimes. For instance, in the FSFI, a woman could say she orgasmed sometimes (3pts), that it's slightly difficult (4pts) and that she's very satisfied with that (5 points), and she's got a score of 12 and is in the "normally orgasmic" group. But another women could say she orgasms sometimes (3pts), that it's very difficult (2pts) and that she's very unsatisfied with it (1pt), and she's got a score of 6 and in the "anorgasmic group." Maybe the only difference between these two women is that one feels worse about what she has to do to get off and her partner is less into it. Granted, that's probably not commonly the case, but even if that happened once among these 30 women, then it's enough to worry about.

But folks, that's just a surface gripe. The problems with this study go way deeper. The authors believe this study can discern if size or location of the clit impacts sexual stimulation and subsequent orgasmic function. I disagree.

It's an irrelevant thing to investigate
Women can orgasm through stimulation of the clitoral glans. There's no indication that there are women with anatomy that makes this impossible, so with sufficient stimulation, any healthy, intact women could orgasm through stimulation of her external clitoral glans area. It doesn't matter where it is or how big it is. It just needs to be found and touched. It's the same way for a man and his penis. Even considering the female orgasm during intercourse, size and location do not necessarily have anything to do with a woman's ability. If a woman wants to orgasm while having intercourse but her clitoral glans is a millimeter further from her vagina than another woman, well, who cares? She can just tilt her hips a millimeter more or less than the other woman would or maybe have her partner adjust their body slightly and then just continue grinding the clit up against his body. Or simply make sure her or her partner's hand or the vibrator is in the right place. It's that easy. The only reason this question about whether size and location makes a difference to orgasm ability even exists is because women's sexual experiences too often don't specifically cater to her organ of sexual pleasure (the clitoral glans) the way that men's sexual experiences regularly cater to the male organ of sexual pleasure (the penis). Thus the clitoral glans is often ignored, yet there is little realization that the lack of orgasm may simply be due to lack of proper clitoral stimulation. So, when a woman says on a survey that she has not orgasmsed much during her latest sexual encounters, it doesn't mean she cannot or that she is innately less capable of orgasm than another woman. It just means that she didn't get proper stimulation and arousal. So discerning between women the way this study does says more about these women's sexual technique, relationships, and past experiences than it does about anything innate. Honestly, thinking that the clitoral size and distance from the vagina has any meaningful relationship to the differences between these women is unrealistic if you really think about it, and frankly it's not very thoughtful about our sexual culture and the actual experiences of women and their orgasms.

Unless it's investigated this way....but, it's not
Okay, so there are a minority of women who say that they can orgasm through inner vaginal stimulation alone - with no additional touching of the outer clitoral glans area. The most high-profile theory (although not necessarily the only or the most well-backed one) right now for how that might occur is that the penis stimulates the inner clitoral legs through the vaginal wall and through the tissue between the clitoral legs and the vaginal wall. So, I can see how an investigation into the distance between the vagina and the inner clitoris might be useful if researchers were studying the anatomical differences between women who say they can regularly orgasm through vaginal penetration alone and women who say they cannot and have never orgasmed this way.

*I would like to point out that unlike our scientific knowledge of clitoral stimulation leading to orgasm, there is simply not any information that tells us exactly what specific kind of inner vaginal stimulation leads a woman to have an orgasm. In fact, an orgasm caused by inner vaginal stimulation has never ever been recorded or verified in any way, and so there is always that wild-card possibility that must be considered in which this type of orgasm doesn't actually exist as a physically verifiable thing in the first place. So, even if women were split up this way, it might actually just be two groups of women that both don't orgasm through vaginal stimulation, yet one group happens to describe the physically non-orgasmic experience as orgasmic and the other doesn't.* However, let's give it the benefit of the doubt and assume there are some women who can orgasm this way. It still leaves the question of whether this study coul have anything useful to say about how clit size/location affects this possible type of orgasm. And, it doesn't. It doesn't because the two groups of women who would need to be tested against each other (women who specifically claim to regularly orgasm vaginally with no extra clitoral stimulation vs. women who never/rarely orgasm this way) are not the groups used for this study. Questions that would have discerned these women from each other were not asked, and so this study simply has nothing to say on this aspect of female orgasm either.

Or this way....which the authors also don't do
There is one more theory about female orgasm that might benefit from information on size and location of the clitoris. Master's and Johnson found that some women could get a Rube-Goldberg thing going during intercourse where the skin around the vaginal opening was stretched, which pulled on the inner labia, which pulled on the clitoral hood, which gave the ol' clit just enough stimulation to orgasm. Never mind that M&J only observed this using a mechanical dildo  machine that the woman controlled and that could go in and out at speeds faster than any man, and also never mind that these orgasms, given their very indirect stimulation route to the clit, were the weakest ones the women had (in the amount of muscle contraction and her subjective rating). Just know that if a woman did get off this way, I could see how the size and location of the clit could affect that. Women who could orgasm this way and woman who could not orgasm that way would be good groups to use in an investigation for this type of orgasm. However, they were not. As I said above, questions that would have discerned these women from each other were not asked, so there is nothing that can be learned about this aspect of female orgasm from this study either.

Which means...
So, my point is that this study is not set up well to investigate the affect clitoral size and location has on female's ability to orgasm. The truth is, simply asking the broad question of whether clit size and location affects women's ability to orgasm seems the same as asking whether dick size and location has an affect on a man's ability to orgasm. It's not a useful question to ask because it seems obvious that people just find a way to stimulate dicks no matter the size or location. It's not hard, actually. I assure you no researchers out there are worrying about whether a dick that is a few millimeters closer to a dude's asshole makes it easier for him to come. It's just absurd when looked at realistically. However, there are specific questions about a woman't ability to orgasm during intercourse (with no additional clitoral stimulation) that warrant investigation into clitoral size and location, but those questions were not specifically asked and a suitable experimental population was not created for those questions. In the end we are left with a study that simply doesn't tell us anything useful about the relationship between a woman's ability to orgasm and her clit size/location...even though it claims that it does.

The Rest of the Study Stuff
So, I've said my main piece. In a lot of ways everything else about this study is irrelevant because the population and the questions they are asking aren't meaningful to the conclusions they made. However, I'll still give you more details, but in bullet form.

  • 10 women were  categorized as "anorgasmic" and 20 were categorized and "normally orgasmic." The women were matched via age and BMI
  • All were over 18, sexually active with at least 1 sexual encounter within the last 4 weeks, and pre-menopausal. Also, they had no pelvic bulge or urinary incontinence, no history of sexual abuse, no sexual dysfunction in the domain of pain, no pregnancy, no use of serotonin uptake inhibitors or testosterone supplements
  • They were questioned about how many times they had sex in the past 4 weeks and the percentage of time to orgasm, and their favorite positions for ease of achieving orgasm were ranked (missionary, female dominant, woman on all fours, manual, and oral) See table below.




  • The women were given a questionnaire to assess their mental and physical health and one to asses their level of body exposure self-consciousness during sexual activity. There was no significant score difference between the two groups of women on those questionnaires.
  • There was a statistically significant difference between the total scores on both the FSFI and PSQI-12 between the 2 groups of women, with the "anorgasmic" group scoring toward higher sexual dysfunction and the "normally orgasmic" group scoring toward lack of sexual dysfunction. It has to be noted (and the authors do briefly note this at the end) that there are problems with using the total scores on the FSFI and the PSQI-12 as indications of different sexual function between the two groups of women given that some questions on each of those surveys were used as criteria for putting the women into those groups in the first place.
  • Their blood was taken at the follicular phase of their menstrual cycle. Estradiol, Free testosterone, Total testosterone, Free androgen index, and Sex hormone binding globulin was measured. There was no statistical difference between levels for the two groups of women except in the Sex hormone binding globulin. The "normally orgasming" group had higher.
  • All kinds of distances were measured from pictures taken through MRI from the Sagittal, Coronal, and Axial view. The table is below, with some, but not all, of the the measurements. The majority of the measurements were not significantly different between groups. The only measurements that were significantly different between the groups were as follows - the coronal view of the glans area (the sagittal view of the glans area was not), sagittal distance between the inferior aspect of the glans to the anterior vaginal wall, sagittal distance between the body and the anterior vaginal wall, lateral axial crura distance, and total vaginal length.



  • All the different variables (the hormone levels, every single measurement taken, every test score, and all the personal information) were all compared to each other to see if any had correlations. Most didn't, but here's a couple that did. A larger distance between the clitoral body and the vagina in sagittal view correlated with poorer scores on the PISQ-12, FSFI, and the BESAQ. Also clitoral glans area from the sagittal view correlated positively to testosterone measurements. A larger clitoral body was also noted to correlate with a higher estradiol level.

Conclusion

The study concluded with the following:
"In conclusion, a smaller clitoral glans and greater distance of the clitoral body from the vaginal lumen were noted in women with anorgasmia. Although adequate sexual function is complex, we document that clitoral size and location may be paramount in impacting sexual function, specifically orgasm. Although these physical characteristics cannot be changed, understanding the physiology of the female sexual response advances knowledge. In addition, such awareness may highlight strategies for treatment of women distressed by sexual dysfunction."
My Thoughts
This study makes a lot of attempts to find some correlation between the size and location of the clitoris and the ability for women to orgasm, but it only found statistically significant differences between the 2 groups of women in just a couple of the clitoral measurements attained - one of which ceased being significant when measured from a different view. However, the bigger issue is that the information taken from the women in this study was not enough to group them in an appropriate way for gaining any useful meaning from the clitoral measurements. The clitoral measurements are maybe a useful things to have, but they certainly do not, contrary to what the study purports, show that women with a larger clit closer to the vagina are better able to orgasm...and it's unfortunate that pop-science studies like THIS and THIS claim it does too.